Corticosteroid injections by epidural or root blocks are commonly used to treat leg and back pain and may indicate that in some cases there may be an inflammatory contribution to the pain. In disc material removed from humans during operation has been found heightened levels of inflammatory chemicals which could be affected by steroid use. These inflammatory chemicals may increase degeneration of discs and sensitise the fibres of the outer disc walls. Some chemicals may also sensitise the discs by elevating reactivity of sensory nerves michael kors Canada
, inhibit the creation of new proteoglycans which hold water in the discs and may contribute to disc degeneration.
The nerve structures which are part of the lumbar motion segment can be sensitised and so become hyper reactive, leading to mechanical stresses which normally would be painless becoming painful. Nerve root or radicular pain is the pain caused by compression, irritation or inflammation of one of the spinal nerves at or close to the area they emerge from the spinal cord. It is not clear exactly what is the pathology underlying severe sciatica, although hypotheses include compression plus dysfunction of the axons, ischaemia, inflammation and biochemical factors. Spinal nerve roots may be more susceptible to compression injuries and to swelling formation inside their structure than other nerves.
Compression of the nerve root may allow increased inflow of fluids to the nerve, resulting in oedema of the nerve which gives a higher internal fluid pressure. This can compromise the flow through local capillaries and cause the nerve to become fibrosed. Since around sixty percent of the nutrition of the spinal nerve roots is provided by the cerebrospinal fluid, any fibrosis of the nerves can reduce this and make them more liable to suffer symptoms of compression due to their increased sensitivity. Pain could be generated by the nerve alterations caused by slowing or interruption of the blood throughput, rather than the sensory and motor loss following peripheral nerve compression.
If the nerve and its vascular supply are compromised quickly then nerve root symptoms are more likely than with a slow onset, perhaps giving a clue to why older people do not suffer such symptoms despite compromise of the nerve exits. Disc material has been experimentally placed in the epidural space of dogs and found to generate a significant inflammatory reaction and may cause damage to nerves when in contact with them. If TNF (tumour necrosis factor) is injected into a nerve it causes similar changes to those which ensue after nerve root compromise. An auto-immune reaction to the internal disc material, which is not normally accessible, has also been proposed but it is likely that many aspects are relevant.
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