Symptoms and treatment of lumbar radicular syndrome. Lumbar radicular syndrome: symptoms and treatment

Spinal cord and nerve roots
The spinal cord is a section of the central nervous system and is a strand consisting of millions of nerve fibers and nerve cells. The spinal cord is surrounded by three membranes (soft, arachnoid and hard) and is located in the spinal canal. Solid meninges forms a sealed connective tissue sac (dural sac) in which the spinal cord and several centimeters of nerve roots are located. The spinal cord in the dural sac washes cerebrospinal fluid(liquor).
The spinal cord starts from the brain and ends at the level of the gap between the first and second lumbar vertebrae. From spinal cord nerve roots depart, which below the level of its end form the so-called cauda equina. The roots of the cauda equina are involved in the innervation of the lower half of the body, including pelvic organs. The nerve roots pass through the spinal canal for a short distance and then exit the spinal canal through the foramina. In humans, as well as in other vertebrates, the segmental innervation of the body is preserved. This means that each segment of the spinal cord innervates a certain area of ​​the body. For example, segments of the cervical spinal cord innervate the neck and arms, the thoracic region innervates the chest and abdomen, the lumbar and sacral segments innervate the legs, perineum and pelvic organs (bladder, rectum). The doctor, determining in which area of ​​the body, disorders of sensitivity or motor function appeared, can assume at what level the damage to the spinal cord occurred.
By peripheral nerves nerve impulses come from the spinal cord to all organs of our body to regulate their function. Information from organs and tissues enters the central nervous system through sensitive nerve fibers. Most of the nerves in our body are composed of sensory, motor and autonomic fibers.

radicular syndrome or radiculopathy are a combination neurological symptoms that occur during compression (squeezing) spinal nerves in the region of the branch from . The pathological process is often found in medical practice and is a manifestation of a chronic progressive course, primarily of a degenerative nature - dorsopathy.

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

The reasons

The most common cause of radicular syndromes is 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 is displaced beyond the boundaries of the vertebrae, compressing the nearby soft tissues. In this case, the root suffers - the spinal nerve at the base of the spinal cord, passing in the bone canal before exiting the spine. The spinal root consists of their sensory and motor nerve fibers and is in conjunction with 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;
• spondylarthrosis;
• vertebral fractures resulting from osteoporosis (weakening of bone tissue);
• infections (osteomyelitis, tuberculosis);
• intense axial loads on the spine (carrying weights, sports overload);
• sedentary lifestyle (physical inactivity);
• prolonged stay in static postures (computer work);
• frequent hypothermia;
• chronic stress;
• endocrine disorders, hormonal imbalance (obesity, diabetes mellitus);
• tumors, cicatricial changes in the spinal column;
• injuries (fractures, bruises, sprains);
• flat feet.

Nerve root compression often occurs during the formation of a herniated protrusion of the intervertebral disc

In the development of degenerative-dystrophic processes of the spinal column in last years the role of a hereditary factor that affects the defective development connective tissue. As a result, a pathology of the spine is formed with a rapidly progressive course and the formation of radiculopathy. In the occurrence of the disease, irrational nutrition is of no small importance, nicotine addiction, alcohol abuse.

Clinical picture

A constant manifestation of the 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, twitching, burning, cutting. It gets worse when walking, bending over, turning, sneezing or coughing. Sometimes the pain syndrome occurs in the form of a backache - a sharp pain from the lumbar region spreads along the course of the nerve. The phenomena of parasthesia are characteristic - numbness, tingling, a feeling of "crawling" in the lower extremities.

This condition is called lumbago, and periodically shooting pains - lumbalgia. Lumbago can appear with an awkward turn during a night's sleep, bending over, lifting weights. The pain is accompanied 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 limbs on the side of the lesion, cause impaired urination, defecation, and weaken potency.

