Osteochondrosis with radicular syndrome: symptoms and treatment of the lumbar, cervicothoracic regions

Back pain that occurs due to osteochondrosis is a common occurrence. You can get rid of them only after proper therapy. However, most people, citing a lack of free time, prefer to endure discomfort, which only aggravates the problem. Then the pathology continues to progress, causing dangerous complications.

Osteochondrosis with radicular syndrome is manifested by a whole complex of symptoms that arise as a result of compression of the spinal nerves. This condition develops as a result of long-term degenerative-dystrophic changes in the intervertebral discs. As a rule, the result of such disorders is an intervertebral hernia, which further injures the spinal roots. Radicular osteochondrosis requires long-term and complex treatment.

Causes

Radicular osteochondrosis is a consequence of damage to the nerve roots that exit the spinal cord. These branches innervate the skin, skeletal muscles, diaphragm, and internal organs.

When nerve bundles are damaged, a sharp shooting pain appears that spreads to different parts of the body. In addition, the sensitivity of the area for which the inflamed nerve is responsible is impaired, and tendon reflexes are impaired.

Degenerative disorders of the spine develop over a long period of time. First, the vessels that nourish the cartilaginous lining of the vertebrae become empty, for this reason there is a lack of nutrients and a disruption of metabolic processes. The disc becomes denser, thinner, and its outer shell (annulus fibrosus) protrudes. Cracks may appear on its surface, then the nucleus pulposus protrudes through them, causing rupture of the outer shell. This is how a hernia is formed. Then an autoimmune process is launched, in which the immune system mistakenly begins to destroy its own tissues. Due to age-related changes, ossification of cartilage tissue occurs and osteophytes form on the vertebrae.

Radicular syndrome develops when nerve bundles are pinched by protrusions, hernias, osteophytes, or displaced vertebrae. Pathology develops with inflammation of the nerve root, damage to the myelin sheath of the nerve, and a decrease in its blood supply.

Reference. Symptoms of osteochondrosis are observed in 50% of people aged 35–40 years. And by the age of 70, degenerative processes are detected in 95% of patients.

Radicular osteochondrosis can be caused by the following factors:

Excessive load on the spinal column due to excess weight, pregnancy, frequent wearing of high-heeled shoes, heavy physical work, and playing strength sports.
Curvature of the spinal column (scoliosis, kyphosis), drooping arches of the feet, deformation of the legs.
Regular static loads during sedentary work.
Frequent hypothermia of the back, infections.
Spinal injuries.
Poor nutrition, lack of nutrients in the diet, excess salt intake, etc.
Systemic diseases, etc.

Radicular syndrome can be provoked by various factors that act individually or in combination.

Nutrition

A balanced diet is part of complex therapy for radicular osteochondrosis, without which it is difficult to achieve recovery. Especially if you are overweight, the diet should be low in calories, rich in vitamins and fiber. Exclude fatty, salty, spicy, smoked, flour, sweet, alcohol, coffee - containing products. Enrich food with vitamins and minerals.

Nutrition must be correct and balanced

General symptoms

Symptoms of radicular osteochondrosis are varied, they depend on which part of the spine is damaged. But doctors have identified the main ones, which indicate pathology:

The main symptom of the disease is intense pain (constant or paroxysmal), which radiates from the damaged nerve branch to the area for which it is responsible.
Loss of sensitivity in the damaged area and along the nerve path. The doctor can identify this symptom during a visual examination. To do this, he makes light injections in the area for which the nerve is responsible. If the sensations are more pronounced on the other side, then this indicates radicular syndrome.
Restricted mobility due to thinning of the muscles served by the affected nerve bundle.

If such symptoms appear, treatment should be started immediately.

Treatment of cervical osteochondrosis with NANOPLAST forte therapeutic plaster

In the therapeutic treatment of cervical osteochondrosis, various agents are used, such as NSAIDs, analgesics, and antispasmodics. All these remedies are effective, but if used for a long time they can cause harm to the body. Therefore, it is very important to minimize side effects and increase the effectiveness of treatment. A new generation product can help with this - the pain-relieving anti-inflammatory medical patch NANOPLAST forte.

The NANOPLAST forte therapeutic patch relieves pain and inflammation, improves blood circulation in the affected area, and allows you to reduce the dose of painkillers and anti-inflammatory drugs.

When treating osteochondrosis of the cervical spine, the NANOPLAST forte therapeutic plaster is applied to the disturbing area of the neck, avoiding the anterior surface, especially the area of the carotid arteries and lymph nodes. A course of treatment of 9 days or more is recommended. It is usually recommended to use the patch in the morning for 12 hours, but it can also be used at night.

