Neurological diseases are one of those groups of diseases that often lead to disability or temporary disability. One of these diseases - radicular syndrome of the spine - is quite common. What is he like?
What is radicular syndrome?
This term is usually understood as a set of symptoms that develop as a result of exposure to the roots of the spinal cord. Most often, osteochondrosis leads to the development of the disease - radicular syndrome with it is less intense than with injuries or a herniated disc. There is a narrowing of the intervertebral foramen, which leads to the infringement of the outgoing nerves.
The main clinical signs or criteria of radicular syndrome are:
- Pain. Intense, aching pain is characteristic in the area of compression of the root emerging from the spinal cord, extending to the limbs, and sometimes to the internal organs.
- Violation of sensitivity. It develops along the outgoing nerves. Most often manifests itself in the form of paresthesias (a feeling of goosebumps, chills).
- Atrophy of innervated muscles and impaired movement. It develops due to damage to the nerves innervating a particular area. It leads to muscle weakness and loss of their functions.
Pathogenesis of the disease
The development of radicular syndrome is the defeat of the spinal column. Over time, there is a depletion of the reserves of nutrients contained in the intervertebral cartilage. The factors aggravating this condition are age, excess weight, adynamia. As a result of this, the so-called vertebral subsidence occurs.
Spinal nerves exit the spinal canal through the intervertebral foramen. Due to the fact that the spine sags, there is a narrowing of these holes, which leads to pinching of the nerves.
Aseptic inflammation develops in the compression zone, which is characterized by swelling of adjacent tissue. This edema further aggravates the condition, which leads to increased pain. The pain spreads along the outgoing nerves, which may cause a picture of damage to the internal organs (for example, radicular syndrome of the thoracic spine can create a picture of angina pectoris or myocardial infarction).
The causes of the development of the disease
In addition to osteochondrosis, other processes can lead to the development of the disease. Among them stand out:
- Intervertebral hernia. Due to the rupture of the cartilage and the exit of the pulpous nucleus beyond the spinal column, the outgoing nerves are compressed.
- Defects in the structure and diseases of the spine. Most often they cause the development of radicular syndrome, starting from early childhood.
- Injuries. Usually, as a result of abnormal fusion of the vertebral processes, root compression occurs.
- Infectious diseases of the spine, leading to the depletion of bone and cartilage tissue (osteomyelitis).
Often, radicular syndrome develops in obese sedentary people.
Sometimes it may develop as a result of excessively hard physical work or the so-called “backache”.
In some cases, radicular syndrome develops due to hypothermia.
Some drugs may cause the development of radicular syndrome (however, in this case, this syndrome will be called pseudo radicular).
Classification
As such, there is no classification of radicular syndrome. Clinicians conditionally divide it according to the defeat of the anatomical zones of the spine. According to this classification, radicular syndrome is distinguished:
- The cervical spine.
- Thoracic department.
- Lumbar.
The area of the sacrum and tailbone is affected by osteochondrosis quite rarely, therefore, these areas are not included in the classification.
There is a secret classification of radicular syndrome by the presence of complications (complicated and uncomplicated).
Sometimes such forms of radicular syndrome are distinguished as acquired and congenital (however, this classification is extremely rare, since basically this syndrome is most often acquired).
Among all these forms, radicular syndrome of the lumbar spine is most common.
The reasons for the defeat of this department
Why is this area most often affected? The reasons for which radicular lumbar syndrome develops are as follows:
- The lumbar has the greatest load. It is here that she is redistributed from hard physical work. In addition, the lower back is loaded with overlying sections of the body, as it contributes to their maintenance and position.
- The lumbar region is formed by large vertebrae forming fairly wide openings. Large vessels and nerve plexuses pass through them, which are rather easily infringed upon as a result of the damping function of the intervertebral discs.
- Radicular syndrome of the lumbar region also often develops due to the fact that it is one of the most mobile parts of the axial skeleton. Excessively wide in amplitude movements easily lead to displacement of the vertebrae relative to each other and cause the development of pain and nerve infringement.
Clinic
If, however, as a result of pinching of the nerves, radicular syndrome of the lumbar spine occurs, the symptoms will not take long.
The first and most common symptom is pain. It has a shooting character, appears suddenly, as a result of hard physical work or injury. A gradual increase in pain is characteristic of osteochondrosis. At the same time, backache will also disturb, but the intensity of the pain is not so high.
Sensory impairment usually accompanies pain. It is violated from the side where nerve infringement takes place. Radicular syndrome of the lumbar region is usually bilateral (with osteochondrosis). Most often there is a decrease in sensitivity and pain threshold. Sometimes paresthesia can occur - perverted or incorrect sensations.
Muscle dysfunction can develop when lumbar osteochondrosis occurs for a long time. Radicular syndrome leads to muscle atrophy, loss of opportunity for active physical work, weakening the strength of muscle contractions.
