Radicular syndrome is diagnosed at an appointment with a neurologist.
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Radicular syndrome occurs when the spinal root is damaged, and from them, in turn, nerves extend to all organs and parts of the body.
Radicular syndrome is characterized by pain along the innervation of a given root.
For example, with sciatica or S1 radicular syndrome, pain begins in the buttock area on the affected side and continues down to the foot, often accompanied by numbness and loss of sensitivity in the area of this segment. Pain of this nature is usually associated with movement and the position in which the lower back is located.
In traditional medicine, there is a name for this forced position with radicular syndrome: “Antalgic position.”
Typically, a patient with acute radicular syndrome feels “lumbago” in the area of the affected nerve.
With radicular syndrome, movement disorders may develop, which manifest themselves in the form of decreased muscle strength and motor impairment.
When the S1 root is damaged, the patient's calf and thigh muscles decrease in volume. Often the patient experiences difficulty when asked to walk on his toes.
Radicular syndrome occurs in various pathologies of the spine: disc hernias, osteochondrosis, spondylolisthesis, spodyloarthrosis, spinal fractures and rarely with spinal cord tumors.
Is it possible to cure radicular syndrome forever or only for a certain period of time?
The prognosis can be discussed only when we know the cause of the radicular syndrome, which can only be established by a specialist doctor using modern examination methods.
Characteristic features of the pathology
Radicular osteochondrosis is the final stage of a long-term destructive and degenerative process occurring in the intervertebral discs. Pain syndrome manifests itself after heavy lifting, a respiratory or intestinal infection, or an awkward sudden movement. The annulus fibrosus of the disc ruptures and it extends beyond its boundaries. In the vacated space, an intervertebral hernia forms, compressing the spinal roots. Radicular syndrome develops - a set of symptoms that significantly complicates a person’s life.
Acute pain occurs not only as a result of trauma to the spinal roots. The situation is aggravated by the resulting bone growths and the extended disc, which infringe on the adjacent soft tissues. This leads to even greater pain, and sometimes to aseptic inflammation. The pathogenesis is also complicated by dyscalgia - pain in the area of innervation of the corresponding roots of the spinal nerves.
Radiculitis (radiculopathy) - symptoms and treatment
First aid. Movement restrictions
It is necessary to exclude or reduce the influence of the factor that led to the development of radicular syndrome: asymmetrical posture, heavy lifting, etc.
Before a neurological examination, you should refrain from physical activity. Rest and pain relief are required: if there are no contraindications, you can take ibuprofen.
Treatment of radiculopathy begins with identifying the cause of the disease and eliminating it. If compression of the nerve root is caused by an intervertebral hernia, treatment will be aimed at reducing swelling in the area of the hernia and the nerve root using various conservative methods, and if they are ineffective, surgical intervention aimed at decompressing the nerve fiber is recommended.
In most cases, with timely contact with a qualified specialist, radiculopathy can be treated conservatively using:
- drug treatment of radiculitis (droppers, therapeutic blockades, drugs for oral administration and injections);
- manual therapy;
- physiotherapy;
- physical therapy.
These methods are aimed at reducing swelling, improving blood circulation and removing accumulated metabolic products in the area of the compressed nerve root.[3][5][6][9]
Surgery
In cases of vertebral instability, massive intervertebral hernia, vertebral destruction and other complex cases, consultation with a neurosurgeon and surgery may be required. The type of intervention is determined by the doctor after assessing the symptoms, the effectiveness of conservative therapy and MRI data.
Drug treatment of acute pain due to radiculitis
A wide range of drugs are used to reduce pain from radiculopathy. First of all, non-steroidal anti-inflammatory drugs (NSAIDs) in tablets, capsules, gels and ointments.
NSAIDs include:
- ibuprofen;
- diclofenac sodium;
- etoricoxib;
- meloxicam;
- nimesulide, etc.
There are dosage forms that deliver the active substance through the skin, such as lidocaine pain relief patches.
For persistent neuropathic pain and ineffectiveness of NSAIDs, antiepileptic drugs with an analgesic effect, such as gabapentin and pregabalin, are used.
If conservative therapy is insufficiently effective, hormonal agents are used that are injected into the radicular space: dexamethasone and betamethasone.
Treatment for chronic pain syndrome
If the pain is chronic, the doctor may recommend taking antiepileptic drugs and antidepressants that have an analgesic effect. If the options for eliminating pain have been exhausted, a neurosurgical operation is possible: installation of a pain stimulator, morphine pump, or transection of the root.
Features of treatment during pregnancy
During pregnancy, especially in the third trimester, many medications cannot be used. Doctors, as a rule, prescribe local medications and non-medicinal methods: therapeutic exercises and wearing corsets.