High efficiency, unique composition, long-term (up to 12 hours!) therapeutic effects, ease of use and affordable price make NANOPLAST forte the drug of choice in the treatment of cervical osteochondrosis.

Symptoms of radicular syndrome in cervical osteochondrosis

Radicular osteochondrosis (RO) of the cervical spine is rarely diagnosed. This is due to the fact that there are strong ligaments in this area, and the diameter of the intervertebral foramina is small, so hernias rarely come out of them.

Radicular osteochondrosis of the neck is manifested by pain, numbness of the neck and upper body

KO of the cervical segment often develops when the artery that supplies nutrients and oxygen to the nerve bundles is compressed.

Painful sensations quickly appear and intensify when turning, tilting the head or torso.

Clinical manifestations of cervical osteochondrosis with radicular syndrome (RS) depend on which vertebra is damaged:

C1 – cephalgia (pain in the head), impaired sensitivity in the area of the crown and back of the head.
C2 - the same symptoms as with damage to C1, and there may also be slight sagging of the muscles and skin on the chin.
C3 – pain, numbness spreads to the affected part of the neck, the tongue becomes numb, speech is impaired.
C4 – pain and sensory disturbance in the area of the collarbone, scapula, and shoulder. Sometimes the heart and liver hurt.
C5 – painful sensations, paresthesia spreads from the neck, down the shoulder to the hand. Weakness appears in the shoulder when the patient tries to raise his arm.
C6 – symptoms radiate from the neck, involving the shoulder blade, shoulder girdle, and thumb. The tone of the biceps decreases, so it is difficult for the patient to move his arm.
C7 – painful sensations from the neck extend to the shoulder blade, the front and back surfaces of the shoulder, forearm, affecting the index, middle finger, and little finger. Sensitivity in the same area is impaired. The tone of the triceps decreases, so weakness appears when moving the affected limb.

The pain intensifies with tension, sneezing or coughing.

Features of osteochondrosis of the cervical spine

Due to the structural features of the cervical spine, the course and symptoms of osteochondrosis in this segment have a number of features. The cervical spine consists of small mobile vertebrae that are constantly exposed to significant and prolonged loads. The spinal canal in the cervical region is the narrowest, so compression of the spinal cord in this segment develops much more often and leads to quite serious lesions. The neck area contains a large collection of nerve endings and blood vessels, including the vertebral artery, which supplies the cerebellum, medulla oblongata and posterior parts of the brain. Impaired blood flow in this artery leads to loss of coordination, dizziness, decreased vision and hearing, and in severe cases, a stroke may develop.

CS for thoracic osteochondrosis

Thoracic osteochondrosis with radicular syndrome is diagnosed more often than CS of the cervical segment. This is due to the structure of this part of the spinal column, where hernias often form.

Making a diagnosis for this type of pathology is not so easy, since painful sensations appear not only in the damaged area of the back, but also in the internal organs. Therefore, patients often confuse osteochondrosis with diseases of the heart, respiratory or digestive organs.

The attack of pain appears sharply, and with immobilization it weakens. When the patient tries to get up again, the pain syndrome resumes.

Radicular thoracic osteochondrosis is often confused with diseases of the heart and respiratory tract

Symptoms of CS for thoracic osteochondrosis also differ, depending on the damaged area:

Symptoms of thoracic osteochondrosis in women

Th1 – discomfort is localized in the shoulder blades, armpits, and reaches the elbow along the inside of the arm. Sensitivity in the same area is impaired. The throat feels dry and painful.
Th2 – Th6 – pain appears, numbness of the skin between the shoulder blades, around them, in the armpits, intercostal area to the lower part of the sternum. In addition, weakening muscles may cause the shoulder blade to droop. The patient feels discomfort in the pharynx, esophagus, which sometimes reaches the stomach. There may be a sensation of a foreign body in the upper parts of the digestive canal.
Th7 – Th8 – sensitivity disorder, pain syndrome spreads from the angle of the shoulder blades and slightly lower on the back of the back, passes along the lower edge of the ribs, closing in the epigastric region (epigastric region). The muscles tense in this same area. Painful sensations appear in the stomach, behind the sternum and in the heart.
Th9 – Th10 – pain passes in front of the navel, along the lower edge of the ribs, ending on the back at the same level. In the same area, the skin becomes numb and the muscles tense. The patient may have stomach or intestinal pain.
Th11 – Th12 – pain syndrome spreads from the navel, reaches the groin area and closes at the level of the thoracic vertebrae. Numbness spreads along the same trajectory, and muscle tone in the lower abdomen increases. Patients complain of pain in the stomach and intestines.

Painful sensations with radicular thoracic osteochondrosis become more pronounced when the patient tries to breathe deeply, coughs, sneezes or sharply moves the body. With this type of pathology, the horizontal position of the body does not help relieve pain, since the load on the vertebrae increases.

