Radicular pain syndrome microbial 10. Damage to the nerve roots and plexuses

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2017

Pain in the thoracic spine (M54.6), Pain in the lower back (M54.5), Dorsalgia other (M54.8), Sciatica (M54.3), Lumbago with sciatica (M54.4), Disorders of thoracic roots, not elsewhere classified G54.3, Disorders of the intervertebral discs of the lumbar and other parts with radiculopathy (M51.1), Disorders of the brachial plexus (G54.0), Disorders of the lumbosacral plexus (G54.1), Disorders of the lumbosacral roots, not classified elsewhere (G54.4), Cervical root disorders not elsewhere classified (G54.2), Radiculopathy (M54.1), Cervicalgia (M54.2)

Neurology

general information

Short description

Approved by the Joint Commission on Medical Quality
Ministry of Health of the Republic of Kazakhstan
dated November 10, 2017
Protocol #32

Damage to the nerve roots and plexuses can have both vertebrogenic(osteochondrosis, ankylosing spondylitis, spondylolisthesis, Bechterew's disease, lumbarization or sacralization in the lumbosacral region, vertebral fracture, deformities (scoliosis, kyphosis)), and non-vertebrogenic etiology(neoplastic processes (tumors, both primary and metastases), damage to the spine by an infectious process (tuberculosis, osteomyelitis, brucellosis) and others.

According to ICD-10 vertebrogenic diseases referred to as dorsopathy (M40-M54) - a group of diseases of the musculoskeletal system and connective tissue, in the clinic of which the leading pain and / or functional syndrome in the trunk and limbs of non-visceral etiology [ 7,11 ].
According to ICD-10, dorsopathies are divided into the following groups:
Dorsopathies caused by spinal deformity, degeneration of intervertebral discs without their protrusion, spondylolisthesis;
spondylopathy;
dorsalgia.
The defeat of the nerve roots and plexuses is characterized by the development of the so-called dorsalgia (ICD-10 codes M54.1- M54.8 ). In addition, damage to the nerve roots and plexuses according to ICD-10 also includes direct lesions of the roots and plexuses, classified under headings ( G 54.0- G54.4) (lesions of the brachial, lumbosacral plexus, lesions of the cervical, thoracic, lumbosacral roots, not elsewhere classified).
Dorsalgia - diseases associated with back pain.

INTRODUCTION

ICD-10 code(s):

Classification

By localization:

· cervicalgia;
thoracalgia;
lumbodynia;
Mixed localization (cervicothoracalgia).

According to the duration of the pain syndrome :
acute - less than 6 weeks,
subacute - 6-12 weeks,
· chronic - more than 12 weeks.

According to etiological factors(Bogduk N., 2002):
Trauma (overstretching of muscles, rupture of fascia, intervertebral discs, joints, sprains, sprains, joints, fracture of bones);
Infectious lesion (abscess, osteomyelitis, arthritis, discitis);
inflammatory lesions (myositis, enthesopathy, arthritis);
tumor (primary tumors and mestastases);
biomechanical disorders (formation of trigger zones, tunnel syndromes, joint dysfunction).

Diagnostics

METHODS, APPROACHES AND DIAGNOSIS PROCEDURES

Diagnostic criteria

Complaints and anamnesis
Complaints:
on pain in the zone of innervation of the affected roots and plexuses;
· for violation of motor, sensory, reflex and vegetative-trophic functions in the zone of innervation of the affected roots and plexuses.

Anamnesis:
Prolonged physical static load on the spine (sitting, standing);
hypodynamia;
a sharp lifting of weights;
hyperextension of the spine.

