Effect on Nerve Roots

      The most direct effect on the nerve root is from compression by the herniated disk, but the disk need not compress the nerve root directly to cause radicular pain. Fragments of nucleus pulposus within the epidural space induce a focal inflammatory reaction that can secondarily irritate the adjacent nerve root.

      In a study by Jinkins, Endnote nerve root enhancement was observed in 5% of patients scanned for back or leg pain. Of that group, 70% had disk protrusion and a radicular pain pattern in the distribution of the enhancing root. The other 30% without protruding disk had multiple enhancing roots, suggesting an idiopathic low-grade inflammation. Lane's group Endnote reported that multilevel nerve root enhancement, especially when continuous from the root sleeve cephalad toward the conus, is often asymptomatic and not associated with any nerve root compression. The continuous enhancement probably represents radicular veins. 

{To return to cases, use the "Back " button on the Toolbar}