Radicular syndrome is a complex of symptoms that arise in the process of compression of the spinal roots (that is, nerves) in those places where they branch from spinal cord. Radicular syndrome, the symptoms of which are somewhat contradictory in its definition, is itself a sign of many different diseases, which is why timely diagnosis and appropriate treatment become important.

general description

The neurological syndrome we are considering is quite common. Compression (squeezing) of nerves leads to a wide variety of pain, which, accordingly, occurs in a variety of places: in the limbs, in the neck, in the lower back. Often pain can also occur in the area of ​​certain internal organs, for example, in the area of ​​the stomach or heart.

Below we can consider what the spinal root looks like externally and, accordingly, determine the effect of a lesion if one occurs.

Causes of radicular syndrome

Damage to the spinal roots can be caused by a number of conditions, including the following:

• Spina bifida;
• Certain types of birth defects relevant to the structure of the spine;
• Constant overloads affecting the spinal column;
• Sedentary lifestyle;
• Spondyloarthrosis;
• Injuries, scarring and tumors;
• Vertebral fractures resulting from osteoporosis;
• Changes in hormonal status;
• Damage to the vertebrae of an infectious nature (for example, changes caused by or);
• Hypothermia.

As a rule, radicular syndrome does not occur immediately after exposure to one or another specified cause. Initially, it is preceded by the development of changes in the area of ​​the intervertebral discs, which, in turn, provoke the occurrence of hernias. Further, the hernia, with its own displacement, begins to compress the spinal root, which leads to difficulty in the outflow of venous blood from it. This subsequently leads to the development of non-infectious inflammation. Thus, the nerve and the tissue around it begin to surround the formed adhesions.

Radicular syndrome: symptoms

The first, and most characteristic symptom of radicular syndrome is the appearance of pain, which is concentrated along the course of a particular nerve. So, when a process develops in the cervical region, pain, accordingly, occurs in the arm and neck. The process in the thoracic region provokes back pain; in some cases, pain concentrated in the stomach or heart becomes possible (these pain disappears only when the radicular syndrome itself is eliminated). The process in the lumbar region leads to pain in the lower back and buttocks, as well as the lower extremities.

Movement, like lifting heavy objects, leads to increased pain. In some cases, the pain is characterized as “shooting”, which is accompanied by its spread to various parts of the body, this is partly due to the location of a particular nerve. A lumbago that occurs in the lumbar region has a name. In this case, the pain may be constant, but it intensifies in any case if any careless movement is made.

Not only physical stress, but also emotional stress can provoke attacks of pain; in addition, hypothermia also influences its appearance. In some cases, pain occurs at night, as well as during sleep, which is particularly accompanied by swelling of the skin and its redness, and increased sweating is also noted.

Another symptom accompanying radicular syndrome manifests itself as a sensitivity disorder that occurs in the zone of innervation of the nerve in question. Thus, a slight tingling sensation with a needle in the indicated area is accompanied by a sharp decrease in sensitivity, which is observed when compared with a similar area, but located on the other side.

Additionally, the symptoms also include movement disorders that occur with muscle changes. The latter are provoked by damage to the nerves that innervate them. The muscles dry out and, accordingly, they atrophy. In addition, their weakness is noted, which in some cases is determined visually, especially when comparing both limbs.

Diagnosis of radicular syndrome

In diagnosing radicular syndrome, it is initially important to determine the cause that provokes compression of the spinal nerve. Thanks to studies regarding movement and sensitivity disorders, it is determined within which vertebrae the damage occurred. For example, if compression of the root occurs in the area of ​​the fifth lumbar vertebra, then this provokes lower back pain (i.e. lumbodynia). This pain, accordingly, radiates along the outer surface of the thigh, as well as along the lower leg to the toes (2,3,4). Already this symptom acquires a slightly different definition - lumbar ischialgia.

When nerves are damaged due to infectious diseases, the process may be accompanied by additional symptoms in the form of fever and increased temperature, which, in particular, is concentrated in the area of ​​the root involved in the pathological process.

General radiography of the spine is used as a standard instrumental method that makes it possible to diagnose the syndrome we are considering. In particular, the diagnostic focus covers the results of radiography in the lateral and anterior projections. Meanwhile, the most informative and at the same time sensitive diagnostic method today is MRI (magnetic resonance imaging). Whatever diagnostic method is chosen, the basis for determining the diagnosis is still directly those clinical symptoms that are relevant in each specific case for the patient.

Treatment of radicular syndrome

Treatment methods for radicular syndrome are determined solely on the basis of considering possible causes, as well as identifying the main one, that is, the one that actually provoked this syndrome. Patients are prescribed strict bed rest, during which they should lie exclusively on a hard surface. Additionally assigned:

• Analgesics (ketorol, baralgin). Their use allows you to eliminate/reduce severe painful manifestations.
• Anti-inflammatory non-steroidal drugs (nurofen, diclofenac, movalis). With their help, they not only reduce inflammation that has formed in areas with damaged nerves, but also relieve pain. Their long-term use, however, is associated with a number of side effects. By the way, the use of drugs of this type is possible in the form of ointments, gels (fastum, ketonal), which, accordingly, provides for their external use while simultaneously reducing possible adverse effects.
• Muscle relaxants are drugs designed to relieve muscle spasms. They can only be used as prescribed by a doctor.
• Vitamins corresponding to group B. Their action is aimed at improving metabolic processes in nerve tissues.
• Chondroprotectors are drugs for stimulating restoration processes and slowing down cartilage destruction in the area of ​​intervertebral joints.
• Non-drug treatment (massage, gymnastics, physiotherapy, reflexology). These treatment options are relevant in all cases except tumors.

Some diseases may require surgical intervention, which is possible with neoplasms and.

To diagnose radicular syndrome, as well as to prescribe adequate treatment, you need to consult a neurologist.

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Diseases with similar symptoms:

Intercostal neuralgia is a painful condition caused by irritation of the intercostal nerves or their compression. Intercostal neuralgia, the symptoms of which are usually observed in older people, is explained by age-related changes that are relevant to the condition of their blood vessels. As for children, this disease is extremely rare in them.

There are also autonomic disorders. At the same time, vertebrogenic syndromes manifesting to varying degrees are determined: muscular-tonic, vegetative-vascular and neurodystrophic.

Clinical manifestations of radicular syndrome depend on the location of herniated intervertebral discs. Most of them are observed at the level of LIV-LV and LV-SI intervertebral discs, which is associated with the greatest load on the lower lumbar spine of a person. Therefore, the L5 and S1 roots are most often compressed, and the L4 root is somewhat less common. Depending on the number of affected roots, mono-, bi- and polyradicular syndromes are distinguished. The main clinical syndrome of damage to the L5 root is pain in the upper buttock, which radiates along the outer surface of the thigh, the anterior surface of the leg and foot to the big toe. The pain is often shooting in nature, sharply aggravated during body movements, changes in body position, sneezing, coughing. There is a feeling of numbness in these same areas. During the examination, weakness and hypotrophy of the muscles that extend the thumb and hypoesthesia in the area of ​​innervation of this root are noted. Knee and Achilles reflexes do not change.

S1 root lesion syndrome is characteristic of osteochondrosis of the lumbosacral disc. The most common complaint is pain in the gluteal region, which spreads along the back of the thigh, lower leg, outer surface of the foot, radiating to the heel and little toe. The muscle tone of the buttock, back of the thigh and lower leg is reduced. Weakness of the flexors of the big toe and sometimes the foot is also noted. Common symptoms include a decrease or disappearance of the Achilles reflex. In the area of ​​innervation of the S1 root, slight hypoesthesia is determined.

Osteochondrosis of the LIII intervertebral disc is much less common. With its posterolateral hernia, signs of damage to the L4 root are revealed. The pain spreads along the front of the thigh and the inner surface of the lower leg. Weakness and atrophy of the quadriceps femoris muscle are noted. The knee reflex decreases or disappears. The sensitivity of the skin is disturbed according to the radicular type, hyperesthesia is determined, which is replaced by hypoesthesia.

Damage to the L5 and S1 roots is much more common. The main clinical symptom is pain in the lumbosacral area, often shooting in nature, with a feeling of numbness. The pain radiates along the back and outer surface of the thigh, lower leg and foot. Physical activity, coughing, and sneezing make it more acute. Painful scoliosis often develops, with its convexity directed towards the healthy side. The location of straightening or strengthening of the lumbar lordosis is noted. The movements of the spine are sharply limited during bending. The pain can be so severe that the patient takes on a characteristic posture. Basically, he lies on his back with his lower limbs bent at the knee joints.

