Sciatica: ICD-10 code, pathology characteristics, therapy and prevention

Polyneuropathy is a disease that affects many peripheral nerves. Neurologists at the Yusupov Hospital determine the cause of the development of the pathological process, the localization and severity of damage to nerve fibers using modern diagnostic methods. Professors and doctors of the highest category take an individual approach to the treatment of each patient. Complex therapy of polyneuropathies is carried out with effective drugs registered in the Russian Federation. They have a minimal range of side effects.

The following types of neuropathies are registered in the International Classification of Diseases (ICD), depending on the cause and course of the disease:

• inflammatory polyneuropathy (ICD code 10 - G61) is an autoimmune process that is associated with a constant inflammatory reaction to various stimuli of a predominantly non-infectious nature (includes serum neuropathy, Guillain-Barré syndrome, a disease of an unspecified nature);
• ischemic polyneuropathy of the lower extremities (ICD code also G61) is diagnosed in patients with impaired blood supply to nerve fibers;
• drug-induced polyneuropathy (ICD code G.62.0) – the disease develops after long-term use of certain drugs or against the background of incorrectly selected doses of drugs;
• alcoholic polyneuropathy (ICD code G.62.1) – the pathological process is provoked by chronic alcohol intoxication;
• toxic polyneuropathy (ICD10 code – G62.2) is formed under the influence of other toxic substances, and is an occupational disease of workers in the chemical industry or those in contact with toxins in the laboratory.

Polyneuropathy, which develops after the spread of infection and parasites, has the code G0. The disease with the growth of benign and malignant neoplasms is encrypted in ICD 10 with code G63.1. Diabetic polyneuropathy of the lower extremities has an ICD 10 code G63.2. Complications of endocrine diseases and metabolic disorders in ICD-10 are assigned code G63.3. Dysmetabolic polyneuropathy (ICD 10 code - G63.3) is classified as polyneuropathies in other endocrine diseases and metabolic disorders.

Forms of neuropathy depending on the prevalence of symptoms

The classification of polyneuropathy according to ICD 10 is officially recognized, but it does not take into account the individual characteristics of the course of the disease and does not determine treatment tactics. Depending on the predominance of clinical manifestations of diseases, the following forms of polyneuropathies are distinguished:

• sensory – signs of involvement of sensory nerves in the process (numbness, burning, pain) predominate;
• motor – signs of damage to motor fibers prevail (muscle weakness, decrease in muscle volume);
• sensorimotor – symptoms of damage to motor and sensory fibers are simultaneously present;
• autonomic – there are signs of involvement of the autonomic nerves in the process: dry skin, rapid heartbeat, tendency to constipation;
• mixed - neurologists determine signs of damage to all types of nerves.

With primary damage to the axon or neuron body, axonal or neuronal polyneuropathy develops. If Schwann cells are affected first, demyelinating polyneuropathy occurs. In the case of damage to the connective tissue sheaths of the nerves, they speak of infiltrative polyneuropathy, and if the blood supply to the nerves is impaired, ischemic polyneuropathy is diagnosed.

Polyneuropathies have various clinical manifestations. The factors that cause polyneuropathy most often first irritate the nerve fibers, causing symptoms of irritation, and then lead to disruption of the function of these nerves, causing “prolapse symptoms.”

Treatment

When sciatica is detected, treatment is aimed at reducing the severity of the inflammatory process, eliminating pain, and normalizing muscle tone. It is important that the patient is able to move again.

To obtain the required result, drug therapy is selected. Therapeutic gymnastics, massage, and physiotherapeutic treatment are also prescribed. Many people use alternative medicine methods.

Drugs

To relieve pain, the doctor selects non-steroidal anti-inflammatory drugs . Tablets and injections may be prescribed. Preparations based on indomethacin, ibuprofen, and diclofenac are considered effective. Nimid, Nimesulide, Diclofenac, Revmoxicam and other drugs are prescribed.

For severe pain in the sciatic nerve, novocaine blockades are prescribed. They are not recommended to be used for a long time, because they negatively affect the digestive organs and kidneys.

At the same time, medications are prescribed that improve tissue trophism and blood circulation . Use vitamins and vasodilators.

Anticonvulsants and tricyclic antidepressants block impulses from diseased nerve endings to the central nervous system. When taken, the production of endorphins is stimulated.

