A set of diagnostic and therapeutic measures for M54.1 Radiculopathy. Radiculitis

Radiculopathies were assigned a code according to μb 10 M54.1, regardless of localization.

At characteristic pain in the back, you need to see a specialist. A doctor who treats sciatica is called a neuropathologist. If, during the initial examination, the patient reveals postural disorders, then another specialist will be an orthopedist.

Lumbar sciatica

Lumbar sciatica is considered to be an ailment related to diseases of the musculoskeletal system. The reason for its occurrence is the process of compression, squeezing of the roots of the spinal nerves and the inflammatory process caused by degeneration processes in the spine, or pathology in the muscles. In essence, radiculitis is a secondary disease, that is, it is a consequence of a previously discovered problem in the musculoskeletal system.

Due to upright posture, a large load falls on the human spine, which reaches its maximum values ​​in the lumbar and sacrum region. That is why sciatica lumbar is the most common form of radiculopathy.

Pathological changes in the structure of intervertebral discs cause disruption of blood supply to cartilaginous tissues and the development of degenerative processes. The nutrition of the cartilage and the process of surface regeneration are disrupted, which ultimately leads to a change in the distance between the vertebrae and compression of the nerve fibers extending from the spinal column.

Symptoms

Signs of sciatica, which primarily draw attention to themselves, are severe pain syndrome, tension in the muscles of the back and limitation of mobility in the spine. Symptoms may vary depending on the underlying cause and course of the underlying disease, but stand out specific traits ailment:

• The pain increases with stress on the spine. Discomfort is caused by sudden movement. Coughing and even sneezing.
• In the area where the pinched occurs, the skin is pale and cold.
• The patient has increased sweating.
• From the side of the strangulated nerve fiber, sensitivity changes.
• On the affected side, the blood supply to the arteries of the foot is noticeably impaired.

The pain can radiate to the gluteal region, thigh, lower leg and feet. It must be remembered that in chronic and acute forms of radiculitis, the symptoms may differ. Sometimes the disease proceeds unnoticed by the patient and is detected only with a tomogram or X-ray examination.

The reasons for the development of radiculitis, regardless of localization, may lie in osteochondrosis, arthritis, physical inactivity, excessive stress on the spinal column, and the consequences of trauma.

Inflammatory processes in the muscles due to the development of edema can also contribute to the compression of the spinal roots. It can also be the consequences of tumors, autoimmune diseases and even a genetic predisposition.

Specialists most often encounter radiculitis, the causes of which lie in a whole complex of diseases. They have to be addressed to prevent relapse.

Treatment

First aid for an attack of sciatica is to block the pain syndrome and relieve inflammation. For this period, it is very important to restore the innervation of the spinal nerve fiber and prevent deterioration of the blood supply to the blocked area.

The doctor prescribes drug treatment after a complete examination, including an X-ray and possibly a tomogram.

The complex includes drugs aimed at:

• to relieve inflammation and edema, including corticosteroids;
• antibiotics in case of infection;
• diuretics to reduce fluid pressure in the tissues;
• muscle relaxants to get rid of increased muscle tension, sedatives;
• analgesics, stopping pain and allowing the patient to relax as much as possible.
• vitamin complexes;
• drugs that improve blood microcirculation and promote cell nutrition in the affected area.

Injections for radiculitis are shown in an acute form, when you need to quickly relieve the patient's condition and relieve tension in the area of ​​the pinched nerve.

Medicines are selected individually, based on the course of the disease and compatibility with additional prescribed drugs.

Cervical sciatica

The cause of the development of cervical sciatica is the process of inflammation of the nerve spinal endings having an outlet in the vertebrae cervical spine.

This area is characterized by a large number of nerve leads that innervate the chest area and upper limbs... The patient suffers from headaches, in the neck, acute pain in the shoulder girdle.

When the cervicothoracic region is affected, problems with the functioning of the muscles of the back and ribs may occur.
Cervico-brachial sciatica is characterized by soreness in the shoulders and can even provoke numbness in the upper extremities.

Most often, the 4th to 6th vertebrae of the cervical spine are affected. This is where most of the workload during the day takes place. The disease is quite young. Most often it affects people aged 20-35 years. Among men and women, the prevalence is approximately the same.

Symptoms

The main and most striking symptom of cervical sciatica is a painful sensation in the neck. When compared with other types of sciatica, the lesion of the cervical spine is perceived most acutely. The patient may complain of soreness affecting not only the back of the head, but also the shoulder blades and shoulders. Moreover, if he tries to turn his head or sneezes, coughs, the pain will instantly intensify.

With an advanced form of radiculitis, the patient loses muscle strength in the affected area due to impaired blood flow and innervation of muscle fibers. This is reflected in decreased sensitivity and numbness in the hands. There may also be a tingling and burning sensation in the neck area.

Dizziness is another characteristic symptom. To avoid an unpleasant sensation, the patient tries to keep his head straight, but due to pronounced pain, he cannot find a comfortable position for himself.

When clamping nerve fibers and inflammatory process the blood supply to the brain may also be impaired in the neck. Because of this, the patient may experience a lack of coordination when walking upright, hearing loss.