In the acute period, during palpation, pain is observed in the paravertebral points in the lumbar region and the spinous processes of the LIV, LV and SI vertebrae. Pain points in the projection area of ​​the sciatic nerve are also determined in places where it comes close to the skin: at the point where the nerve exits the pelvic cavity between the ischial tuberosity and the greater trochanter of the femur, in the middle of the gluteal fold, in the popliteal fossa, posterior to the head of the fibula, behind medial malleolus (Vallee point).

Except pain points The so-called tension symptoms are also determined (Lasega, Bekhterev, Neri, Dejerine, Sicara, landing, etc.).

Lasègue's symptom is the appearance or intensification of pain in the lumbar region and along the sciatic nerve in a patient lying on his back, while bending the outstretched leg at the hip joint (Phase I of Lasègue's symptom). If you further bend it at the knee joint, the pain disappears or sharply decreases (phase II of Lasegue's symptom).

Ankylosing spondylitis symptom (crossed Lasegue symptom) is the appearance of pain in the lumbar region during flexion of the healthy lower limb at the hip joint.

Neri's symptom is an increase in pain in the lumbar region with passive bending of the head (bringing the chin to the sternum) of the patient lying on his back with straightened lower limbs.

Dejerine's symptom is increased pain in the lumbar region when coughing or sneezing.

Sicard's symptom - - increased manifestations of lumboischialgia during extension of the patient's foot, lying on his back with straightened legs.

Symptom of landing - if a patient lying on his back is asked to sit down, then the lower limb on the affected side bends at the knee joint during landing.

If the pathological process is localized in the vertebral segments L1 - L4 and is manifested by signs of damage to the femoral nerve, symptoms of Wasserman and Matskevich tension are observed.

Wasserman's symptom is the occurrence or intensification of pain in the area of ​​innervation of the femoral nerve during extension of the leg in the hip joint in a patient lying on his stomach.

Matskevich's symptom is the occurrence of sharp pain in the area of ​​innervation of the femoral nerve during sharp flexion of the lower leg in a patient lying on his stomach.

Damage to the roots of the lumbar and sacral segments of the spinal cord may be accompanied by autonomic disorders, which are manifested by a decrease in skin temperature, increased sweating in the area of ​​innervation of the corresponding roots, and a weakening of the pulse in the corresponding arteries.

When compression of the cauda equina develops in the presence of a median hernia, extremely acute pain occurs that spreads to both limbs. Characteristic signs are peripheral paresis of the feet, perineal anesthesia, and dysfunction of urination.

Radicular-vascular syndrome develops due to compression of the radicular or radicular-spinal arteries by herniated lumbar intervertebral discs or under the influence of other factors. As a rule, the clinical picture that arises is not radiculopathy, but radiculo-ischemia or radiculomyeloischemia. It can manifest itself as syndromes affecting the epiconus, conus, cauda equina, and “paralytic sciatica.” The clinical picture is mostly dominated by motor and sensory disorders in the presence of moderate or mild pain, and sometimes its absence.

Spinal compression syndrome is mostly caused by a median or paramedian hernia. Obviously, there are other factors: osteophytes, epiduritis, etc. Their development is acute, and the clinical picture is manifested by various neurological syndromes: epiconus, conus, cauditis. Patients experience significant motor (lower paraparesis or paralysis) and sensory (conductor or radicular type) lesions. There may be sensitivity disorders in the perineal area. Such lesions are accompanied by urination problems.

The course of lumbosacral radiculopathy (radiculitis) is characterized by periodic exacerbations and remissions. Exacerbations occur due to the influence of various factors (hypothermia, unsuccessful movement, lifting loads, etc.).

Diagnostics, differential diagnosis. The diagnosis of cervical reflex syndromes and cervical radiculopathy is established on the basis of the clinical manifestations of the disease and X-ray examination data.

As for pain in the thoracic spine, it can be caused by various factors: tuberculous spondylitis, spinal cord tumor, ankylosing spondylitis. Pain in the thoracic spine can be observed with a tumor of the mediastinum, esophagus, etc. Sometimes it is a consequence of duodenal ulcer or diseases of the pancreas and kidneys. Only after a comprehensive examination of patients and exclusion of these diseases can a diagnosis of thoracic radiculopathy (radiculitis), which is a consequence of spinal osteochondrosis, be established.

In typical cases, diagnosing the neurological manifestations of lumbar osteochondrosis, starting with non-radicular forms (lumbago, lumbodynia, lumboischialgia) and ending with radicular and radicular-vascular syndromes, is not difficult. However, pain in the lumbosacral area can be predetermined by various diseases that need to be excluded. These are primarily tumors, inflammatory processes of the spine and pelvic cavity, spinal arachnoiditis, tuberculous spondylitis. Therefore, the doctor should always remember both atypical lumbosacral pain and the possibility of serious pathology. To do this, it is necessary to examine each patient in detail. Often, auxiliary examination methods are used: examination of cerebrospinal fluid, radiography, CT, MRI of the spine.

Treatment. In the acute period, bed rest, rest and painkillers are first of all necessary. The patient should be placed on a hard bed; for this, a wooden shield is placed under a regular mattress. Local remedies are also used: a heating pad, a bag of hot sand, mustard plasters, jars. Local irritants are various anesthetic ointments that are rubbed into painful areas of the skin.

Painkillers are also used medicinal products. Analgin is prescribed - 3 ml of a 50% solution, reopirin - 5 ml or baralgin 2 ml intramuscularly. Apply an anesthetic mixture (analgin solution 50% - 2 ml, cyanocobalaminamkg, no-shpa - 2 ml, diphenhydramine 1% - 1 ml) intramuscularly in one syringe. Irrigation of the paravertebral region with ethyl chlorine is effective. You can also use quartz irradiation in an erythemal dose. Sometimes these activities are enough to relieve pain.

In cases where there is no effect, the scope of treatment measures must be expanded. It is advisable to carry out treatment in a neurological hospital. They continue to use painkillers: analgin, baralgin, sedalgin, trigan. Often the pain is caused by damage to the sympathetic fibers, i.e. it is sympathalgic in nature. In this case, finlepsin 200 mg, gangleron 1 ml of 1.5% solution, diclofenac sodium 3 ml, xefocam (8 mg) 2 ml intramuscularly are prescribed. The use of drugs that have anti-inflammatory and analgesic effects is effective: movalis 7.5 mg 2 times a day after meals for 5-7 days or 1.5 ml intramuscularly every other day (3-5 infusions); Rofica (rofecoxib) 12.5-25 ml 2 times a day for days, Celebrex 1 capsule (100 mg) per day for 5-7 days.

To reduce swelling of the spinal nerve root, dehydration agents are prescribed: furosemide 40 mg, hypothiazide - 25 mg per day for 3-4 days, aminophylline 10 ml of a 2.4% solution intravenously in 10 ml of a 40% glucose solution. In the presence of reflex muscular-tonic syndromes, use mydocalm 50 mg, sirdaludmg 3 times a day. The administration of chondroprotectors (traumeel, discus compositum intramuscularly) is effective. In case of prolonged pain syndrome, a good result is obtained by novocaine blockade (20-40 ml of 0.5% solution) in combination with flosterone - 1 ml, cyanocobalamin 0 mcg. In case of chronic recurrent course of the disease, B vitamins and biogenic stimulants (aloe extract, peloid distillate, plasmol, vitreous) are prescribed subcutaneously throughout the day.

Physiotherapeutic methods include electrophoresis of novocaine, calcium chloride, magnetic therapy, and diadynamic therapy. Balneotherapy is carried out using coniferous, radon baths, as well as mud or paraffin-ozokerite applications. Massage and exercise therapy are also effective. When acute manifestations subside, orthopedic treatment is used - spinal traction using a variety of traction devices and devices. Dosed underwater traction, as well as manual therapy, have a positive effect.

Experience shows that sometimes the pain subsides completely after conservative treatment for several months. In the chronic stage of the disease, sanatorium-resort treatment is recommended, in particular mud therapy (Odessa, Saki, Slavyansk, Kholodnaya Balka), radon baths (Khmelnik, Mironovka), paraffin-ozokerite applications (Sinyak).

For persistent pain, surgical treatment is used. It is carried out only if there are indications such as continuous pain, severe movement disorders. Urgent indications for surgical treatment are prolapse of the intervertebral disc with compression of the radicular spinal artery and the development of movement disorders in the form of flaccid paresis or paralysis, and urinary disorders.

