I'm a neuroradiologist reporting daily the spines and I must admit that your lecture is super practical for every student, resident and specialist doctor for evaluating the spine and disk topography . All your lectures are excellent! The animations and graphics are stunning! Big Thanks!
What does this mean if you're a neuroradioligist Moderate bilateral uncovertebral joint and facet arthropathy contribute to moderate right and severe left neural foraminal narrowing at this level and impingement of exiting left C6 nerve root.
I am short of words to express my gratitude and appreciation. I am a resident of PMR and I had a tough time grabbing this concept of exiting, transiting nerve roots and disc herniation You made it look so simple when in reality it's not that easy. Kudos and thanks for the effort. Highly recommend this video to all the PMR physicians, young neurosurgery and spinal residents
Nobody could explain what was difference between Exiting and Traversing Nerve Root!! I honestly didnt know what it was for more than 15 years!! But finally I do!!! Thank You So Much Dr. Morton!!!
Just Amazing lecturer I wish all teachers and medical programs taught like this it would cover a lot of insecurities students have that some textbooks just cant teach.
Thanks so much for explaining this. I currently have broad based disk with paracentral protrusion impinging and posterior displacing L5 nerve root. It didn't make sense until I watched your video. Thanks for that!
Hello Sir.. you just do it so clearly.. please write a book on anatomy, it will be the ATLAS of anatomy for sure. The way you are simplifying stuff is going to benefit millions. Animation is costly and it takes time. I know little bit of it so i can imagine how much effort you are putting. Writing a book can cover more topics and with less investment. Thank you..
Shailesh jain thanks very much for your kind words. My textbook aligns closely with the videos on this channel: www.amazon.com/Big-Picture-Anatomy-Medical-Course/dp/1259862631
Dr. Morton, can you do a video on the anatomy of the liver please? The liver has a lot of clinical relevance and is confusing because of functional vs morphological division. That would help so many healthcare professional students!
Hi, very interesting to listen to this. A little twist on this, what do you think it looks like on a person who has an Extra lumbar vertebra? an L6 not a lumbarised S1 but 25 vertebrae + a fully developed sacrum of 5 fused blocks. Is there then also an Extra nerve pair or is it even the case that it is the S1 nerve root that passes out under the L6 TP?
@@TheNotedAnatomist But, at the end (7:15) the image says that T and L-Spine herniations impinge the nerve (...) infra-adjacent vertebra, so what is correct? 😅
@@TheNotedAnatomist Thank you. I had this problem at 28 years old and an operation was suggested but considering my age at that time and considering how I was going to live for the rest of my life after an operation such as that, I decided not to have the operation even if the condition caused me so much pain and numbing of my entire shoulders down to the tips of my fingers because C6 and C7 in my cervical spine was affected. I got over it through some unconventional procedure and I'm 60 now and never had the pain for over 30 years as far as I can remember. I suffered the pain for 11 months and that was all... Thank you for the reply.
But does the thoracic follow cervical pattern or lumbar pattern of correlating with inferior vertebrae? And when the nerve Impingement is caused by the facets in cervical then does it still follow the same cervical pattern of the involved nerve being in the foramen? @@TheNotedAnatomist
Lumbar: Impingement in the neural foramen affects the nerve in that foramen. Ex: between L4-L5 pedicles/neural foramen=L4 affected. IV herniations usually impinge the nerve level associated with the infra-adjacent vertebrae. For example, L4-L5 IV affects L5 Cervical: Impingement in the neural foramen by bone spur or IV disc herniation affects the nerve in that foramen. C5-C6 bone spur/herniated disk=affect C6
Excellent video. Are you aware of any visual aids that show lateral disc herniations? That happened to me at L4-5 in 2019, ended up with disc replacement surgery last month to resolve after all forms of conservative treatment failed me.
My report says : study reveals central and bilateral paracentral disc protrusion with right lateral propensity at L4-L5 with thecal indentation and right traversing nerve root impingement. Small central and bilateral paracentral disc protrusion is noted at L5-S1 level with anterior epidural fat impingement.