Physical examination
· in andZualinspection:
- assessment of spinal statics - antalgic posture, scoliosis, smoothness of physiological lordosis and kyphosis, defense of the paravertebral muscles of the affected spine;
- assessment of dynamics - limitation of movements of the arms, head, various parts of the spine.
· PalpaciI: pain on palpation of the paravertebral points, spinous processes of the spine, Valle points.
· PercusiI malleus of the spinous processes of various parts of the spine - a positive symptom of Razdolsky - a symptom of the "spinous process".
· positive tonut samples:
- Lassegue's symptom: pain appears when the straightened leg is bent at the hip joint, measured in degrees. The presence of the Lasegue symptom indicates the compression nature of the disease, but does not specify its level.
- Wassermann's symptom: the appearance of pain when lifting the straightened leg back in the prone position indicates damage to the L3 root
- Matskevich's symptom: the appearance of pain when bending the leg in the knee joint in the prone position indicates damage to the L1-4 roots
Bechterew's symptom (Lasegue's cross symptom): the appearance of pain in the supine position when the straightened healthy leg is bent at the hip joint and disappears when it is bent at the knee.
- Neri's symptom: the appearance of pain in the lower back and leg when bending the head in the supine position indicates damage to the L3-S1 roots.
- a symptom of a cough shock: pain when coughing in the lumbar region at the level of the spinal lesion.
· aboutpricebutmotorfunctions for the study of reflexes: decline (fall out) next tendon reflexes.
- flexion-elbow reflex: a decrease / absence of a reflex may indicate damage to the CV - CVI roots.
- extensor-elbow reflex: a decrease / absence of a reflex may indicate damage to the CVII - CVIII roots.
- carpo-radial reflex: a decrease / absence of a reflex may indicate damage to the CV - CVIII roots.
- scapular-brachial reflex: a decrease / absence of a reflex may indicate damage to the CV - CVI roots.
- upper abdominal reflex: decrease / absence of the reflex may indicate damage to the DVII - DVIII roots.
- middle abdominal reflex: decrease / absence of the reflex may indicate damage to the DIX - DX roots.
- lower abdominal reflex: a decrease / absence of a reflex may indicate damage to the DXI - DXII roots.
- cremaster reflex: a decrease / absence of a reflex may indicate damage to the LI - LII roots.
- patellar reflex: a decrease / absence of a reflex may indicate damage to both the L3 and L4 roots.
- Achilles reflex: a decrease / absence of a reflex may indicate damage to the SI - SII roots.
- Plantar reflex: decreased / absent reflex may indicate damage to the L5-S1 roots.
- Anal reflex: decrease/absence of the reflex may indicate damage to the SIV - SV roots.

Scheme for express diagnosis of root lesions :
· PL3 root lesion:
- positive symptom of Wasserman;
- weakness in the extensors of the lower leg;
- violation of sensitivity on the anterior surface of the thigh;

· lesion of L4 root:
- violation of flexion and internal rotation of the lower leg, supination of the foot;
- violation of sensitivity on the lateral surface of the lower third of the thigh, knee and anteromedial surface of the lower leg and foot;
- Change in knee jerk.
· L5 root lesion:
- Violation of walking on the heels and dorsal extension of the thumb;
- violation of sensitivity on the anterolateral surface of the lower leg, the dorsum of the foot and I, II, III fingers;
· lesion of S1 root:
- violation of walking on toes, plantar flexion of the foot and fingers, pronation of the foot;
- violation of sensitivity on the outer surface of the lower third of the leg in the region of the lateral ankle, the outer surface of the foot, IV and V fingers;
- change in the Achilles reflex.
· aboutpricebutsensitive functionAnd(sensitivity study on skin dermatomes) - the presence of sensory disturbances in the zone of innervation of the corresponding roots and plexuses.
· laboratoryresearch: No.

Instrumental research:
Electromyography: clarification of the level of damage to the roots and plexuses. Identification of secondary neuronal muscle damage makes it possible to determine the level of segmental damage with sufficient accuracy.
Topical diagnosis of damage to the cervical roots of the spine is based on testing the following muscles:
C4-C5 - supraspinatus and infraspinatus, small round;
C5-C6 - deltoid, supraspinous, biceps shoulder;
C6-C7 - round pronator, triceps muscle, radial flexor of the hand;
C7-C8 - common extensor of the hand, triceps and long palmar muscles, ulnar flexor of the hand, long muscle that abducts the first finger;
C8-T1 - ulnar flexor of the hand, long flexors of the fingers of the hand, own muscles of the hand.
Topical diagnosis of lesions of the lumbosacral roots is based on the study of the following muscles:
L1 - ilio-lumbar;
L2-L3 - iliopsoas, graceful, quadriceps, short and long adductors of the thigh;
L4 - iliopsoas, tibialis anterior, quadriceps, large, small and short adductors of the thigh;
L5-S1 - biceps femoris, long extensor of the toes, tibialis posterior, gastrocnemius, soleus, gluteal muscles;
S1-S2 - own muscles of the foot, long flexor of the fingers, gastrocnemius, biceps femoris.

Magnetic resonance imaging:
MR signs:
- bulging of the fibrous ring beyond the posterior surfaces of the vertebral bodies, combined with degenerative changes in the disc tissue;
- protrusion (prolapse) of the disc - protrusion of the nucleus pulposus due to thinning of the fibrous ring (without rupture) beyond the posterior edge of the vertebral bodies;
- prolapse of the disc (or disc herniation), the release of the contents of the nucleus pulposus beyond the fibrous ring due to its rupture; disc herniation with its sequestration (the dropped out part of the disc in the form of a free fragment is located in the epidural space).