To prevent frequent relapses, the patient should be temporarily or permanently transferred to work that does not involve significant stress on the spine. If there is no positive effect in treatment for 4-5 months, it can be established III group disability. Sometimes the patient is declared incapacitated.

Prevention. Among the preventive measures, the fight against hypokinesia, physical education and sports are important. It is necessary to avoid hypothermia and sudden movements while performing work associated with significant load on the spine and tension on the roots of the spinal nerves.

Features of radicular syndrome in the lumbar spine

Radicular syndrome or radiculopathy is a set of neurological symptoms that occur when spinal nerves are compressed in the area where they branch off from the spinal cord. The pathological process is often encountered in medical practice and is a manifestation of the chronic progressive course of diseases of the spinal column, primarily of a degenerative nature - dorsopathies.

According to statistics, in 80% of cases, radicular syndrome of the lumbar spine is diagnosed due to mobility of the vertebrae, weakness of the musculo-ligamentous apparatus in this area and heavy load in the process motor activity.

Causes

The most common cause of radicular syndromes is considered to be the progressive course of osteochondrosis with the formation of protrusions, hernias, and osteophytes. The disease is accompanied by deformation of the intervertebral discs as a result of metabolic disorders and insufficient blood supply. As a result, the height of the disc decreases, which moves beyond the boundaries of the vertebrae, compressing nearby soft tissues. In this case, the root is affected - the spinal nerve at the base of the spinal cord, passing in the bone canal before exiting the spine. The spinal root consists of sensory and motor nerve fibers and is in connection with the vertebral vessels. Compression of the neurovascular bundle by a hernia or osteophyte leads to the appearance of neurological symptoms.

Other causes of radiculopathy include:

• congenital pathology of the spinal column;
• spondyloarthrosis;
• vertebral fractures caused by osteoporosis (weakening of bone tissue);
• infections (osteomyelitis, tuberculosis);
• intense axial loads on the spine (carrying heavy objects, sports overloads);
• sedentary lifestyle (hypodynamia);
• prolonged stay in static positions (working at a computer);
• frequent hypothermia;
• chronic stress;
• endocrine disorders, hormonal imbalance (obesity, diabetes);
• tumors, scar changes in the spinal column;
• injuries (fractures, bruises, sprains);
• flat feet.

Compression of the nerve root often occurs when a herniated protrusion of the intervertebral disc forms

In the development of degenerative-dystrophic processes of the spinal column in last years the role of a hereditary factor that influences the defective development of connective tissue has been proven. As a result, spinal pathology develops with a rapidly progressive course and the formation of radiculopathy. Poor nutrition, nicotine addiction, and alcohol abuse are of no small importance in the onset of the disease.

Clinical picture

A constant manifestation of radicular syndrome is pain of varying intensity, which occurs at the site of infringement of the neurovascular bundle and in other parts of the body along the innervation of the affected nerve.

It can be aching, tugging, burning, cutting. Worsened by walking, bending, turning, sneezing or coughing. Sometimes the pain syndrome occurs in the form of a lumbago - sharp pain from the lumbar region it spreads along the course of the nerve. Characteristic phenomena of parasthesia are numbness, tingling, a feeling of “crawling goosebumps” in the lower extremities.

This condition is called lumbago, and periodically shooting pains are called lumbodynia. Lumbago can appear when turning awkwardly during night sleep, bending over, or lifting heavy objects. In this case, the pain is accompanied by autonomic disorders: redness of the skin, sweating, swelling over the area of ​​root compression. Depending on the level of damage to the lumbosacral region, pain can radiate to the groin, buttocks, lower extremities on the affected side, cause problems with urination, defecation and weaken potency.

On the MRI image, arrows indicate pathological changes in the intervertebral discs in the lumbar region

Sensory and motor nerve fibers pass through the spinal root. Their compression causes swelling and inflammation of the nervous tissue, disruption of the conduction of nerve impulses from the central sections to the periphery. As a result, the lower limb on the affected side suffers. In this case, sensitivity is impaired - the sensation of tactile touch, temperature and pain stimuli of the lower limb is weakened. The innervation of the muscle fibers of the thigh, leg, and foot also changes and their atrophy (“shrinkage”) develops. Weakening of the muscles causes impairment of the ability to move normally. Atrophied muscles decrease in volume, which can be seen when visually comparing the diseased and healthy legs.

Diagnostics

For the diagnosis of radicular syndrome, clinical data of the disease are of significant importance. The lumbosacral region is affected by different levels, and based on the specificity of the symptoms, one can with high probability assume the localization of the pathological process.

Schematic location of nerve roots

1. Compression of the spinal root at the level of 1-3 lumbar vertebrae (L1-L3) is accompanied by discomfort in the lower back, pain in the perineum, pubis, lower abdomen, inner and anterior thigh. Paresthesia and numbness of the skin are observed in this area.
2. Compression of the spinal roots at the level of the 4th lumbar vertebra (L4) is characterized by pain on the anterior and outer surface of the thigh, which descends to the knee joint and lower leg. There is a decrease in the volume of the thigh due to atrophy of the quadriceps muscle and weakening of movements in the knee. The gait changes and lameness develops.
3. Compression of the spinal roots at the level of the 5th lumbar vertebra (L5) causes pain along the outer surface of the thigh and lower leg, the inner part of the foot with damage to the big toe. Paresthesia in the foot area and weakening of the muscle strength of the lower limb are detected, which complicates the supporting and motor function of the affected leg.

Pain sensations decrease or completely stop when lying on the healthy side of the body.

To prescribe effective treatment, the etiological disease of the spine, which caused the appearance of radicular syndrome, is identified. They recommend instrumental examination methods that reveal the specifics and severity of the pathological process and clarify its localization:

• radiography in direct and lateral projection - determines disorders of the bone tissue of the spine, indirectly indicates narrowing of the intervertebral discs and pinched nerve roots;
• Magnetic resonance imaging (MRI) is a more accurate and expensive diagnostic method that provides information about the condition of not only the vertebrae, but also the intervertebral discs, vessels, nerves, muscles, ligaments, and spinal cord;
• myelography - reveals the condition of the spinal cord and nerve roots using a contrast agent injected into the subarachnoid space, followed by fluoroscopy.

Correct diagnosis facilitates the prescription of adequate therapy, which prevents the development of complications and disability.

Treatment tactics

Treatment of radiculopathy is aimed at eliminating pain, reducing inflammation and swelling of the neurovascular bundle. After the acute process has stopped, therapy for the etiological disease is continued to prevent the progression of the pathology. Patients are prescribed bed rest on a hard, flat surface, which prevents spinal deformation and additional injury to soft tissues. Fried, salty, spicy, fatty foods are excluded from the diet. The diet is enriched with fresh vegetables, fruits, herbs, cereals and dairy products. For effective treatment, you should stop smoking and drinking alcoholic beverages.

Conservative therapy for radicular syndrome includes:

• analgesics for the purpose of relieving pain - baralgin, ketorol in solutions for intramuscular injections;
• non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammatory reaction in the affected area, eliminate swelling and pain - movalis, diclofenac, nimesulide for the first 5 days through intramuscular injections, then in tablet form every day;
• lubricating the lower back with anti-inflammatory and locally irritating ointments - capsicum, diclak-gel, finalgon;
• novocaine blockades with the addition of lidocaine, antibiotics, glucocorticoids for quick pain relief;
• muscle relaxants to relax spasmodic muscles in the area of ​​nerve compression, which has an analgesic effect, improves blood flow to tissues, reduces congestion - sirdalud, mydocalm;
• vitamin complexes based on preparations B 1, B 6, B 12 in order to normalize metabolic processes and trophism of nerve roots, improve the conduction of nerve impulses, regenerate damaged tissues - milgamma, neuromultivitis in injections or tablets;
• physiotherapy after the subsidence of acute pain to activate metabolism, normalize muscle tone, improve blood flow - magnetic therapy, UHF, electrophoresis, radon baths;
• physical therapy to restore the anatomically correct position of the spinal column and strengthen the muscular frame of the back;
• massage, acupuncture, reflexology - to strengthen the back muscles, normalize blood circulation, improve nutrition of the spine.

In severe cases of the disease, persistent symptoms develop that do not respond to conservative methods of therapy. In such cases, surgical treatment is resorted to.

Indications for surgical intervention include chronic pain syndrome, impaired motor activity (paresis, paralysis), pathology of the pelvic organs with urinary and fecal incontinence.

