Inflammation of the nerve endings of the spine. What is radicular syndrome (pinched nerve in the back), symptoms and treatment of the disease

The spine is an organ responsible for the normal functioning of the musculoskeletal system and internal organs, each of which has a network of nerve endings.

Nerve trunks originate from the roots coming from the posterior and anterior horns of the spinal cord.

There are 62 nerve roots in the spine, respectively, there are 31 pairs of them.

The roots of the spinal nerves transmit signals from the internal organs to the spinal cord, and then to the brain - the central "control system" of the body.

The “commands” coming from the brain are first received by the spinal cord, which distributes them throughout the body through the nerve endings.

Functions of the spinal roots and deviations from the norm

The specified number of paired roots is due to the structure of the spinal column. The spinal roots extend from the vertebrae of the neck (8 pairs), from the vertebral segments of the chest (12 pairs), lower back (5 pairs), sacrum (5 pairs), coccyx (1 pair).

Inflammatory processes in these areas lead to pinching of nerve fibers, severe pain and disruption of the innervation of internal organs, arms, legs, and skin.

The posterior roots regulate the activity of pain receptors and are responsible for sensory perception. They are made up of afferent fibers. When the posterior roots are damaged, neurological disorders are observed. With a strong compression of these fibers, an acute pain syndrome develops, and muscle trophism is disturbed. With any attempt to move, the pain intensifies, as it increases. If it is damaged, motor functions are preserved, but the sensitivity of skin receptors is lost.
The anterior roots are formed by the axons of efferent neurons. They are responsible for movements and reflexes, contractions of ligaments. Without these fibers, motor activity would be impossible: a person could not pick up objects, walk, run, or perform physical work. The nerve formed from the anterior roots of the spinal cord, when damaged and excised, does not cause pain, except in cases of recurrent reception (in the anterior root of the spinal nerve, afferent fibers can be found passing through it, then turning into the posterior root and going to the spinal cord). Their damage causes severe pain, which disappears when 2-3 posterior roots are excised.

Squeezing and infringement of the posterior and anterior roots becomes not only the cause of a painful condition, but also, if left untreated, leads to disability.

If an arm or leg loses sensitivity, “goosebumps” and numbness appear in the soft tissues, movements in them are limited - you need to urgently consult a doctor to establish an accurate diagnosis.

The disease in an advanced stage may require a radical method of solving the problem - surgical intervention.

The reasons

Since the roots contain fibers on which the receptor sensitivity of soft tissues and the functioning of the musculoskeletal system depend, immediate hospitalization and a thorough examination of the patient make it possible to bypass the worst - paralysis of the arms and legs, atrophy of muscle tissues.

In the process of diagnostic measures, the true causes of the pathological condition are also established. It:

Injuries.
Degenerative changes in bone tissue caused by spondylosis, arthritis.
Tumor formations.
Postoperative complications.
Wrong posture.
A long static posture in which a person stays regularly for several hours.

The data of MRI, CT, X-ray and ultrasound examinations and others allow us to assess the degree of damage to the spinal roots, determine the location of the process, after which the specialists decide on the direction of treatment and prescribe a set of treatment procedures.

Treatment

Traditional methods of therapy consist of taking painkillers and, limiting motor activity, using muscle relaxants,.

But if the symptoms do not lose their severity and continue to grow, then specialists can decide on the advisability of surgical intervention. It can be:

Microdiscectomy.
Operative root decompression.
Pulse radiofrequency ablation (Latin for the word "ablation" translates as "taking away").

Microdiscectomy is a minimally invasive method that does not violate the structure of nerve fibers, but allows them to be released from compression by removing part of the bone tissue, due to which the inflammatory process began.

Operative root decompression is used for hernias and tumors, which, increasing in size, cause infringement of nerve fibers. The purpose of the operation is to remove partially or completely these formations.

Pulsed radiofrequency ablation in 80% of cases gives the desired result, because the integrity of the vertebral segments is not violated during the operation.