Home remedies
Home treatment of radicular syndrome is possible only after a comprehensive consultation with a doctor. The doctor will recommend exercises for self-study. If necessary, the doctor will explain how to wear the corset and, if requested by the patient, will tell you how to use home physiotherapy devices.
Treatment of radiculitis with folk remedies
The effectiveness and safety of traditional medicine methods have not been scientifically proven. Their use can be dangerous to the health and life of the patient.
Symptoms
Clinically, radicular osteochondrosis is manifested by pain, decreased reflexes, partial sensitivity disorder, and autonomic disorders. The painful sensations that occur immediately after rupture of the fibrous ring resemble a “lumbago” or the pain that accompanies muscle inflammation. And the formation of the syndrome occurs after the formation of an intervertebral hernia. Tingling and numbness appear first. Traumatization of the root leads to a disorder of innervation - temperature, tactile, and pain sensitivity is reduced or completely absent.
Over time, the muscles located in the area of the affected spinal root weaken. In severe cases, their complete atrophy (reduction in size) is observed.
Radicular osteochondrosis is classified depending on the location of the damaged sensory nerve endings:
- cervical;
- chest;
- lumbosacral.
But quite often several spinal nerve plexuses are involved in the destructive process. In such cases, patients are diagnosed with a combined lesion, for example, cervicothoracic osteochondrosis with radicular syndrome. This pathology is characterized by severe symptoms, including signs of damage to the cervical and thoracic vertebrae and discs, as well as pinching of several nerve endings.
Cervical radicular osteochondrosis
The pathology of this localization is quite rare due to the anatomical structure of the cervical vertebral structures. This part of the spine is equipped with strong ligaments, and the diameter of the intervertebral canals is relatively small. Therefore, bulging of the contour of the intervertebral disc beyond the vertebral body without rupture of the fibrous ring (protrusion) is observed in exceptional cases.
The syndrome develops with cervical pathology as a result of compression of the artery through which oxygen and nutrients enter the spinal roots. Its compression causes persistent hypoxia (oxygen starvation of cells), and consequently damage to nerve endings. The following signs are characteristic of cervical pathology:
- Neri's symptom - inert adduction of the chin to the chest in a lying position leads to severe pain;
- Dejerine's symptom - a sharp attack of pain causes coughing, sneezing, loud laughter, slight muscle tension;
- decreased sensitivity, which is detected by a neurologist when pressing and tingling the area innervated by damaged roots.
Neck pain with cervical radicular osteochondrosis spreads to the chest, shoulders, and forearms. Often, when visiting a doctor, a patient complains of painful sensations and numbness of the tongue, lower jaw, and hands. The danger of the pathology lies in the gradual hypotrophy of the trapezius, deltoid, and sublingual muscles.
Thoracic radicular osteochondrosis
Thoracic osteochondrosis with radicular syndrome is accompanied by pain in paravertebral points and muscle-tonic disorders. In the area of damaged nerve endings, sensitivity is disrupted and range of motion is reduced.
Patients are often diagnosed with paresis (decreased strength) of the muscles responsible for flexing the fingers and hands. There have also been cases of involvement of the sympathetic formations of the hands in the pathological process. Clinically, this manifests itself in their swelling, coldness, and increased sweating.
A specific sign of thoracic pathology is spondylocoronary syndrome. A person experiences pain in the heart when bending, straightening the body, turning or bending. It is difficult to eliminate such sensations by taking coronary dilator drugs.
Lumbosacral radicular osteochondrosis
Most often, an intervertebral hernia forms in the lumbar region, which leads to very sharp pain (“lumbago”). The person freezes without moving for several minutes, trying not to breathe deeply. The prevalence of osteochondrosis of the lumbar spine with radicular syndrome is explained by serious loads on the discs and vertebrae when walking, and the relative weakness of the muscles and ligamentous-tendon apparatus. In addition, the diameter of the holes in which blood vessels, spinal roots, and spinal nerves are located is very small. Even minor deformation leads to traumatization of these structures.
Clinically, the pathology manifests itself as follows:
- pain occurs in the lumbar region, radiating to the feet, legs, thighs, and groin area;
- to minimize pain, a person takes a forced body position, for example, bends his legs a little;
- lumbar radicular osteochondrosis is accompanied by a symptom of Lasegue tension - the pain increases when the straight leg is raised up;
- pinching is characterized by Wasserman's symptom - the severity of pain increases when the leg is bent at the knee while lying on the stomach.
The pain is not constant and occurs with sudden movement, hypothermia, or working in the country. Its intensity is variable. At first the pain is sharp, cutting, and then it becomes aching, pressing, dull.