Massage and manual therapy are prescribed for the prevention of radiculopathy

Preference is given to minimally invasive methods, which are characterized by less damaging effects on healthy tissue and a short recovery period. For lumbar osteochondrosis complicated by protrusion, hernia, or proliferation of osteophytes, nucleoplasty, microdiscectomy, and removal of damaged spinal tissue with replacement with implants are prescribed.

Prevention

To prevent radiculopathy, it is necessary to promptly consult a doctor when the first alarming symptoms of the spinal column occur. Infringement of the spinal root occurs against the background of a chronic course of the disease, untimely diagnosis and treatment of the pathological process. You should adhere to a balanced diet, give up bad habits, exercise, and monitor the maintenance of normal body weight. It is important to sleep on a firm mattress and wear comfortable low-heeled shoes. It is necessary to avoid heavy physical labor associated with axial load on the spine. It is useful to undergo therapeutic back massage courses twice a year.

Complexes of therapeutic exercises are prescribed during the recovery period of the disease

To prevent exacerbation of radiculopathy due to osteochondrosis, you can perform a set of exercises daily to strengthen the lumbar spine:

• lying on your back with your arms extended along your torso and legs straight, contract your press muscles;
• the starting position is the same, lift the upper half of the body from the floor, stay in this position for as long as possible and return to the previous position, number of repetitions – once;
• lying on your back, bend your knees and place them to the right of your body, at the same time point your head and chest to the left, perform springing movements 6-8 times, and then do the same exercise, changing the sides of the head and legs;
• sit on the floor, stretch out one leg and bend the other at the knee joint and move it to the side, bend towards the straight leg and try to clasp your foot with your hands, swap your legs and repeat the exercise 5-6 times;
• in a position on all fours, alternately arch your back up and bend down until you feel a pleasant warmth in your lower back. Repeat the exercise 8-10 times.

If possible, hang on the horizontal bar several times a day for minutes. Do a morning warm-up for all muscle groups before you begin active physical activity.

Radicular syndrome in the lumbar region causes intense pain, impairs sensitivity and motor ability of the limbs, disrupts pelvic functions and contributes to the appearance of sexual impotence. This significantly reduces the quality of life and can lead to disability. To prevent pathology, it is necessary to consult a doctor in a timely manner and undergo comprehensive treatment for diseases of the spinal column.

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Radicular syndrome

Radicular syndrome is a symptom complex formed as a result of lesions of the spinal root of various etiologies and manifested by symptoms of irritation (pain, muscle tension, antalgic posture, paresthesia) and loss (paresis, decreased sensitivity, muscle wasting, hyporeflexia, trophic disorders). Radicular syndrome is diagnosed clinically, its cause is determined by the results of radiography, CT or MRI of the spine. Treatment is often conservative; if indicated, surgical removal of the root compression factor is performed.

Radicular syndrome

Radicular syndrome is a common vertebrogenic symptom complex with variable etiology. Previously, the term “radiculitis” was used in relation to radicular syndrome - inflammation of the root. However, it is not entirely true. Recent studies have shown that the inflammatory process in the root is often absent; reflex and compression mechanisms of its damage take place. In this regard, the term “radiculopathy” - root damage - began to be used in clinical practice. Most often, radicular syndrome is observed in the lumbosacral spine and is associated with damage to the 5th lumbar (L5) and 1st sacral (S1) vertebrae. Cervical radiculopathy is less common, and thoracic radiculopathy is even less common. The peak incidence occurs in the middle age category - from 40 to 60 years. The tasks of modern neurology and vertebrology are the timely identification and elimination of the factor causing compression of the root, since long-term compression entails degenerative processes in the root with the development of persistent disabling neurological dysfunction.

Causes of radicular syndrome

On both sides of the human spinal column, 31 pairs of spinal nerves depart, which originate in the spinal roots. Each spinal root is formed by the posterior (sensory) and anterior (motor) branches emerging from the spinal cord. It exits the spinal canal through the intervertebral foramen. This is the narrowest place where root compression most often occurs. Radicular syndrome can be caused by both primary mechanical compression of the root itself and its secondary compression due to edema developing as a result of compression of the radicular veins. Compression of the radicular vessels and microcirculation disorder that occurs with edema, in turn, become additional factors in root damage.

The most common cause of radicular syndrome is spinal osteochondrosis. A decrease in the height of the intervertebral disc entails a decrease in the diameter of the intervertebral foramina and creates the preconditions for pinching the roots passing through them. In addition, a compression factor may be an intervertebral hernia that forms as a complication of osteochondrosis. Radicular syndrome is possible when the root is compressed by osteophytes formed during spondylosis or parts of the facet joint that are changed due to spondyloarthrosis.

Traumatic damage to the spinal root can occur with spondylolisthesis, spinal injuries, and vertebral subluxation. Inflammatory damage to the root is possible with syphilis, tuberculosis, spinal meningitis, and spinal osteomyelitis. Radicular syndrome of neoplastic origin occurs with spinal cord tumors, spinal root neuroma, and vertebral tumors. Instability of the spine, resulting in displacement of the vertebrae, can also cause radicular syndrome. Factors contributing to the development of radiculopathy include excessive stress on the spine, hormonal imbalances, obesity, physical inactivity, spinal abnormalities, and hypothermia.

Symptoms of radicular syndrome

The symptom complex of radiculopathy consists of various combinations of symptoms of irritation of the spinal root and loss of its functions. The severity of signs of irritation and loss is determined by the degree of compression of the root, individual characteristics of the location, shape and thickness of the spinal roots, and interradicular connections.

Symptoms of irritation include pain, motor disturbances such as cramps or fascicular muscle twitching, sensory disturbances such as tingling or crawling sensations (paresthesia), local feelings of heat/cold (dysesthesia). Distinctive Features radicular pain is its burning, baking and shooting nature; appears only in the area innervated by the corresponding root; spread from the center to the periphery (from the spine to the distal parts of the arm or leg); aggravated by overexertion, sudden movement, laughter, coughing, sneezing. Pain syndrome causes reflex tonic tension of muscles and ligaments in the affected area, which increases pain. To reduce the latter, patients take a gentle position and limit movements in the affected part of the spine. Muscular-tonic changes are more pronounced on the side of the affected root, which can lead to distortion of the body, in the cervical region - to the formation of torticollis, with subsequent curvature of the spine.

Symptoms of loss appear with advanced damage to the root. They are manifested by weakness of the muscles innervated by the root (paresis), a decrease in the corresponding tendon reflexes (hyporeflexia), and a decrease in sensitivity in the zone of innervation of the root (hypoesthesia). The area of ​​skin for which one root is responsible for sensitivity is called the dermatome. It receives innervation not only from the main root, but also partially from the one above and below. Therefore, even with significant compression of one root, only hypoesthesia is observed, while with polyradiculopathy with pathology of several adjacent roots, complete anesthesia is observed. Over time, trophic disorders develop in the area innervated by the affected root, leading to muscle wasting, thinning, increased vulnerability and poor healing of the skin.

Symptoms of damage to individual roots

Spine C1. The pain is localized in the back of the head, often accompanied by dizziness and possible nausea. The head is tilted to the affected side. Tension of the suboccipital muscles and their palpation pain are noted.

Spine C2. Pain in the occipital and parietal region on the affected side. Head turns and tilts are limited. Hypoesthesia of the skin of the back of the head is observed.

Spine C3. The pain covers the back of the head, the lateral surface of the neck, the mastoid region, and radiates to the tongue, orbit, and forehead. In these same areas, paresthesia is localized and hypoesthesia is observed. Radicular syndrome includes difficulty bending and straightening the head, pain in the paravertebral points and points above the spinous process of C3.

Spine C4. Pain in the shoulder girdle extending to the front surface of the chest, reaching the 4th rib. Distributes along the posterolateral surface of the neck to its middle 1/3. Reflex transmission of pathological impulses to the phrenic nerve can lead to hiccups and phonation disorders.

Spine C5. Radicular syndrome of this localization is manifested by pain in the shoulder girdle and along the lateral surface of the shoulder, where sensory disturbances are also observed. Abduction of the shoulder is impaired, hypotrophy is noted deltoid muscle, the biceps reflex is reduced.

Spine C6. Pain from the neck spreads through the biceps area to the outer surface of the forearm and reaches the thumb. Hypoesthesia of the last and outer surface of the lower 1/3 of the forearm is detected. Paresis of the biceps, brachialis, supinators and pronators of the forearm is observed. Reduced wrist reflex.