The arrows on the MRI image indicate pathological changes intervertebral discs in the lumbar

The spinal root contains sensory and motor nerve fibers. Their compression causes swelling and inflammation. nervous tissue, violation of the conduction of a nerve impulse from the central departments to the periphery. As a result, the lower limb on the side of the lesion suffers. At the same time, sensitivity is disturbed - the sensation of tactile touch, temperature and pain stimuli is weakened. lower limb. The innervation of the muscle fibers of the thigh, lower leg, foot also changes and their atrophy (“shrinkage”) develops. Weakening of the muscles causes a violation 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 great importance. The lumbosacral region is affected by different levels, and according to the specifics of the symptoms, it is highly likely to suggest the localization pathological process.

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 thighs. In this area, paresthesia and numbness of the skin are observed.
2. Compression of the spinal roots at the level of the 4th lumbar vertebra(L4) is characterized by pain in the anterior and outer surface thighs that descend 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 a weakening of movements in the knee. The gait changes, lameness develops.
3. Compression of the spinal roots at the level of the 5th lumbar vertebra (L5) causes pain on the outer surface of the thigh and lower leg, the inner part of the foot with damage to the big toe. Detect paresthesias in the foot area and weakening muscle strength lower limb, which makes it difficult to support and motor function the affected leg.

Pain sensations decrease or completely stop when lying down. healthy side body.

For appointment effective treatment identify the etiological disease of the spine, which caused the appearance of radicular syndrome. Recommend instrumental methods examinations that reveal the specifics and severity of the pathological process, clarify its localization:

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

Proper diagnosis facilitates prescribing adequate therapy which prevents the development of complications and the formation of disability.

Medical tactics

Treatment of radiculopathy is aimed at eliminating the pain syndrome, reducing inflammation and swelling of the neurovascular bundle. After cupping acute process continue therapy etiological disease to prevent disease progression. Patients are prescribed bed rest on a hard, flat surface, which prevents deformation of the spine and additional injury to soft tissues. From the diet exclude fried, salty, spicy, fatty meals. The diet is enriched fresh vegetables, fruits, greens, cereals and dairy products. For effective treatment, you should stop smoking and taking alcoholic beverages.

Conservative therapy for radicular syndrome includes:

• analgesics for relief pain- baralgin, ketorol in solutions for intramuscular injections;
• non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammatory response in the affected area, elimination of swelling and pain syndrome - movalis, diclofenac, nimesulide for the first 5 days through intramuscular injections, then in tablet form for a course of 10-14 days;
• lubrication of the lower back with anti-inflammatory and locally irritating ointments - capsikam, diklak-gel, finalgon;
• novocaine blockade with the addition of lidocaine, antibiotics, glucocorticoids for quick relief of pain;
• muscle relaxants to relax spasmodic muscles in the area of ​​nerve compression, which has an analgesic effect, improves blood flow to tissues, reduces stagnant processes- sirdalud, midokalm;
• vitamin complexes based on preparations B 1, B 6, B 12 for the purpose of normalization metabolic processes and trophism of nerve roots, improvement of conduction nerve impulses, regeneration of damaged tissues - milgamma, neuromultivit in injections or tablets;
• physiotherapy after the acute pain syndrome subsides to activate metabolism, normalize muscle tone, improve blood flow - magnetotherapy, UHF, electrophoresis, radon baths;
• physiotherapy exercises to restore the anatomically correct position of the spinal column and strengthen the muscular frame of the back;
• massage, acupuncture, reflexology - to strengthen the muscles of the back, normalize blood circulation, improve nutrition of the spine.

At severe course diseases develop persistent symptoms that are not amenable to conservative methods therapy. In such cases, resort to surgical treatment.

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 prescribed for the prevention of radiculopathy

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

Prevention

To prevent radiculopathy, it is necessary to consult a doctor in a timely manner when the first anxiety symptoms from the spinal column. Infringement of the spinal root occurs against the background chronic course disease, untimely diagnosed and treated pathological process. should be adhered to rational nutrition, give up bad habits, engage in physical education, monitor the maintenance of normal body weight. It is important to sleep on a firm mattress and wear comfortable shoes with low heels. Heavy activities should be avoided physical labor associated with axial load on the spine. It is useful to take courses twice a year therapeutic massage back.

