Nerve root

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A nerve root (Latin : radix nervi) is the initial segment of a nerve leaving the central nervous system. Nerve roots can be classified as:

Contents

Cranial nerve roots

Cranial nerves originate directly from the brain's surface: two from the cerebrum and the ten others from the brain stem. [2] Cranial roots differ from spinal roots: some of these roots do not separate into individual sensory (dorsal) and motor (ventral) roots, but can emerge from one fusion root instead; [3] of the eleven cranial nerves, four express this concept of fusion. The remaining eight nerve roots only express one of the two types of connections. Five of these are exclusive motor roots, and the remaining three are all sensory. [4]

Spinal nerve roots

Spinal nerve roots are much more uniform than cranial nerves, one emerging from each level of the spinal column. These roots look extremely similar to one another, and form separate sensory and motor root connections to the central nervous system. Sensory nerves all enter the column as dorsal nerve roots, while motor nerves enter as ventral roots. [4] They are expressed uniformly on both sides of each vertebra along the spinal column.

The specific vertebrae classify spinal nerve roots they originate from. These are separated into three sections: cervical, thoracic, lumbar, and sacral. The cervical is separated into eight vertebrae named C1-C8. The thoracic segment consists of T1-T12; the lumbar is L1-L5; and sacral S1-S5. [5]

Pain and pathologies

Damage to nerve roots can cause paresis and paralysis of the muscle innervated by the affected spinal nerve. It may also cause pain and numbness in the corresponding dermatome. A common cause of damage to the nerve roots is spine lesions, such as prolapse of the nucleus pulposus, spinal tuberculosis, cancer, inflammation, spinal tabs. Root pain syndromes, known colloquially as radiculitis and sciatica, are among the most common symptoms caused by damage to the nerve root. Radiculopathy is commonly called the "root". In addition to pain, nerve damage may lead to impaired muscle control. Typically, mechanical dysfunction is caused by pressure on the nerve root or shock, affecting both the lower limbs and arms' roots.

The first sign of disease (sometimes preceding the occurrence of the radicular syndrome by up to a few years) is a sensation of pain in the neck and shoulder area. This pain often manifests due to hypothermia, poor posture or ergonomics during work or sleep, or sudden head movement. Team roots are localized mostly within the three lower cervical roots, namely C5, C6, and C7.

Symptoms

C5 radiculopathy

C6 radiculopathy

C7 radiculopathy

Treatment

Treatment should be initiated as early as possible, before any muscle tone increases, which further intensifies the pain. Traction is recommended to decompress compressed roots. Radiculopathy can be caused by herniated nucleus pulposus. Surgery is the last resort when conservative therapy is unsuccessful.

Lower limb radiculopathies

The cause is a herniated intervertebral disc, often on a single nerve root. The first sign of the nerve root sickness is usually lumbago, which usually occurs with periods of remission. The time to develop a full radicular syndrome may take several months or several years. Pain generally increases gradually, but it can also be sudden. Cold causes muscle contraction, which leads to increased previously hidden symptoms.

Symptoms

L4 radiculopathy

L5 radiculopathy

S1 radiculopathy

Treatment

Treatment can vary based on the nature and severity of the disease. A compressed nerve root can cause radicular pain with or without radiculopathy. Most of the time, symptoms from a compressed nerve will start to feel better within 6 to 12 weeks of nonsurgical treatment.

To unlock the nerve root in the acute phase, it is recommended to apply traction and isometric muscle relaxation, and should be the first procedure to be performed in cases of severe pain. In cases where manipulation is undesirable or impossible to carry out, the infiltration may be root.[ clarification needed ] Anti-inflammatory medications may be used to alleviate symptoms. In the acute setting, the main goal is to restore proper mobility by reducing pain. Surgery is used when other methods do not produce results, except when paralysis is observed; in those cases, surgery should be performed as soon as possible to avoid irreversible paralysis of muscles.