Reference. Some patients develop cervicothoracic osteochondrosis with radicular syndrome, which is accompanied by symptoms of both diseases. Patients often confuse this disease with pathologies of the heart or respiratory organs. This is one of the most dangerous types of the disease, since diagnosis becomes more complicated and 2 segments of the spine are affected at once.

Prevention

Prevention of osteochondrosis should be taken care of at a young age. Strong back muscles will maintain the spine in a normal position, preventing the development of degenerative processes.

Measures to prevent osteochondrosis:

Lead an active lifestyle - it is not necessary to go to the gym every day and do strength training. To strengthen the spine, therapeutic exercises, swimming, and regular courses of preventive massage are sufficient.
Calculate physical activity - do not lift heavy objects, if your work involves physical labor, distribute the load evenly.
Eat right - for the health of the skeletal system, the human body must receive a sufficient amount of useful elements: vitamins B and D, protein, phosphorus, calcium.
Choose comfortable shoes - excessive stress on the feet has a negative impact on the condition of the musculoskeletal system. Often, women, sacrificing their comfort, wear too high heels and do not take them off throughout the day. This is a huge load on the spine, so periodically wear comfortable shoes with low speed.
Seek medical help in a timely manner - any pathologies at an early stage can be successfully corrected. Therefore, if you are experiencing severe pain in any part of your back, do not rush to take painkillers, but consult a neurologist.

Manifestations of radicular syndrome in lumbar osteochondrosis

Osteochondrosis of the lumbar region with CS occurs most often. This is due to the fact that the load on the vertebrae of this segment is high, and the diameter of the intervertebral foramina is large. The situation is aggravated if the patient has an underdeveloped muscle corset.

Lumbar osteochondrosis with radicular syndrome occurs most often

Aching or sharp pain in the lumbar region occurs on one side and is quite strong. The nature of the pain syndrome depends on the degree of damage to the nerve bundle, the level of the pain threshold and external factors (concomitant diseases, wearing a special corset, etc.).

Reference. Lower back pain will be relieved if the patient turns over onto his healthy side.

Lumbar osteochondrosis with CS is accompanied by the following symptoms:

L1 – L3 – pain, numbness in the lower back, anterior thigh, lower abdomen and groin area.
L4 – pain radiates from the lower back to the front and outer surface of the thigh, knee, reaching the lower leg. Weakness is felt when bending/extending the knee. The likelihood of a decrease in thigh muscle mass on the affected limb increases, this is due to the fact that the quadriceps muscle atrophies. It is difficult for the patient to lean on the affected limb.
L5 – pain and numbness are present on the outer thigh, lower leg, inner surface of the foot, big toe. The muscles of the foot become weak, then it is difficult for the patient to stand on the affected leg.

With radicular lumbar osteochondrosis, the patient tries to take a position in which the pain is relieved. This usually requires bending your legs slightly. When raising a straight leg in a horizontal position, the pain intensifies (Lasegue's symptom). When the affected limb is bent at the knee from a prone position, the pain syndrome becomes more pronounced (Wassermann's symptom).

Lumbosacral osteochondrosis with CS is manifested by pain in the groin, external genitalia, and lower abdomen. When the cauda equina is damaged (a bundle of roots from the 4 lower lumbar, 5 sacral nerves, with the terminal filament of the spinal cord), the likelihood of involuntary urination, defecation, and sexual disorders in men increases.

Treatment of osteochondrosis of the cervical spine

In the treatment of cervical osteochondrosis, surgical and conservative methods are used. But surgical treatment is prescribed only in the presence of severe complications that occur in the later stages of osteochondrosis if:

stenosis (narrowing) of the spinal canal has formed;
the vertebral artery is compressed;
a significant hernia or protrusion has formed, compressing the nerve roots;
excessive spinal instability developed.

In other cases, the standard treatment for osteochondrosis of the cervical spine is conservative therapy. This is due to the fact that with all the achievements of modern medicine, the consequences of surgical intervention are not always expected.

Conservative treatment of cervical osteochondrosis

The best results in the treatment of osteochondrosis of the cervical spine, as well as other types of osteochondrosis, are achieved with early consultation with a doctor. Unfortunately, many patients often do not pay attention to minor back discomfort or occasional headaches. On the other hand, there are many cases of incorrect diagnosis and long-term useless treatment, since osteochondrosis of the cervical spine can simulate other diseases, such as arthritis, myalgia or angina. That is why vertebrologists recommend checking the spine if there are symptoms of any disease, especially those accompanied by headaches or back pain.