Complexes of therapeutic gymnastics are prescribed in recovery period disease

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

• lying on your back with arms extended along the body and straight legs, contract the abdominal muscles 10-15 times;
• the starting position is the same, lift the upper half of the body off the floor, stay in this position for as long as possible and return to the previous position, the number of repetitions is 10-12 times;
• lying on your back, bend your knees and place to the right of the body, at the same time the head and chest send to left side, make springy movements 6-8 times, and then do the same exercise, changing the sides of the head and legs;
• sit on the floor, stretch one leg, and bend the other at the knee joint and take it to the side, lean towards the straight leg and try to clasp the foot with your hands, change 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 the lower back. Repeat the exercise 8-10 times.

If possible, hang on the horizontal bar several times a day for 10-15 minutes. Do a morning workout for all muscle groups before you start active motor activity.

Radicular syndrome in the lumbar region causes intense pain, impairs sensitivity and motor ability 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 complex treatment diseases of the spinal column.

This disease is a symptom complex of a number of manifestations associated with the destructive processes of the spine. Often, the radicular syndrome makes itself felt with such multiple and varied signs that a serious differential diagnosis is required to clarify the causes of the pathology. Therefore, a timely visit to a specialist is so important.

A pinched nerve is a very serious condition that requires urgent medical care. You should contact a neurologist who will conduct an examination, carry out a number of diagnostic measures, will prescribe treatment, will monitor its progress. Don't try to help yourself on your own. Signs of radicular syndrome may indicate other diseases provoked by similar phenomena. Only an experienced specialist can understand here.

The clinical picture usually clearly indicates what a radicular syndrome is. The main factor in the development of this condition is a pinched nerve in the spine. It can arise for a number of reasons. Usually these include osteochondrosis. But, in addition, it can be:

• heavy physical work;
• long stay in an uncomfortable position;
• hypodynamia;
• hormonal imbalance;
• cold.

A pinched nerve in the spine does not manifest itself immediately. Therefore, it is sometimes difficult to determine the cause of its occurrence. The pathogenic factor serves only as an impetus to the beginning degenerative changes cartilage tissue and nerve roots extending from it. Edema occurs, develops venous congestion, a strong inflammatory process is formed, in which all surrounding tissues are involved.

This is a symptom complex associated with the occurrence of an extensive pathological process of the spine, affecting the root. When a nerve is pinched in the back, the resulting syndrome usually accompanies a triad, which includes: pain; change in sensitivity in the affected area (for opposite side it is completely preserved, which can serve as a bright diagnostic sign); severe muscle spasm, preventing the implementation of a holistic range of motion.

Radicular pain syndrome is also characterized by aggravation of the patient's condition from any stress.

When a pinched nerve in the back occurs, the symptoms are usually quite severe. The patient is in severe pain. Often it gives to nearby areas, as well as to internal organs.

Symptoms of a pinched nerve in the spine are usually directly related to the limitation of the patient's mobility. Every slight turn of the head or change in posture causes a severe attack of pain. Sometimes they continue constantly, disturbing him even at night.

Signs of pinching are usually quite clear:

• pain;
• muscle tension;
• stay in a forced position;
• difficulty in movement;
• numbness of the limbs;
• puffiness;
• decreased sensitivity;
• change in blood circulation;
• hyporeflexia;
• tissue ischemia.

Often the discomfort manifests itself most strongly not even in vertebral department and in the upper or lower extremity. A person cannot raise his arm, move his shoulder, roll over from side to side.

The patient often experiences general malaise, chills, sweating. If you postpone the visit to the doctor, then the infringement will worsen, the pinched nerve ending will begin to experience more and more squeezing, swelling and myospasm will only increase due to severe pain. The inflammatory process, of course, will continue to grow rapidly. Then paresis, dystrophic effects on surrounding tissues, even death of the nerve are possible.

Diagnosis of pathology

All this can be absolutely irreversible damage to the nerves in the spine. The main reason for such a severe pathology is that it is of a long progressive nature. All the structures involved in this process are gradually deformed, lose their functions and, over time, simply begin to die.