Spine C7. The pain goes from the neck along the back of the shoulder and forearm, reaching the middle finger of the hand. Due to the fact that the C7 root innervates the periosteum, this radicular syndrome is distinguished by the deep nature of the pain. Decreased muscle strength is noted in the triceps, pectoralis major and latissimus muscles, flexors and extensors of the wrist. Decreased triceps reflex.

Spine C8. Radicular syndrome at this level is quite rare. Pain, hypoesthesia and paresthesia spread to the inner surface of the forearm, ring finger and little finger. Characterized by weakness of the flexors and extensors of the wrist, and the finger extensor muscles.

Roots T1-T2. The pain is limited to the shoulder joint and armpit area, and can spread under the collarbone and to the medial surface of the shoulder. Accompanied by weakness and hypotrophy of the hand muscles and numbness. Horner's syndrome is typical, homolateral to the affected root. Dysphagia and peristaltic dysfunction of the esophagus are possible.

Roots T3-T6. The pain has a girdling character and goes along the corresponding intercostal space. It may cause pain in the mammary gland, and if localized on the left, it can simulate an angina attack.

Spines T7-T8. The pain starts from the spine below the scapula and along the intercostal space reaches the epigastrium. Radicular syndrome can cause dyspepsia, gastralgia, and pancreatic enzyme deficiency. The upper abdominal reflex may be reduced.

Spines T9-T10. Pain from the intercostal space spreads to the upper abdomen. Sometimes radicular syndrome has to be differentiated from an acute abdomen. There is a weakening of the mid-abdominal reflex.

Spines T11-T12. Pain may radiate to the suprapubic and inguinal areas. The inferior abdominal reflex is reduced. Radicular syndrome at this level can cause intestinal dyskinesia.

Spine L1. Pain and hypoesthesia in the groin area. The pain spreads to the upper outer quadrant of the buttock.

Spine L2. The pain affects the front and inner thighs. There is weakness in hip flexion.

Spine L3. The pain goes through the iliac spine and greater trochanter to the anterior surface of the thigh and reaches the lower 1/3 of the medial part of the thigh. Hypesthesia is limited to the area of ​​the inner thigh located above the knee. The paresis that accompanies this radicular syndrome is localized in the quadriceps muscle and adductors of the thigh.

Spine L4. The pain spreads along the front of the thigh, knee joint, medial surface of the leg to the medial ankle. Hypotrophy of the quadriceps muscle. Paresis of the tibial muscles leads to external rotation of the foot and its “slapping” when walking. Decreased knee reflex.

Spine L5. The pain radiates from the lower back through the buttock along the lateral surface of the thigh and lower leg to the first 2 toes. The pain zone coincides with the area of ​​sensory disorders. Tibialis muscle hypotrophy. Paresis of the extensors of the big toe, and sometimes the entire foot.

Spine S1. Pain in the lower back and sacrum, radiating along the posterolateral thigh and lower leg to the foot and 3rd-5th toes. Hypo- and paresthesia are localized in the area of ​​the lateral edge of the foot. Radicular syndrome is accompanied by hypotension and hypotrophy of the gastrocnemius muscle. Rotation and plantar flexion of the foot are weakened. Decreased Achilles reflex.

Spine S2. Pain and paresthesia begin in the sacrum, covering the back of the thigh and lower leg, sole and big toe. Cramps in the hip adductors are often observed. The Achilles reflex is usually unchanged.

Roots S3-S5. Sacral caudopathy. As a rule, polyradicular syndrome is observed with damage to 3 roots at once. Pain and anesthesia in the sacrum and perineum. Radicular syndrome occurs with dysfunction of the sphincters of the pelvic organs.

Diagnosis of radicular syndrome

In the neurological status, attention is drawn to the presence of trigger points above the spinous processes and paravertebral, muscle-tonic changes at the level of the affected segment of the spine. Symptoms of root tension are revealed. In the cervical region, they are provoked by a quick tilt of the head opposite to the affected side, in the lumbar region - by raising the leg in a horizontal position on the back (Lasegue's symptom) and on the stomach (Matskevich and Wasserman's symptoms). Based on the localization of the pain syndrome, areas of hypoesthesia, paresis and muscle wasting, the neurologist can determine which root is affected. Electroneuromyography can confirm the radicular nature of the lesion and its level.

The most important diagnostic task is to identify the cause that provoked the radicular syndrome. For this purpose, radiography of the spine is performed in 2 projections. It allows you to diagnose osteochondrosis, spondyloarthrosis, spondylolisthesis, ankylosing spondylitis, curvatures and anomalies of the spinal column. A more informative diagnostic method is a CT scan of the spine. MRI of the spine is used to visualize soft tissue structures and formations. MRI makes it possible to diagnose intervertebral hernia, extra- and intramedullary tumors of the spinal cord, hematoma, and meningoradiculitis. Thoracic radicular syndrome with somatic symptoms requires additional examination of the corresponding internal organs to exclude their pathology.

Treatment and prognosis of radicular syndrome

In cases where radicular syndrome is caused by degenerative-dystrophic diseases of the spine, conservative therapy is used predominantly. In case of intense pain syndrome, rest, analgesic therapy (diclofenac, meloxicam, ibuprofen, ketorolac, lidocaine-hydrocortisone paravertebral blockades), relief of muscular-tonic syndrome (methyllycaconitine, tolperisone, baclofen, diazepam), decongestant treatment (furosemide, ethacrynic acid), neurometabolic products (vitamins B). In order to improve blood circulation and venous outflow, aminophylline, xanthinol nicotinate, pentoxifylline, troxerutin, and horse chestnut extract are prescribed. According to indications, chondroprotectors (cartilage and calf brain extract with vitamin C, chondroitin sulfate), absorbable treatment (hyaluronidase), and drugs to facilitate neuronal transmission (neostigmine) are additionally used.

Long-term radicular syndrome with chronic pain is an indication for the use of antidepressants (duloxetine, amitriptyline, desipramine), and when pain is combined with neurotrophic disorders, for the use of ganglion blockers (benzohexonium, ganglefen). For muscular atrophy, nandrolone decanoate with vitamin E is used. Traction therapy has a good effect (in the absence of contraindications), increasing intervertebral distances and thereby reducing negative impact on the spinal root. In the acute period, reflexology, UHF, and hydrocortisone ultraphonophoresis can be an additional means of pain relief. IN early dates they begin to use exercise therapy, during the rehabilitation period - massage, paraffin therapy, ozokerite therapy, therapeutic sulfide and radon baths, mud therapy.

The question of surgical treatment arises when conservative therapy is ineffective, prolapse symptoms progress, or the presence of a spinal tumor. The operation is performed by a neurosurgeon and aims to eliminate compression of the root, as well as remove its cause. For herniated intervertebral discs, discectomy or microdiscectomy is possible; for tumors, their removal is possible. If the cause of radicular syndrome is instability, then the spine is fixed.

The prognosis of radiculopathy depends on the underlying disease, the degree of root compression, and the timeliness of treatment measures. Long-term symptoms of irritation can lead to the formation of a difficult-to-control chronic pain syndrome. If compression of the root is not eliminated in time, accompanied by symptoms of prolapse, over time it causes the development of degenerative processes in the tissues of the spinal root, leading to persistent impairment of its functions. The result is irreversible paresis that disables the patient, pelvic disorders (with sacral caudopathy), and sensory disturbances.

Lumbar compression syndromes. Any lumbar root can be compressed by a herniated disc. However, early wear of Liv-v and Lv-Si disks is especially typical. Therefore, the L5 and S1 roots are most often compressed. In the epidural space, due to the paramedian Liv-v hernia, the L5 root is affected, and due to the Lv-Si hernia, the S1 root is affected. These are the most common types of compression radicular syndromes. If the hernia spreads in the lateral direction, it compresses the root in the intervertebral foramen at the Liv-v level - the L4 root, at the Lv-Si level - the L5 root . A large hernia can compress two roots at once, stretching the dural sac, and with it the adjacent dural radicular cuffs. Thus, one hernia can manifest itself clinically as bi- and polyradicular syndromes. Such a Liv-v hernia exerts direct compression on the L5 and L4 roots, and a Lv-Si hernia on the S1 and L5 roots. In a tense and compressed root, swelling, venous congestion occurs, and subsequently, due to trauma and autoimmune processes (tissue of a prolapsed disc - autoantigen) - aseptic inflammation. Since these processes unfold in the epidural space, aseptic adhesive epiduritis develops here.