In the effective treatment of cervical osteochondrosis, an integrated approach is of great importance, including the following areas:

drug therapy - aimed at improving the trophism of the intervertebral disc and relieving pain, relieving muscle spasm and inflammation during an exacerbation. For these purposes, non-steroidal anti-inflammatory drugs, analgesics, muscle relaxants, chondroprotectors are prescribed to stimulate the restoration of joint cartilage tissue, multivitamins and B vitamins;
physiotherapy - prescribed to reduce pain, improve nutrition of the cartilage tissue of the disc, stimulate cartilage regeneration processes, relieve muscle spasms, inflammatory processes in the postoperative period for a speedy recovery;
manual therapy - used to eliminate muscle spasms, reduce pain, improve blood and lymphatic metabolism, correct posture and improve the range of motion of joints. The manual intervention scheme is selected individually for each patient;
massage is a long-used and well-proven method of treating diseases of the musculoskeletal system. Has the same effect as manual therapy;
Physical therapy is one of the most important methods of treating all types of osteochondrosis, including osteochondrosis of the cervical spine. The purpose of exercise therapy is to relieve muscle spasm and compression of nerve roots, improve blood and lymph flow in the spine, strengthen the muscle frame and increase the flexibility of the ligamentous apparatus. A set of exercises is selected for each patient, the correct implementation of which is monitored by a specialist;
Reflexology is an alternative type of treatment that is widely used today and gives very good results when combined with other treatment methods. The essence of the method is the impact on acupuncture points and/or reflexogenic zones in order to achieve the same results as with other therapeutic methods (reduction of pain and muscle spasm, decompression of the spinal roots, improvement of tissue trophism in the vertebrae), as well as to improve sleep , relieving psycho-emotional stress, normalizing weight, and so on.

For the treatment of chronic osteochondrosis, chondroprotectors, B vitamins (B6, B12), preparations for external use - ointments, creams, gels that contain NSAIDs, local irritants and tissue regeneration stimulants are also used.

In addition to the main methods of treatment, for osteochondrosis of the cervical spine, patients are recommended to change their usual lifestyle, since in most cases the disease occurs against the background of low mobility, poor or unhealthy diet, obesity or, conversely, excessively low weight and the presence of bad habits. In most cases, in the early stages of cervical osteochondrosis, it is enough to lead a healthy lifestyle, prevent the occurrence of muscle spasms and overload of the muscles of the cervical-shoulder region, provide comfortable sleeping conditions, normalize nutrition and follow the doctor’s recommendations for exercise therapy in order to stop the further development of the pathological process, and at the first stage even achieve recovery.

In the treatment of cervical osteochondrosis , especially in its initial stages, as well as for the prevention of this disease with constant static or dynamic stress in the cervical-brachial region, an effective remedy of a new generation - the therapeutic pain-relieving anti-inflammatory patch NANOPLAST forte - can provide effective assistance.

Diagnostic measures

If signs of radicular osteochondrosis appear, you should urgently contact a neurologist. During diagnosis, the specialist determines the stage of the pathology and tries to distinguish radicular osteochondrosis from other pathologies (oncology, diseases of the gastrointestinal tract, kidneys, heart).

The study begins with a patient interview and visual examination. During the survey, the doctor tries to determine the nature of the pain syndrome and provoking factors. Then he identifies pain sensitivity, checks tendon reflexes, and evaluates muscle tone. During a visual examination, the specialist pays attention to the patient’s posture, the configuration of the spine, and his gait.

In some cases, you may need to consult with specialized specialists: gastroenterologist, cardiologist, oncologist, therapist, gynecologist, urologist.

To clarify the diagnosis, radiography is performed. This study allows you to identify symptoms of osteochondrosis, curvature of the spine, displacement of the vertebrae, deposition of calcium salts, and signs of a hernia.

If necessary, an MRI or CT scan is prescribed. These are highly informative studies that help determine the location of protrusions or hernias, swelling of nerve bundles.

Reference. Magnetic resonance or computed tomography is required before surgery.

If necessary, the doctor may prescribe ultrasound, myelography, and laboratory tests to clarify the diagnosis.

Diagnosis of cervical osteochondrosis

The doctor can make the primary diagnosis of “cervical osteochondrosis” already during the first examination of the patient, and also determine the level of the affected spine, anatomical features, including posture, physique, body structure, line of the spinous processes, lateral contours of the neck, lower angle of the shoulder blades; localization, nature and degree of pain; range of motion of the spine, relief and muscle tone.

The diagnosis is clarified using visual diagnostic methods (x-rays, CT, MRI), which makes it possible to determine the stage of the disease, the level of damage to the spine, and the exact location of the deformed disc. And based on these data, the most optimal treatment for cervical osteochondrosis is selected.