The causes of the disease are very diverse: sciatica can be caused by the consequences of diseases spinal column, as well as inflammatory processes due to hypothermia.

Doctors call the most common causes of sciatica in all categories of the population:

• Age-related changes in the spine, growth bone tissue reducing the outlet for nerve roots.
• Overweight.
• Stress-related occupations cervical muscles, - teachers, people engaged in manual labor, jewelers, librarians.
• Cool rooms conducive to hypothermia and drafts.
• Endocrinological diseases affecting the condition of the nerve fibers and the muscles surrounding them.

Given the variety of pathways leading to the disease, you need to remember about the possibilities and predispositions to radiculitis. Elementary attention to your health will help you avoid unpleasant consequences and long-term treatment.

Treatment

First of all, the treatment of sciatica is aimed at ridding the patient of acutely expressed symptoms. That is why comprehensive funds will be used aimed at:

• to relieve pain - analgesics;
• reduction of local edema of surrounding tissues;
• weakening the inflammatory process - non-steroidal anti-inflammatory drugs are applicable here.

Main impact drugs should be aimed at the root cause of the disease - degenerative processes in the tissues of the intervertebral discs, which in fact led to the compression of the nerve root. If we restrict ourselves to only analgesics, then muscle spasm and inflammation will not go anywhere and soreness will return as soon as the effect of the drug ends.

The first thing that is done with sciatica is to relieve pain. This is where pure analgesics can be effective. Further - NSAIDs (Ibuprofen, Ortofen, Naproxen) - these drugs reduce the inflammatory response and have an analgesic effect. Removing inflammation leads to a decrease in tissue edema and a decrease in compression on the nerve root.

Treatment of sciatica at home

Of course, sciatica is also treated with folk remedies. Who has not heard of a belt made of dog hair or a heated brick on the lower back. Home remedies can be divided into external and internal use.

External include all kinds of compresses and lotions. Ointments based on natural ingredients - bee venom, mustard. For internal - alcoholic tinctures on herbs, beekeeping products.

The largest percentage of all funds is aimed at relieving pain and relieving the inflammatory process.

• Compress of birch leaves scalded with boiling water. It is not for nothing that birch brooms in a bath are considered an effective remedy for the prevention of sciatica.
• Alcohol tincture of burdock roots for grinding.
• Mustard baths and gluing mustard plasters. They have an irritating effect on the skin, enhance blood microcirculation in the affected area. Warm up, relieve inflammation.

Rational use of recipes traditional medicine sometimes helps to get rid of the disease forever. However, such methods require a systematic approach and, as a rule, differ in the duration of the course.

Massage for radiculitis is indicated without fail. A correctly implemented technique will help not only unblock the pinched nerve roots, but also increase the distance between the vertebrae, thus, in principle, solving the pinching problem.

Now for home use of medications.

• You can do sciatica injections on your own if you have the skill of injections, and the drug has been prescribed by a doctor. In this situation, independent experiments can lead to a disastrous outcome.
• It is better to use a safe method of relieving muscle tension and wear a radiculitis belt. Dog, sheep or camel hair stimulates blood microcirculation in the affected area. It relieves pain and restores joint mobility. The belt should be worn on the warmed-up muscles. It is optimal to do this immediately after the massage session. Also, the belt is an excellent preventive measure.
• With sciatica, you can put mustard plasters, but not directly on the spine, but nearby, avoiding the kidney area.
• Medicines for sciatica must be purchased in strict accordance with the doctor's prescriptions. Since you yourself will not be able to make a diagnosis, choosing the drugs for treatment yourself is not a good idea. An exception may be tinctures for grinding - with ant, bee ooze, snake venom.
• Taking only pain-relieving pills means simply drowning out the symptoms of the disease, which means that your condition may deteriorate sharply at some point. A single remedy for sciatica does not exist in nature. Since the disease, as a rule, is caused by several reasons, then taking medications requires a multifaceted approach.
• Radiculitis gel, like ointments, acts on the soft tissues and muscles surrounding the affected nerves. She will not be able to defeat sciatica herself, but to help warm up and relieve inflammation - yes.
• Suppositories for sciatica are a great alternative to pills. Suppositories allow active substances to enter the bloodstream more quickly and have anti-inflammatory and analgesic effects.

Before using any remedy, make sure that it is not only suitable for the disease, but also does not contain substances that can cause allergies, or do not combine with drugs that you are taking concurrently.

Exercises for sciatica

Remembering that the root cause of sciatica is problems with the spine, we understand why exercise therapy and various exercises are indicated here. Bubnovsky developed a set of exercises dedicated to sciatica. They help relieve soreness and strengthen your back muscles. This, in turn, relieves stress from the intervertebral discs.

The doctor is sure. That most of our problems are associated with the immobilization of muscle groups due to a sedentary lifestyle. The consistent, progressive return of movement has a rehabilitative effect on the body, forcing it to use internal resources.

Gymnastics is combined with physiotherapy procedures - manual therapy, massage, acupuncture, even hirudotherapy.

Exercise, like massage, should not cause discomfort. Everything will be done without sudden movements, smoothly, without overloading. It is very important to restore mobility to the spine and joints.