Treatment of radicular syndrome begins with the establishment of its cause. The neurologist usually determines what to do first. Usually a lot of explicit and reliable data is provided by radiography in two projections, computed and magnetic resonance imaging, electroneuromyography.

It is very important to carry out differential diagnosis, since the symptoms of a pinched nerve in the back may be similar to those of other spinal nerve diseases. These include intervertebral hernia, spondylarthrosis, bone tuberculosis, malignant or benign neoplasm, congenital anomalies, trauma, vertebral fractures, infection, osteoporosis.

They are characterized by the development of a pathological process at the point of contact nerve ending with tissues of the back and spinal column. Therefore, there is a very large area of ​​damage, including internal organs. All this can last for a very long time, until the patient receives full medical care.

Pharmacotherapy of the disease

Treatment of radicular syndrome is usually associated with the degree of nerve damage. Usually the doctor prescribes the patient a strict bed rest. To alleviate his condition, analgesics are used (Analgin, Ketanov, Baralgin), anti-inflammatory drugs (Diclofenac, Indomethacin ointment, Ibuprofen), glucocorticosteroids.

good effect render local funds, contributing to the removal of edema caused by congestion, increased blood circulation, and facilitated movements. Their influence helps to eliminate nerve compression, relax muscles, and normalize reflexes. Painful sensations begin to gradually disappear, as well as the local hyperemia and fever associated with them.

When the doctor determines what to do to relieve the most pronounced manifestations of the disease, they are most often used pepper patch, ointments, gels, balms (Fastum gel, Voltaren, Diclofenac, Finalgon), local anesthetics.

Muscle relaxants help restore nerve roots (Baclofen, Mydocalm, Sirdalud), antispasmodics, epidural blockade using painkillers, anticonvulsants. These measures prevent the development of further degenerative processes and greatly alleviate the patient's condition.

In the treatment of a pinched nerve in the spine, chondroprotectors (Alflutop, Dona, Teraflex, Chondroxide), immunostimulants, and substances that promote tissue regeneration help restore tissues. Angioprotectors are used to normalize blood circulation, vasodilators, venotonics.

They activate the disturbed blood flow caused by the development of radicular syndrome, relieve lymphostasis, and strengthen the walls of blood vessels. As a result, the threat of muscle atrophy, ischemia of nearby tissues and limbs is eliminated, as well as internal organs.

Symptoms of intervertebral hernia decrease, the nerve is released, blood supply and innervation are fully restored.

For stabilization nervous state patients are usually prescribed sedatives, sleeping pills, tranquilizers. Self-medication is unacceptable, since these medicines are prescribed only by prescription and are taken under the strict supervision of a specialist. In addition, it should be noted that they have a number side effects and can cause unwanted reactions in the body.

The patient's condition is also stabilized by the regular intake of B vitamins and a number of minerals, which include Magnesium, Calcium, Manganese, Bromine, Sodium, Potassium. They contribute to a significant strengthening of the central and peripheral nervous system, trigger the processes of tissue regeneration, and also prevent the irreversible narrowing of the holes through which the affected spinal roots exit.

Additional methods of treatment of radicular syndrome

When deciding how to treat a pinched nerve, advantages are given to certain methods of influencing tissues. A range of ancillary treatments are provided, including back massage, physiotherapy, physiotherapy, reflexology, paraffin, mud, UHF, phonophoresis, electrophoresis, sulfide and radon baths, acupuncture, manual therapy, special medical nutrition, mineral water intake.

These methods allow you to eliminate the main symptoms of the lesion radicular nerve, contribute to the restoration of intervertebral cartilage and reduce the intensity inflammatory process.

Only a doctor can say with absolute certainty how to cure this pathology and how long it will take to restore the patient's health. Severe pinching of the spinal nerve may require surgery. Then the spine is released. For this, an operation is performed to eliminate the intervertebral hernia.