Treatment methods

In the acute stage of the disease, treatment is aimed at relieving pain and restoring motor activity. When the pain disappears, complex therapy is carried out to help prevent relapses. At this stage, doctors decide whether surgical intervention is necessary.

Important. In the acute period of radicular osteochondrosis, it is recommended to remain in bed for 1 to 3 days. The patient should rest on a hard, level surface. If the pain has disappeared earlier, the patient can allow himself light physical activity in the form of walking.

On the first day after the onset of pain, it is recommended to use applications with cooling ointments. On the second day, you can rub gels and ointments with a warming, analgesic, anti-inflammatory effect, for example, Fastumgel, Finalgon, into the diseased area.

Treatment of osteochondrosis with radicular syndrome is carried out using the following medications:

Analgesics (Analgin, Ketoral) will help relieve pain. For this purpose, different forms of drugs are used: capsules, injection solutions. To get rid of severe pain, therapeutic blockades with Novocaine, Lidocaine, and in advanced cases - narcotic analgesics are used.
NSAIDs have analgesic and anti-inflammatory effects. The most commonly used are Diclofenac, Nimesulide, Meloxicam, Indomethacin, Ibuprofen, Celocoxib.
Muscle relaxants relax spasmodic muscles, improve blood circulation, and relieve pain. These include Clonazepam, Diazepam, Miolastane.
Psychotropic medications reduce psychoemotional stress caused by debilitating pain. Patients are prescribed Amitriptyline, Desipramine.
Chondroprotectors inhibit the process of destruction of the intervertebral disc and accelerate its recovery. The most popular drugs from this group include Artra, Dona, Structum, Teraflex, Chondroxide.
Preparations based on B vitamins help restore nerve fibers. For radicular osteochondrosis, Milgamma, Neurobion, Neuromultivit are used.

Before using any medications, consult your doctor.

Surgical intervention is used in the following cases:

Presence of intervertebral hernia.
Damage to the cauda equina, the appearance of neurological disorders of the pelvic organs.
Severe pain that is not relieved by medication for a long time.
Numbness or paralysis of the limbs.

Surgical intervention is performed to correct spinal deformities that arose as a result of the CS.

Osteochondrosis with CS at the remission stage should be treated with exercise therapy. A set of exercises is compiled by a doctor or instructor for each patient individually, taking into account the severity of the pathology, the location of the lesion and the general state of health. Therapeutic gymnastics will help strengthen muscles and ligaments, make them more elastic, and increase the flexibility of the spine.

Massage for radicular osteochondrosis relieves pain, increases blood circulation and trophism of damaged tissues, normalizes muscle tone

Massage can be performed during exacerbation and during remission. After a course of procedures, local blood circulation and nutrition of the affected tissues improve, muscle tone is normalized, and pain is reduced.

Manual therapy allows you to get rid of pain, make the spinal column more flexible, reduce disc herniation, and restore the position of displaced vertebrae. This type of therapy is used only outside the acute stage. It is important to find an experienced chiropractor as there is a risk of further damage to the nerves and other tissues that surround the spine.

Physiotherapeutic procedures will help increase the effectiveness of treatment. Patients are prescribed diadynamic therapy, electrophoresis using Novocaine, phonophoresis, etc. Acupuncture helps reduce the intensity of pain and has virtually no contraindications.

Reference. Warm baths are useful for radicular osteochondrosis. In addition, the patient is recommended to wear orthopedic devices that will remove some of the load from the spine.

The patient should supplement the diet with foods rich in vitamins and chondroitins. To do this, it is recommended to consume more fresh vegetables, fruits, dairy products, lean meat, and fish. The patient should eat jellied meat, jelly, and jellied dishes more often.

When treating radicular osteochondrosis, it is worth limiting the amount of salt, marinades, smoked foods, fatty, fried foods, and foods containing large amounts of refined carbohydrates. You should also give up coffee, strong tea, and alcoholic beverages.

If you are overweight, you need to gradually reduce the number of calories in your daily diet.

Attention. For osteochondrosis with CS at the stage of remission, it is recommended to consume at least 2 liters of water per day. In the acute period, you need to reduce the amount of fluid to reduce the swelling that compresses the nerve bundle.

Publications in the media

Back pain, familiar to almost every person, is most often associated with damage to the lumbosacral spine. The development of chronic vertebral pain, including lumbar pain, is facilitated by heavy physical exertion and, conversely, by the lack of adequate exercise, unfavorable meteorological factors (especially permanent ones associated with unsatisfactory working and living conditions), congenital or acquired pathology of the musculoskeletal system and spinal column, and also the presence of excess weight and osteoporosis. In terms of its prevalence in our country, chronic vertebral pain is one of the mass public health problems.

Lumbar vertebral pain, in addition to primary damage to the spine, can have an “extravertebral” origin - due to secondary involvement of the osteochondral and nervous structures of the spinal column.