, novocaine or lidocaine blockades are immediately prescribed .

If sciatica has developed due to the progression of osteochondrosis, then vasodilator drugs . With their help, it is possible to normalize blood circulation. Long-term use of chondroprotectors can improve the condition of intervertebral discs.

Surgery

If there is no improvement after 10 weeks of drug treatment, your doctor may recommend surgery . A discectomy or laminectomy is performed. The operation allows you to get rid of muscle weakness, pain, and inflammation. Most often it is performed if fecal and urinary incontinence occurs. After surgery, antibiotics, analgesics, and non-steroidal anti-inflammatory drugs are prescribed.

Exercise therapy and massage

Having reduced the severity of pain, you can begin to massage . With the help of physical impact on the surrounding muscles, it is possible to normalize the condition of the spine. By strengthening the muscle corset, the severity of discomfort in patients is reduced. But until the end of the massage course, the patient must follow a gentle regime. Doctors recommend avoiding any physical activity if possible.

After completing the massage, exercise therapy allows you to consolidate the result and prevent further progression of the disease.

Special exercises are designed for:

• keeping the body in good shape;
• increasing physical activity;
• improving blood circulation;
• removing clamps.

It is important to prevent weakening of the spinal muscles, otherwise the disease may return. Exercises must be done daily.

Video: “How to eliminate inflammation of the sciatic nerve?”

Treatment at home

After the diagnosis is established, the patient can use not only the drugs recommended by the doctor.

At home, with sciatica, it is necessary to ensure relaxation of the lumbar region. You can alleviate the condition and speed up recovery if you follow these recommendations:

• ensure maximum relaxation of the spine using bed rest during an exacerbation;
• use a support bandage or a support crutch if necessary to move;
• apply lotions and compresses to the problem area.

Among traditional methods of treatment, warm wax compresses are popular. It is applied to the affected area, fixed and held until it cools completely. You can increase the effectiveness of the procedure if you mix wax with propolis.

A compress of chamomile and elderberry flowers improves the condition. The plants are placed in gauze, boiled, squeezed and applied to the problem area.

A black radish compress helps relieve inflammation. A paste is made from it and applied to the affected area, securing it with a bandage. The problem area needs to be insulated.

Prevention

You can prevent the development of sciatica by keeping your back muscles toned. It is important not only to exercise daily, but also to monitor your posture. The lumbar region should not be allowed to become hypothermic. Women are advised to avoid wearing high-heeled shoes.

For somatic diseases

Diabetic polyneuropathy (ICD10 code G63.2.) is one of the most common and studied forms of somatic polyneuropathies. One of the manifestations of the disease is autonomic dysfunction, which has the following symptoms:

• orthostatic arterial hypotension (decrease in blood pressure when changing body position from horizontal to vertical);
• physiological fluctuations in heart rate;
• disorders of gastric and intestinal motility;
• bladder dysfunction;
• changes in sodium transport in the kidneys, diabetic edema, arrhythmias;
• erectile disfunction;
• skin changes, impaired sweating.

With alcoholic polyneuropathy, paresthesia in the distal limbs and pain in the calf muscles are noted. One of the early characteristic symptoms of the disease is pain, which intensifies with pressure on the nerve trunks and compression of the muscles. Later, weakness and paralysis of all extremities develop, which are more pronounced in the legs, with predominant damage to the extensors of the foot. Atrophy of paretic muscles develops rapidly, periosteal and tendon reflexes are strengthened.

In the later stages of development of the pathological process, muscle tone and muscle-joint sensation decrease, and the following symptoms develop:

• surface sensitivity disorder of the “gloves and socks” type;
• ataxia (instability) in combination with vasomotor, trophic, secretory disorders;
• hyperhidrosis (increased skin moisture);
• swelling and pallor of the distal extremities, decreased local temperature.

Complications and prevention

If the disease is ignored or treated incorrectly, it poses a great danger to human health. In case of complications:

1. the foot loses sensitivity and sag;
2. the motor function of the limb is impaired, the leg muscles are paralyzed;
3. Dysfunction in the excretory system (bladder and intestines) manifests itself.

The basic treatment is complemented by physiotherapy, massage, acupuncture, exercise therapy (a set of exercises is developed taking into account age characteristics, general health, and severity of the disease).