Clinical manifestations of root compression: shooting pain, dermatomal hypalgesia, peripheral paresis, weakening or loss of the deep reflex.

Only the detection of one of these signs or their combination makes it possible to diagnose the participation of the radicular component in the picture of lumboischialgia and cervicobrachialgia along with spondylogenic and musculofascial pain. The list below does not include Lasegue's symptom, which for many years was considered a classic indicator of radicular damage. This point of view turned out to be wrong. Lasègue's symptom can certainly occur as direct consequence root lesions, for example in acute and chronic inflammatory demyelinating polyradiculoneuropathy. However, within the framework of lumboischialgia, Lasègue’s symptom makes it possible to differentiate this symptom complex from other pain in the leg (thrombophlebitis, coxarthrosis), but is not a sign of complicity in the pain complex of radicular compression.

Radicular pain intensifies when coughing, sneezing due to reflex tension of the lumbar muscles and due to the resulting liquor push affecting the root, when taking Queckenstedt. Pain intensifies in the lower back with movements, especially when bending the body, i.e., when the anterior parts of the vertebral bodies come together, which aggravates the displacement of the disc.

Upper lumbar roots L1, L2, L3 (discs Li-Lп, Lп-Lш and Lш-Liv). Relatively rare localization. Li-Lp disc herniation also affects the conus medullaris. The onset of radicular syndrome is manifested by pain and loss of sensitivity in the corresponding dermatomes, and more often in the skin of the inner and anterior thighs. With median hernias, symptoms of damage to the cauda equina appear early. As a rule, symptoms of lower lumbar radicular lesions are also detected as a result of tension of the dura mater of the spinal cord by an upper lumbar hernia. In old age, cruralgia with paresthesia occurs in a wide area above and below the knee due to compression of the upper lumbar roots. Weakness, hypotrophy and hypotonia of the quadriceps femoris muscle, decreased or loss of the knee reflex and sensitivity disorders are determined. Compression of the L1 and L3 roots can cause symptoms in the lateral femoral cutaneous nerve; however, discogenic origin of Roth disease is very rare.

Spine L4 (disc Lп-Liv). Infrequent localization; There is a sharp pain that radiates along the inner anterior thigh, sometimes to the knee and a little lower.

In the same zone there are also paresthesias; motor disorders appear almost only in the quadriceps muscle; mild weakness and malnutrition with a decrease or absence of the knee reflex.

L5 spine (Liv-Lv disc). Frequent localization. The L5 root is compressed by a herniated Liv-Lv disc, usually after a long period of lumbar pain, and the picture of the radicular lesion turns out to be very severe. During this long time, the nucleus pulposus manages to break through the fibrous ring, and often the posterior longitudinal ligament. The pain radiates from the lower back to the buttock, along the outer edge of the thigh, along the anterior outer surface of the leg to the inner edge of the foot and big toes, often to just the first toe; the patient experiences a feeling of tingling and chilliness. Pain from the “hernial point” can also radiate here, when causing the phenomenon of the intervertebral foramen, when coughing and sneezing. In the same zone, especially in the distal parts of the dermatome, hypalgesia is detected. A decrease in the strength of the extensor of the first finger (a muscle innervated only by the L5 root) is determined. , hypotonia and hypotrophy of the tibialis anterior muscle. The patient experiences difficulty standing on his heel with the foot extended.

Spine S1 (disk Lv-Si). Frequent localization. Since a disc herniation is not held for long by the narrow and thin posterior longitudinal ligament at this level, the disease often begins immediately with radicular pathology. The period of lumbago and lumbodynia, if it precedes radicular pain, is short. The pain radiates from the buttock or from the lower back and buttock along the outer posterior edge of the thigh, along the outer edge of the lower leg to the outer edge of the foot and the last fingers, sometimes only to the fifth finger. Often the pain extends only to the heel, more to its outer edge. In these same areas, only sometimes the patient experiences a tingling sensation and other paresthesias. Pain from the “hernial point” can also radiate here when causing the phenomenon of the intervertebral foramen (when coughing and sneezing). In the same zone, especially in the distal parts of the dermatome, hypalgesia is determined. A decrease in the strength of the triceps surae muscle and the flexors of the toes (especially the flexor of the fifth finger), hypotension and hypotrophy of the gastrocnemius muscle are determined. The patient has difficulty standing on his toes, and there is a decrease or absence of the Achilles reflex.

When the S1 root is compressed, scoliosis is observed, more often heterolateral - tilting the body to the affected side (which reduces the tension of the relatively short root above the hernia). When the L5 root is compressed, scoliosis is often homolateral (which increases the height of the corresponding intervertebral foramen). The direction of scoliosis is also determined by the localization of the hernia: with lateral hernias, as a rule, homolateral scoliosis is observed, with medial hernias, heterolateral scoliosis.

The conventionality of the topical meaning of the direction of antalgic scoliosis is demonstrative in the so-called alternating scoliosis, when scoliosis changes its “sign” several times during the day.

An extremely unfavorable variant of the lumbar vertebrogenic compression radicular symptom complex is compression of the cauda equina. It occurs with median hernias that exert pressure not in the lateral sections of the epidural zone, where one radicular nerve passes in each segment, but more medially, where the roots of the cauda equina are compactly located in the dural sac. The pain is usually severe, spreading to both legs, and loss of sensation like “rider’s pants” affects the anogenital area. As a rule, pelvic disorders occur.

Clinical manifestations of compression at the lower lumbar level also include spinal cord ischemia syndromes. In the acute development of the process, they talk about spinal strokes, in subacute and chronic ones - about myelopathy due to (pressure of the radicular arteries. Compression of the radicular artery L5 and S1 comes down to the following. A patient experiencing pain in the leg and lower back develops weakness in the foot. In this case, sensory disturbances do not occur. These disorders are apparently associated with ischemia of the anterior horns of the spinal cord and are defined as paralyzing (paresis) sciatica. More extensive areas of the spinal cord may also be affected - the conus medullaris, epiconus and thoracic parts of the spinal cord, causing the development of severe paralysis and sensory disorders in the legs and lower torso, as well as pelvic disorders.

The course of radiculomyeloischemia is usually two-stage. Initially, due to irritation of the posterior longitudinal ligament receptors by the disc herniation, lumbar pain occurs. An attack of these pains can be repeated in the future, and then (in one of the exacerbations) paresis or other spinal disorders develop in a stroke-like manner.

Lumbar reflex syndromes. Irritation of the receptors of the fibrous ring of the affected disc or the posterior longitudinal, interspinous and other ligaments, as well as joint capsules, as already mentioned, becomes a source of not only pain, but also reflex reactions. This is primarily tonic tension of the lumbar muscles. Vertebrogenic lumbar pain syndrome is defined as lumbago in the acute development of the disease and as lumbodynia in the subacute or chronic development.

Lumbago. Lumbago often occurs at a moment of physical stress or during awkward movement, and sometimes without apparent reason. Suddenly or within a few minutes or hours, a sharp pain appears, often shooting (“lumbago”). Often the pain is burning, bursting (“as if a stake was stuck in the lower back”). The patient freezes in an uncomfortable position and cannot straighten up if the attack occurs while lifting something heavy. Attempts to get out of bed, turn over, cough, sneeze, or bend a leg are accompanied by a sharp increase in pain in the lower back or sacrum. If the patient is asked to stand on his feet, a sharp immobility of the entire lumbar region is revealed, with flattening of the lumbar lordosis or kyphosis, often with scoliosis, noted. The lumbar spine remains fixed (natural immobilization) even when trying to passively shift the leg at the hip joint, so carefully bending the leg straightened at the knee joint with lumbago is not always accompanied by pain in the lower back: the affected disc is well protected in the immobilized spinal segment.

Lumbodynia. Lumbodynia can also occur due to awkward movement, prolonged tension, cooling, but not acutely, but for several days. The pain is aching, aggravated by movement, when the patient is standing or sitting, and especially when moving from one position to another. Intense palpation reveals tenderness of the spinous processes or interspinous ligaments at the level of the affected vertebral segment. When the patient is positioned on his stomach with well-relaxed lumbar muscles, strong palpation of the facet joint area (at a distance of 2-2.5 cm from the interspinous space) often reveals pain in the corresponding articular capsule. The lumbar region may be deformed, as with lumbago, but to a lesser extent. Movements in this part of the spine are possible, which provides conditions for a detailed assessment of the condition of the lumbar muscles, especially the multifidus muscles. Turning off and becoming soft when the body tilts back, they sharply tense up, keeping the body leaning forward from falling. With such an inclination within 15-20°, a sharp tension in the multifidus muscles is normally observed. They are visually identified as two paravertebral shafts as thick as a finger, and by palpation - as cords of stony density. With further tilt of the body forward (more than 15-20°), the superficial lumbar muscles healthy person turn off. With lumbodynia, as with other vertebrogenic syndromes, the release of this muscle tension is delayed on one or both sides.

