Do L5 and s1 nerve root compressions produce radicular pain in a dermatomal pattern?
Three pages on PainSci cite Taylor 2013: 1. The Complete Guide to Low Back Pain 2. Shin Splints Treatment, The Complete Guide 3. The Complete Guide to Neck Pain & Cricks
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
STUDY DESIGN: Observational case series.
OBJECTIVE: To compare the pattern of distribution of radicular pain with published dermatome charts.
SUMMARY OF BACKGROUND DATA: Dermatomal charts vary and previous studies have demonstrated significant individual subject variation.
METHODS: Patients with radiologically and surgically proven nerve root compression (NRC) caused by prolapsed intervertebral disc completed computerized diagrams of the distribution of pain and pins and needles. Ninety-eight patients had L5 compressions and 83 had S1 compressions.
RESULTS: The distribution of pain and pins and needles did not correspond well with dermatomal patterns. Of those patients with L5 NRC, only 22 (22.4%) recorded any hits on the L5 dermatome on the front, and only 60 (61.2%) on the back with only 13 (13.3%) on both. Only 1 (1.0%) patient placed more than 50% of their hits within the L5 dermatome. Of those patients with S1 NRC, only 3 (3.6%) recorded any hits on the S1 dermatome on the front, and only 64 (77.1%) on the back with only 15 (18.1%) on both. No patients placed more than 50% of their hits within the S1 dermatome. Regarding pins and needles, 27 (29.7%) patients with L5 NRC recorded hits on the front alone, 27 (29.7%) on the back alone, and 14 (15.4%) on both. Nineteen (20.9%) recorded more than 50% of hits within the L5 dermatome. Three (3.6%) patients with S1 NRC recorded hits on the front alone, 44 (53.0%) on the back alone, and 18 (21.7%) on both. Twelve (14.5%) recorded more than 50% of hits within the S1 dermatome.
CONCLUSION: Patient report is an unreliable method of identifying the anatomical source of pain or paresthesia caused by nerve root compression.
LEVEL OF EVIDENCE: 4.
related content
- “Anatomic issues related to cervical and lumbosacral radiculopathy,” Goldstein, Phys Med Rehabil Clin N Am, 2002.
- “The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine,” Tanaka et al, Spine (Phila Pa 1976), 2000.
- “Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps?,” Slipman et al, Spine (Phila Pa 1976), 1998.
- “Exploration of sensory impairments associated with C6 and C7 radiculopathies,” Rainville et al, Spine J, 2016.
- “Pain patterns and descriptions in patients with radicular pain: does the pain necessarily follow a specific dermatome?,” Murphy et al, Chiropr Osteopat, 2009.
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