Diagnostics
Diagnosis of this disease is necessary, taking into account most factors. First of all, attention should be paid to patient complaints, since it is on the basis of the latter that one can make assumptions about the localization of the pathological process.
Palpation of the area where the pain is located can give auxiliary information during examination - local muscle tension will be felt. Visually, you can detect the patient's tilt to the sick side (in this way he manages to reduce the pain).
A general blood test is uninformative - only a relative increase in white blood cells due to limited inflammation can be observed.
The main advantage in the diagnosis of radicular syndrome is MRI of the lumbar spine. This study allows you to detect even the slightest infringement of the nerve and accurately determine the localization of the process. However, the difficulty is tomography itself. MRI of the lumbar spine is a rather costly procedure, so it is not for everyone.
Radicular Syndrome Treatment
What to do if this disease has developed? Is it possible to be treated at home or is it better to go to the hospital?
If you nevertheless have developed radicular syndrome of the lumbar spine, it is worth starting treatment immediately and preferably in a hospital.
Like any type of treatment for diseases of the musculoskeletal system, this should include non-drug methods, drug therapy and surgical interventions.
If the symptoms of the disease do not significantly affect life, general methods can help - proper nutrition, avoiding physical exertion, massage, relaxing hot baths.
If, nevertheless, the radicular syndrome of the lumbar region begins to bother, treatment at the initial stages should include the use of non-steroidal anti-inflammatory drugs (Nimesulide, Diclofenac) inside or intramuscularly. If intense pain begins to bother, the use of intervertebral blockade is recommended. If the condition worsens, it is recommended to seek an appointment with a neurologist or neurosurgeon to determine further treatment tactics.
Physiotherapeutic treatment
According to many traumatologists, neurologists and physiotherapists, some diseases of the musculoskeletal system can be cured with the help of physiotherapy.
Electrophoresis, electro-pulse currents are often used to eliminate radicular syndrome.
Electrophoresis with some drugs can achieve effects such as:
- Removal of the inflammatory process.
- Elimination of pain.
- Improving metabolism in the affected roots.
- Recovery of trophism of affected muscles and joints.
The use of EIT (electropulse therapy) is aimed at relaxing tense muscles, improving the nutrition of atrophied tissues, tonic effect.
In addition to instrumental methods, classes in the pool or physical therapy sessions are also useful.
Treatment of the lumbar spine can be carried out with the help of acupuncture and manual therapy sessions. These methods are not widely used in conventional medicine, but they help a fairly large number of people.
Surgery
The main factor characterizing radicular syndrome is symptoms. Treatment in a surgical hospital is recommended when they begin to become threatening.
The main indications for surgery are:
- Intense pain syndrome that cannot be stopped by taking NSAIDs and narcotic analgesics.
- Violation of limb function with a complete loss of active movements.
- Irreversible changes in the bone-ligamentous apparatus, leading to compression.
- Complicated intervertebral hernia.
- Complete loss of limb sensitivity.
Operations are carried out in specialized hospitals. Under anesthesia, quick access to the root compression site is created, and vertebral particles obstructing the normal position of the root are removed. With a hernia, excision of the fallen site is performed. At present, with hernial radicular syndrome, nucleoplasty is more and more often used - reduction or excision of the prolapsed disc with low access.
Disease complications
As was said, untimely treatment of the lumbar spine can lead to other other diseases. For example, the main complications may be:
- Lameness. It develops due to the forced position of the body. Subsequently, it can lead to flat feet and worsening of the condition of the disease (vicious circle).
- Mental disorders. Intense pain in the limbs and back will not give rest day and night. Against the background of overwork, neurosis and psychosis can develop.
- Ankyloses and joint contractures. The reason for their development is again a long stay in a certain position and low activity.
- In severe cases, nerve damage can lead to complete paralysis of the limbs.
- The onset of inflammation can retrogradely enter the spinal cord, causing a picture of meningism, spinal cord infarction, or an increase in the spread of the process to other roots.
Disease prevention
In order to prevent the development of radicular syndrome, you should remember a few simple rules:
- Daily morning exercises. Helps to stretch muscles, tone them.
- Overweight control. As was said, it is a factor worsening the course of the disease.
- Preventive massage sessions. They help in warming up muscles and vertebral joints, prevent displacement of the vertebrae relative to each other, and also prevent intervertebral discs from falling out of their bed.
- Proper nutrition. One of the factors in the development of osteochondrosis is a decrease in the nutrient content in cartilage. A properly composed diet allows you to pause the process.
- Pool. Allows you to reduce the load on the spine, simultaneously leading to tone all the muscles.
- Competent distribution of labor and rest. This rule avoids overwork and injury during physical labor.