Main factors and clinical forms of spinal lesions

The primary factors of damage to the spine - in particular, its lumbosacral region - include focal or widespread vertebral changes associated with independently occurring pathology of the spinal column. Among them, the main factor is the dystrophic vertebral process (osteochondrosis of the spine).

Secondary damage factors are associated with the presence of an extravertebral pathological process, which also leads to the development of focal or widespread changes in the spine. Among them, osteoporosis and metastatic lesions of the spine are of greatest clinical importance.

The first factor (osteoporosis) is highly prevalent among middle-aged, elderly and senile women. At the same time, spinal osteoporosis most often occurs without the development of neurological disorders, and therefore its clinical manifestations are rarely a reason for neurological observation. The second factor (metastatic lesions) is many times higher than the incidence of primary spinal tumors. In some cases, vertebral disorders of metastatic origin come under the supervision of a neurologist even before the diagnosis of the underlying disease is made. The diagram - factors and clinical forms of primary and secondary spinal lesions - is presented on

Clinical manifestations of pathology of the lumbosacral spine

In neurological practice, differentiation of forms of vertebral lesions begins with the definition of vertebral syndrome, taking into account the characteristics of which the underlying disease is established. Clinical manifestations of pathology of the lumbosacral spine represent 3 groups of vertebral syndromes (

actually painful;
radicular monoradicular;
polyradicular.

Pain (reflex) syndromes

Painful (reflex) syndromes of the lumbosacral region, not accompanied by focal neurological symptoms, can manifest themselves:

lumbodynia - acute, subacute or chronic pain in the lumbosacral region (Fig. 3), in some cases - lumbago (sharp, sudden lumbar pain - “lumbago”);
lumboischialgia - lumbar pain radiating along the dermatome of the sciatic nerve - n. ischiadicus (Fig. 3);
coccydynia—pain in the coccyx area (Fig. 3).

Radicular syndromes (radiculopathies)

Radicular syndromes (radiculopathies) caused by damage to the lumbosacral spine are less common than lumbar pain syndromes. The presence of radiculopathy is indicated by symptoms of loss of sensitive, reflex and motor functions of a certain spinal root.

Manifestations of lumbosacral radiculopathy:

pain in the lumbar region, radiating to the leg (down to the foot);
hyperesthesia or paresthesia (tingling sensation, crawling “goosebumps”) - mainly in the area of pain;
hypoesthesia/hypalgesia - mainly in the distal innervation of the root (outer/inner edge of the foot);
asymmetry (due to decreased) or absence of Achilles and knee reflexes;
decreased muscle strength—mainly in the extensor and flexor muscles of the toes.

The most common forms of lumbosacral radiculopathies are associated with damage to the fifth lumbar (L5) and first sacral (S1) spinal roots. Clinical differences between these radiculopathies relate to the areas of localization of pain and sensory disorders, as well as the presence of the Achilles reflex, which disappears with S1 radiculopathy (Fig. 4).

Clinical features of spinal osteochondrosis

In the vast majority of cases, the development of lumbar pain and radicular syndromes is caused by spinal osteochondrosis, especially often affecting the joints of the two lower lumbar vertebrae and the base of the sacrum (intervertebral discs LIV-LV, LV-SI).

The main clinical manifestations of spinal osteochondrosis, which limit the patient's motor activity to varying degrees, include recurrent or chronic vertebral pain, painful spinal mobility, as well as monoradicular neurological disorders.

The course of clinical manifestations of spinal osteochondrosis is most often cyclical - with alternating periods of exacerbation and remission (complete or partial). Exacerbations are usually seasonal (autumn and spring). The highest frequency of exacerbations of the disease occurs in the fifth decade of life. In most cases, the development of exacerbations of vertebral pathology is predictable - in case of violation of the regime that limits physical activity and excludes cooling.

The most characteristic clinical feature of spinal osteochondrosis as a disease with a chronic, long-term course is the inevitability of a gradual “subsidence” of vertebral pain (usually at the turn of the 5th–6th decades of life). This feature of spinal osteochondrosis is due to the transition of the current degenerative process to the final stage, stabilizing the position of the bone and soft tissue structures of the spinal column. In this regard, regression of vertebral pain is often accompanied by an even greater limitation of spinal mobility. Pain and limitations in the patient’s daily physical activity that persist after 50 years are most often associated with a previous injury, another form of spinal damage, or osteoarthritis of the hip joint.

The most unfavorable form of manifestation of lumbar osteochondrosis is the development of discogenic compression of the structures of the spinal canal, in particular the cauda equina, which threatens severe neurological complications and disability of the patient. Compression of the spinal canal structures may also be associated with secondary forms of spinal damage ().

