Determination of the degree of severity of nerve damage | Herniated disc with nerve damage

Determination of the degree of severity of nerve damage

There are two important, common classifications for damage to peripheral nerves: the Seddon classification and the Sunderland classification. The Seddon classification of nerve injury includes three degrees of severity, while the Sunderland classification classifies nerve damage into five degrees. The severity of nerve damage depends on the extent of injury to the axons, medullary sheaths and connective tissue sheaths (epineurium) that surround the nerves.

Neurologists determine the severity of a nerve lesion by means of electromyography, electroneurography and, if necessary, magnetic resonance imaging (MRI). The slightest form of nerve damage involves an injury to the myelin sheath, while the axons and epineurium are uninjured. The prognosis is very good and the symptoms disappear within days to weeks.

This degree of severity corresponds to grade one according to Seddon, the so-called neurapraxia, and grade one according to Sunderland. The degree of severity of nerve damage in a herniated disc is crucial for the prognosis. It determines the possible regeneration of the nerve damage and the chances of recovery.

Are you more interested in this topic?a herniated disc can lead to a reduction in function due to nerve entrapment. This manifests itself for example in the form of muscle weakness or numbness. It is important to measure the function of a nerve in order to be able to decide later whether surgery is necessary or not.

In case of a normal nerve function, despite a herniated disc, the symptoms can be treated conservatively, i.e. with sports and medication. If there is a clearly measurable impairment of nerve function, surgical relief of the nerve may be indicated. In most cases, nerve function is determined by electromyography.

Electrodes are attached to the nerve as well as to a muscle that the nerve reaches. A weak electrical impulse is then applied to the nerve and the muscle response is registered. The speed at which the nerve is able to transmit the electrical impulse is decisive.

If the nerve is damaged, the nerve conduction speed is reduced. It is important to have a reference value available beforehand, as each nerve has an individual nerve conduction speed depending on its thickness and its condition. The procedure is completely harmless and painless.

This is because only very weak electrical signals are transmitted to the nerve. During the examination, there may be a tingling sensation on the skin or muscle twitches, but after the end of the electromyography, these symptoms disappear again by themselves. An examination usually takes no longer than 20 minutes.

If a nerve is insufficiently supplied with blood and nutrients over a long period of time, one speaks of irreversible damage and root death. Only a trained doctor can clearly recognize that the nerve is dead. An acute herniated disc can cause enormous pain.

As long as the pain is present, the nerve “lives” and transmits the pain signals. A sudden disappearance of the pain is an important indication of possible root death. At the same time, root death can cause paralysis and loss of sensitivity, such as numbness, to increase significantly or disappear altogether.

Unfortunately, the regeneration of a herniated disc with nerve damage takes a long time. The affected intervertebral discs are poorly supplied with fluid and nutrients due to the pressure load. Back training, weight loss and a balanced diet or surgical decompression of the disc can help to counteract the compression of the disc and nerves.

Furthermore, the prognosis depends on the extent of the nerve damage. Complete lesions regenerate worse than incomplete nerve injuries. With incomplete nerve injury, the damage can be regenerated within a few weeks with appropriate treatment.

In the case of more severe injuries, regeneration can last several months, and in the case of complete nerve sheath injuries, regeneration may even fail to occur. The freezing of nerves, the so-called cryotherapy of the nerve, is a relatively new procedure for the treatment of pain. It is mainly used for back pain, as is the case with a slipped disc or facet syndrome.

Cryotherapy has a long effect and is usually reversible. Icing can be carried out on an outpatient or inpatient basis. It is important that the patient is sufficiently informed about the possible complications before the procedure.

Among the most frequent complications are infections and frostbite in the area around the puncture, as well as permanent paralysis of the frozen nerve. Before the operation, it is important to ensure that blood-thinning medication is discontinued in good time and that the blood clotting has been checked by a doctor. If there is insufficient coagulation, major bleeding in the spinal canal may occur during the procedure.

The procedure itself is performed either openly, i.e. within the framework of an operation under general anaesthesia, or minimally invasive with a local anaesthetic. The minimally invasive variant is preferable to open surgery. Once the local anesthesia is in place, a small skin incision is made and a probe is inserted into the affected nerve.

The probe can be cooled down considerably from the inside using nitrogen or carbon dioxide. Once the probe has reached its destination, it is cooled down to about -60 degrees Celsius. This freezing process numbs the nerve and prevents it from sending pain signals.

Care must be taken to ensure that the probe does not remain on the nerve for too long and that the nerve is not cooled down too much. Otherwise, unwanted frostbite of adjacent structures can occur or the nerve can be irreversibly damaged. Immediately after cryotherapy, the result should be checked regularly to prevent possible complications at an early stage.

The vitamin B group comprises eight vitamins that act as precursors for important coenzymes in the body. The B vitamins are found in animal foods such as fish, dairy products or liver, as well as in vegetable foods such as broccoli or spinach. Vitamin B12 is mainly found in animal products and, unlike the other vitamins, can be stored in the body.

Vitamin B1 is important for the transmission of stimuli to the nervous system and vitamin B12 also fulfils essential tasks for the functioning of the nervous system. A lack of B vitamins can cause disorders of the nervous system. At the same time, an adequate supply of the vitamins can have a positive effect on nerve function.