Expert advice:
consultation of a traumatologist and/or neurosurgeon - if there is a history of trauma;
· consultation of a rehabilitation specialist - in order to develop an algorithm for a group/individual exercise therapy program;
consultation of a physiotherapist - in order to resolve the issue of physiotherapy;
psychiatric consultation - in the presence of depression (more than 18 points on the Beck scale).

Diagnostic algorithm:(scheme)

Differential Diagnosis

Differential Diagnosisand rationale for additional research

Table 1.

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Treatment

Drugs (active substances) used in the treatment

Treatment (ambulatory)

TACTICS OF TREATMENT AT OUTPATIENT LEVEL:

Non-drug treatment:
mode III;
· exercise therapy;
maintaining physical activity;
Diet number 15.
kinesio taping;
Indications:
· pain syndrome;
muscle spasm;
violation of motor function.
Contraindications:
individual intolerance;
Violation of the integrity of the skin, flabbiness of the skin;

NB! In case of pain syndrome, it is carried out according to the mechanism of estero-, proprioceptive simulation.

Medical treatment:
For acute pain table 2 ):


non-narcotic analgesics - have a pronounced analgesic effect.
An opioid narcotic analgesic has a pronounced analgesic effect.

For chronic pain( table 4 ):
NSAIDs - eliminate the effect of inflammatory factors in the development of pathobiochemical processes;
Muscle relaxants - reduce muscle tone in the myofascial segment;
non-narcotic analgesics - have a pronounced analgesic effect;
opioid narcotic analgesic has a pronounced analgesic effect;
Cholinesterase inhibitors - in the presence of motor and sensory disorders improves neuromuscular transmission.

Treatment regimens:
NSAIDs - 2.0 i / m No. 7 e / day;
flupirtine maleate orally 500 mg 2 times a day.
Additional drugs: in the presence of nociceptive pain - opioid narcotic analgesics (in transdermal and / muscle form), in the presence of neuropathic pain - antiepileptic drugs, in the presence of motor and sensory disorders - cholinesterase inhibitors.

List of Essential Medicines for Acute Pain(having a 100% cast chance) :
Table 2.

Treatment (hospital)

TACTICS OF TREATMENT AT THE STATIONARY LEVEL:
leveling of pain syndrome;
Restoration of sensitivity and motor disorders;
Use of peripheral vasodilators, neuroprotective drugs, NSAIDs, non-narcotic analgesics, muscle relaxants, anticholinesterase drugs.

Patient follow-up card, patient routing: no.

Non-drug treatment:
Mode III
diet number 15,
physiotherapy (thermal procedures, electrophoresis, paraffin therapy, acupuncture, magneto-, laser-, UHF-therapy, massage), exercise therapy (individual and group), kinesio taping

Medical treatment

Scroll essential medicines(having a 100% cast chance) :

Hospitalization

INDICATIONS FOR HOSPITALIZATION WITH INDICATING THE TYPE OF HOSPITALIZATION

Indications for planned hospitalization:
failure of outpatient treatment.

Indications for emergency hospitalization:
Severe pain syndrome with signs of radiculopathy.

