RADICULITIS

Sciatica - the defeat of roots of spinal nerves, characterized by pain and impaired sensitivity of radicular type, rarely peripheral paresis. The primary cause of sciatica is osteochondrosis, degeneration of the intervertebral disc, often with their displacement (disc herniation). Less commonly, sciatica occurs when the birth defects of the spine, internal diseases, inflammatory and degenerative lesions of the spine and joints, tumors of the peripheral nervous system, bone and ligaments, gynecological diseases, spinal injuries, infectious diseases of the nervous system.

The clinical picture of sciatica has different localization features in common: spontaneous pain in the innervation of the affected root zone, aggravated by movement, coughing, sneezing and straining; limit spinal mobility, protection (analgesic) patient posture, pain with pressure on the spinous processes of the vertebrae and paravertebral points, an increase or decrease in sensitivity, movement disorders - weakness and wasting of muscles in the zone radicular innervation. In clinical practice, the most common sciatica caused by spinal osteochondrosis. Lumbosacral spine bears the greatest functional load, and accordingly intervertebral discs at this level undergo the most significant changes. Degenerative changes in the intervertebral disc accompanied by a narrowing of the intervertebral gap, compression of spinal roots in the intervertebral foramen with radicular symptoms, musculo-tonic disorders with reflex voltage innervated muscles, vegetative-vascular disorders, changes in tendons, ligaments, symptoms of compression of the spinal cord vessels.

During sciatica and radicular distinguish lyumbalgicheskuyu stage. In the first stage there is a dull, aching, but more often a sharp pain in the lumbar region. The pain can occur suddenly first in the muscles after exercise, cooling, or increase gradually, increasing by coughing, sneezing, and so on. N. There restriction of mobility in the lumbar spine, flattening the lumbar lordosis, muscle tension and soreness of the lumbar region.

As we move into the second, radicular, pain increases stage, changes the character begins to radiate in the gluteal region, in posteroexternal surface of the femur and tibia. There have symptoms of tension roots - Neri symptom (pain in the lumbar region of the head is tilted forward), Dejerine symptom (pain in the lumbar region when coughing, sneezing). Depending on the location of the affected intervertebral disc or hernia (protrusion) of the disk sensitivity disorder identified in the respective zones. So, with the defeat of IV lumbar spine pain, hyperesthesia or hypoesthesia localized in the lumbar region at the anterior-surface of the femur and tibia, medial edge of the foot. With the defeat of V lumbar spine pain localized in the lumbar region, the upper quadrants of the buttocks, on the posterolateral surface of the tibia, on the rear of the foot. The defeat of the intervertebral disc is accompanied by compression of the sacral spine I. Pain and sensitivity disorders are located in the sacrum, buttocks, back of the thigh, lower leg, the outer edge of the foot.

In some cases, the pathologic process extends from the roots to the sciatic nerve, which is accompanied by the development of symptoms of nerve trunk lesions (sciatica) pain in the lumbar region and in the course of the sciatic nerve, atrophy of the anterior group of leg muscles with feet dangling, reduction or disappearance of the Achilles reflex. Characterized as pain along the nerve trunk pain with pressure on the transverse processes IV and V of the lumbar vertebrae (back Hara point), in the midline of the abdomen below the navel (front point Hara). Positive pain reflexes tension: Lasegue symptom - raising the patient's legs straightened, is in the supine position, causing a sharp pain in the lumbar region with irradiation along the sciatic nerve (the first phase), after folding the lifted leg in the knee joint pain disappears (second phase); Bonn symptom - pain at the back of the thigh during abduction or reduction of legs straightened; spondylitis symptom - pain along the sciatic nerve with vigorous feet pressed against the patient's bed, straightened at the knee joint; planting a symptom - the emergence of pain in the lumbar region and the popliteal fossa during the transition of the patient in the prone position in a sitting position with the legs straighten.

The appearance of the patient's radicular syndrome requires careful clinical examination. All patients underwent spine radiography in frontal and lateral projections. Myelography allows you to specify the level and nature of the lesion. Recommended consulting gynecologist, urologist, oncologist to exclude tumors or metastases in a particular area that can squeeze and irritate the spinal roots.

Treatment of the complex and can be recommended only after a thorough examination of the patient. Conservative treatment during the acute phase includes bed rest for 6 - 7 days on a hard bed, receiving analgesic, anti-inflammatory agents, procaine blockade, lidocaine blockade, trimecaine. Reduction of pain contributes to the patient's position on the rigid inclined plane with a raised head end or horizontal stretching small loads on a special table with a device to reduce the lumbar lordosis. In some cases, intervertebral discs administered proteolytic enzymes (papain).

Arsenal means conservative treatment includes vitamins (B1, B12), dehydration therapy (lasix furosemide, diakarb) ganglioplegic (hexon, pentamin), muscle relaxants, hormones. By reducing acute pain administered physiotherapy (Bernard currents, ultraviolet irradiation, UHF, short-wave therapy, electrophoresis with neostigmine methylsulfate), physiotherapy, massage the neck muscles, back, limbs, underwater traction in the pool or in a special bath on board traction, underwater massage. In addition, use drugs that improve the microcirculation (teonikol, trental, komplamin), biogenic stimulators. Beyond the acute stage it is recommended spa treatment (balneotherapy, mud).

Therapeutic exercise is prescribed based on the patient's condition, the localization process. Contraindications to its use are pronounced pain, increased pain during exercise. Thanks to a specially designed exercise gradually strengthening natural "muscular corset", normalize metabolic processes in the affected segment. The use of therapeutic exercise and massage reduces pain, increase strength abdominal muscles, hip extensors, the intercostal muscles, the long muscles of the back.

When sciatica should be chosen to facilitate certain assumptions. Thus, in the supine position under his knees enclose the roller, in the prone position - a pillow under the stomach; used for unloading of the spine Bozeman's position, with emphasis on his knees. it is recommended to lie on an inclined plane (angle of inclination of 15 - 40 °) Before class physiotherapy with an emphasis in the axillary regions. Such a procedure lasting from 3 - 5 to 30 minutes helps the spine stretching, expanding intervertebral gaps, reduce the compression of the nerve roots.

With the ineffectiveness of conservative treatment produced rapid decompression of the nerve roots. Absolute indications for surgery are the symptoms of compression of the cauda equina or spinal cord.

In the prevention of sciatica important role belongs to the development of correct posture, the rational organization of work and rest. For the prevention of relapse, patients should sleep on a hard bed; pillow should be low, which eliminates the sharp bend of the neck during sleep. The load should not be lifted "back" (bent on completely straightened feet), it is better to use a reception weight lifter - lifting cargo "feet" (crouching slightly). Persons whose profession is associated with prolonged periods of sitting, it is useful to learn to sit, leaning back in his chair and creating a focus on both legs, are advised to avoid prolonged awkward postures.