What to do in this case and how the surgical intervention will be carried out can only be decided by the attending physician, based on the patient's condition, the degree of neglect of the disease, and the complications that have arisen.

Forecast and prevention

Timely treatment of radicular syndrome usually ends in recovery. However, with advanced forms of the disease, it can become chronic.

Such a course of pathology leads to a gradual degenerative lesion of all surrounding tissues. The functions of the spine and associated limbs are severely limited. This can result in disability.

In order for the symptoms of radicular syndrome not to manifest themselves again, a number of restorative and preventive measures. Required permanent reception drugs that help normalize the activity of the nerve of the back and the cartilaginous tissue surrounding it, therapeutic exercises, swimming, balneology, wearing a corset, careful weight control, spa treatment.

All these measures should be carefully and strictly observed, since neglect of the doctor's instructions can cause a relapse of the disease.

Many have heard of such a disease as sciatica. However, its full name sounds like inflammation of the nerve roots or radicular syndrome (the concept of sciatica is not applicable to all roots). This disease is characteristic of any age and is manifested by severe pain in the area of ​​​​inflammation, however, first things first.

human nervous system complex mechanism, which has a branched structure. At the end of this structure is the root and similar roots in the body 62, in addition, the system includes fibers and bundles. These nerve fibers roots and bundles act as messengers. In the event of any impact on the body (heat, cold, pain, etc.), this impulse is transmitted to the spinal cord, after which it is transmitted to the brain. It happens almost instantly.

The structure of the upper part of the nerve roots

The anatomy of the nerve roots is simple. There are two subspecies:

1. Front roots.
2. Back roots.

The anterior ones are formed by axons of efferent neurons. The main function that the anterior roots perform is physical activity and reflex contractions.

The defeat of the anterior roots does not cause pain in a person, but leads to motor disorders and disorders in reflexes. Nevertheless, among this group there are also afferent fibers (responsible for sensitivity). There are not so many of them, but when they are damaged, severe pain can occur. These fibers can come out in the region of the posterior roots.

The posterior roots, in turn, consist of afferent fibers and are responsible for sensitivity and pain. It is damage to these nerves that causes severe pain. In addition to the pain reaction, there may be a loss of sensation in that part of the body for which the affected nerve is responsible.

Precisely for the reason internal structure inflammation of the nerve roots is primarily associated with vertebral disorders (back pain, etc.)

In addition, according to the location, the roots are divided into:

• cervical (cervical, cervicobrachial, cervicothoracic);
• Good (innervate the chest around);
• lumbar;
• sacral (innervate the sacrum);
• coccygeal.

Roots located in the lumbar and sacral region, often combined into one subspecies - lumbosacral.

The reasons

There are several reasons that can provoke inflammation, from a banal pinched nerve root in the lumbar spine to the presence of a hidden disease that provokes the formation of a hernia or tumor.

The root can become inflamed for the following reasons:

• infectious diseases affecting the vertebra;
• trauma (in this situation, a fragment or a displaced vertebra can pinch the nerve);
• osteocondritis of the spine;
• osteoporosis;
• herniated disc;
• displacement of the vertebrae;
• narrowing of the spinal canal;
• osteomyelitis;
• tumor in the spine;
• hypothermia (in this situation, as such, there is no infringement, perhaps the development of an inflammatory process);
• hormonal disorders;
• sedentary lifestyle;
• birth defects (narrow opening through which the nerve passes, etc.).

Availability related problem in the body does not immediately cause neuralgia, it takes time. For example, an intervertebral hernia begins to grow and gradually compresses the nerve root, thereby pinching it, disrupting the function of transmitting nerve impulses.

Symptoms

The nerve roots of the spine are located in the body in certain places, which indicates the classification of the inflammatory process. So, the following variants of the disease are distinguished:

• cervical;
• chest;
• lumbar;
• mixed (cervical-brachial, lumbosacral, etc.).

The inflammatory process can occur as a result of exposure to the root from the outside, then we are talking about the secondary type of illness, and directly due to problems with nervous system, then we are talking about the primary type of ailment.