Signs of acute compression of the spinal canal structures (including the cauda equina):

the occurrence of bilateral weakness and numbness of the legs, numbness in the perineum;
retention of urine and feces;
with compression (compression-ischemic) damage to the spinal cord—spontaneous reduction of pain, followed by a feeling of numbness of the pelvic girdle and limbs.

Clinical features of secondary spinal lesions

Symptomatic vertebral pain caused by secondary damage to the spine, at the very beginning of its development, can occur similar to manifestations of spinal osteochondrosis. The presence of this pain often becomes the reason for physiotherapy, which can further aggravate the manifestations of the underlying disease.

Establishing the symptomatic nature of vertebral pain is facilitated by:

a thorough analysis of the patient’s complaints during “chronization” and increasing intensity of vertebral pain, as well as its atypical manifestations;
clinical examination of the patient if the treatment is insufficiently effective.

Atypical vertebral manifestations (characteristic of secondary spinal lesions):

vertebral pain:

–more often occurs in patients over 40, especially 50 years old; – gradually increases; – intensifies with movement, persists or intensifies at rest; – daytime, as well as nighttime, including “awakening”; – accompanied by local vertebral pain - “soreness” or sharp pain within one or two adjacent vertebrae when pressing and “tapping” the spinous processes;

the effectiveness of non-narcotic analgesics: in usual therapeutic doses - short-term, gradually decreasing;
the presence of extravertebral pain - paravertebral, abdominal, lower abdomen or groin area;
combination with somatic disorders:

– increased body temperature; – general weakness, loss of appetite, loss of body weight; – changes in laboratory parameters—acceleration of ESR, anemia, leukocytosis.

Principles of treatment

Analgesics

The main analgesic drugs for eliminating vertebral pain are non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs, like other painkillers, are usually self-administered by patients when pain intensifies and returns. However, long-term use of analgesics, which increases the risk of complications of drug therapy, requires the use of NSAIDs under medical supervision.

Today, in the arsenal of a practicing physician there is a wide range of NSAIDs, which, according to their mechanism of action, belong to “non-selective” anti-inflammatory drugs - blocking the enzyme cyclooxygenase (COX) and “selective” - blocking the COX-2 isoenzyme. These drugs differ significantly in the ratio of advantages and disadvantages, respectively, in the severity and duration of therapeutic effects and the side effects caused. Probably more preferable for patients with vertebral pain (in terms of availability, effectiveness and lower likelihood of side effects) are: among the “non-selective” NSAIDs - diclofenac, ibuprofen and ketoprofen, and among the “selective” - meloxicam.

Methods of using NSAIDs:

Diclofenac - orally 100-150 mg/day (regular tablet forms 25-50 mg, retard form - 100 mg); intramuscularly or subcutaneously; rectally; locally.

Ibuprofen - orally 1200 mg/day; locally.

Ketoprofen - orally 150–300 mg/day (regular tablet form 50 mg, retard form 150 mg); intramuscularly; rectally; locally.

Meloxicam—orally 7.5–15 mg/day (once); intramuscularly; rectally.

The general rule for NSAIDs is to take the oral form during or immediately after a meal with plenty of water.

The duration of NSAID use depends on the severity and duration of vertebral pain. For acute back pain, short-term (several days) use of NSAIDs is sufficient. In the presence of intense, especially radicular pain, the period of use of the same NSAID is usually at least 3–4 weeks.

The most likely side effects of NSAIDs are related to their effects on the gastrointestinal tract. A lower incidence of gastric and intestinal dyspepsia, as well as gastrointestinal bleeding, is observed with the use of meloxicam.

B vitamins

The use of neurotropic B vitamins is a common method in clinical practice for the treatment of patients with damage to the peripheral nervous system, including neurological manifestations of spinal osteochondrosis. To carry out the so-called vitamin therapy, the method of alternately administering solutions of thiamine (vitamin B1), pyridoxine (vitamin B6) and cyanocobalamin (vitamin B12) - 1-2 ml intramuscularly with daily alternation of each drug - for 2-4 weeks was traditionally used. The disadvantages of this scheme have long been known - small doses and frequent injections lead to low compliance.

Currently, the multicomponent drug “Milgamma” is more often used, each ampoule of which contains 100 mg of thiamine and pyridoxine and 1000 mcg of cyanocobalamin, as well as lidocaine, which provides a local anesthetic effect when administered intramuscularly. Milgamma, which has an antinociceptive (probably serotonergic) effect, is used for acute, recurrent and chronic vertebral pain. Due to the established influence of Milgamma on the processes of regeneration of nerve fibers and the myelin sheath, this drug is especially widely used in vertebral and extravertebral forms of damage to the peripheral nervous system.