Related Research Articles

<span class="mw-page-title-main">Peripheral nervous system</span> Part of the nervous system excluding the brain and spinal cord

The peripheral nervous system (PNS) is one of two components that make up the nervous system of bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia, which lie outside the brain and the spinal cord. The main function of the PNS is to connect the CNS to the limbs and organs, essentially serving as a relay between the brain and spinal cord and the rest of the body. Unlike the CNS, the PNS is not protected by the vertebral column and skull, or by the blood–brain barrier, which leaves it exposed to toxins.

<span class="mw-page-title-main">Spinal nerve</span> Nerve that carries signals between the spinal cord and the body

A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into the corresponding cervical, thoracic, lumbar, sacral and coccygeal regions of the spine. There are eight pairs of cervical nerves, twelve pairs of thoracic nerves, five pairs of lumbar nerves, five pairs of sacral nerves, and one pair of coccygeal nerves. The spinal nerves are part of the peripheral nervous system.

<span class="mw-page-title-main">Trigeminal nerve</span> Cranial nerve responsible for the faces senses and motor functions

In neuroanatomy, the trigeminal nerve (lit. triplet nerve), also known as the fifth cranial nerve, cranial nerve V, or simply CN V, is a cranial nerve responsible for sensation in the face and motor functions such as biting and chewing; it is the most complex of the cranial nerves. Its name (trigeminal, from Latin tri- 'three', and -geminus 'twin') derives from each of the two nerves (one on each side of the pons) having three major branches: the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve (V3). The ophthalmic and maxillary nerves are purely sensory, whereas the mandibular nerve supplies motor as well as sensory (or "cutaneous") functions. Adding to the complexity of this nerve is that autonomic nerve fibers as well as special sensory fibers (taste) are contained within it.

<span class="mw-page-title-main">Somatic nervous system</span> Part of the peripheral nervous system

The somatic nervous system (SNS) is made up of nerves that link the brain and spinal cord to voluntary or skeletal muscles that are under conscious control as well as to skin sensory receptors. Specialized nerve fiber ends called sensory receptors are responsible for detecting information within and outside of the body.

<span class="mw-page-title-main">Afferent nerve fiber</span> Axonal projections that arrive at a particular brain region

Afferent nerve fibers are axons of sensory neurons that carry sensory information from sensory receptors to the central nervous system. Many afferent projections arrive at a particular brain region.

<span class="mw-page-title-main">Spondylosis</span> Degeneration of the vertebral column

Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints. If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.

<span class="mw-page-title-main">Neuromere</span>

Neuromeres are distinct groups of neural crest cells, forming segments in the neural tube of the early embryonic development of the brain. There are three classes of neuromeres in the central nervous system – prosomeres, mesomeres and rhombomeres that will develop the forebrain, midbrain, and hindbrain respectively.

<span class="mw-page-title-main">Dermatome (anatomy)</span> Type of area of skin

A dermatome is an area of skin that is mainly supplied by afferent nerve fibres from the dorsal root of any given spinal nerve. There are 8 cervical nerves , 12 thoracic nerves, 5 lumbar nerves and 5 sacral nerves. Each of these nerves relays sensation from a particular region of skin to the brain.

Radicular pain, or radiculitis, is pain "radiated" along the dermatome of a nerve due to inflammation or other irritation of the nerve root (radiculopathy) at its connection to the spinal column. A common form of radiculitis is sciatica – radicular pain that radiates along the sciatic nerve from the lower spine to the lower back, gluteal muscles, back of the upper thigh, calf, and foot as often secondary to nerve root irritation from a spinal disc herniation or from osteophytes in the lumbar region of the spine. Radiculitis indicates inflammation of the spinal nerve root, which may lead to pain in that nerve's distribution without weakness – as opposed to radiculopathy. When the radiating pain is associated with numbness or weakness, the diagnosis is radiculopathy if the lesion is at the nerve root, or myelopathy if at the spinal cord itself.