To prevent the disease, it is recommended:

• monitor correct posture, prevent scoliosis;
• avoid injury and hypothermia in the lumbar region;
• control body weight, prevent obesity;
• prevent, promptly detect and treat infectious lesions;
• strengthen your back muscles, play sports.

Nerve neuropathy requires immediate attention. When the first signs of inflammation appear, you should immediately consult a doctor.

Hereditary and idiopathic polyneuropathy (code G60)

Hereditary polyneuropathy is an autosomal dominant disease with systemic damage to the nervous system and varied symptoms. At the onset of the disease, patients experience fasciculations (visible contractions of one or more muscles) and spasms in the muscles of the legs. Next, atrophy and weakness develop in the muscles of the feet and legs, a “hollow” foot and peroneal muscular atrophy are formed, the legs resemble the limbs of a stork.”

Later, movement disorders in the upper extremities develop and increase, and difficulties arise in performing small and routine movements. Achilles reflexes are lost. The preservation of other groups of reflexes varies. Vibration, tactile, pain and muscle-joint sensitivity decreases. In some patients, neurologists determine thickening of individual peripheral nerves.

The following types of hereditary neuropathies are distinguished:

• sensory radiculopathy with disorders of the functions of peripheral nerves and spinal ganglia;
• atactic chronic polyneuropathy - Refsum's disease.
• Bassen-Kornzweig disease is a hereditary acanthocytotic polyneuropathy caused by a genetic defect in lipoprotein metabolism;
• Guillain–Barré syndrome – unites a group of acute autoimmune polyradiculoneuropathies;
• Lhermitte syndrome, or serum polyneuropathy, develops as a complication of serum administration.

Neuropathologists also diagnose other inflammatory polyneuropathies that develop from insect bites, after administration of anti-rabies serum, rheumatism, systemic lupus erythematosus, periarteritis nodosa, as well as neuroallergic and collagenoses.

Drug-induced polyneuropathy (ICD code G.62.0)

Drug-induced polyneuropathy occurs as a result of metabolic disorders in myelin and feeding vessels as a result of taking various medications: antibacterial drugs (tetracycline, streptomycin, kanamycin, viomycin, dihydrostreptolysin, penicillin), chloramphenicol, isoniazid, hydralazine. Antibacterial polyneuropathies with symptoms of sensory neuropathy, night pain in the limbs and paresthesias, vegetative-trophic dysfunctions are detected not only in patients, but also in workers of factories that produce these medications.

At the initial stage of development of isoniazid polyneuropathy, patients are bothered by numbness of the fingers, then a burning sensation and a feeling of tightness appear in the muscles. In advanced cases of the disease, ataxia joins sensory disorders. Polyneuropathies are detected when taking contraceptives, antidiabetic and sulfa drugs, phenytoin, drugs of the cytotoxic group, and the furadonin series.

Risk factors and causes

In most cases, sciatica develops in patients who have impaired integrity of the intervertebral discs in the lumbar region.

The likelihood of developing this pathology increases if the patient:

• suffers from obesity;
• smokes;
• abuses alcohol and drugs;
• leads a sedentary lifestyle and is forced to remain in static positions for a long time.

Eliminating the main risk factors helps prevent the development of sciatica. But there are risk factors whose effects cannot be neutralized. The likelihood of developing pathology is higher in patients who are over 40 years old. This is due to the progression of age-related changes in the spine.

The disease can develop under the influence of such factors:

• intervertebral hernia;
• curvatures, tumors, traumatic lesions of the spine;
• osteochondrosis;
• pregnancy;
• infectious lesions of bone tissue (for example, tuberculosis);
• metabolic disorders (diabetes mellitus, menopausal changes in women);
• development of piriformis syndrome;
• spondylolisthesis;
• spinal canal stenosis;
• dysfunction of the sacroiliac joint.

In almost 90% of cases, the development of sciatica is provoked by the presence of intervertebral hernias . When the core of the intervertebral disc protrudes through the damaged annulus fibrosus, the distance between adjacent vertebrae decreases. As a result, the nerve roots begin to be compressed or pinched.

Consequences

When the sciatic nerve becomes inflamed, the patient begins to feel pain, the intensity of which increases over time. At the same time, the person’s sensation in the legs is impaired, and a feeling of tingling and numbness in the lower back may occur. Over time, muscles weaken.