It is known that Chinese retirees who practice gymnastics, even at an advanced age, remain vigorous and efficient. Their spine is flexible and healthy, which means there is no soil for the development of sciatica. Gymnastics in combination with massage relieves muscle tension, and stretching helps to restore normal blood supply to nerve fibers and muscles.

Exercise therapy and massage should be carried out with a proviso - the exercises are started after the pain syndrome is relieved. If the problem is in the stage of exacerbation, then first there is treatment with the provision of peace to the diseased area and only then appropriate activity.

We conclude: sciatica, according to statistics, is by no means the lot of stooped old women. On the contrary, the disease affects people of working age who are mainly engaged in sedentary work.

As a prevention of sciatica, you can effectively use folk remedies, but in case of an acute form, you should immediately consult a doctor to block the pain syndrome and relieve inflammation.

Radiculitis is easier to prevent by paying attention to your spine to keep it youthful and mobile for as long as possible. This means avoiding a sedentary lifestyle and exercising regularly.

Details about the disease sciatica:

Pain in the lower back while carrying a baby, especially in the late period, is familiar to many women. Sometimes sciatica during pregnancy becomes a companion of the expectant mother almost from the very first day before the onset of labor.

This is due to the fact that the body works with a doubled load to ensure the vital functions of both the woman and the unborn baby. The risk increases if, before pregnancy, a woman experienced discomfort in the back or was treated for sciatica.

What is sciatica?

A spasmodic attack in the back often overtakes a person in the most unexpected situations, when bending down for a fallen object, it becomes impossible to return to its previous position.

Radiculopathy (sciatica) is an inflammatory reaction in the nervous system in which the roots are pinched spinal cord, which explains the attack of pain.

A few years ago, when they talked about this disease, it was understood that people over 45 years old were sick. Currently, the first attack of sciatica can appear at a young age. This is due to a lack of physical activity, or vice versa, strong physical stress.

Types of sciatica

According to the localization of the inflammatory process, radiculitis is divided into the following types:

• Cervical - 4 cervical vertebrae are involved in the process, while the sensitivity of the occipital and shoulder regions is impaired;
• Cervicothoracic - most often appears as a consequence of osteochondrosis, pain spasms affect the neck, shoulder girdle, chest;
• Lumbosacral - pain is localized in the lumbar region with irradiation to the thigh, lower leg, foot, characterized by impaired movement. This type is most common during pregnancy.

Along the course, the disease is acute and chronic. In the first case, pain syndrome appears, numbness in the lower back, buttocks, legs, sometimes the foot is captured, the pain intensifies when walking, bending.

In a chronic course, periods of exacerbation are replaced by periods of remission. When choosing an individual course of therapy, the neuropathologist tries not only to reduce the pain syndrome, but also to maximize the remission time.

What is the reason for radiculopathy in pregnant women?

Fast weight gain. During pregnancy, a woman gains 10 to 20 kg of weight. Such an increase in body weight increases the load on the spinal column, this can be the cause of pinching of the spinal roots and displacement of the disks in the vertebral space. Most of all, women are at risk of getting sick, whose life is not distinguished by mobility.

Displacement of the center of gravity. As the fetus grows and develops in the mother's abdomen, the posture of the pregnant woman changes, the bulk of the load falls on the lumbar spine, which increases the risk of pinching the nerve fibers.

Change in the background of hormones. Pregnancy is characterized not only by physical changes, hormonal changes occur in the woman's body. At this time, there is an increased production of hormones that a woman will need in childbirth. An increase in the hormone relaxin, which is responsible for relaxing the ligaments and tendons, leads to the fact that the ligamentous apparatus of the spine becomes more vulnerable.

Increased nervous tension. During gestation, a woman worries about her condition, the health of the unborn baby, and the outcome of childbirth. Strong emotions are provocateurs of various diseases, including sciatica. For this reason, a woman during pregnancy should avoid stress and intense anxiety.

These reasons are most common. In addition, radiculopathy in a pregnant woman occurs as a result of hypothermia, or as a result of existing disorders in the musculoskeletal frame.

The cause is often a complication after influenza, meningitis, tick-borne encephalitis, rheumatic diseases, syphilis, herpes, and other diseases. Also, if a woman gives birth at a mature age, the past injuries of the spinal column, hernias, tumors, narrowing in the spinal canal, and bone dystrophy associated with age can be influenced.

How does sciatica manifest during pregnancy?

Symptoms of radiculopathy in pregnant women are very diverse, they depend on the level, type and place of damage to the nerve roots.

Common signs of sciatica are combined into 3 groups:

1. Pain symptoms - soreness, constant or temporary, arising at regular intervals, acute, burning, aching, dull, radiating to different parts of the body. The pain signal appears with mechanical entrapment and an inflammatory response. When the nerve fibers are pulled during movement, the attack intensifies, it interferes with sitting, walking, sleeping;
2. Violation of sensitivity to touch - loss of sensitivity, sometimes complete or partial. A woman may experience a burning sensation, tingling, numbness of the back and limbs, this is because the conduction of an impulse in the nerve fibers between the spinal cord and muscle tissues is interrupted in some place;
3. Muscle weakness - due to a decrease in mobility, the muscles gradually begin to lose their function and atrophy; pregnant women may experience flaccid paresis when the nerve impulse does not reach the muscle.

