Nerve Root Disorders

The most common cause of nerve root disorders is

A herniated disk can cause a nerve root disorder by putting pressure on the nerve root next to it.

Rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more (RA) or osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more can cause changes in the spine that put pressure on (compress) nerve roots, especially in the neck and lower back. In osteoarthritis, bone in the spine can overgrow and narrow the opening between the vertebrae that the nerve root goes through.

Less commonly, a tumor or other mass (such as an abscess) puts pressure on a nerve root.

Diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more can cause a nerve root disorder by damaging blood vessels that provide blood to the nerve root.

Infections, such as tuberculosis Tuberculosis (TB) Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs, but almost any organ can be involved. Tuberculosis... read more (TB), Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by Borrelia species, primarily by Borrelia burgdorferi and sometimes by Borrelia mayonii in the United States. These... read more , syphilis Syphilis Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. It can occur in three stages of symptoms, separated by periods of apparent good health. Syphilis... read more , and shingles Shingles Shingles is a painful skin rash caused by a viral infection that results from reactivation of the varicella-zoster virus, the virus that causes chickenpox. What causes the virus to reactive... read more , sometimes affect nerve roots.

Symptoms of nerve root disorders depend on which nerve root is affected. Pain, abnormal sensations, and/or muscle weakness occur in the area of the body supplied by the nerve root. The pain may feel like an electric shock that radiates through the affected area. Muscles may waste away and/or twitch. Affected muscles may become paralyzed.

Pain may be worsened by movement, including moving the back, coughing, and sneezing.

If the lowest roots of the spinal cord (the cauda equina Cauda Equina Syndrome Cauda equina syndrome occurs when the bundle of nerves that extends from the bottom of the spinal cord is compressed or damaged. The most common cause of cauda equina syndrome is a herniated... read more ) are affected, people may have weakness in the legs, urinary problems (such as incontinence or retention of urine), lose control of their bowels, and lose sensation in the buttocks, genital area, bladder, and rectum. Men may have trouble having an erection. This disorder, called cauda equina syndrome, is a medical emergency. The problem—such as a herniated disk, an abscess, a tumor, or a blood clot—that is putting pressure on the cauda equina must be corrected to prevent permanent nerve damage.

Doctors ask about symptoms and do a physical examination. The findings provide clues to the diagnosis and help doctors determine where the problem is.

Magnetic resonance imaging (MRI) or computed tomography (CT) is done to confirm the diagnosis. MRI shows the spinal cord, as well as abnormalities in the soft tissues around the cord, such as abscesses, hematomas (collections of blood), tumors, and ruptured disks, and in bone, such as tumors, fractures, osteoarthritis, and cervical spondylosis Cervical Spondylosis Cervical spondylosis is degeneration of the bones in the neck (vertebrae) and the disks between them, putting pressure on (compressing) the spinal cord in the neck. Osteoarthritis is the most... read more .

If MRI cannot be done and if results of CT are unclear, myelography is done. For myelography, a radiopaque contrast agent (which can be seen on x-rays) is injected into the space around the spinal cord, and x-rays are taken. CT myelography may also be done. CT myelography can provide detailed images of the spinal cord and surrounding bone.

Electrodiagnostic tests (electromyography and nerve conduction studies Electromyography and Nerve Conduction Studies Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more ) are done to identify which nerve roots are damaged and to confirm that symptoms are caused by compression of the spinal nerve rather than by problems in the spinal cord or in a nerve plexus Plexus Disorders Plexuses (networks of interwoven nerve fibers from different spinal nerves) may be damaged by injury, tumors, pockets of blood (hematomas), or autoimmune reactions. Pain, weakness, and loss... read more (a network of nerve fibers, where fibers from different spinal nerves are sorted and recombined to serve a particular area of the body). However, these tests cannot always identify the cause.

If imaging tests do not identify a cause, a spinal tap is done, and doctors analyze the fluid that surrounds the brain and spinal cord (cerebrospinal fluid) to check for infections. Doctors also measure the blood glucose level after people have fasted to check for diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more and may do other tests depending on the suspected cause.

Causes of nerve root disorders are treated when possible.

For sudden, immediate pain, pain relievers (analgesics), such as acetaminophen and nonsteroidal anti-inflammatory drugs Nonopioid Pain Relievers Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more (NSAIDs), are used. If symptoms are not relieved, corticosteroids may be given by mouth or by injection into the space between the spine and the outer layer of tissue covering the spinal cord (called an epidural injection). However, with corticosteroids, pain relief tends to be modest and temporary.

For long-lasting (chronic) pain Chronic Pain Chronic pain is pain that lasts or recurs for months or years. Usually, pain is considered chronic if it does one of the following: Lasts for more than 3 months Lasts for more than 1 month after... read more , treatment can be difficult. Acetaminophen and NSAIDs are often only partly effective, and taking NSAIDs for a long time has substantial risks. Opioid pain relievers Opioid Pain Relievers Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more have a risk of addiction. Some antidepressants Antidepressants Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more and antiseizure drugs Antiseizure drugs Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more , which are usually not considered pain relievers, can lessen pain due to nerve damage Neuropathic Pain Neuropathic pain is caused by damage to or dysfunction of the nerves, spinal cord, or brain. (See also Overview of Pain.) Neuropathic pain may result from Compression of a nerve—for example... read more . Physical therapy may also help relieve pain. If all of these treatments are ineffective, some people may wish to try alternative medicine (such as transdermal electrical nerve stimulation Nondrug Pain Treatments Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more , chiropractic Chiropractic In chiropractic, a manipulative and body-based practice, the relationship between the structure of the spine and the function of the nervous system is seen as key to maintaining or restoring... read more , acupuncture Nondrug Pain Treatments , or medicinal herbs Overview of Dietary Supplements Dietary supplements are used by about 75% of Americans. They are the most common therapies included among integrative medicine and health (IMH) and complementary and alternative medicine (CAM)... read more ).

If the pain is unrelenting or if pressure on spinal nerves is causing muscle weakness or loss of sensation, surgery to relieve the pressure may be necessary. If compression of the cauda equina or the spinal cord causes urinary or fecal incontinence, surgery is usually necessary and is done promptly to prevent permanent damage.