By puncture, an electrode is inserted into the area of the hernial formation, and cold plasma pulses flow through it. The hernia begins to "melt", noticeably decreases in size and in some cases is set back.

But this is possible if the fibrous ring has not ruptured, and the gelatinous contents remain within this shell.

Vertebral pathologies are dangerous because any delay and ignoring a deteriorating condition can lead to a real disaster. The spinal cord is inextricably linked with the brain structures of the head.

Sympathetic nerve fibers that run from the vertebral segments to the internal organs transmit signals about malfunctions to the "main center".

And if the work of any of the links in this chain is disrupted, then the consequences of a late visit to the doctors may have to be corrected for all the remaining years.

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 for medicinal purposes. This article is not a substitute for medical advice from a doctor (neurologist, internist). Please consult your doctor first to know the exact cause of your health problem.

I will be very grateful if you click on one of the buttons
and share this material with your friends :)

Sciatica is a common disease of the spine. Inflammation of the spinal nerve root most often affects people between the ages of 25 and 60 years. The disease can be both primary and secondary, i.e. occur as a result of other diseases

Symptoms and types of inflammation of the spinal nerve root

The main symptom of the disease is a pronounced pain syndrome, which can appear both directly at the site of the nerve infringement, and in remote areas. Depending on the location of inflammation, there are several types of sciatica:

Disease of the cervical spine.

Shoulder sciatica

Inflammation of the root of the spinal nerves of the thoracic region

Lumbar sciatica.

The most common is inflammation in the lumbar spine, since this area has the greatest load. In addition to physical activity and hypothermia, the development of this disease is negatively affected by pathologies of the lumbar spine - osteochondrosis, abrasion of intervertebral discs, spinal hernia, and so on. As a rule, the presence of one of these diseases contributes to the fact that radiculitis passes into the chronic stage.

Regardless of the form, radiculitis of the lower back proceeds in almost the same way. The main symptom of the disease is a constant aching pain in the sacrum, which becomes acute, with any attempt to change position or walk. In some cases, partial numbness of the leg and loss of sensation from the side of the infringement are possible.

Features of the treatment of inflammation of the spinal nerve root

Treatment of the disease is conservative. Patients are prescribed complete rest and bed rest. Anesthetic ointments and warming patches have a positive effect for relieving pain. In the acute course of the disease, a blockade is used. Patients suffering from chronic forms of inflammation are advised to regularly undergo massage courses, as well as engage in physiotherapy exercises.

In the treatment of inflammation of the root of the spinal nerves, folk methods are actively used. One of the great ways is to take baths based on a decoction of fir paws. To prepare a decoction, fir legs (in the ratio of 2/3 buckets to one small bath) are crushed, poured with boiling water and boiled over low heat for 5 minutes. The resulting broth is filtered and added to a bath of water. Also, in the case when it is impossible to take baths, you can rub fir oil into preheated joints. In parallel, it is recommended to use 5-9 drops daily (the amount depends on the weight of the person and on the individual tolerance of the drug by the patient) of fir oil inside 1 time per day.

No less effective against inflammation of the roots helps to fight a bath based on fir emulsion, which is prepared as follows:

a saucepan (preferably enamelled) with 550 ml of water and 0.75 g of salicylic acid is heated.
The solution is brought to a boil, after which about 30 g of soap is added to it (it is preferable to take baby soap) and kept on low heat until the soap is completely dissolved in water.
After that, the fire is turned off and 0.5 liters of fir oil are added to the resulting solution.
The mixture will need to be thoroughly mixed, while being careful (fir oil ignites quite easily and quickly), pour into glass containers and close tightly with lids.
Store the prepared emulsion in a dry, dark room.

Use the resulting emulsion in courses daily.

Causes of inflammatory disease of the spinal nerve root

There are many reasons for inflammation. The main ones include:

Hypothermia of the body.

Spinal injury.

Strong physical activity, heavy lifting.

Violation of metabolism and calcium balance in the body.

Emotional loads, stresses as the causes of inflammation.