Can you please explain to me what kind of hope I have. My feet burn and are cold at the same time and I have mass spams in both legs and feet sometimes. My report reads L2-L3 right foraminal/extraforiminal disc extrusion has mass effect on L2 nerve root/dorsal root ganglion. Right foraminal stenosis. L3-L4 degenerative disc disease, reactive endplate edema, retrolisthesis, central braod-based disc protrusion abuts L4 root sleeves, greater on right, moderate right greater than left lateral recess stenosis. Moderate bilateral foraminal narrowing. L4-L5 shallow based right paracentral disc protrusion right L5 root sleeve without mass effect. Moderate right forminal narrowing. Left L5 nerve root exits inferior foramen and abuts buldging disc.
Hi I’m in a world of pain from an impinged nerve and I don’t want an operation and the surgeon is also very hesitant due to the last Laminectomy I had where it took 3 operations to stop a spinal fluid leak and now I have like a sack of fluid showing up on the MRI but exactly where they would need to operate again risking that happening again and not being able to be controlled. My problem is I can’t live like this there is no end to the pain in my hip, leg and knee cap this time the back pain is bad enough. I don’t know what to do but if it can’t be fixed then there is only one option to end the pain. Not that I can say on this why it is.
What really affects humans compared to other animals is walking upright, wheres on 4 legs gravity does not affect the spine nearly as much. To have a healthy spine it is important to reduce the effects of gravity and use an inversion table. You will be amazed how much better your body and spine will feel. It is very important to use Only the velcro straps to hold your feet for proper inversion. Herniated discs occur generally when someone "lifts too much weight or improperly lifts weight". That weight you pick up along with body mass compresses the spine and vertebra. Reversing that compression is what is important to reduce damage (and thus pain) with your spine. And help prevent a herniated disc in the first place. Prevention and taking care of yourself is the best way to stay healthy. Reversing the effects of gravity from standing upright should not be underestimated for good spinal health and feeling good/no aches and pains. take care..
The referred pain story story keeps being inconsistent for now. From On the definitions and physiology of back pain, referred pain, and radicular pain, 2009: “Thus, although disc herniation is the most common cause of radicular pain, it is not a common cause of back pain.” So they are saying even though there are nociceptors in the disc, a herniated disc usually doesn’t even cause back pain. So back pain then must be caused by facet joint inflammation. “The vast majority of patients with nociceptive back pain does not have radicular pain, and do not have a disc herniation.” Nociceptive back pain can radiate, but I think there is confusion in that the term radiate is always used implying the highest pain is in the back, not the pheriphery, so assuming back pain is causing a worse extremity pain would be false. Ie fixing the back pain would not fix the other pain in patients who are experiencing more pain at another location. If the spine is causing the referred pain, you wouldn’t be trying to localize it to where the back hurts necessarily, unless nociceptive pain and impingement have the same cause, but per above quote that is rare. “However, radiculopathy is not defined by pain [but numbness]” So again, the patient is ill advised to think a location of severe pain is caused by either a nociceptive or radiculopathy spine problem. Radicular pain (not same as radiculopathy) also does not feel like nociceptive pain but more like an electric shock and goes down the leg in a narrow band. Also the ganglion has to be inflamed, by a herniating disc (which usually dry out though so it seems unlikely to me even that kind of pain could be chronic) “ If clinicians ceased to confuse somatic referred pain and radicular pain, fewer patients would be mismanaged, and fewer would sustain iatrogenic (clinician caused) problems” From how I’ve read this the problem is blaming any real pain away from the spine on nerve impingements or spinal abnormalities
I'm a neuroradiologist reporting daily the spines and I must admit that your lecture is super practical for every student, resident and specialist doctor for evaluating the spine and disk topography . All your lectures are excellent! The animations and graphics are stunning! Big Thanks!
Robert Prejs thanks Robert ! I am thrilled to hear they are helpful
What does this mean if you're a neuroradioligist
Moderate bilateral uncovertebral joint and facet arthropathy contribute to moderate right and severe left neural foraminal narrowing at this level and impingement of exiting left C6 nerve root.
This topic was so confusing to me for so long. Thank you so much for clearing my doubts. In such a perfect way. Also I love the practice questions!
Thanks Anusmita ... Glad it was helpful!
I never understood spinal injury until now. Thanks a million
I am short of words to express my gratitude and appreciation. I am a resident of PMR and I had a tough time grabbing this concept of exiting, transiting nerve roots and disc herniation
You made it look so simple when in reality it's not that easy. Kudos and thanks for the effort. Highly recommend this video to all the PMR physicians, young neurosurgery and spinal residents
Hey thanks
Nobody could explain what was difference between Exiting and Traversing Nerve Root!! I honestly didnt know what it was for more than 15 years!!