Information

Sources and literature

1. Minutes of the meetings of the Joint Commission on the quality of medical services of the Ministry of Health of the Republic of Kazakhstan, 2017
   1. 1. Barulin A.E., Kurushina O.V., Kalinchenko B.M. Application of kinesio taping technique in neurological patients // BC. 2016. No. 13. pp. 834-837. 2. Belskaya G.N., Sergienko D.A. Treatment of dorsopathy from the standpoint of efficiency and safety // BC. 2014. No. 16. S.1178. 3. Danilov A.B., N.S. Nikolaeva, The effectiveness of a new form of flupirtine (Katadolon forte) in the treatment of acute back pain //Manage pain. - 2013. - No. 1. - P. 44-48. 4. Kiselev D.A. Kinesio taping in the medical practice of neurology and orthopedics. St. Petersburg, 2015. -159 p. 5. Clinical protocol "Nerve root and plexus damage" dated 12.12.2013. 6. Kryzhanovsky, V.L. Back pain: diagnosis, treatment and rehabilitation. - Minsk: DD, 2004. - 28 p. 7. Levin O.S., Shtulman D.R. Neurology. Handbook of practical doctor. M.: MEDpress-inform, 2012. - 1024s. 8. Neurology. National leadership. Brief edition / ed. Guseva E.I. M.: GEOTAR - Media, 2014. - 688 p. 9. Podchufarova E.V., Yakhno N.N. Backache. - : GEOTAR-Media, 2014. - 368s. 10. Putilina M.V. Peculiarities of diagnostics and treatment of dorsopathy in neurological practice // Сopsilium medicum. - 2006. - No. 8 (8). – P. 44–48. 11. Skoromets A.A., Skoromets T.A. Topical diagnosis of diseases of the nervous system. SPb. "Polytechnic", 2009. 12. Subbotin F. A. Propaedeutics of functional therapeutic kinesiology taping. Monograph. Moscow, Ortodinamika Publishing House, 2015, -196 p. 13. Usmanova U.U., Tabert R.A. Features of the use of kinesio tape in pregnant women with dorsopathy // Proceedings of the 12th international scientific and practical conference "Education and Science of the XXI century - 2016". Volume 6. P.35 14. Erdes Sh.F. Nonspecific pain in the lower back. Clinical recommendations for local therapists and general practitioners. - M .: Kit Service, 2008. - 70s. 15. Alan David Kaye Case Studies in Pain Management. - 2015. - 545 rubles. 16. Bhatia A., Bril V., Brull R.T. et al. Study protocol for a pilot, randomised, double-blinded, placebo controlled trial of perineural local anaesthetics and steroids for chronic post-traumatic neuropathic pain in the ankle and foot: The PREPLANS study.// BMJ Open/ - 2016, 6(6) . 17. Bishop A., Holden M.A., Ogollah R.O., Foster N.E. EASE Back Study Team. Current management of pregnancy-related low back pain: A national cross-sectional survey of UK physiotherapists. //Physiotherapy.2016; 102(1):78–85. 18. Eccleston C., Cooper T.E., Fisher E., Anderson B., Wilkinson N.M.R. Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 8 Art. No.: CD012537. DOI: 10. 1002 / 14651858. CD 012537. Pub 2. 19. Elchami Z. , Asali O., Issa M.B. and Akiki J. The efficacy of the combined therapy of pregabalin and cyclobenzaprine in the treatment of neuropathic pain associated with chronic radiculopathy. // European Journal of Pain Supplements, 2011, 5(1), 275. 20. Grant Cooper Non-operative Treatment Of The Lumbar Spine. - 2015. - 163 rubles. 21. Herrmann W.A., Geertsen M.S. Efficacy and safety of lornoxicam compared with placebo and diclofenac in acute sciatica/lumbo-sciatica: an analysis from a randomised, double-blind, multicentre, parallelgroup study. //Int J Clin Pract 2009; 63(11): 1613–21. 22. Interventional Pain Control in Cancer Pain Management/Joan Hester, Nigel Sykes, Sue Pea $283 23. Kachanathu S.J., Alenazi A.M., Seif H.E., et al. Comparison between kinesio taping and a traditional physical therapy program in treatment of nonspecific low back pain. //J. Phys Ther Sci. 2014; 26(8):1185–88. 24. Koleva Y. and Yoshinov R. Paravertebral and radicular pain: Drug and/or physical analgesia. // Annals of physical and rehabilitation medicine, 2011, 54, e42. 25. Lawrence R. Robinson M.D. Trauma Rehabilitation. - 2005. - 300 rubles. 26. McNicol E.D., Midbari A., Eisenberg E. Opioids for neuropathic pain. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006146. DOI: 10.1002/14651858.CD006146.pub2. 27. Michael A. Uberall, Gerhard H.H. Mueller-Schwefe, and Bernd Terhaag. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study October 2012, Vol. 28, no. 10, Pages 1617-1634 (doi:10.1185/03007995.2012.726216). 28. Moore R.A., Chi C.C., Wiffen P.J., Derry S., Rice ASC. Oral nonsteroidal anti-inflammatory drugs for neuropathic pain. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD010902. DOI: 10.1002/14651858.CD010902.pub2. 29. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study].//Fortschr Med Orig. 2003;121(1):11-8. German. 30. Neuropathic pain - pharmacological management. The pharmacological management of neuropathic pain in adults in non-specialist settings. NICE clinical guideline 173. Issued: November 2013. Updated: February 2017. http://guidance.nice.org.uk/CG173 31. Pena Costa, S.Silva Parreira. Kinesiotaping in Clinical practice (Systematic review). - 2014. - 210p. 32. Rossignol M., Arsenault B., Dione C. et al. Clinic in low back pain in interdisciplinary practice guidelines. – Direction de sante publique. Montreal: Agence de la santé et des services sociaux de Montreal. - 2007. - P.47. 33. Schechtmann G., Lind G., Winter J., Meyerson BA and Linderoth B. Intrathecal clonidine and baclofen enhance the pain-relieving effect of spinal cord stimulation: a comparative placebo-controlled, randomized trial. // Neurosurgery, 2010, 67(1), 173.