Infections can also cause inflammation

All of the above factors can provoke both a primary attack of sciatica and “wake up” a chronic inflammation that is in remission.

Radiculitis(lat. radicula root + -itis) - damage to the roots of the spinal nerves, characterized by pain and impaired sensitivity of the radicular type, less often by peripheral paresis. Although radiculitis in the direct sense means inflammation of the roots of the spinal nerves, only in 4-5% of cases there are infectious and infectious-allergic radiculitis, in which the membranes of the spinal cord are often involved in the pathological process, and the pathological process is essentially meningoradiculitis.

The main reason for the development of radiculitis is osteochondrosis of the spine, degeneration of the intervertebral discs, often with their displacement (disc hernia). Less commonly, sciatica occurs with congenital malformations of the spine, diseases of internal organs, inflammatory-dystrophic lesions of the spine and joints, tumors of the peripheral nervous system, bone and ligament apparatus, gynecological diseases, spinal injuries, infectious diseases of the nervous system. Depending on the localization, lumbosacral, cervicothoracic and cervical sciatica are distinguished. The division is conditional.

Symptoms sciatica in different places has common features: it is spontaneous pain in the zone of innervation of the affected roots, aggravated by movements, coughing, sneezing and straining; restriction of mobility of the spine, protective (pain) posture of the patient, soreness with pressure on the spinous processes of the vertebrae and at paravertebral points, increased or decreased sensitivity, motor disorders - weakness and hypotrophy of muscles in the zone of radicular innervation.

In clinical practice, the most common sciatica caused by osteochondrosis of the spine. The lumbosacral spine bears the greatest functional load, and, accordingly, the intervertebral discs at this level undergo the most significant changes. Dystrophic changes in the intervertebral disc are accompanied by narrowing of the intervertebral fissure, compression of the spinal roots in the intervertebral foramens with radicular symptoms, muscular-tonic disorders with reflex tension of the innervated muscles, vegetative-vascular disorders, changes in the tendons, ligaments, symptoms of compression of the vessels of the spinal cord.

During lumbosacral sciatica, lumbar and radicular stages are distinguished. In the first stage, there is a dull, aching, but more often acute pain in the lumbar region. Pain can occur suddenly, first in the muscles, after exercise, cooling, or increase gradually, aggravated by coughing, sneezing, etc. There is a limitation of mobility in the lumbar spine, flattening of the lumbar lordosis, tension and soreness of the muscles of the lumbar region.

As you move to the second, radicular, stage, the pain intensifies, changes its character, begins to radiate to the gluteal region, along the posterior surface of the thigh and lower leg. There are symptoms of root tension - Neri's symptom (pain in the lumbar region when the head is tilted forward), Dejerine's symptom (pain in the lumbar region when coughing, sneezing).

Depending on the location of the affected intervertebral disc or herniated (bulging) disc, sensitivity disorders are detected in the corresponding areas. So, with damage to the IV lumbar root, pain, hyperesthesia or hypoesthesia are localized in the lumbar region, along the anterior inner surface of the thigh and lower leg, and the medial edge of the foot. With the defeat of the V lumbar root, the pain is localized in the lumbar region, the upper quadrants of the gluteal region, along the posterolateral surface of the lower leg, on the back of the foot. The defeat of the intervertebral disc L5-S1 is accompanied by compression of the first sacral root. Pain and sensitivity disorders are localized in the sacrum, gluteal region, back of the thigh, lower leg, outer edge of the foot.

In some cases, the pathological process spreads from the roots to the sciatic nerve, which is accompanied by the development of symptoms of damage to the nerve trunk (sciatica): pain in the lumbar region and along the sciatic nerve, atrophy of the anterior leg muscles with drooping foot, decrease or disappearance of the Achilles reflex. Pain along the nerve trunk, pain when pressing on the transverse processes of the IV and V lumbar vertebrae (posterior point of Hara), in the region of the midline of the abdomen below the navel (anterior point of Hara) are also characteristic.