For sciatica of the lower back and sacrum, all three types of symptoms are characteristic, which are localized in the lower back with spread to the abdomen and lower extremities. One or another root or several at once cause various signs radiculitis. Decreased tendon reflexes in the lower extremities, vegetative disorders are possible.

The acute stage is characterized by a lumbago, during which the pregnant woman freezes in the same position in which she was caught by the attack. Lumbago happens as a result of weight lifting, hypothermia, overheating, usually lasting from two to three minutes to a day or more.

How to identify radiculopathy during pregnancy?

Often, pregnant women associate low back pain with signs of sciatica. Pain in the lower back during pregnancy occurs due to the significant growth of the fetus, the enlarged uterus compresses the sciatic nerve and the pain radiates to one or both legs.

An increased load on the spine, changes in hormonal levels change the state of the vertebrae, but this may not have any connection with sciatica, the disease is diagnosed only in 30% of pregnant women.

Also, a pain symptom in the abdomen with spread to the buttocks and legs may be a sign of another disease. They can be associated with the threat of miscarriage, with false contractions, with the onset of labor, or occur in diseases of the genitourinary system, in diseases of the gastrointestinal tract (constipation). Therefore, if you have back pain, you should consult a neurologist.

For diagnosis, first of all, the doctor pays attention to the complaints of the pregnant woman. Further, an examination is carried out, in which muscle strength and the volume of motor disorders are ascertained. In order to assess the neurological status, pathological reflexes are checked:

• Lasegue symptom - lying on her back, a woman is asked to raise a straight leg, with radiculitis, acute pain in the lower back and along everything sciatic nerve, pain immediately disappears if the limb is bent at the knee;
• Ankylosing spondylitis symptom - in the supine position, a quick tapping is performed on the back of the foot, the pathology is evidenced by the flexion of the sole in the area of ​​2-5 toes;
• Neri's symptom - the patient is asked to lie on her back, after which her head is pulled by her breasts, with sciatica, back pain occurs;
• Symptom Dejerine - a pregnant woman is necessarily asked the question of what aggravates the pain, after which it arises. If the enhancement is associated with physical activity, sneezing, straining, with irradiation of pain along the innervation of the nerve roots, this indicates a syndrome of tension during sciatica.

In severe cases, the pregnant woman is prescribed magnetic resonance therapy (MRI). The principle of the survey is the action of a magnetic field. It does not affect pregnancy and can be performed to diagnose a condition in pregnant women or for a more detailed examination of the fetus.

It is not recommended to have an MRI scan for up to 3 months. At this time, all organs and systems begin to form in the child, he is more susceptible to negativity from the outside. Therefore, if there are no necessary indications, it is better to postpone MRI until the second half of pregnancy.

Treatment of sciatica during pregnancy

If signs of sciatica are found in a pregnant woman, treatment is carried out carefully so as not to affect the development of the child and not cause a state of uterine activity. Most of medications, which are intended to relieve the symptoms of the disease, during this period are not suitable for treatment, as they have a negative effect on the fetus.

What should be the first aid if sciatica is detected in a woman for the first time during pregnancy?

1. First of all, a woman needs to adhere to bed rest. You need to lie on a firm mattress or on a special orthopedic surface so that the spine can rest from stress;
2. Strengthen the muscles and ligaments of the back. A special exercise therapy complex, designed to stretch and relax the muscles of the lower back, serves as both prevention and treatment;

Important! The exercise therapy complex cannot be carried out in the acute period of the disease, all exercises are done after the pain syndrome has been relieved.

1. Do massage. This method maintains muscle and ligament tone, relieves back pain and compression of nerve roots. The procedure is best performed while sitting, with a slight forward bend and emphasis on the limbs;
2. You can apply the acupuncture method, it affects the muscles of the lower back, relieves pain and does not affect the activity of the uterus;
3. The need to support the ligamentous apparatus. A pregnant woman needs to constantly fix her stomach and lower back with a special bandage, the pressure on the nerve roots decreases, the pregnant woman feels a decrease in pain. In addition, the bandage prevents the appearance of stretch marks after pregnancy;
4. To support the foot, special orthopedic insoles are used for this. The role of the foot in reducing back pain is very important. The increased weight during pregnancy leads to the fact that the foot is flattened, physiological flat feet appear, the depreciation function of the foot is lost, and the woman's gait and posture change. Orthopedic insoles eliminate these problems.

With severe pain syndrome, when the pain becomes unbearable, the treatment of the disease is carried out medications: by means for external use or for use in the form of injections.

Local treatment

In the early stages of the disease, help local preparations: gels, ointments or creams. They contain active ingredients aimed at getting rid of sciatica, they relieve the inflammatory process, relieve pain.

External agents do not penetrate into the circulating blood, ointments provide local treatment, as a result of which side effects practically not observed. Despite this, when choosing an ointment, it is necessary to consult a doctor.

What ointments to use for sciatica during pregnancy?

• pain relievers - Nikoflex, Finalgon;
• anti-inflammatory - Voltaren, Nurofen;
• warming - Apizatron; Capsicum;
• combined - Dolobene; Bischofite.