Information

ORGANIZATIONAL ASPECTS OF THE PROTOCOL

List of protocol developers with qualification data:
1) Kispayeva Tokzhan Tokhtarovna - doctor of medical sciences, neuropathologist of the highest category of RSE on REM "National Center for Occupational Health and Occupational Diseases";
2) Kudaibergenova Aigul Serikovna - Candidate of Medical Sciences, neuropathologist of the highest category, Deputy Director of the Republican Coordinating Center for Stroke Problems of JSC "National Center for Neurosurgery";
3) Smagulova Gaziza Azhmagievna - Candidate of Medical Sciences, Associate Professor, Head of the Department of Propaedeutics of Internal Diseases and Clinical Pharmacology of RSE on REM "Marat Ospanov West Kazakhstan State Medical University".

Indication of no conflict of interest: no.

Reviewer:
Baymukhanov Rinad Maratovich - Associate Professor of the Department of Neurosurgery and Neurology of the FNPR RSE on REM "Karaganda State Medical University", doctor of the highest category.

Indication of the conditions for the revision of the protocol: revision of the protocol 5 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.

Attached files

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The cause of the syndromes is more often mechanical compression of the root and the radicular artery, which may be inside or near the root. Clinically, the syndrome is expressed by radiculo-ischemia or radiculomyeloishemia, ischemia of the lumbar thickening of the spinal cord, ischemia of the cone and epiconus of the spinal cord.

Complaints of the patient and neurological symptoms depend on the level of damage to the spinal cord, the rate of development of ischemia. Most often, such patients are referred to the neurosurgical department for removal of the intervertebral hernia, after which the patients are treated by a neuropathologist or physiotherapist.

The treatment of such patients is time-consuming, the effectiveness of the therapy depends on the duration of the process. The earlier treatment is started, the more capacious the recovery process. It was noted that the best dynamics was observed with the duration of the disease up to 1 year.

IR spectrum lasers are used on the segment and on the radiculomedullary arteries, at the level of the roots L5-S1. The neurovascular bundle of the affected limb, the region of the neck of the fibula, and the anterior tibial muscle are also subject to laser exposure. Laser therapy should be combined with medical treatment.

It should be remembered that osteochondrosis of the spine is a rare cause of back pain (10%). Most often, the cause of such pains are functional blockades, inflammatory-dystrophic changes in the musculoskeletal system: damage to the intervertebral joints - spondyloarthrosis, ligaments (anterior and posterior longitudinal, yellow, interspinous, intertransverse, sacrospinous, sacro-tuberous and ilio-lumbar), fascia, muscles of the back and limbs (myofascial syndrome). Rare causes of back pain and therefore poorly diagnosed are fibromyalgia, spinal osteoporosis, instability of individual vertebrae, lateral recessus stenosis, and stiff filament syndrome.

Myofascial syndrome is manifested by non-generalized, non-specific muscle pain and is non-segmental. This pain is caused by dysfunction of myofascial tissues and the appearance in the muscle of foci of increased irritability (trigger points, when pressed, pain occurs in a remote part of the body) or foci of myogenosis. It is assumed that this pain occurs when the facet joints are damaged, as well as when overstraining and overstretching the muscles with an uncomfortable posture during work, with shortening of the leg, oblique pelvis, flat feet, and stress.

Mythoascial pain syndromes should be treated in a complex manner, first magnetic laser therapy with an IR laser is performed at the points of maximum pain for 1-3 minutes, then after 5-10 minutes.

IR lasers are recommended for the treatment of myofascial lumboischialgic syndromes. The exposure time to the painful trigger zone is 1-2-4 minutes, the total exposure time is up to 15 minutes, it is practiced in the procedure for changing the frequency values.

On the first day, a frequency of 80 Hz is chosen,

on the second day 150 Hz,

on the third day - 300 Hz,

on the fourth day - 600 Hz,

on the fifth day -1500 Hz,

on the sixth day - 3000 Hz,

on the seventh day - 1500 Hz,

on the eighth day - 600 Hz,

on the ninth day - 300 Hz,

on the tenth day - 150 Hz,

on the eleventh day - 80 Hz.

No more than 10-15 zones of influence are taken for the procedure. The trigger zone and the area around the zone are irradiated with slow circular movements, firmly pressing the emitter to the surface of the body. Be sure to irradiate the projection of the area of ​​the vertebral motor segments at the level of L3-S1, 2 minutes for each zone.

Preference is given to the BIM block emitter with the maximum radiation power.

