Table of contenT:

Animation: Leg pain caused by foraminal stenosis pinching a nerve:
What do you mean by radiating pain: sciatica ?
What in the back (neck) can cause leg (arm) pain?
- Nerve pinching through "soft" tissue
- Nerve compression due to bony stenosis
Why a small disk herniation sometimes causes extreme sciatica!
Nerve irradiation without a pinched nerve, is that possible?

Animation: Leg pain caused by foraminal stenosis pinching a nerve:

What do you mean by radiating pain: sciatica?

A pinched nerve in the back causes radiating pain in the leg. This is also called "sciatica". Sometimes there are sensory disturbances or even loss of strength in the leg. The compression of the lower back nerve can be caused by a disk herniation (softer tissue) and/or by bony structures (hard). The cause is in the lower back and yet usually the worst symptoms are in the leg. Sometimes there is even no real back pain (anymore). The vertebral column is as it were the fuse box from where electrical cables run to the legs. The radiation complaints can be compared to a defective lamp in the house due to a problem in the fuse box. That there is no light you notice in a room (lamp), but the cause is in the fuse box (e.g. garage). Due to a cause in the back there is pain in another place in the thigh, buttock, calf or even the foot, depending on which nerve causes the radiation.

What in the back (neck) can cause leg (arm) pain?

Broadly speaking, the main causes of pinched nerves in the back are pressure from a hernia and/or bone.

1/ DISK HERNIATION

2/ BONY COMPRESSION

With a disk herniation, there is rather sudden pressure on the nerves, which also causes sudden radiation. A spinal canal stenosis has a more mild progressive course with progressive worsening of the radiating symptoms and typically progressively reduced walking distance (neurogenic claudication) . Whit an existing bony spinal canal stenosis, a relatively small hernia can already provoke considerable sciatica. In the reduced area of the stenotic canal, a nerve being compressed by a disk herniation is not free tot move away to the opposite side.

1. Nerve compression due to "soft" tissue:

Frequent: disk herniation

A herniated disk that presses on the nerves causes leg and back complaints. The leg complaints are usually most pronounced. A hernia in the spinal cord canal can sometimes be large before it causes radiation. Since the spinal canal is relatively muc… — A **herniated disk** that presses on the nerves causes leg and back complaints. The leg complaints are usually most pronounced. A hernia in the spinal cord canal can sometimes be large before it causes radiation. Since the spinal canal is relatively much wider than the nerves, the latter can push aside under pressure from a hernia.

Rarely: facet cyst

A facet cyst can press on a nerve and therefore be the cause of radiation pains. A facet cyst is caused by wear and tear of a facet weight itself and the joint capsule. This is a rarer cause of sciatica. — A **facet cyst** can compress a nerve and cause sciatica pains. A facet cyst is caused by wear and tear of a facet joint (degenerative arthrosis) and the joint capsule. This is a **rare cause** of sciatica.

2. NERVE COMPRESSION by bone :

Lateral spinal canal stenosis ( “lateral recess stenosis”)

Central spinal canal stenosis

Eénzijdige kanaal vernauwing ontstaat langzaam door beelderige aangroeingen veroorzaakt door slijtage aan de rug. Gezien dit langzaam gebeurt kunnen zenuwen zich vaak aanpassen en is er geen beenpijn. Echter bij plots knellen van een zenuw zit deze … — **Lateral recess stenosis** occurs slowly due to bony prominences growth caused by wear and tear of the back. Since this happens **slowly**, nerves can often adapt and there is no leg pain. However, if a nerve suddenly becomes pinched (e.g. by a concomitant acute disk herniation) it is immediately trapped in a very narrow space, resulting in **sciatica in the leg on the same side**.

Centrale vernauwing van het volledige kanaal treedt ook langzaam op. Ook hier is slijtage van de rug met verdikt weefsel en bolaangroei de oorzaak van verkleining van het centrale kanaal. Er ontstaat hier meestal geen pijn maar vooral ernstige gangs… — **Central stenosis** of the spinal canal also occurs slowly. Here, too, wear and tear of the psine with thickened tissue and bony spur growth is the cause of narrowing of the central canal. There is usually no sciatica, but rather **severe gait problems** with reduced walking distances(neurogenic claudication).

lateral spinal stenosis ("lateral recessus stenosis")

Bony narrowing of the neuroforamen occurs due to wear and tear. This process takes years, which allows the nerve to adapt at some point. Leg complaints are therefore sometimes milder. Sudden pain can be caused by making the wrong movement and pinchi… — **Bony narrowing of the neuroforamen** occurs due to wear and tear. This process takes years, which allows the nerve to adapt at some point. Leg complaints are therefore sometimes milder. Sudden pain can be caused by making the wrong movement and pinching the nerve with prominent bony spurr's. The nerve swells and gets pinched even more in an already too narrow opening.
Severe pains in the leg on the same side can occur even with smaller **foraminal disk herniations**. The diameter of the neuroforamen is so limited that the **exiting nerve does not have much spare room**. Here a relative small smaller disk herniation often provokes severe one-sided leg complaints.

Displaced vertebra ("spondylolisthesis")

A spondylolisthesis is the shifting of two vertebrae opposite each other. The displacement is only a few millimeters. This is usually caused by wear and tear on the back. There is also a congenital variant. The two "hoops" of the rear arches of the … — A ***spondylolisthesis*** is the **shifting of two vertebrae** opposite each other. The displacement is only a **few millimeters**. This is usually caused by wear and tear on the back. There is also a congenital variant. The two "hoops" of the rear arches of the back are no longer exactly on top of each other, which reduces the **remaining diameter** and therefore there is **less space left** for the nerves. If next to a spondylolysthesis, a lateral canal narrowing and/or relatively small acute disc herniation occurs, acute one-sided **sciatica** pain can occur. Significant narrowing of the entire canal can also lead to **walking disorders** similar as in a central canal narrowing.

Why a small disk herniation sometimes causes extreme sciatica!

Even a small herniated disc can cause a lot of symptoms; if the herniated disc is positioned "strategically wrong" and firmly squeezes a nerve, a smaller herniated disc can cause very severe symptoms. Normally, there is spare room for the nerves in the spinal canal. If there are also a bony stenosis, the nerve cannot slide away from pressure created a small herniated disc and a lot of sciatica pain is generated.

Nerve **irradiation without a pinched nerve**, is that possible?

It is indeed possible that there is some kind of radiation without nerve pinching. These pains are usually at the back of the buttock or on the side of the hip. Typically, the pain is no further than the knee and there are no sensory disturbances.

This pain is called pseudo-radicular pain. By pseudo is meant that it looks as if radicular refers to the radix or nerve root. The radiation pattern that makes it look like a nerve is pinched (but it is not so).

Often these kinds of complaints are caused by a hip disorder or by muscular-tendon radiations from wear and tear of the facet joints of the lower back.

Pseudo- radicular radiation: facet joint osteoarthritis