More often, the treatment of the symptoms of this ailment is carried out with complex or homeopathic ointments. The principle of their action is combined, they have several effects at once: they remove the inflammatory process, regenerate tissues, increase local blood circulation, affect metabolism, increase immunity in the lesion focus.

The gel or ointment must be applied to the affected area with a thin layer, rub it well into the skin. The use of local remedies is possible only for a short period and only after consulting a doctor.

In addition, you can relieve lower back pain with a pepper patch. It is taken without fear for their health, since all the ingredients of the drug are harmless. Its mechanism of action is based on relieving tension in deep muscles, it also removes toxins, reduces edema, and increases blood circulation in the lesion.

The pepper patch is sometimes applied pointwise. This is used by reflexologists, applying pieces of a plaster to biologically active points of the spine.

Traditional methods

If you experience back pain while carrying a child, you can use traditional medicine methods. Despite their simplicity, homemade medicines have a strong healing effect, improving tissue metabolism, relieving inflammation, and strengthening local immunity.

To cook homemade ointment need to:

• take 150 g of internal fat, steam it;
• add one tablespoon of wax, stir everything well;
• boil for 15 minutes, add a spoonful of fir oil and cook for another 15 minutes;
• at the end add a large spoonful of ammonia.

Store the radiculitis ointment in a glass container in the cold. She needs to rub the sore spot at night, then wrap her back with a warm scarf.

A compress made of clay helps very well with radiculitis, which must be diluted with water to a dough state, then add half a glass of kerosene. A cake is prepared from the resulting mass and applied to a sore spot on the back through parchment paper. The compress is fixed with a warm bandage; you need to change it several times a day. A severe attack of sciatica disappears after several procedures.

Radiculopathy is a pathology that develops due to dystrophic and degenerative processes localized at the level of the intervertebral discs and the vertebrae themselves. People are susceptible to disease different ages and gender, it often leads to disability. The disease is also called radicular syndrome, or radiculopathy L5-S1 in case of damage to the lower back and sacrum. The ICD disease code is 10 - M 54.1. The common name for pathology is radiculitis, although it is not entirely correct. The disease is confirmed by X-ray and ro-gram.

Classification

Medicine uses a number of classifications of the disease, among which there is a division depending on the level of localization. According to this feature, the following forms are distinguished:

• cervical;
• chest;
• lumbosacral;
• mixed (polyradiculopathy).

If we proceed from the damaged structure, then such forms of pathology as vertebrogenic and discogenic should be distinguished. This division makes it possible to identify both the level of damage and the nature of the violation of the structural components, which together led to the onset of pain. - M 54.1.

Pregnancy.

Oncological processes.

Endocrine Disorders.

Immune system pathologies.

Vertebrogenic progressive radiculopathy differs from discogenic only by a causative factor, the subsequent development of pathogenesis has similar signs. The ICD disease code is 10 - M 54.1. Lumbosacral pathology occurs more often due to the fact that the maximum load falls on this level, which causes damage to L4, L5. Less common pathology at the level of the thoracic region, for example, the Th 10 vertebra. The level of the lesion can be identified using ro-grams.

Pathogenesis

The pathological process develops immediately after the action of the etiological factor on the structures of any part of the spinal cord. Initially, the spinal root is pinched, then it leaves the cavity of the spinal cord canal through a narrow opening. Infringement of the root causes the development of non-infectious metabolic disorders localized in the nerve fibers. After this, the process of inflammation progresses.

The root, which has undergone inflammation, provokes a pronounced) and a decrease in its own functionality. ...

Infringement at the level of the lumbar - L4, L5, or sacral region - S5, serves as a starting point for inflammation of three pairs of nerves of the spinal cord. Complex infringement causes increased pain syndrome (lumbodynia in combination with sciatica). Often, it is after such an attack that the patient seeks medical help. The doctor diagnoses pathologies using a ro-gram.

Symptoms

When visiting a doctor, the patient complains of severe pain, localized at the site of innervation of the strangulated nerves. Pain (lumbodynia) is often shingles in nature. The lumbosacral level of radiculopathy causes pain, which is localized from the back to the midline of the abdomen and can increase with palpation and moderate physical exertion. The damage level is worth checking with a ro-gram.

Damage to L4, L5, S1 provokes characteristic pain syndromes - sciatica and lumbago. Lumbodynia is of a shooting nature. In addition, “mimicking” pain occurs. These painful sensations can be easily confused with pain in appendicitis, colic, peritonitis, as well as irritable bowel syndrome. ...

In addition to pain, there are other symptoms. Lumbosacral radiculopathy causes skin changes - from hyperemia to paleness, muscle swelling is also manifested, clonic seizures are provoked, localized in the muscles of the anterior abdominal wall.

Lesions at other levels, for example, at Th 10, cause similar symptoms, which are slightly displaced in localization.

Diagnostics

The doctor interviews the patient, collects an anamnesis, and then proceeds to the examination, during which he palpates the affected areas. In addition, the specialist prescribes an x-ray. On roentgenograms (ro-grams), the level of the lesion is revealed. The lower back is more often affected, however, pathology at the Th 10 or C2 level may occur. An X-ray allows a qualified doctor to make a diagnosis, while the ICD disease code is 10 - M54.1.