Positive pain reflexes of tension:

Lasegue's symptom - raising the extended leg of the patient, who is in the prone position, causes acute pain in the lumbar region with irradiation along the sciatic nerve (first phase), after bending the raised leg in the knee joint, the pain disappears (second phase);

Bonnet's symptom - pain along the back of the thigh when abducting or adducting an extended leg;

Ankylosing spondylitis - pain along the sciatic nerve with vigorous pressing to the bed of the patient's leg, unbent at the knee joint;

The symptom of landing is the appearance of pain in the lumbar region and in the popliteal fossa when the patient moves from a lying position to a sitting position with legs extended.

Cervical-thoracic sciatica occurs in deforming spondylosis, osteochondrosis, traumatic and tumor lesions of the spine, additional ribs, diseases of internal organs, etc. Infectious lesions of the roots, viral damage to the intervertebral sympathetic nodes occur much less frequently.

cervical sciatica characterized by sharp pains in the neck, nape with irradiation to the arm, shoulder blade. There is tension in the neck muscles, forced position of the head, sensitivity disorders, pain when pressing on the spinous processes of the cervical vertebrae and at paravertebral points, as well as when the head is tilted forward with pain radiating to the shoulder blade and arm.

Depending on the level of damage to the roots, the functions of certain muscle groups are disrupted. So, with the defeat of the III-IV anterior cervical roots, the muscles of the diaphragm are affected, the V-VI roots - the muscles of the shoulder and shoulder girdle, the VIII cervical and I thoracic roots - the muscles of the hand.

Thoracic sciatica occurs in isolation in diseases of the lungs, organs of the posterior mediastinum, lesions of the pleura, vertebrae and ribs, infections, including herpetic lesions of the ganglia of the sympathetic trunk (ganglionitis). Pain spreads along the course of one or more intercostal nerves, often aching in nature, less often paroxysmal. Soreness is noted in the paravertebral points, in the intercostal spaces; hyperesthesia or anesthesia in the areas of radicular innervation, sometimes bubble rashes in these areas.

The occurrence of a radicular syndrome in a patient requires a thorough clinical examination. All patients undergo X-ray of the spine in frontal and lateral projections. Myelography allows you to clarify the level and nature of the lesion. It is recommended to consult a gynecologist, urologist, oncologist to exclude neoplasms or their metastases in a particular area, which can compress and irritate the spinal roots.

Treatment of sciatica complex and can be recommended only after a thorough examination of the patient. Conservative treatment in the acute period includes strict bed rest for 6-7 days on a hard bed, taking analgesic, anti-inflammatory drugs, novocaine blockades, blockades with lidocaine, trimecaine. The position of the patient on a rigid inclined plane with a raised head end or horizontal traction with small loads on a special table with a device for reducing lumbar lordosis contributes to the reduction of pain syndrome. In some cases, proteolytic enzymes (papain) are injected into the intervertebral discs.

The arsenal of conservative treatment also includes vitamins (B1, B12), dehydration therapy (lasix, furosemide, diacarb), ganglioblockers (hexonium, pentamine), muscle relaxants, hormonal drugs. With a decrease in acute pain, physiotherapy is prescribed (Bernard currents, UV irradiation, UHF, inductotherapy, electrophoresis with prozerin), therapeutic exercises, massage of the muscles of the neck, back, limbs, underwater traction in the pool or in a special bath on the traction shield, underwater massage. In addition, drugs that improve microcirculation (theonicol, trental, complamin), biogenic stimulants (FiBS, etc.) are used. Outside the stage of exacerbation, sanatorium treatment (balneotherapy, mud therapy) is recommended.

Physiotherapy exercises are prescribed taking into account the patient's condition, the localization of the process. Contraindications to the use of exercise therapy are a pronounced pain syndrome, increased pain during exercise. Thanks to specially selected physical exercises, the natural "muscular corset" is gradually strengthened, metabolic processes in the affected segment are normalized. The use of therapeutic exercises and massage leads to a decrease in pain, an increase in the strength of the abdominal muscles, hip extensors, intercostal muscles, and long back muscles.

