discogenic radiculopathy

Discogenic radiculopathy (radiculitis banal) - pain, motor and autonomic disorders caused by lesions of the spinal cord due to the roots of spinal osteochondrosis.

Etiology, pathogenesis. -degenerativno Osteochondrosis, degenerative process that occurs on the basis of the loss of the intervertebral disc of the damping function, which is caused by degeneration of the disc tissue, resulting in a reduction in the pressure inside it. Except in cases of injury, the etiology is unclear discopathy. In the segment of diseased disc arise relative instability of the spine with the development of vertebral osteophytes (spondylosis), damage to the ligaments and intervertebral joints arthropathy (spondylarthritis). Bulging disc (protrusion or herniation) and osteophytes can compress the roots, causing radicular pain.

In addition, the source of both local and radiating pain in the limbs are themselves damaged spinal tissue. The immediate cause of -podnyatie severity of pain, awkward movement, cold, negative emotions, infections and others. In general, at least 95% of the lumbosacral and sciatica caused by cervical vertebral osteochondrosis, and at the heart of radiculopathy is usually mechanical, compression factor . An important role is played in pain syndrome and local neurodystrophic changes in tendons, ligaments and muscles. These factors are especially pronounced in cases of myelitis contractions of individual muscles (myofascial pain).

The first attacks of the lumbar and cervical pain, apparently related to the anguish of the fibrous ring of the disc (diskalgiya) and damage to the capsule of the intervertebral joints. This predominantly affects the autonomic innervation, and the pain is diffuse (backache, myositis). Only the development of disc herniation, compressing the spine, resulting in the formation of proper radicular syndrome. The shape of the spinal column is such that the maximum load falls to the lower cervical, lower thoracic and low-lumbar departments, so the clinical picture often prevails root compression at these levels.

Cervical radiculitis. The first attack of the disease - a pain in the neck, neck muscle tension, involuntary head position, straightening the cervical lordosis. In the case of disc herniation and compression of one of the roots (usually C6 or C7), pain spreading to the arm, shoulder or the front surface of the chest; in the latter case often simulated myocardial infarction. The pain is aggravated by coughing, sneezing, head movements. Usually the pain is most pronounced in the proximal arms and distal are paresthesias. Loss of sensitivity and paresis rare. More often decrease deep reflexes. The pain intensifies at night, and patients often have to walk for many hours, "rocking" the affected arm. Sometimes the pain is reduced after laying his hands behind his head.

Breast sciatica. Girdle pain at the level of the chest or abdomen. Extremely rare variant banal sciatica.

Sciatica. During an attack of lumbago at the next exacerbation of pain in the leg extends generally along the sciatic nerve, as more than 90% of cases lyumboishialgicheskogo syndrome is caused by compression of the roots of L5 - S1. Pain is often accompanied by weakness of the flexors and extensors of the thumb or the entire foot. Often falls ankle reflex. Typical, Lasegue symptom. The defeat of the spine L4 flows with a picture of neuritis of the femoral nerve: the pain at the front of the thigh and knee, and sometimes the weakness of the quadriceps femoris muscle and loss of knee reflex. Vertebral syndrome consists of the strain of lumbar muscles, smoothing the lumbar lordosis, which is sometimes replaced with kyphosis. Especially common antalgic scoliosis. Complete loss of disc herniation leads to compression of the cauda equina (paralysis of the legs and feet, saddle anesthesia, violation of the pelvic organs).

X-ray of the spine research at myelitis usually detects low back pain, but because of the high frequency of similar findings in the population of small value. Spondylograms can not reliably verify the nature of discogenic disease, it is necessary primarily to avoid the destructive processes in the spine. When lumbar puncture in patients with sciatica is often found a moderate increase in protein content. With many years of history in the form of repeated exacerbations diagnosis of discogenic sciatica nature of the disease is evident. Very high diagnostic role antalgic scoliosis (scoliotic sciatica), which in other forms of radiculopathy is not found.

The differential diagnosis is carried out primarily with tuberculous spondylitis, Bechterew's disease, tumors of the spine and spinal cord, spondylolisthesis. The accuracy of their recognition promotes careful study of history, clinical and paraclinical data (spondylograms, CBC, the study of cerebrospinal fluid, myelography). It is essential that the discogenic radiculopathies usually suffer only one or two of the spine. It should be borne in mind the extreme rarity of discogenic syndromes in the thoracic level; compression of the root cause here is not vertebrapny osteochondrosis, and other factors.

Treatment. Spine Immobilization (bed with a hard mattress), heat, analgesics - the basic triad of medical techniques that allow in many cases, to stop the aggravation of pain. Showing irritant agents - grinding. Manual therapy. Widely apply traction, massage, exercise therapy, physiotherapy, blockade. An important role in the follow-up care and prevention of exacerbations plays spa treatment. In the case of long intense pain, despite the complete conservative therapy (3-4 months), the patient should be offered surgery - removal of disc herniation. Absolute indications for surgery arise in paralyzing sciatica, caused by compression of the cauda equina fallen drive.