If it is impossible to localize the process in this way, it is advisable to use computed or magnetic resonance imaging. This allows you to confirm the diagnosis and assign a disability group.

Therapy

Lumbosacral and other radiculopathy responds well to treatment. If a pathology is detected on a ro-gram, it is worthwhile to immediately start therapy. If complex therapeutic measures are not followed, the disease can lead to a disability group. Therapy of the disease is aimed at eliminating both the etiological factor and the characteristic symptoms of the pathology.

Pain syndrome (lumbodynia) is stopped with the help of non-steroidal anti-inflammatory drugs. Select the most effective remedy stands individually. Chronic hernia of the spine at any level (for example, Th 10), which is complicated by radiculopathy, requires hospital treatment for at least three weeks.

In some cases, this therapy is ineffective. Then the doctor raises the question of the need for surgery to correct the pathology. Ro-graphy is prescribed before the operation. After the operation, it is required to provide the patient with a full course of the rehabilitation program. For this purpose, massage is used, as well as exercise therapy. ...

Drug treatment includes the use of a number medicines, which include:

• non-steroidal anti-inflammatory drugs (Diclofenac);
• analgesic drugs (Ketorol);
• drugs for the implementation of paravertebral blockade (Novocaine, Lidocaine, vitamin B12);
• antispasmodics (Sibazon).

In addition, physiotherapeutic treatment is highly effective. It includes the following activities - ultrasound procedures, the use of diadynamic currents and ionogalvanization.

Treatment, in addition to the above drugs and procedures, is complemented by manual therapy, massage. Physiotherapy exercises have a good effect.

It should be noted that non-steroidal anti-inflammatory drugs are used both in the form of injections and blockades, and locally in the form of ointments. If they are ineffective, glucocorticoids are prescribed, for example, Prednisolone. Inpatient treatment involves epidural administration of such drugs. This measure ensures the duration of the analgesic and anti-inflammatory effect.

In addition to the listed funds, the treatment is supplemented with compresses based on Dimexidum. This medication is diluted with water, Novocaine, Hydrocortisone and vitamin B12 are also added to the mixture. This procedure helps to reduce the severity of pain, reduces swelling, and improves local blood circulation.

In addition, timely therapeutic measures can prevent the assignment of a disability group to a patient.

Control of therapy must be carried out using ro-gram.

Prophylaxis

Radiculopathy often becomes a chronic process. To prevent recurrence of the disease, it is worth doing exercises to strengthen the muscular corset of the lower back and the entire back. Physiotherapy exercises provide protection against overload. Swimming, swimming pools are also recommended. you should limit weight lifting.

These measures minimize the likelihood of developing complications, which include myeloradiculopathy. Pain syndrome (lumbodynia) is minimized. In the event that a person was denied an extension of disability, it is worth collecting all the necessary documents, test results, ro-grams and re-commissioning.

Due to degenerative and dystrophic processes at the level of intervertebral discs, a pathology develops, which is called radiculopathy. Distinguish between discogenic and vertebrogenic forms of the disease. Vertebral radiculopathy is a secondary type of disease in which the spinal cord root is compressed in a kind of tunnel formed by various pathological processes. This can be soft tissue edema, swelling, osteophytes, disc herniation.

As the degenerative inflammatory process develops, the tunnel narrows, there is an indentation and severe pain. Most often the problem occurs at level 6-7 cervical vertebra, the first lumbar and fifth thoracic. Painful sensations appear not only in the place of compression of the nerve root, but also radiates to the extremities. It should be noted that a decrease in tendon reflexes, impaired sensitivity, paresis may appear not at the onset of the disease. Due to muscle spasm, motor activity is limited - this is an important sign of damage to the roots of the spinal cord. The duration of the disease is from 2 months to six months.

Classification

Depending on the localization, the following forms of radiculopathy are distinguished:

• chest;
• cervical;
• lumbosacral;
• mixed.

The disease can occur in adults of any age; if the disease is started, it can lead to disability. Another name for this disease is radicular syndrome. Complicated names have not taken root among the people, so you can often hear that a person suffers from sciatica. Although this name is not entirely correct.

Lumbosacral radiculopathy occurs more often than others. It affects the vertebrae L5, L4, S1. To understand which vertebrae are involved in the inflammation process, it is necessary to remember that all parts of the spine are designated by Latin names. The sacral region is Os Sacrum, therefore, the vertebrae are designated by the letter S from 1 to 5. The lumbar region is Pars Lumbalis (L1-L5). Cervical spine - Pars Cervicalis (C1-C7). Thoracic spine - Pars Thoracalis (Th1-12).

Having familiarized yourself with this classification, it is easy to understand that Th3 means damage to the third vertebra in the thoracic region, and C2 means damage to the second cervical vertebra. The level of damage is determined using an X-ray.

Exists international classification diseases - ICD 10. It is generally accepted for coding all medical diagnoses. According to the ICD of radiculotherapy, the code M 54.1 is assigned.