<span class="mw-page-title-main">Nerve plexus</span> Network of nerve fibres

A nerve plexus is a plexus of intersecting nerves. A nerve plexus is composed of afferent and efferent fibers that arise from the merging of the anterior rami of spinal nerves and blood vessels. There are five spinal nerve plexuses, except in the thoracic region, as well as other forms of autonomic plexuses, many of which are a part of the enteric nervous system. The nerves that arise from the plexuses have both sensory and motor functions. These functions include muscle contraction, the maintenance of body coordination and control, and the reaction to sensations such as heat, cold, pain, and pressure. There are several plexuses in the body, including:

A sensory nerve, or afferent nerve, is an anatomic term for a nerve that contains exclusively afferent nerve fibers. Nerves containing also motor fibers are called mixed. Afferent nerve fibers in a sensory nerve carry sensory information toward the central nervous system (CNS) from different sensory receptors of sensory neurons in the peripheral nervous system.

<span class="mw-page-title-main">Facial motor nucleus</span>

The facial motor nucleus is a collection of neurons in the brainstem that belong to the facial nerve. These lower motor neurons innervate the muscles of facial expression and the stapedius.

<span class="mw-page-title-main">Spinal disc herniation</span> Injury to the connective tissue between spinal vertebrae

A spinal disc herniation is an injury to the intervertebral disc between two spinal vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including good posture.

<span class="mw-page-title-main">Dorsal ramus of spinal nerve</span> Posterior division of a spinal nerve

The dorsal ramus of spinal nerve, posterior ramus of spinal nerve, or posterior primary division is the posterior division of a spinal nerve. The dorsal rami provide motor innervation to the deep muscles of the back, and sensory innervation to the skin of the posterior portion of the head, neck and back.

<span class="mw-page-title-main">Ventral ramus of spinal nerve</span> Anterior division of a spinal nerve

The ventral ramus is the anterior division of a spinal nerve. The ventral rami supply the antero-lateral parts of the trunk and the limbs. They are mainly larger than the dorsal rami.

<span class="mw-page-title-main">Facet joint</span> Joint between two adjacent vertebrae

The facet joints are a set of synovial, plane joints between the articular processes of two adjacent vertebrae. There are two facet joints in each spinal motion segment and each facet joint is innervated by the recurrent meningeal nerves.

<span class="mw-page-title-main">General visceral afferent fiber</span> Part of the visceral nervous system

The general visceral afferent (GVA) fibers conduct sensory impulses from the internal organs, glands, and blood vessels to the central nervous system. They are considered to be part of the visceral nervous system, which is closely related to the autonomic nervous system, but 'visceral nervous system' and 'autonomic nervous system' are not direct synonyms and care should be taken when using these terms. Unlike the efferent fibers of the autonomic nervous system, the afferent fibers are not classified as either sympathetic or parasympathetic.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

<span class="mw-page-title-main">Spinal cord</span> Long, tubular central nervous system structure in the vertebral column

The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal cord is hollow and contains a structure called central canal, which contains cerebrospinal fluid. The spinal cord is also covered by meninges and enclosed by the neural arches. Together, the brain and spinal cord make up the central nervous system.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

References

  1. Blumenfeld, Hal (2010). Neuroanatomy Through Clinical Cases (2nd ed.). Sunderland: Sinauer Associates. p. 321. ISBN   978-0-87893-058-6.
  2. Sanders, K. (2019, March 30). Summary of the Cranial Nerves. Teach Me Anatomy. https://teachmeanatomy.info/head/cranial-nerves/summary/
  3. Hagan, Catherine (2012). Comparative Anatomy and Histology. Academic Press: Piper M. Treuting, Suzanne M. Dintzis. ISBN   9780123813619.
  4. 1 2 Biga, L., Dawson, S., Harwell, A., Hopkins, R., Kaufmann, J., LeMaster, M., . . . Runyeon, J. (unk). 13.3 Spinal and Cranial Nerves. Retrieved November 20, 2020, from https://open.oregonstate.education/aandp/chapter/13-3-spinal-and-cranial-nerves/
  5. "A Neurosurgeon's Overview of the Anatomy of the Spine and Peripheral Nervous System". www.aans.org. Retrieved 2020-12-17.