Diagnosis
As already mentioned, root compression of the spinal nerves is characterized by its characteristic symptomatology. Only on the basis of these symptoms, the corresponding suspected diagnosis can be made with a high degree of certainty.A thorough physical examination can further help to confirm the suspicion. The so-called Lasègue test is particularly important in this respect.
In this test, the stretched leg of the patient, who is in the supine position, is lifted. If pain shooting into the leg at an angle of up to 45° from the back, the test is considered positive. A final confirmation of the diagnosis is ultimately made by means of imaging procedures, primarily magnetic resonance imaging (MRI) or computer tomography (CT).
Some symptoms, symptom complexes and triggers of nerve root compression should always be treated immediately as soon as they become apparent during diagnosis. They are known as “red flags” and are indications of serious disease progression or circumstances. These include an accident as the cause of root compression syndrome, as well as fecal incontinence and bladder voiding disorders. Also fever, night sweats, unintentional weight loss in recent times and other indications of a tumor disease belong to the Red Flags.
Therapy of nerve root compression
Once a root compression syndrome has been diagnosed, subsequent treatment must be based on the exact cause of the disease. A very large proportion of root compressions are caused by herniated discs. In over 90% of cases, these can be treated conservatively, i.e. non-surgically.
In this case, appropriate pain therapy plays a major role. With its help, the patient should return to sports, exercise and physiotherapy as soon as possible after diagnosis. Surgical intervention to treat the disease is particularly suitable if all previous conservative treatment attempts have been unsuccessful or if serious symptoms occur.
A degenerative change in the small vertebral joints (facet joints) is also typically treated conservatively. Here, too, pain and physiotherapy play a major role. In addition, local anesthesia and anti-inflammatory drugs can be administered by injecting local anesthetics and glucocorticoids.
Definitely surgical treatment is required for bleeding, tumors and vertebral body fractures, which lead to neurological deficits. Infections are also sometimes treated surgically if they lead to the formation of abscesses. If this is not the case, only antibiotics are used instead.