The exercise therapy technique is determined by the level of damage and the nature of movement disorders. With lumbosacral sciatica, certain facilitating starting positions should be selected. So, in the supine position on the back, a roller is placed under the knees, in the prone position on the stomach - a pillow under the stomach; to unload the spine, a knee-elbow position is used with an emphasis on the knees. Before doing therapeutic exercises, it is recommended to lie on an inclined plane (angle of inclination 15-40 °) with emphasis in the axillary areas. This procedure, lasting from 3-5 to 30 minutes, helps to stretch the spine, expand the intervertebral fissures, and reduce the compression of the roots.

With the ineffectiveness of conservative treatment, surgical decompression of the roots is performed with suturing of the disc herniation or removal of the disc (discectomy). Indications for surgery are strictly individual. Absolute indications are symptoms of compression of the cauda equina or spinal cord. In all other cases, indications for surgical intervention are relative.

AT prevention sciatica, an important role belongs to the development of correct posture, the rational organization of work and rest. To prevent exacerbations of sciatica, patients should sleep on a hard bed; the pillow should be low, which eliminates a sharp bend in the neck during sleep. The load should not be lifted with the "back" (bending over, on fully extended legs), it is better to use the weightlifter's technique - lifting the load with the "legs" (squatting a little). Persons whose profession is associated with prolonged sitting, it is useful to learn how to sit, leaning on the back of a chair and placing emphasis on both legs, it is recommended to avoid prolonged uncomfortable postures.

Medical sections: diseases of the musculoskeletal system

Medicinal plants: marshmallow, drooping birch, sarepta mustard, elecampane high, medicinal ginger, Norway maple, European larch, large burdock, sunflower, common radish

Get well!

If you are worried about pain in the back - do not rush to go for a CT scan, MRI, be afraid of Schmorl's hernias and diagnoses of osteochondrosis. Visit a good massage therapist, or a specialist who owns soft manual techniques.

"Currently, the idea of the causes of pain in the trunk, especially the back, as well as the limbs, if they are localized outside the joints, is based on the world-wide idea of the pathology of the intervertebral discs (discogenic pain), they blame osteochondrosis of the spine, which allegedly damages spinal nerve roots.Herniated discs are referred to as osteochondrosis.Pain in the joints is attributed to arthrosis.

In fact, there is no place in the human body where the roots of the spinal nerves could be damaged.

In general, there are no roots of spinal nerves outside the spinal canal (“dural sac”). The roots of the spinal nerves can be compressed together with the "dural sac" only in their entire mass and only in the lumbar region in case of severe fractures of this spine, tumors and inflammatory abscesses in the spinal canal.

Such damage to the entire mass of the roots is called "horse tail syndrome", which is accompanied by a loss of motor and sensory functions of the lower extremities and pelvic organs, and not at all by pain. The loss of these functions, and not pain, is characterized by any damage to any nerve conductors.

Thus, if individual roots of the spinal nerves cannot be damaged, then there are no "radiculitis" and "radicular" syndromes in nature, just as there are no vertebrogenic peripheral pain syndromes. Clarification of these circumstances radically changes not only the diagnosis, but also the treatment and prognosis of the disease.

Diagnosis is simplified, treatment is reduced from several months to several days, the prognosis from pessimistic or uncertain becomes, in most cases, absolutely favorable.

Therefore, the search for the cause of pain syndromes in the spine is a waste of time and money, especially for expensive and time-consuming radiation methods.

From speculative reflections to knowledge

Unfortunately, not only clinicians do not read morphological and physiological literature, but also anatomists, pathologists, physiologists, pathophysiologists do not read clinical literature, otherwise they would find a lot of interesting things for themselves. And they would also make sure that they teach students poorly, that their pedagogical work has zero output.

So, after reading the literature on back pain, anatomists would find that the authors are only hearsay familiar with the student course of normal anatomy of the spine and spinal cord, that many of them do not know the differences between the spinal and spinal canals, that, thinking about the roots of the spinal cord nerves, do not know what it is and where the roots are located, and even call them spinal roots. Meanwhile, roots are present in the nerves, and not in the spinal cord.