In cases where the sciatic nerve becomes inflamed due to damage to the spine, loss of sensation in the lower extremities is possible , and paresis or paralysis of the legs develops.

Diagnostics

Neurologists make a diagnosis of polyneuropathy based on:

• analysis of complaints and how long ago symptoms appeared;
• clarification of possible causative factors;
• establishing the presence of diseases of internal organs;
• establishing the presence of similar symptoms in close relatives;
• identifying signs of neurological pathology during a neurological examination.

An obligatory component of the diagnostic program is an examination of the lower extremities in order to identify autonomic failure:

• thinning of the skin of the legs;
• dryness;
• hyperkeratosis;
• osteoarthropathy;
• trophic ulcers.

During a neurological examination, if the nature of the polyneuropathy is unclear, doctors palpate the available nerve trunks.

To clarify the cause of the disease and changes in the patient’s body, the Yusupov Hospital determines the levels of glucose, glycated hemoglobin, protein metabolic products (urea, creatinine), perform liver tests, rheumatic tests, and toxicological screening. Electroneuromyography allows one to evaluate the speed of impulse transmission along nerve fibers and determine signs of nerve damage. In some cases, a nerve biopsy is performed for examination under a microscope.

If there are indications, instrumental methods for studying the somatic status are used: radiography, ultrasound. Cardiointervalography allows identifying violations of autonomic function. A study of cerebrospinal fluid is carried out if demyelinating polyneuropathy is suspected, and when searching for infectious agents or an oncological process.

Vibration sensitivity is examined using a biotensiometer or a graduated tuning fork with a frequency of 128 Hz. The study of tactile sensitivity is carried out using hair monofilaments weighing 10 g. Determination of the threshold of pain and temperature sensitivity is carried out using a needle prick and a Tip-therma thermal tip in the skin of the dorsal surface of the big toe, dorsum of the foot, medial surface of the ankle and lower leg.

Symptoms

Patients come to doctors complaining of pain in the lower back and legs. But people's feelings differ. Some talk about a feeling of numbness, tingling, goosebumps. Others complain of numbness or a burning sensation.

With sciatica, the pain is of a different nature, but the localization is the same

In addition to pain, symptoms of sciatica include:

• pathological muscle tension in the pelvis, lower back, lower extremities;
• low sensitivity of the problem area;
• movement disorders (range from slight lameness to complete immobility);
• dysfunction of the pelvic organs (in rare cases, urinary and fecal incontinence may occur).

If you feel pain in the lumbar region that radiates to your leg, you should consult a doctor. Only with timely initiation of treatment can you get rid of unpleasant symptoms and minimize the risk of complications.

With sciatica, patients find it difficult to sleep normally. Pain occurs when sitting, standing, walking, turning, bending. They are localized in the buttocks area. For many, pain is observed along the entire sciatic nerve: it is concentrated in the lateral or posterior surface of the thigh, lower leg, and foot. Often their appearance is accompanied by cramps of the calf muscles.

Diagnostics

Did you know that...

Next fact

To identify sciatica, the doctor conducts an examination and interviews the patient. What matters is the intensity of the pain, its location, nature, and disorders of the spinal motion segments.

To confirm the diagnosis, X-rays, magnetic resonance or computed tomography are done . At the same time, a blood test is prescribed. With its help, you can determine the severity of the inflammatory process. When complaining of lower back pain, differential diagnosis is carried out to exclude the possibility of kidney disease.

Video: “Symptoms of Sciatica”

Basic principles of therapy

In case of acute polyneuropathy, patients are hospitalized in a neurology clinic, where the necessary conditions for their treatment have been created. For subacute and chronic forms, long-term outpatient treatment is carried out. Prescribe drugs to treat the underlying disease, eliminate the causative factor in case of intoxication and drug-induced polyneuropathies. In case of demyelination and axonopathy, preference is given to vitamin therapy, antioxidants and vasoactive drugs.

Rehabilitation specialists provide hardware and non-hardware physiotherapy using modern techniques. Patients are advised to avoid exposure to extreme temperatures, heavy physical activity, and contact with chemical and industrial poisons. If you have signs of polyneuropathy of the lower extremities, you can consult a neurologist by making an appointment by calling the Yusupov Hospital.