Symptoms for each subspecies are individual, but there are symptoms that are common to all, including:

• increase in body temperature;
• pain syndrome along the course of the nerve;
• increased pain in sharp turns trunk, coughing;
• restriction in movements (depending on the type of ailment);
• decreased sensitivity;
• weakness;
• increased pain on palpation of the spinal spinal column.

cervical sciatica

The cervical region is located as close as possible to the vessels of the head, therefore, when the roots of the cervical region are squeezed, the pain spreads towards the back of the head and parietal region. In addition, pain in the shoulder blade or arm can be diagnosed.

Signs of cervical sciatica:

• loss of sensation in the fingertips;
• pain in case of a change in the position of the hands or movement of the shoulder blades;
• difficulty breathing;
• pain similar to heart;
• burning, tingling and tension in the muscles of the neck;
• violation of posture;
• change in the neck.

Due to the proximity of the neck to the head, the following manifestations are possible:

• migraine;
• nausea;
• vomit;
• dizziness;
• increase in pressure.

Thoracic sciatica

The least common disease, since inflammation in thoracic region one of the rarest manifestations. Usually associated with infectious diseases respiratory system, as well as with herpes ganglia.

Main symptoms:

• aching pain;
• breathing problems (it is difficult for the patient to breathe);
• pain is localized in the region of the ribs;
• increase or decrease in sensitivity at the site of pinching;
• possibly a vegetative manifestation (bubble rash at the site of pinching).

Lumbar sciatica

This disease is one of the most common. The nerve roots of the lumbar region suffer from pinching more often than others due to heavy loads on the this department and have the following symptoms:

• tension in the muscles of the lower back;
• sudden and gradually increasing pain;
• shooting pain in the leg or buttock;
• numbness of the toes;
• pain syndrome during back extension.

The pain does not allow the patient for a long time be in a standing position, forcing him to take a sitting or lying position.

Diagnostics

The study of the patient's condition begins with the collection of anamnesis of the patient. So, the doctor conducts a survey and initial examination of the patient, Special attention referring to the localization of pain and the nature of its occurrence.

Standard for everyone medical institutions a set of tests (general clinical analysis of blood, urine) is not very informative and the specialist prescribes advanced diagnostics, which includes:

• x-ray of the inflamed spine;
• computed tomography (CT);
• magnetic resonance imaging (MRI);
• study of the spinal fluid through a puncture of the spinal cord;
• electromyography;
• myelography (a study based on the use of contrast fluid).

Treatment

Currently, the approach to the treatment of inflammation or pinched roots has changed significantly. The basis is not the elimination (blockade) of the pain syndrome, but the identification and elimination of the cause of pain.

There are the following treatment options:

1. Medical (conservative) treatment.
2. Operative (surgical) intervention.

The above options are the basis, and in addition, physiotherapeutic procedures, immobilization therapy, as well as folk remedies can be used.

Medical therapy

This complex medical procedures is intended not to treat the cause, but to eliminate the consequence, and includes the appointment of the following drugs:

• non-steroidal anti-inflammatory drugs;
• analgesics;
• a complex of vitamins;
• muscle relaxants;
• chondroprotectors.

Depending on the severity of the disease, one or another is used. medications. For example, with a moderate pain syndrome, it is enough to apply an ointment to the localization of pain or take a pill, while severe pain requires the administration of a medicine through an injection (shot).

Concomitant treatment

In the case of sciatica, it is impossible to get by with tablets and ointments alone, complex treatment is necessary, which includes:

• physiotherapy treatment (UHF, ultraviolet irradiation, mud applications, radon and hydrogen sulfide baths, electromyostimulation, phonophoresis, electrophoresis);
• physiotherapy exercises (LFK);
• massotherapy;
• immobilization.

Physiotherapy has a beneficial effect on the body, helping to relieve inflammation, relaxing muscle fibers and increasing blood flow.

Immobilization is carried out through the use of various corsets and restraints.

As for exercise therapy and massage, they are necessary for the rehabilitation of the patient after immobilization and surgery.