Pathologists might also find that the authors of numerous monographs on osteochondrosis also do not know what it is, and therefore pain in the back and even limbs is attributed to osteochondrosis of the spine, and many simply call these pains osteochondrosis. They would also know that the authors of many solid manuals do not know that bones, cartilage, nerve conductors, the spinal cord and brain do not have pain receptors, and therefore their damage, and even more so slow, chronic, does not give pain symptoms.

Therefore, the conversation about the etiology and pathogenesis of pain syndromes comes down to speculative reflections and drawing the same speculative schemes, where bones exposed from cartilage rub against each other, where drawn hernias infringe on ephemeral roots and thereby supposedly cause excruciating pain.

The role of the spinal column is, of course, great in providing the function of support and movement, protecting the spinal cord and roots of the spinal nerves. But there is no reason to dump all our troubles on him. To prove this, first of all, a few words about the normal clinical anatomy of the spine and the neurological structures contained in it.

"Likbez" for specialists

vertebral columnforms the spinal canal, bounded in front by the vertebral bodies and intervertebral discs, covered with a posterior longitudinal ligament.

On the sides and behind the spinal canal is limited by the arches of the vertebrae and yellow ligaments between them.

Inside the spinal canal is the spinal canal ("dural sac"), which contains the spinal cord (from the base of the skull to the 2nd lumbar vertebra), and from the 2nd vertebra - the roots of the spinal nerves ("cauda equina").

The space between the walls of the spinal and spinal canals is filled with loose connective tissue, which allows the "dural sac" to move easily in all directions. So on a corpse, with flexion-extensor movements of the head, the “dural sac” moves in the longitudinal direction by 3-5 cm.

The spinal canal is filled with cerebrospinal fluid, in which the spinal cord "floats", and below the first lumbar vertebrae - the roots of the spinal nerves. With any pressure on the "dural sac", the roots are displaced in the cerebrospinal fluid, easily avoiding compression.

The roots of the spinal nerves (anterior and posterior, that is, motor and sensory) exist separately only in the spinal canal, beyond which they go in pairs in one sheath and are called the spinal nerve.

This nerve goes to the intervertebral foramen and exits through its upper part, directly from under the arch of the eponymous vertebra, that is, much higher than the intervertebral disc. In other words, the spinal nerve and disc are located in different transverse planes.

Therefore, not only protrusions of the disc, but any hernia can not damage the spinal nerve. It is curious that American anatomists have known this for a long time and even created a special training dummy showing the impossibility of such compression. And despite this, the United States is the largest number of operations to remove herniated discs.

A few words about the pathology of osteochondrosis

Osteochondrosis is a pathomorphological term introduced by Schmorl in 1932 and means a dystrophic change in cartilage and adjacent bone, that is, it can be anywhere where there is cartilage and bone - in the spine, joint, symphysis, ribs, etc. Moreover, the dystrophic process always begins with cartilage. The cartilaginous phase is called Schmorl chondrosis. In essence, osteochondrosis is a process of aging - "timely" or premature.

This is not a disease, but a slowly developing pathomorphological condition, the same as graying hair, baldness, senile skin changes, etc.

Having fun with speculative exercises, many authors argue that osteochondrosis marginal bone growths of the vertebral bodies can injure the spinal cord or spinal nerve roots. On this occasion, it should be said that there are practically no such growths in the rear direction. Osteochondrosis growths go forward and to the sides, along protruding discs. In addition, as already mentioned, spinal nerves (and not roots!) And bone growths at the level of intervertebral discs are located in different transverse planes.

Thus, neither herniated discs nor bone osteochondrosis growths can damage the spinal nerves either in the spinal canal or in the intervertebral foramina (at least in the thoracic and lumbar spine), and even more so the roots of the spinal nerves for the simple reason that the roots outside the "dural sac" is not.