Osteochondrosis with radicular syndrome is otherwise called sciatica or radiculopathy. Infringement of the nerves can occur in any part of the spine, causing severe pain and temporarily completely removing the patient from working condition. According to ICD-10, the pathology does not have its own code (osteochondrosis of the spine - M42, radicular syndrome in the neck, chest and lower back with the sacrum, respectively - G54.2 - 54.4 and 54.1)

What is radicular syndrome? This is a consequence of neglected osteochondrosis, as well as a herniated disc and other pathologies. The mechanism of formation is simple - there is an infringement of the nerves by the vertebral bodies due to the drying of the intervertebral discs due to degenerative-dystrophic processes in them. Usually, radiculopathy overtakes people of age, however, a sedentary lifestyle, a weak muscular corset around the spine and other reasons often provoke the onset and progression of osteochondrosis in young people.

Clinical manifestations by groups

The nerve can be pinched in any part of the spine, so the symptoms will vary. The only general will be pain directly at the site of compression of the nerve bundle.

Symptoms of radicular syndrome of the cervical spine:

• Weakness of the muscles of the upper limbs, which is expressed in the inability to hold more or less heavy objects - the fingers simply unclench.
• Constant "tracking" of hands during sleep, "goosebumps", local freezing (cold hands, although the room is hot).
• Unreasonable headaches, dizziness.
• Persistent increase in blood pressure.
• Pain in the shoulder girdle and neck.

Symptoms of radicular syndrome of the thoracic spine are disguised as other pathologies. With pinched nerves in this area, the following are observed:

• discomfort in the esophagus and stomach;
• supposedly a foreign body in the throat;
• pain behind the sternum, under the scapula (shoulder blades), under the armpits, girdle;
• weakness of the muscles of the upper limbs;
• pain in the region of the heart.

On a note. Cervical-thoracic osteochondrosis is a combined pathology in which both the cervical and thoracic spine are simultaneously affected. Accordingly, the probability of infringement of the nerves in two places at once is quite large.

Symptoms of sciatica in the lumbar spine (lumbar and lumbosacral osteochondrosis) are familiar to most. This:

• pain in the lower back, shooting into the buttock and giving to the leg along the nerve (with infringement of the sciatic nerve);
• violation of urination (too frequent or, on the contrary, extremely rare);
• increased pain when bending and lifting weights;
• pain in a horizontal position when changing the position of the body, which is often accompanied by sweating, redness and hyperthermia of the skin.

Diagnostics

Before sending the patient for hardware research, the doctor carefully examines him, talks, clarifying the anamnesis. Next, an x-ray is taken in two projections. If the pictures cannot establish an accurate diagnosis (no infringement is visible), the patient is sent for an MRI. Magnetic resonance imaging determines problem areas very accurately and is the best diagnostic method for radicular syndrome in osteochondrosis.

Therapy

The standard recommendation for the treatment of sciatica is rest. However, according to some doctors - the authors of therapeutic exercises - this only aggravates the situation. You can and should move, but you need to do it correctly so that the pain does not increase, but rather gradually subsides, and without the help of potent analgesics.

However, official medicine does not listen to the opinion of such doctors. The standard treatment regimen for radicular syndrome:

• rest - until the pain subsides;
• taking a certain set of pills;
• physiotherapy procedures;
• massage;
• visiting the office of a manual therapist;
• physiotherapy.

Tablets and ointments

The main emphasis is on drug therapy, which includes several groups of drugs:

• non-steroidal anti-inflammatory external - Nimesil, Nise, Diclofenac;
• muscle relaxants - drugs that relieve muscle spasm;
• a complex of vitamins of group B - to improve nerve conduction;
• chondroprotectors - nourish the cartilage, at a young age contribute to its regeneration.

As an additional effect, external agents are used - ointments, gels, creams. Usually they are based on NSAIDs. There are also combined and warming agents. Menovazin can be used as an ambulance for muscle spasm in the cervical-collar zone.

On a note. With severe pain, novocaine blockade is used to alleviate the patient's condition.

Physiotherapy

This is electrophoresis with Novocain or Prednisolone (or Kenalog-40). A good effect is given by magnetotherapy and vibroacoustic effects. In medical centers where there is a skenar therapy room, patients are provided with quite effective assistance, influencing the area of ​​pain and in the course of its spread by the skenar device.

Pain in sciatica is well relieved by dry heat, but not everyone can warm their lower back or chest. That's why it's so important to see a doctor rather than treat yourself.

Massage

It can bring relief or vice versa aggravate the situation. It is important that the massage therapist has a medical background and knows how to treat the patient's back. Improper massage may result in increased pain or complete immobilization of the patient.

Manual therapy

The main task of a chiropractor is to relieve pain, muscle tension and, if possible, release the pinched nerve. The impact is carried out in three different ways - it is done:

• segmental massage, which relaxes tight and tones relaxed muscles;
• mobilization - the spine in the zone of nerve infringement is stretched using various techniques, traction can be used (natural - under the weight of one's own body, and forced - with the help of additional weights).
• force impact - activity returns to the spine.