Surgical method

This method is necessary in the case when it is impossible to achieve the elimination of the cause in another way. It is not always possible to change the patient's condition with pills alone.

So, one of the most common operations is decompression of the nerve root. Decompression is necessary when it is not possible to release it from pressure by physiotherapy or immobilization (as a rule, this happens due to trauma or tumor processes).

Prevention and prognosis

After the end of medication or surgical treatment it is necessary to exclude the possibility re-development disease, for which the patient is required to comply with the following recommendations:

• weight loss (carried out as part of reducing the load on the spine and legs);
• reduce weight lifting
• use more opportunities for walking;
• avoid hypothermia;
• pay attention to posture (curvature of the spine is unacceptable).

Forecast this disease favorable in most cases. However, in case of delayed treatment or its total absence sciatica can flow into the chronic phase, which is treated longer than usual.

So, inflammation of the nerve roots is a rather unpleasant, but curable disease that must be treated under the supervision of a specialist. In the absence of proper treatment, it is not excluded severe pain. Do not joke with your body, treat yourself correctly!

A symptom complex that is formed as a result of lesions of the spinal root of various etiology and manifested by symptoms of irritation (pain, muscle tension, antalgic posture, paresthesia) and prolapse (paresis, decreased sensitivity, muscle hypotrophy, hyporeflexia, trophic disorders). Radicular syndrome is diagnosed clinically, its cause is established by the results of X-ray, CT or MRI of the spine. Treatment is usually conservative, according to indications. surgical removal root compression factor.

Symptoms

The radicular syndrome clinic consists of various combinations 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 features location, shape and thickness of the spinal roots, interradicular connections.

Irritation symptoms include pain syndrome movement disorders crampy or fascicular muscle twitches, sensory disturbances in the form of a tingling or crawling sensation (paresthesia), a local feeling of heat / cold (dysesthesia). Distinctive features radicular pain is its burning, stinging and shooting character; appearance only in the zone innervated by the corresponding root; distribution from the center to the periphery (from the spine to distal departments arms or legs); surge gain, sudden movement, laughing, coughing, sneezing. Pain syndrome causes reflex tonic tension of muscles and ligaments in the affected area, which contributes to increased pain. To reduce the latter, patients take a sparing position, limit movements in the affected spine. Muscular-tonic changes are more pronounced on the side of the affected root, which can lead to distortion of the body, in cervical region- to the formation of torticollis, followed by curvature of the spine.

Symptoms of prolapse appear with far-reaching root damage. They are manifested by weakness of the muscles innervated by the root (paresis), a decrease in the corresponding tendon reflexes (hyporeflexia), a decrease in sensitivity in the zone of innervation of the root (hypesthesia). The area of ​​​​skin, for the sensitivity of which one root is responsible, is called the dermatome. It receives innervation not only from the main root, but also partially from the above and below. Therefore, even with significant compression of one root, only hypesthesia is observed, while with polyradiculopathy with the pathology of several adjacent roots, complete anesthesia is noted. Over time, trophic disorders develop in the area innervated by the affected root, leading to muscle hypotrophy, 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 against the background of pain, dizziness appears, nausea is possible. The head is tilted to the affected side. Tension of the suboccipital muscles and their palpation soreness is noted.

Spine C2. Pain in the occipital and parietal region on the affected side. Head turns and tilts are limited. There is hypoesthesia of the skin of the occiput.

Spine C3. The pain covers the back of the head, the lateral surface of the neck, the region of the mastoid process, radiates to the tongue, orbit, forehead. In the same zones, paresthesias are localized and hypesthesia is observed. The radicular syndrome includes difficulties in tilting and extension of the head, soreness of the paravertebral points and points above the spinous process of C3.

Spine C4. Pain in the shoulder girdle with the transition to the anterior surface of the chest, reaching to the 4th rib. It spreads along the posterolateral surface of the neck to its middle 1/3. Reflex transmission of pathological impulses to the phrenic nerve can lead to the appearance of hiccups, a phonation disorder.