Etiology

The etiological factors for which radiculopathy develops include:

• Rickets.
• Osteochondrosis.
• Herniated disc.
• Osteoporosis.
• Endocrine Disorders.
• Displacement of the vertebrae or discs.
• Intervertebral disc protrusion.
• Oncological processes.

The most common cause of the disease is osteochondrosis, in which, during degenerative-dystrophic processes, the intervertebral discs dry out. They lose their elasticity, bone growths (osteophytes) appear on them, pressing on the nerve endings of the spinal cord, causing severe pain... In second place in popularity is a herniated disc. If the causes of primary radiculopathy can be an improper lifestyle, physical activity, poor posture and endocrine disorders. That secondary radiculopathy occurs only as a result of serious changes in the spinal column.

Symptoms and Diagnosis

Regardless of the classification of radiculopathy, the main symptom of the disease is pain. She overtakes a person, not abating either at rest or in motion. The pain is felt in the back, it radiates in the limbs, heart, head. There may be nausea, dizziness, hearing impairment, lack of coordination, change in gait, soreness in the legs.

Diagnostic measures that the doctor prescribes include x-rays in the lateral and anterior projection. This study is very important, but, unfortunately, it cannot show how damaged the nerve roots of the spinal cord are. Therefore, many patients definitely need to undergo an MRI. Tomography will show how much the surrounding tissues are affected, reveal the true cause of the secondary disease, and help to make the correct diagnosis faster and more correctly.

Vertebral cervical radiculopathy

Nearly 30% of the adult population suffers from neck pain. The pain can appear suddenly, be acute and subacute, occur in the morning and last all day. It increases with coughing, muscle tension, and can be given to the hand. In the place of compression of the nerve roots, numbness is possible. There is stiffness in the muscles of the neck, weakness.

Most often, with this form of the disease, the cervical root C7 suffers, a little less often C6. This is due to the high stress on the lower joints of the cervical spine. Pain can be caused by two factors:

• damage to the nerve fibers of the root due to compression, edema or inflammation, malnutrition in the tissues surrounding it;
• irritation of pain receptors in the outer layers of the damaged intervertebral disc.

Symptoms may vary depending on the localization of the infringement site. The doctor prescribes treatment after the location of the lesion of the nerve roots has been identified. For most patients, with timely access to a doctor and treatment, the prognosis is favorable.

Vertebral thoracic radiculopathy

Radiculopathy of the thoracic region is the least common. This is due to the fact that this part of the spinal column is the most protected and less vulnerable. But due to the existing osteochondrosis or a developing tumor of the spinal cord, secondary radiculopathy may occur. One awkward movement can cause severe pain. Often it looks like a pain in the heart, the disease is disguised as diseases of the internal organs.

Put correct diagnosis in this case, only a doctor can, on the basis of the studies and photographs carried out. Therefore, if there is acute pain in the chest, lungs, hypochondrium, it is worth contacting a specialist. Compression or irritation of the nerve roots is difficult to remove on your own; complex qualified treatment will be required to cope with the disease.

Vertebral lumbosacral radiculopathy (RCC)

What it is? This is the most severe type of secondary pain syndromes, characterized by persistent pain and limited mobility. It occurs in about 5% of the population, more common in men after 40 years, in women after 50. Those who are engaged in heavy physical labor are at risk.

The most common cause of the disease is a herniated disc. Clinical picture is this: the patient complains of constant intense pain or lumbago. There is pain in the lower back and / or leg. History - cases of lumbar ischialgia and lumbodynia. At first, the pain can be dull, then it grows, reaching maximum intensity.

The hernia is most often formed at the level of the L4 - L5 vertebrae. According to clinical data, L5 radiculopathy is detected in 60% of cases, and S1 in 30% of cases. In older people, hernia can occur at a high level, therefore, L3 and L4 radiculopathy is not uncommon. The diagnosis can only be made after undergoing an MRI or CT scan. Additionally, a comprehensive examination is carried out, for women a consultation with a gynecologist is required, for men - a prostate-specific antigen test.

In the international system, one code is assigned to all forms of radiculopathy - M 54.1.

General principles of treatment

In the acute period, you cannot do without bed rest. Activity should be kept to a minimum. The primary task of the doctor is to relieve pain, relieve inflammation. The doctor will select a comprehensive treatment, which in most cases has a positive effect on the course of the disease, quickly eliminates the painful syndrome. With an advanced form of the disease, if the treatment does not have the desired effect, a decision can be made about surgical intervention.

Conservative therapy

Medication includes the use of anti-inflammatory drugs and pain relievers. At the beginning of the disease, the doctor will suggest injections, they will help to relieve pain faster and more effectively. After a course of injections, a course of pills may be prescribed. Most often, the use of ointments, gels at this stage of the disease does not bring results. Drugs are prescribed by a doctor, most often they are Baralgin, Ibuprofen, Diclofenac. But they have many side effects, so using them on your own can be harmful.

Treatment can be carried out in a hospital setting. In this case, it can be expanded. To improve the microcirculation of blood in the spine, Trental can be prescribed, and to relieve muscle spasms, Midocalm. The drugs have contraindications, side effects, the treatment is carried out under the strict supervision of the attending physician.