On a note. Manual therapy is contraindicated in oncological diseases of the spine, infectious diseases of any etiology, high blood pressure, pathologies of the hematopoietic system, during pregnancy, after surgery.

Physiotherapy

Designed to strengthen the muscles that support the spine. There are several sets of exercises - Peter Popov and Yuri Popov. Because of the same names, the methods are often confused, although they are completely different. Interestingly, both of them are effective and have proven themselves well in the treatment of radicular syndrome in osteochondrosis. Petr Popov's gymnastics is based on micromovements. Yuri Popov believes that bipedalism is the source of all troubles with the human spine. His set of exercises is performed lying down.

ethnoscience

Here, external means are mainly used - rubbing, ointments, compresses. It is clear that only the symptoms of infringement, such as pain and inflammation, are eliminated, while the cause itself remains. However, some folk remedies can be used as an ambulance:

1. Grate the black radish on a fine grater. Put the gruel on the gauze and form something like a mustard plaster. Put on a sore spot, secure and wrap with a scarf. Keep on condition. Change the compress once a day.
2. Take a relaxing bath. Then ask a relative to give you a back massage with fir oil. This is an effective remedy for sciatica and inflammatory diseases of the joints, such as arthritis and arthrosis.
3. Ask relatives to put jars. Only not on the spine, but nearby, along the inflamed nerve. Usually, several procedures are enough for the radicular syndrome to recede for a long time.

How to treat radicular syndrome can only be told by a doctor. Self-medication is not recommended, as it is impossible to determine the cause of back pain on your own. An accurate diagnosis is made on the basis of hardware studies. The doctor prescribes treatment, which, among other methods, can include folk recipes - as an adjuvant that relieves pain and inflammation.

Radicular syndrome does not occur immediately, as a rule, it leads to a long degenerative process in the intervertebral discs, which ends with the formation of a hernia. In turn, the hernia, growing and shifting, can damage the spinal root and ganglion, which leads to its compression and the development of an inflammatory reaction, as a result, radiculopathy and radicular syndrome develop.
The standard instrumental method for diagnosing radicular syndrome includes radiography of the spine in the anterior and lateral projections. Today, the most sensitive and informative method for diagnosing spinal pathology is magnetic resonance imaging. However, when establishing a diagnosis of radicular syndrome, clinical symptoms play an important role.
The first and most characteristic sign of radicular syndrome is pain along the course of the nerve involved. So, the process in the cervical spine causes pain in the neck and arm, in the chest - in the back, sometimes there are sensations of characteristic pains in the heart or stomach (such pains disappear only after the treatment of radicular syndrome), in the lumbar - in the lumbar region, buttocks and lower extremities and so on. When moving or lifting weights, the pain intensifies. Sometimes the pain is in the form of backaches that radiate to different parts of the body in accordance with the location of the corresponding nerve; in the lumbar region, such a backache is called lumbago. The pain may be constant, but it still increases with any careless movement (for example, lumbalgia - pain in the lumbar region). Attacks of pain can be provoked by physical or emotional stress, hypothermia. Sometimes pain occurs at night or during sleep, accompanied by redness and swelling of the skin, excessive sweating.
Another sign of radicular syndrome is a violation of sensitivity in the zone of innervation of this nerve: with a slight tingling of the needle in this zone, a sharp decrease in sensitivity is noted compared to the same area on the opposite side.
The third sign of radicular syndrome is a violation of movements that appear with changes in the muscles that occur against the background of damage to the nerves innervating them. Muscles shrink (atrophy), become weak, sometimes it can be seen even by eye, especially when comparing two limbs.
The pain is localized in the area of ​​root compression and in those organs that are innervated by the damaged spinal nerve. For example, if the root is damaged at the level of the 5th lumbar vertebra (L5), pain is determined in the lumbar region (lumbalgia), while walking - in the upper outer quadrant of the buttock, radiating along the outer surface of the thigh and lower leg to the II-IV toes of the foot (lumbalgia). When the L4 root is damaged, the pain spreads from the buttock through the anterior surface of the thigh and the anterior-inner surface of the lower leg to the inside of the foot.
Since the composition of the spinal root includes the motor processes of the neuron and sensory nerve fibers, with radicular syndrome there may be a violation (decrease) in the sensitivity of the tissue. For example, with L5 radicular syndrome, the sensitivity of the skin (hypesthesia) in the region of the outer surface of the thigh and lower leg decreases.