The cause of the pain would probably have been established long ago if, when examining a patient, they examined what hurts, and did not look for the cause in the spine or even in the head. Now we are already faced with such facts when, having not found any pathology in the spine, they believe that there is no morphological basis for pain, which means that these are psychogenic pains. The joint treatment of such chronic patients with psychiatrists is presented as the latest achievement of neurological science. And this is no longer a difficulty, but a disgrace to medicine. Many clinicians have rejected the discogenic concept of pain syndromes.

J.F. Brailsford (1955), G.S. Hackett (1956), R. Wartenberg (1958), G. Keller (1962) paid attention to the pathology of muscles, fibrous tissues (tendons: ligaments, fascia) of the limbs and trunk and receptors in them.

This position, especially G. Keller, was subjected to merciless criticism by J. Popelyansky (1974), which he called "magnificent attacks on the discogenic theory of sciatica." Indeed, the weakness of the positions of these authors was that they relied only on their extensive clinical experience, although critically comprehended, but not confirmed by anatomical studies.

Therefore, despite some critical works, the discogenic concept of pain syndromes in the region of the trunk and extremities gradually won more and more supporters, and by the 80s of the twentieth century began to dominate almost completely. If discogenic lesions of the roots appear in foreign literature, then in domestic literature and practice, thanks to the authoritative works of Y. Popelyansky and his school, the view of lumbar pain as a result of spinal osteochondrosis, which includes disc herniation, has been established.

Way out of the impasse

The impasse in which neurology and orthopedics have entered in the diagnosis and treatment of pain syndromes is explained by the fact that, instead of a straight and clear path of a conscientious clinical study of the patient, they took the path of speculative far-fetched concepts and "theories" about the fault of the spine in general and osteochondrosis and herniated discs in particular. After that, all accidental findings in the spine, ranging from osteochondrosis to normal variants, began to be attributed to pain in pain syndromes. And when it became possible to detect protrusions and herniated discs using CT and MRI tomography, then all the troubles were dumped on them.

In almost no case history of a patient with back pain, one can find information about the exact localization of the pain point or at least the zone, not to mention the palpation examination of the zone indicated by the patient. And this can be understood: why should a doctor overloaded with patients conduct such studies, if everyone knows that it hurts from osteochondrosis or disc herniation. That is why the patient is immediately sent for “X-ray”, for CT, for MRI.

Signs are posted in front of many neurologists' and orthopedists' offices stating that patients with back pain without spinal X-rays are not accepted. And from the radiologist, patients come with a conclusion about the “common osteochondrosis” identified in them. There is a special discussion about the qualifications of radiologists, CT and MRI specialists.

Of the 1490 patients examined by us, referred by various specialists for X-ray, CT, MRI, 82% were not undressed at all and examined.

We managed to show and prove that the cause of pain in the musculoskeletal system lies not at all in the spine, but in a trivial mechanical damage to the ligaments, tendons, muscles, often already altered by the dystrophic process. But all these anatomical structures are not located in the spine, but in those places that hurt. These places must be identified clinically and radiographs of the entire area around the painful zone must be made without fail, so as not to miss the inflammatory or neoplastic pathology.

The main result of our work was the conclusion that only those anatomical structures that have pain receptors can be the source of pain. There are no pain receptors either in the vertebrae, or in the intervertebral discs, or in the bones, or in the articular cartilage, or in the spinal cord, or in the roots of the spinal nerves, or in the nerves themselves, just as they are not in the nails and hair. They are present in small quantities only in the membranes of the brain and nerves (perineurium). But on the other hand, they are saturated with ligaments, tendons of muscles, the muscles themselves, the periosteum, and blood vessels. It is the anatomical formations that have pain receptors that are the source of pain in all body systems.

Wake up from hypnosis

Our studies have shown the complete failure of concepts based on incorrect speculative anatomical ideas. Ignorance of the exact anatomical details and topography of the nervous system of the spine led to fictitious "compression" of the roots of the spinal nerves and, accordingly, the diagnoses of "radiculitis" and "radicular syndromes", and hence to the search for osteochondrosis and herniated discs.