Milgamma compositum - for oral administration, includes benfotiamine (a fat-soluble form of vitamin B1 that retains its pharmacological activity after absorption in the gastrointestinal tract) and pyridoxine. The presence of these two components ensures the effectiveness of further therapy (within 6 weeks, after a course of use of the drug "Milgamma".

Treatment regimen:

Milgamma - 2 ml intramuscularly, daily, for 10 or 15 days.

Milgamma compositum - orally, 1 tablet 3 times a day, for 6 weeks.

Non-drug treatments

In case of exacerbation of vertebral pain and its reverse development, along with drug treatment, physiotherapy (including massage), acupuncture and manual therapy are carried out alternately and in different sequences. At the same time, gradual motor activation, which does not increase the severity of pain, should be carried out, which is an effective method of “self-help” for the patient, and, without exacerbation, a method of preventing chronic vertebral pain.

Surgical methods of treatment

Surgical methods for treating vertebral pathology can be planned or emergency. The planned procedure for surgical intervention is determined by a relatively stable clinic of vertebral pathology, requiring radical removal or accessible for surgical intervention.

The purpose of such operations (at the lumbar level) is:

decompression of the spinal roots in case of discogenic compression or spinal canal stenosis;
removal of a tumor of the spine, spinal cord, spinal membrane or root, which is not accompanied by signs of increasing compression.

Most spinal surgeries are performed for chronic or frequently recurring low back pain. The main argument in favor of choosing surgical treatment is usually the “exhaustion” of the entire arsenal of conservative methods available for a given case.

When making a decision to undergo surgical treatment - radical, but much more expensive - it is necessary to take into account:

a certain likelihood of resumption of vertebral pain (including in the area of other vertebrae) after surgery;
the possibility of gradual spontaneous weakening and even complete regression of vertebral pain without surgical intervention;
a significant dependence of the results of surgical treatment, even methodically successful operations, on the premorbid status of the patient: postoperative persistence and resumption of vertebral pain is typical for patients with hypochondriacal and depressive disorders, alcohol addiction, as well as those with concomitant somatic pathology.

The need for emergency surgical intervention arises with the acute development of neurological disorders caused by compression of the spinal cord and cauda equina. In the absence of radical treatment, against the background of a further increase in spinal and polyradicular symptoms, the development of irreversible neurological disorders is possible. However, an emergency surgical operation can eliminate acute compression of the spinal cord, its vessels and the cauda equina, and ensure the restoration of motor, sensory and pelvic functions.

The most important

Osteochondrosis with radicular syndrome is a consequence of long-term degenerative-dystrophic processes in the spine. This pathology is manifested by pain, numbness in the area that serves the damaged nerve, and limited mobility. When different segments of the spinal column are affected, the symptoms differ. If signs of the disease appear, you should visit a neurologist. It is important to carry out comprehensive treatment: medications, exercise therapy, physiotherapy, massage, etc. In the presence of intervertebral hernias, long-term pain that is not relieved by medications, and spinal deformities, surgery is prescribed. To avoid radicular osteochondrosis, you need to control your weight, eat right, include moderate physical activity, and wear comfortable shoes.

Diagnostics

Osteochondrosis of the lumbar spine with radicular syndrome is important to diagnose and differentiate from other pathologies in a timely manner. This is the first and important step on the path to recovery. At the first signs of the disease, you should immediately contact a neurologist who will conduct an examination, taking into account the complaints presented.

Very often, with osteochondrosis, the nature of the pain is very similar to the manifestations of such pathologies as: hepatic and renal colic, heart attacks, diseases of the gastrointestinal tract. Therefore, it is important to conduct a comprehensive examination, which includes:

consultation with specialists of various profiles (neurologist, cardiologist, therapist, surgeon);
instrumental methods (X-ray, MRI, CT scan of the spine);
laboratory diagnostic methods (detailed clinical blood tests).

MRI is one of the methods for diagnosing pathology.
At the first examination by a neurologist, the patient is identified with a source of pain, risk factors, intensity and nature of pain, the presence of tendon reflexes, the degree of limitation of mobility, and the presence of special specific signs.

An X-ray image can reveal signs of osteochondrosis - displacement of the vertebrae, the presence of intervertebral hernias, bone growths. X-rays help differentiate pain caused by tumors or injuries from pain associated with osteochondrosis.

The most informative in this case will be computer and magnetic resonance imaging. With their help, it is possible to examine all layers of the spine, determine the position of a hernia, if present, as well as swelling of the nerve roots of the spinal cord.

If the above methods are not enough to make a diagnosis, the specialist will use additional methods such as:

ultrasound diagnostics;
general blood and urine tests, biochemical blood parameters;
myelography.

An accurate diagnosis is necessary to begin effective treatment.