But finally I do!!!
Thank You So Much Dr. Morton!!!
Really appreciate from the bottom of my heart.
As a chiropractic student, this information is extremely valuable and practical for what I will be doing in my field
Great video, well done with good graphics and solid science.
Thank you very much!
Just Amazing lecturer I wish all teachers and medical programs taught like this it would cover a lot of insecurities students have that some textbooks just cant teach.
Excellent video as always!
Thanks so much for explaining this. I currently have broad based disk with paracentral protrusion impinging and posterior displacing L5 nerve root.
It didn't make sense until I watched your video. Thanks for that!
See a Gonstead Chiropractor and they will fix you up.
Nice explanation
amazing
spectacular
splendid
perfect
big mac
Hello Sir.. you just do it so clearly.. please write a book on anatomy, it will be the ATLAS of anatomy for sure. The way you are simplifying stuff is going to benefit millions.
Animation is costly and it takes time. I know little bit of it so i can imagine how much effort you are putting. Writing a book can cover more topics and with less investment. Thank you..
Shailesh jain thanks very much for your kind words. My textbook aligns closely with the videos on this channel: www.amazon.com/Big-Picture-Anatomy-Medical-Course/dp/1259862631
@@TheNotedAnatomist oh great. Will surely check it out and get it. Thank you.. 🙏
Dr. Morton, can you do a video on the anatomy of the liver please? The liver has a lot of clinical relevance and is confusing because of functional vs morphological division. That would help so many healthcare professional students!
That’s a great suggestion ... I will add it to my list of tutorials to create!
Thank you so much for such a great explanation. It is simple and well done. However suggest how can it be cured or surgery is the only way out 😢
Awesome! Thank you.
Good explanation
Brilliant. Thanks for this amazing expert illustartion.
Ur our hero 💗💗💗
Thank you 🙏
This is the greatest breakdown of the herniated disk ever caught on tape.👍🏋♀️👩🦽
Haha thanks
Very good #thanks dear#
Thanks very much
thats was great thank you 😍
great video
Thanks
Thank you so much
Wonderful
Hi, very interesting to listen to this.
A little twist on this, what do you think it looks like on a person who has an Extra lumbar vertebra? an L6 not a lumbarised S1 but 25 vertebrae + a fully developed sacrum of 5 fused blocks. Is there then also an Extra nerve pair or is it even the case that it is the S1 nerve root that passes out under the L6 TP?
Thank you
Thanks for all the great videos you're making. Will you make one for intrinsic and extrinsic foot muscles/nerves?
Great video buy What nerve root does a herniated disc in the thoracic region?
The nerve in the foreman (ex, T5-T6 disc hits T5 nerve)
@@TheNotedAnatomist thank you
@@TheNotedAnatomist But, at the end (7:15) the image says that T and L-Spine herniations impinge the nerve (...) infra-adjacent vertebra, so what is correct? 😅
If I may ask please, what is the difference between nerve impingement and slip disc? Thank you.
A slipped disc can hit or compress a nerve and then that nerve becomes impinged
@@TheNotedAnatomist Thank you. I had this problem at 28 years old and an operation was suggested but considering my age at that time and considering how I was going to live for the rest of my life after an operation such as that, I decided not to have the operation even if the condition caused me so much pain and numbing of my entire shoulders down to the tips of my fingers because C6 and C7 in my cervical spine was affected. I got over it through some unconventional procedure and I'm 60 now and never had the pain for over 30 years as far as I can remember. I suffered the pain for 11 months and that was all... Thank you for the reply.
@@stellamiguel4063 congrats and best wishes on your good health!
What did u do -would u like to share and care?
So the T12 nerve root would be affected by a disc protrusion at T12-L1, is that correct?
Yes that is correct (however that would be very rare)
But does the thoracic follow cervical pattern or lumbar pattern of correlating with inferior vertebrae?
And when the nerve Impingement is caused by the facets in cervical then does it still follow the same cervical pattern of the involved nerve being in the foramen?
@@TheNotedAnatomist
Lumbar:
Impingement in the neural foramen affects the nerve in that foramen. Ex: between L4-L5 pedicles/neural foramen=L4 affected.