Sciatica. Lumbonschialgia is pain and reflex manifestations caused by osteochondrosis, spreading from the lumbar to the gluteal region and leg. The source of pain impulses is the receptors of the fibrous ring, posterior longitudinal ligament, facet joint and other ligaments and muscle formations. The irradiation of pain occurs not along the dermatomes, but through the sclerotomes. Pain is felt in the buttock, in the posterior parts of the leg, without reaching the toes! As with lumbodynia, they intensify when changing the body, when walking and staying in a sitting position for a long time, when coughing, when sneezing. When palpating the above-mentioned areas of the lumbar region and leg tissues, painful areas are detected. They are localized at such bony protrusions as the superior posterior iliac spine, the inner edge of the greater trochanter, and the head of the fibula. The areas of the triceps surae muscle in the popliteal fossa are often painful. Along with this, painful nodules are found in the muscles themselves. These nodules often cause referred pain, acting as trigger points. Thus, a typical picture of myofascial pain develops.

The sign of stretching of the posterior tissues of the leg (Lasegue's symptom), as already mentioned, has long been mistakenly associated with nerve stretching. If you lift the straightened leg of a patient lying on his back (or sitting on a chair), then at a certain angle of elevation, pain appears in the lumbosacral region or in the tissues of the back surface of the leg: in the lower leg, popliteal fossa, in the ischiocrural area (muscles attached to the ischial tuberosity and shin) or gluteal muscles. When this symptom is caused, the leg and pelvis begin to act as one and the lumbar lordosis straightens or turns into kyphosis. In this case, the anterior sections of the lumbar vertebrae come together and the tissue behind the displaced disc is injured in the affected spinal segment. This explains the variant of the sign when the patient indicates the appearance of pain in the lumbosacral region. However, fixing the leg and pelvis as a single whole is by no means a passive closure of the joint. Raising the leg stretches the ischiocrural muscles behind the femur. They are thrown over the hip and knee joints, so they are “short” when they are required to be stretched to full extension at the knee joint and flexion at the hip. The lumbar spine is included in this movement - it bends due to the tonic reaction of its flexor - the iliopsoas muscle. At the same time, the gluteal muscles are tensed (the pelvis rises), as well as the rectus abdominis muscles.

By the same mechanisms, pain appears in the popliteal fossa with forced pressure on a knee patient lying on his back with passive extension of the foot.

The sign of stretching of the iliopsoas muscle (Wassermann's symptom, “reverse Lasegue's symptom”) was mistakenly associated with stretching of the femoral nerve: the appearance of pain below the groin area when passively lifting the leg of a patient lying on his stomach. The same pain also appears with passive flexion of the leg at the knee joint (Matskevich maneuver); at the same time the pelvis rises.

No matter how informative the symptoms of tissue stretching and their pain are in lumboischialgia, when making a diagnosis, especially in difficult cases, it is necessary to exclude aggravation of the tension symptoms. Incomparably more valuable for these purposes are muscular-tonic symptoms, for example, persistent tension in the multifidus muscles after bending the body forward by 20° or more. Particularly important is the symptom of homolateral tension of the multifidus muscle. Normally, when standing on one leg, this muscle relaxes on the homolateral side and sharply tenses on the heterolateral side. With lumboischialgia, relaxation on the homolateral side does not occur - the muscle always remains tense.

Reflex manifestations of lumboischialgia extend not only to muscle and fibrous tissue, but also to vascular tissue. Vasomotor disorders can cause subjective (feelings of chilliness, heat) and objective symptoms (impaired blood flow, changes in color and temperature of the skin of the leg, etc.).

Radicular syndrome is one of the most common neurological diagnoses. What are roots and why are they affected? Groups of nerve fibers emerge from the sides of the spinal cord. Inside the spinal canal, the motor and sensory parts connect and form the roots of the spinal nerves. They exit through special openings bounded by adjacent vertebrae and the intervertebral disc.

When the roots are damaged, compressed, displaced or inflamed, a condition called radicular syndrome occurs.

This is a complex of signs, including local manifestations (in the affected area) and symptoms of damage to those nerves that are formed from the corresponding roots.

Etiology

Radicular syndrome is most often caused by structural changes in the vertebrae and discs, the presence of additional formations in the area where the roots emerge. This creates conditions for external compression of nerve fibers. Less commonly, radiculopathy occurs when the roots themselves are affected before they exit the spinal column.

Main reasons radicular syndrome:

• consequences of spinal trauma, postoperative scar changes, pathological fractures;

• congenital anomalies of the spine;

• tumors of various origins - neuromas, meningiomas, neurofibromas, metastases;

• inflammation, including those caused by specific pathogens - meningitis, syphilitic lesions, fungal infection, herpetic process;

• vascular damage leading to radicular ischemia - isolated radicular stroke, vascular changes in diabetes;

• autoimmune-allergic process in Guillain-Barré polyradiculopathy;

• compression of the roots by nearby muscles, which is especially important in the presence of occupational hazards (forced postures, turns).

The most common osteochondrosis of the spine is with radicular syndrome. The bone growths that appear along the edges of the vertebrae and the flattened disc narrow the lumen of the channels for the exit of the roots. And often the resulting protrusion or herniation of the disc additionally compresses the nerve fibers.

Types of radicular syndrome

Radicular syndrome has several classifications. There are monoradiculopathies (isolated damage to one root) and polyradiculopathies. Also, when making a diagnosis, localization is taken into account - cervical, thoracic and lumbar. Separately, there is cauda equina syndrome - compression of the roots of the terminal parts of the brain in the sacral spine.

It should be taken into account that the roots do not exit the spinal canal horizontally, but go down and obliquely. Moreover, if at the cervical level there is almost no difference in the levels of the spinal cord segments and the openings between the vertebrae, then as you move from the head end of the spine this difference increases. Therefore, if compression occurs before the nerve fibers enter the opening between the vertebrae, then the cause may be a hernia between the overlying vertebrae.

To indicate the level of damage, combinations of Latin letters and numbers are used:

• The cervical spine (C) consists of 8 segments,

• in the chest (Th) there are 12 of them,

• in the lumbar (L) 5 segments,

• in sacral (S) 5

• in the coccygeal (Co) 1 segment.

Based on the location of the lesion (vertebrae or discs between them), discogenic (spondylogenic), vertebrogenic and mixed radiculopathy are distinguished.

General manifestations

Radicular syndrome that occurs at any level has characteristic manifestations. It includes pain, motor disorders (peripheral paresis), sensory disorders, and autonomic disorders. In addition, depending on the level of damage, dysfunction of the innervated organs occurs.

Pain is caused by several mechanisms:

• irritation of the nerve innervating the vertebrae and discs between them (Luschka nerve);

• pain due to root ischemia;

• pain along the nerve formed from the pinched root;

• pathological sensations at a distance, in the innervated area;

• pain with the development of muscular-tonic syndrome.

Therefore, the pain near the spine from the side of the pinching, in the tense paravertebral muscles, radiates along the corresponding nerve and is accompanied by pain in the innervation zones.

When the motor portion of the root is damaged, peripheral paresis develops in certain muscle groups. It is manifested by weakness, decreased tendon reflexes, decreased muscle tone, and possible twitching of individual fibers (fasciculations). And with long-term radiculopathy, muscle atrophy occurs.

Disorders of skin sensitivity in the corresponding dermatome are characteristic. Possible numbness, crawling sensations, tingling, burning, tightening, coldness. In addition, temperature sensitivity changes. Sometimes there is increased sensitivity to certain irritants - hyperpathy.

Cervical symptoms

The cause of radicular syndrome at the cervical level is often degenerative changes in the spine. Moreover, it may not be the cervical region that is affected, but the lumbar region. In this case, hypermobility of the neck is compensatory when the range of movements in the lower parts of the spine is limited.

Severe pain is localized in the neck and radiates to the shoulder girdle and arm down to the fingers, accompanied by muscle weakness and paresthesia. And when the first roots are affected, it hurts in the parieto-occipital and postauricular regions. There is a dependence on head movements, often the pain intensifies during sleep. The sudden development of root compression is called cervical lumbago.