Since, according to the supporters of this concept, hernias are the cause of pain, they must be removed, and often not only the hernia, but the entire disc, and even with the vertebral bodies adjacent to it.

On this pseudo-theoretical base, an entire industry of diagnostics and treatment of pain syndromes in the musculoskeletal system has grown. Here are the latest diagnostic tests, high-tech surgeries, and the manufacture of complex endoprostheses, and most importantly, hundreds of pharmaceuticals.

All this together is a colossal business "and nothing personal." In such a business, the interests of patients are not taken into account.

I believe that Russian neurology sincerely does not know what it is doing, being under the hypnosis of "advanced Western medicine." The wave of abuses of prescribing surgical interventions and expensive pharmaceuticals is quite large and is steadily growing, especially in the field of paid medicine.

As far as Western medicine is concerned, business seems to have beaten the Hippocratic Oath. Russia is actively attached to the ideology - the maximum profit by any means available in this situation. The introduction of such an ideology is the easier, the less competent and more immoral the environment of implementation. The task of public health is to create a situation in which the desire for immoral gain not only of ours, but also of Western medical businessmen on our territory would be nipped in the bud. published

Radicular syndrome or radiculopathy is a collection of neurological symptoms that occur when compression (squeezing) of the 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, in 80% of cases, radicular syndrome of the lumbar spine is diagnosed due to the mobility of the vertebrae, weakness of the muscular-ligamentous apparatus in this area and a large load during 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 sensory and motor nerve fibers and is in conjunction 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;
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 recent years, the role of a hereditary factor that affects the inferior development of connective tissue has been proven. As a result, a pathology of the spine is formed with a rapidly progressive course and the formation of radiculopathy. In the appearance of the disease, irrational nutrition, nicotine addiction, and alcohol abuse are of no small importance.

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. In this case, the pain is accompanied by vegetative disorders: reddening 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.

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

As part of the spinal root are sensory and motor nerve fibers. Their compression causes swelling and inflammation of the nervous tissue, impaired conduction of the nerve impulse from the central sections 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 touches, temperature and pain stimuli of the lower limb is weakened. 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 at different levels, and according to the specifics of the symptoms, it is highly likely to assume the localization of the pathological process.

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.
Compression of the spinal roots at the level of the 4th lumbar vertebra (L4) is characterized by pain sensations on the anterior and outer surface of the thigh, which 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.
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. Paresthesias in the area of the foot and weakening of the muscle strength of the lower limb are revealed, which makes it difficult to support 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, an etiological disease of the spine is identified, which caused the appearance of radicular syndrome. Recommend instrumental examination methods 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 state of the spinal cord and nerve roots with the help of a contrast agent introduced into the subarachnoid space, followed by fluoroscopy.

Correct diagnosis contributes to the appointment of 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 stopping the acute process, the therapy of 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 deformity 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 taking alcoholic beverages.

Conservative therapy for radicular syndrome includes:

analgesics to relieve pain - baralgin, ketorol in solutions for intramuscular injections;
non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammatory response in the affected area, eliminate 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 congestive processes - sirdalud, mydocalm;
vitamin complexes based on drugs B 1, B 6, B 12 in order to normalize metabolic processes and trophic nerve roots, improve the conduction of nerve impulses, regenerate 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;
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 muscles of the back, normalize blood circulation, improve nutrition of the spine.

In a severe course of the disease, persistent symptoms develop that are not amenable to conservative methods of 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 are 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. In case of 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 alarming symptoms from the spinal column occur. Infringement of the spinal root occurs against the background of the chronic course of the disease, an untimely diagnosed and treated pathological process. You should adhere to a balanced diet, give up addictions, 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. It is necessary to avoid engaging in heavy physical labor associated with an axial load on the spine. It is useful to take courses of therapeutic back massage twice a year.

Complexes of therapeutic exercises are prescribed during the recovery period of the 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 lay to the right of the body, at the same time point your head and chest to the left side, perform 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 the 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 a comprehensive treatment of diseases of the spinal column.