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

Spine C6. Pain from the neck extends through the biceps to the outer surface of the forearm and reaches the thumb. Hypesthesia of the last and outer surface of the lower 1/3 of the forearm is revealed. There is paresis of the biceps, brachialis, supinators and pronators of the forearm. Decreased wrist reflex.

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

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

Roots T1-T2. The pain is limited to the shoulder joint and the armpit area, it can spread under the collarbone and on the medial surface of the shoulder. It is accompanied by weakness and hypotrophy of the muscles of the hand, its numbness. Horner's syndrome is typical, homolateral to the affected root. Possible dysphagia, peristaltic dysfunction of the esophagus.

Roots T3-T6. The pain has a girdle character and goes along the corresponding intercostal space. Could be the reason pain in the mammary gland, with localization on the left - imitate an attack of angina pectoris.

Roots 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, pancreatic enzyme deficiency. There may be a decrease in the upper abdominal reflex.

Roots T9-T10. Pain from the intercostal space extends into upper divisions belly. Sometimes the radicular syndrome has to be differentiated from the acute abdomen. There is a weakening of the mid-abdominal reflex.

Roots T11-T12. Pain may radiate to the suprapubic and inguinal zone. Decreased lower abdominal reflex. Radicular syndrome of this level can cause intestinal dyskinesia.

Spine L1. Pain and hypoesthesia inguinal region. Pain extends to the upper outer quadrant of the buttocks.

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

Spine L3. The pain goes through the iliac spine and greater skewer on 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 above the knee inner surface hips. The paresis that accompanies this radicular syndrome is localized in the quadriceps muscle and adductors of the thigh.

Spine L4. Pain radiates down the front of the thigh knee joint, the medial surface of the leg to the medial malleolus. Hypotrophy of the quadriceps muscle. Paresis of the tibial muscles leads to external rotation of the foot and its "slamming" when walking. Decreased knee jerk.

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 area of ​​pain coincides with the area of ​​sensory disorders. Hypotrophy of the tibial muscle. Paresis of the extensors of the big toe, and sometimes of the entire foot.

S1 spine. Pain in the lower back and sacrum, radiating along the posterolateral parts of the thigh and lower leg to the foot and 3rd-5th fingers. Hyp- and paresthesias are localized in the region of the lateral edge of the foot. The radicular syndrome is accompanied by hypotension and hypotrophy of the gastrocnemius muscle. Weakened rotation and plantar flexion of the foot. Decreased Achilles reflex.

S2 spine. Pain and paresthesias begin in the sacrum, cover the back of the thigh and lower leg, sole and thumb. Often there are cramps in the adductors of the thigh. The Achilles reflex is usually unchanged.

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

Diagnostics

In the neurological status, attention is drawn to the presence of trigger points above the spinous processes and paravertebral, muscular-tonic changes at the level of the affected spinal segment. 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 - by raising the leg in horizontal position on the back (symptom of Lasegue) and on the stomach (symptoms of Matskevich and Wasserman). According to the localization of the pain syndrome, zones of hypesthesia, paresis and muscle hypotrophy, the neurologist can determine which root is affected. Confirm the radicular nature of the lesion and its level allows electroneuromyography.

The most important diagnostic task is to identify the cause that provoked the radicular syndrome. For this purpose, X-rays of the spine are performed in 2 projections. It allows you to diagnose osteochondrosis, spondylarthrosis, spondylolisthesis, Bechterew's disease, curvature and anomalies of the spinal column. More informative method The diagnosis 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, meningoradiculitis. Thoracic radicular syndrome with somatic symptoms requires additional examination of the relevant internal organs to exclude their pathology.

Treatment of radicular syndrome

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

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

Question about surgical treatment occurs with the ineffectiveness of conservative therapy, the progression of symptoms of prolapse, the presence of a spinal tumor. The operation is performed by a neurosurgeon and aims to eliminate root compression, as well as to remove its cause. With herniated intervertebral discs, discectomy, microdiscectomy are possible, with tumors - their removal. If the cause of the radicular syndrome is instability, then the spine is fixed.

Forecast

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