Osteochondrosis of the spine is an insidious disease and, perhaps, one of the most common. Very often, people do not suspect that they are sick, and they attribute pain in the lumbar region, in the thoracic region or in the neck region to a variety of reasons for their occurrence. However, osteochondrosis can be so different, with so many manifestations, that it is worth treating it with due attention, it is especially often observed in women. An experienced doctor can accurately determine the cause of the disease, using the ICD code and signs of osteochondrosis. The disease is divided into 3 degrees, each of which has its own characteristics.

1. Osteochondrosis of the 1st degree is characterized by pain in the muscles, this is provoked by damage to the capsule of the intervertebral disc, and the load on the spine is redistributed. This leads to constant irritation of the above area and, as a result, to periodic pain.
2. Osteochondrosis of the 2nd degree is characterized by the presence of constant pain, that is, the disease becomes chronic, and pain intensifies with exercise. The intervertebral disc is erased, ceases to fully perform its functions and as a result; the peripheral parts of the nervous system are affected.
3. Grade 3 is the most difficult, as a hernia can form. This is due to the violation and displacement of the collagenous capsule, the pulp penetrates through the gaps and very severe pain occurs. The disc may fall out, then the patient becomes practically inactive, unable to straighten up.

radicular syndrome

This common disease is characterized by several symptoms that occur due to compression of the roots or nerves, they are called spinal. It provokes this compression, and the reason may also be due to the presence of:

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• hernia;
• tumors;
• spinal injury, vertebral fracture;
• infectious disease of the spine;
• spondylarthrosis;
• compression by lateral osteophytes.

It takes a long time before such a syndrome can develop, and a hernia is formed. It is she who, growing, squeezes, causes inflammation and the development of radiculopathy, the so-called osteochondrosis with radicular syndrome. Radiography helps to identify the disease, the spine in two projections. The most complete picture is presented after MRI, however, in the diagnosis, it is important to take into account the symptoms, since they play an important role.

The main complaint with which patients turn to a medical institution, assuming that they are sick with osteochondrosis with radicular syndrome, is pain and numbness, these are signs of osteochondrosis. The concentration of pain occurs in places of root compression and in organs that are innervated by the affected spinal nerve. The following relation is defined:

• the root in the area of ​​the fifth vertebra is damaged - pain in the lumbar region, called lumbalgia;
• root at the level of the fourth vertebra - pain is felt starting from the buttock and passes along the thigh, ending in the lower leg;
• the eighth cervical root affects the shoulder area;
• the sixth extends about the neck and shoulder blades over the shoulder to the hand.

With radicular syndrome, there may be the following signs of osteochondrosis:

• reduced sensitivity of the skin;
• sharp or aching pain in the lumbar region, it is important not to confuse with kidney or other pain.

In the ICD, osteochondrosis corresponds to a specific code. M51.1, for example, degeneration of the intervertebral discs of the lumbar and other departments with radiculopathy. So, each disease has its own code, which helps doctors navigate in terms, reduces time, and eliminates sometimes inappropriate explanations for a suspicious patient. ICD is a convenient system that has been tested and shows excellent results.

Here are some codes for diseases of the spine, corresponding to the ICD:

• M41.1 - adolescent idiopathic scoliosis;
• M41 - scoliosis;
• M42 - code for osteochondrosis of the spine;

The code carries certain information, which can only be understood by a specialist. ICD codes for the spine, or diseases associated with the spine, are in the dorsopathy section in the range from M-40 to M-54. Not all diseases are associated with osteochondrosis, it is necessary to correctly interpret the signs of osteochondrosis.

Osteochondrosis with radicular syndrome, treatment

First of all, bed rest is necessary, and strict. The bed should be with a hard surface. Painkillers and anti-inflammatory drugs are prescribed. You can apply local irritants, that is, ointments, and pepper patch.

Since osteochondrosis with radicular syndrome often becomes chronic, it is important to adhere to a certain scheme, the course should not be long-term. When taking such drugs, side effects occur, so the emphasis should be on more gentle methods, such as:

• physiotherapy;
• massage;
• electrophoresis;
• physiotherapy;
• diet.

In more severe cases, a decision is made on surgical intervention. Prevention has proven itself well, the main element is therapeutic exercises aimed at strengthening the back muscles.

There is such a thing as the international classification of diseases, ICD. Each disease corresponds to a specific code, which is easy to navigate, the ICD code greatly simplifies the doctor's work. In the international classification of ICD-10, osteochondrosis has its own code. Further, each type of disease that is related to this disease is assigned a different code, following the ICD.

No need to treat joints with pills!

Have you ever experienced unpleasant joint discomfort, annoying back pain? Judging by the fact that you are reading this article, you or your loved ones are faced with this problem. And you know firsthand what it is.