One of the methods conservative treatment- a high dose of B vitamins. Although the results of studies in this area are contradictory, they show that drugs such as Milgamma can contribute to the rapid regression of pain in vertebral radiculopathy, increasing the effectiveness of therapy.

Therapeutic block can be used for acute and persistent pain. With the help of injections, impulses emanating from the damaged root are blocked. This measure is only effective for temporarily relieving pain, but not treating the underlying cause.

Surgical intervention

Indications for surgery may be:

• an increase in neurological symptoms;
• compression of the roots with paresis of the foot;
• dysfunction of the pelvic organs;
• deterioration of the patient's well-being, despite the received treatment.

Before surgery, conservative therapy is required; its duration is at least 6 weeks. Discectomy remains the main operation. But recently, more sparing methods have been actively used: high-frequency disc ablation, laser decompression of the intervertebral disc, microdiscectomy.

For example, for radiculopathy (code M 54.1) caused by a herniated intervertebral disc, without damage to the annulus fibrosus and the patient has no movement disorders, laser vaporization is successfully used. The use of sparing operational measures expands the range of indications for it.

Treatment and recovery measures such as physiotherapy exercises, massage, physiotherapy procedures, manual therapy aimed at relaxation and mobilization of muscles, and an increase in the mobility of the spine, the doctor can prescribe only in case of persistent remission. Traction lumbar, which was actively used earlier, was recognized as ineffective, capable of provoking deterioration.

Radiculitis, or, in other words, radicular syndrome, is one of the manifestations of osteochondrosis: degenerative changes occur in the intervertebral discs, due to which the annulus fibrosus breaks and a hernia forms. It compresses one or more roots of the spinal cord, or it exerts compression on the ligamentous apparatus of the spine. As a result of pinching the roots, radiculitis occurs.

Symptoms of sciatica

In most cases, lumbosacral and cervicobrachial sciatica occurs. The main signs that sciatica has is pain in the lower back, which can radiate to the back of the leg, buttocks, knees or lower leg. If you try to bend forward or sit down with your legs straight, the pain will be much worse. To reduce pain, the patient slightly bends the leg. Along with pain, there is tingling or numbness in the lower leg and fingers. In addition to the pain syndrome, there is a change in the patient's posture, curvature of the spine.

Radiculitis, regardless of the location, have similar symptoms: the appearance of rapid pain in the area of ​​the affected roots, which increases when the patient moves, coughs or sneezes, stiffness in the mobility of the spine; pain on palpation of the spinous processes of the vertebrae and paravertebral points; increase or decrease in sensitivity; muscle weakening in the area of ​​radicular innervation.

The pains that accompany sciatica are usually shooting, breaking, increasing when raising the leg, coughing, hypothermia. Sciatica can recur, accompanied by tension on the nerves and roots, the presence of pain points and impaired sensitivity. Lumbosacral sciatica is characterized by the appearance of pain throughout the day, regardless of the time, increase with a change in the position of the body.

Radiculitis treatment

If you have sciatica, bed rest must be strictly observed. Analgesics are used to reduce pain. Before getting out of bed, you need to fix the patient's lower back with a special belt, in the lying position it should be removed.

Blocks of novocaine, lidocaine and vitamin B12 in pain points have a positive effect. At night, you can apply a compress of Dimexide diluted with water, novocaine, analginum, vitamin B12 and hydrocortisone on the lumbar region.

Indomethacin is taken internally. To eliminate muscle tension that accompany sciatica, it is advisable to take seduxen, diazepam. Also shown is a relaxing massage of the back and buttocks. The massage should be performed by a professional so as not to injure the patient with careless movements. Sciatica can also be relieved with acupuncture and physiotherapy using current, ultrasound, etc.

Radiculitis can be calmed with the help of heat on the lumbar region (heating pad, paraffin application), mud therapy, the use of salt-pine baths are practiced. For prevention, hardening of the body, limiting physical activity, hypothermia, and long walking are also recommended.

Traction treatment, or traction of the spine, positively affects the receptors of the damaged ligaments of the spine and muscles, relaxing them. This method is widely used during the rehabilitation period after you have practically cured sciatica and has the following effect: unloads the spine, increasing the space between the segments of the spinal column; reduces muscle tension; lowers pressure inside the disc, and also relieves compression on the nerve roots.

Prophylaxis

In order to prevent sciatica, it is recommended to perform exercises that strengthen the muscles of the back, swim, avoid hypothermia, physical overload. The main task physical exercise in the treatment of sciatica - to help normalize muscle tone back, increase the mobility of the spine, improve overall well-being and accelerate the process of rehabilitation and recovery labor activity... The set of exercises is selected based on the symptoms of the disease, the general condition and age characteristics of the patient.

Radiculitis is a fairly common disease of the peripheral nervous system, which is formed as a result of compression of the roots of the spinal cord. Only a specialist can prescribe treatment and conduct an examination. For the most accurate determination of the diagnosis of sciatica, the doctor will first determine muscle strength, differentiate the symptoms, the nature of pain, their intensity, duration, determine if there is a sensitivity disorder, prescribe X-ray or other examination methods, after which complex treatment will be prescribed.

Medical Expert Editor

Alexey Portnov

Education: Kiev National Medical University them. A.A. Bogomolets, specialty - "General Medicine"