IV herniations usually impinge the nerve level associated with the infra-adjacent vertebrae. For example, L4-L5 IV affects L5
Cervical:
Impingement in the neural foramen by bone spur or IV disc herniation affects the nerve in that foramen. C5-C6 bone spur/herniated disk=affect C6
Excellent video. Are you aware of any visual aids that show lateral disc herniations? That happened to me at L4-5 in 2019, ended up with disc replacement surgery last month to resolve after all forms of conservative treatment failed me.
My report says : study reveals central and bilateral paracentral disc protrusion with right lateral propensity at L4-L5 with thecal indentation and right traversing nerve root impingement. Small central and bilateral paracentral disc protrusion is noted at L5-S1 level with anterior epidural fat impingement.
Is it something serious? cause i had it 2 year ago now i am 18 years old
thx
Can you please explain to me what kind of hope I have. My feet burn and are cold at the same time and I have mass spams in both legs and feet sometimes. My report reads L2-L3 right foraminal/extraforiminal disc extrusion has mass effect on L2 nerve root/dorsal root ganglion. Right foraminal stenosis. L3-L4 degenerative disc disease, reactive endplate edema, retrolisthesis, central braod-based disc protrusion abuts L4 root sleeves, greater on right, moderate right greater than left lateral recess stenosis. Moderate bilateral foraminal narrowing. L4-L5 shallow based right paracentral disc protrusion right L5 root sleeve without mass effect. Moderate right forminal narrowing. Left L5 nerve root exits inferior foramen and abuts buldging disc.
Greate
It's Amazing ..
Hi I’m in a world of pain from an impinged nerve and I don’t want an operation and the surgeon is also very hesitant due to the last Laminectomy I had where it took 3 operations to stop a spinal fluid leak and now I have like a sack of fluid showing up on the MRI but exactly where they would need to operate again risking that happening again and not being able to be controlled. My problem is I can’t live like this there is no end to the pain in my hip, leg and knee cap this time the back pain is bad enough. I don’t know what to do but if it can’t be fixed then there is only one option to end the pain. Not that I can say on this why it is.
but in any of the Xray you have shown there is no spur
What really affects humans compared to other animals is walking upright, wheres on 4 legs gravity does not affect the spine nearly as much. To have a healthy spine it is important to reduce the effects of gravity and use an inversion table. You will be amazed how much better your body and spine will feel. It is very important to use Only the velcro straps to hold your feet for proper inversion. Herniated discs occur generally when someone "lifts too much weight or improperly lifts weight". That weight you pick up along with body mass compresses the spine and vertebra. Reversing that compression is what is important to reduce damage (and thus pain) with your spine. And help prevent a herniated disc in the first place. Prevention and taking care of yourself is the best way to stay healthy. Reversing the effects of gravity from standing upright should not be underestimated for good spinal health and feeling good/no aches and pains. take care..
but big fan of your videos
The referred pain story story keeps being inconsistent for now. From
On the definitions and physiology of back pain, referred pain, and radicular pain, 2009:
“Thus, although disc herniation is the most common cause of radicular pain, it is not a common cause of back pain.”
So they are saying even though there are nociceptors in the disc, a herniated disc usually doesn’t even cause back pain. So back pain then must be caused by facet joint inflammation.
“The vast majority of patients with nociceptive back pain does not have radicular pain, and do not have a disc herniation.”
Nociceptive back pain can radiate, but I think there is confusion in that the term radiate is always used implying the highest pain is in the back, not the pheriphery, so assuming back pain is causing a worse extremity pain would be false. Ie fixing the back pain would not fix the other pain in patients who are experiencing more pain at another location.
If the spine is causing the referred pain, you wouldn’t be trying to localize it to where the back hurts necessarily, unless nociceptive pain and impingement have the same cause, but per above quote that is rare.
“However, radiculopathy is not defined by pain [but numbness]”
So again, the patient is ill advised to think a location of severe pain is caused by either a nociceptive or radiculopathy spine problem.
Radicular pain (not same as radiculopathy) also does not feel like nociceptive pain but more like an electric shock and goes down the leg in a narrow band. Also the ganglion has to be inflamed, by a herniating disc (which usually dry out though so it seems unlikely to me even that kind of pain could be chronic)
“ If clinicians ceased to confuse somatic referred pain and radicular pain, fewer patients would be mismanaged, and fewer would sustain iatrogenic (clinician caused) problems”
From how I’ve read this the problem is blaming any real pain away from the spine on nerve impingements or spinal abnormalities
Cervical -same
Lumbar - change lol
Can you stop saying chink in the video, is actually so racist
Thank you so much
You're most welcome