Thoracic level

Thoracic radiculitis has symptoms such as pain in the back (usually between the shoulder blades), in the heart area and girdle pain in the intercostal spaces. Disturbances in the functioning of internal organs are common - stomach pain, constipation, shortness of breath and cough, palpitations, and possibly a moderate increase in blood pressure. It is difficult to detect muscle weakness during examination, but EMG allows us to determine the level and nature of the lesion.

Infringement of the roots at this level requires careful differential diagnosis, since the pain syndrome can resemble the condition of many pathologies. Exclude coronary heart disease, pancreatitis, cholecystitis, diseases of the respiratory and digestive systems.

It is at the thoracic level that primary infectious lesions of the roots most often occur - with herpes zoster (herpes), chicken pox, and influenza.

Lumbosacral radiculopathy

Damage at this level occurs most often, due to the high load on the lumbar vertebrae and discs. Bone growths are usually massive, lead to deformation and narrowing of natural openings, and disc herniations often occur. And powerful layers of muscles form a pronounced muscular-tonic syndrome, increasing pain and compression of the root. In the vast majority of cases, the 4th and 5th lumbar and the first sacral root are affected.

Twisting movements, improper lifting of weights, and incorrect seating at the workplace provoke the appearance of lumbodynia with radicular syndrome. At the same time, pain in the lower back is bothersome, very intense when the shooting occurs or moderate when the process lasts for a long time.

Depending on the level of damage, the pain gives off:

• along the back of the thigh to the knee (if S1 is affected),

• in the lower third of the thigh in front with transition to the inner surface of the lower leg (L4),

• along the upper outer surface of the thigh (L3).

Characteristic motor disturbances appear, leading to changes in gait. For example:

• when the S1 root is compressed, the ability to walk on toes is lost,

• compression of L5 gives a slapping foot, which causes the patient to raise his leg bent at the knee high when walking,

• damage to the L4 root leads to difficulty climbing stairs.

These disorders are caused by paresis of certain muscles of the leg and foot. Upon examination, atrophy of the muscles of the lower leg and foot, and the quadriceps femoris muscle may be detected.

There is also loss of superficial sensitivity on the legs, strictly in accordance with the zones of innervation.

Diagnostics

Anamnesis collection, thorough neurological examination allow us to quickly assume not only the nature of the suffering, but also the level of root infringement. They assess movements, muscle strength, reflexes, sensitivity, and check for symptoms of tension.

Difficulties may arise when treating a patient with thoracic radiculitis, when the general practitioner has to exclude other diseases.

Additional examination methods help to establish the cause, degree of compression, and determine treatment tactics. For this purpose, radiography, MRI, CT, and EMG are performed.

Treatment

When prescribing treatment, several goals are pursued:

• pain relief,

• B vitamins.

For chronic pain, anticonvulsants and antidepressants are additionally prescribed. The drugs are prescribed in tablets, injections, cutaneously and administered using electrophoresis.

Various types of physical therapy, acupuncture, dry or underwater traction are indicated.

Rest is necessary on the first day.

Exercise therapy is not carried out in the acute period of radiculopathy, so as not to increase muscle spasm and further injure the affected root. But as the pain subsides, special exercises can be used. In the subacute stage, on days 3-5, gentle manual techniques and massage are acceptable.

Based on the results of the examination and the dynamics of the condition, a decision is made on the need for surgical treatment, the purpose of which is to restore the structures (in case of traumatic injuries) and remove the herniated disc.

After pain relief, a course is prescribed rehabilitation treatment, aimed at eliminating the consequences, strengthening the muscle corset, and combating muscular-tonic syndrome.

In addition to medications, it is possible to use folk remedies for radicular syndrome. Mainly used:

• honey-alcohol rubbing,

• turpentine-based ointments.

• apply a mixture of chopped green walnuts and kerosene,

• make hot applications with heated salt.

All these methods are for local use only, and they must be applied over the place where the root is pinched, and not on the area where the pain radiates.

Radicular syndrome requires not only pain relief, but also, if possible, elimination of the cause of compression and subsequent rehabilitation work.

A sudden movement caused severe back pain, and do you have a history of hernial deformation of the cartilage? Most likely, the cause of severe pain is compression of the nerve root caused by. But why does nerve compression occur, and how can you help yourself?

Mechanism of development of pain syndrome

After diagnosing hernial changes in the interdiscal cartilage, the doctor finds out that now a section of the disc protrudes beyond the spinal column.

But the protruding part of the cartilage is not directed in one direction; it is mobile and can shift under the influence of various factors (concussions, jumps or sudden movements). Once displaced, the disc deformity can compress nearby nerve processes.

Nerve compression can develop in two ways:

• The cartilaginous protrusion puts pressure on the nerve root, but remains mobile. Such compression of the nerve during a hernia is short-term and can go away on its own after the person moves a little and takes it.
• In addition to squeezing, the hernial bulge is fixed in this position by pathologically displaced vertebrae. In this case, they say that the hernia has pinched a nerve in the spine. If pinched, it is impossible to eliminate the symptoms that have arisen on your own; you will need medical help.

Any, even short-term, compression of a nerve root is dangerous, and it is necessary to visit a medical facility as soon as possible.

How to diagnose that pinching has occurred

Diagnosis in this case is simple. Most patients, when acute pain occurs, will immediately say that the hernia has pinched a nerve.

In addition to pain, which is the main sign of the development of pathology, compression, depending on the location, may have the following symptoms:

• , dizziness, sometimes loss of consciousness if a herniated disc has pinched a nerve in the cervical spine.
• Radiation of severe pain into the arm or leg.
• Sensitivity disorder in the limbs (tingling or goosebumps).
• Muscle weakness in an arm or leg - sometimes it is difficult for a person to walk or hold a spoon.
• Disorder of the functioning of internal organs due to a violation of their innervation (discomfort occurs in the heart, stomach or other organ, depending on the location of the compression of the appendix).

At first, these phenomena are reversible, but if the intervertebral hernia puts pressure on the nerve for a long time, then organic changes begin to occur in organs and tissues, which do not disappear after the compression is eliminated.

Self help

What to do if the root is compressed by an intervertebral hernia, or a pinched nerve occurs, and there is no opportunity to seek medical help? Then you should do the following to alleviate the patient’s condition:

• Keep the affected area immobile. If you previously had to wear it, then you should use these devices - they will optimally reduce the pressure on the pinched area. If there is no corset, then lay the person on his back on a flat surface (it is better if it is hard) and use rollers to give an anatomical position to the damaged area of ​​the back (place it under the neck or lower back).
• Pain relief. Anti-inflammatory painkillers, for example, “” or, are well suited for this. In case of severe pain, it is allowed to take an analgesic in the recommended pharmaceutical dosage. As a pain reliever, you can use various ones, which can be purchased at the pharmacy.

What not to do:

• Trying to “develop” the diseased spine by performing various physical exercise. It is only allowed, in case of moderate pain, to do exercises to stretch the vertebrae from the physical therapy complex.
• . Often applying a heating pad provides temporary relief. But heating increases swelling in the pinched area and worsens the prognosis of the disease.

Even if you can get rid of pain with the help of ointments and plasters, you need to be examined by a doctor. If all the measures taken do not bring relief, then the person must be hospitalized.

Hospital treatment

Any compression of the nerve processes, accompanied by severe pain, requires hospital treatment. It can be carried out as follows:

• Conservative therapy (medicines to relieve pain, etc.). In most cases, conservative treatment gives a lasting positive effect.
• when it is not possible to eliminate compression using a conservative method.
• Denervation (interruption of the conduction of nerve endings). Spinal denervation for hernia is used in cases where surgical intervention is impossible, and allows you to relieve pain for a long time (up to several years).

Compression of the nerve ending by a protruding part of the cartilage not only causes severe pain, but is also dangerous to health. Long-term disruption of the innervation of tissues and organs leads to the development of organic pathology, and in severe cases- to disability.

An excellent way to get rid of constant pain and maintain a toned muscle corset will be advice from Alexandra Bonina.

If you want to get more information like this from Alexandra Bonina, check out the materials on the links below.

Denial of responsibility

The information in the articles is for general information purposes only and should not be used for self-diagnosis of health problems or medicinal purposes. This article is not a substitute for medical advice from a doctor (neurologist, therapist). Please consult your doctor first to know the exact cause of your health problem.

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