Vertebrogenic cervical radiculopathy: symptoms, syndromes and treatment of cervical radiculopathy

Cervical radiculitis is a range of symptoms that occur when the nerve endings of the cervical spine are compressed. Pain, loss of sensitivity, or muscle weakness can be localized on the right or left side, depending on which side the affected root is located on.

Painful symptoms are usually very severe and require immediate relief. You can undergo a course of treatment for cervical radiculitis at the CELT Clinic! Our neurologists, pain clinic specialists, and neurosurgeons have extensive and successful experience in this area and have modern methods and means to quickly and effectively relieve our patients from suffering.

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Causes

Symptoms of cervical radiculitis can appear as a result of a number of spinal diseases that are accompanied by pinched nerve endings:

• osteochondrosis in advanced stages;
• intervertebral disc herniation;
• osteoarthritis;
• spondylosis;
• spinal canal stenosis;
• spinal injuries, with displacement of the vertebrae.

Recovery prognosis

The prognosis for cervical radiculitis is generally favorable. Complete rehabilitation of the patient occurs in most cases. However, the recovery process may take several months.

The reasons for long recovery are:

• developmental abnormalities (for example, narrowness of the spinal canal);
• non-compliance with the treatment regimen, leading to prolonged static and physical stress on the cervical spine;
• elderly age.

During the first 2 years of observation, relapses are observed in 32% of patients . Five-year follow-up shows 90% of cases of stable remission.

Classification

The classification of cervical radiculitis is based on the etiology of the disease, its form and location. Depending on the cause of cervical radiculitis, there are:

• primary - develops as a result of inflammatory processes;
• secondary - develops due to chronic changes in the spine.

As for the localization of the disease, according to it, the following types of radiculitis are distinguished:

• cervical - characterized by pain in the back of the head and neck, dizziness, nausea, blurred vision and hearing, and impaired coordination of movement;
• cervical-brachial - accompanied by pain and numbness of the arms, shoulder blades, dizziness, nausea, and impaired coordination of movement;
• cervicothoracic - pain in the upper chest is added to the above clinical manifestations.

Depending on the development of the disease, there are two forms of cervical radiculitis:

• acute - accompanied by intense pain and rapid development;
• chronic - characterized by exacerbations due to hypothermia or unsuccessful sudden movements.

Causes of cervicothoracic radiculitis

There are a number of reasons for the appearance of cervicothoracic radiculitis. It is simply impossible to take into account all probable causes, so experts highlight several of the most basic :

1. Osteochondrosis of the cervical spine. This reason is one of the most common. With this type of pathology, partial destruction of the hard tissue of individual segments of the spine occurs. The segment affected in this way begins to put pressure on the intervertebral disc, and since the disc is surrounded by nerve endings, they begin to send a signal from the roots of the spinal column to the brain. This entire structure begins to move and several roots become pinched in the cervicothoracic region. This is how signs of radiculitis appear;
2. Spasms in muscle tissue. Muscle spasms are a constant companion to severe physical overload. It can also occur when there is a sudden abnormal movement of the head. The muscle frame becomes tense, the tissue becomes denser, and inflammation appears. The inflamed (and, accordingly, increased in size) muscle begins to compress the spine. Nerve endings become pinched and radiculitis appears;
3. Sudden temperature changes in the environment. Severe hypothermia of the cervicothoracic region can lead to inflammation. The process of inflammation develops very quickly and is accompanied by a sharp tension in muscle tissue. The tissue swells, swelling appears (the patient can sometimes feel it on his own). Such dense muscle tissue compresses the roots of the spine, thereby blocking nerve impulses;
4. Injuries of the cervicothoracic spine. One of the rare cases of sciatica is injury or other physical damage. Since any injury (in any part of the body) is accompanied by compression of soft tissues, it is not surprising that inflammation occurs in the affected area. Such inflammation leads to pinching, inflammation of the roots, and pain in the patient. Cervicothoracic radiculitis is a consequence of an injury;
5. Various neoplasms on the spinal column. This reason is one of the most dangerous, since neoplasms can be malignant and lead to the development of oncology. In this situation, it is best to immediately contact an oncologist. Only he will be able to accurately determine the type and quality of the new growth that has appeared. Surgery may be necessary;
6. Intervertebral hernia. A hernia occurs when the vertebrae are in an incorrect position. They seem to compress the intervertebral disc, which in turn changes its normal location. Fluid begins to accumulate in the resulting cavity, which leads to the appearance of a hernia. Unfortunately, the hernia has a habit of growing. If the growth is too intense, then the matter may end in surgery;
7. Infectious and inflammatory processes in bone tissue. This is the only reason that occurs even at the stage of intrauterine development of the raft. Another name for this inflammatory process is rickets. Rickets softens hard tissues, so the patient does not have the process of ossification. Accordingly, due to the absence of this process, deformation of the spine occurs. Some segments of the column are displaced and an additional range of pathologies develops. All this leads to the development of cervicothoracic radiculitis.

Video: “What is sciatica?”

Clinical manifestations

One of the most striking clinical manifestations of cervical radiculitis is pain. They are localized in the neck area, radiate to the back of the head, shoulder blades, shoulders, forearms, hands and have a cutting, piercing, searing nature. When trying to make movements, they intensify. In addition, symptoms of radiculitis include the following:

• pain in the cervical spine spreading to the scapula area. shoulder, forearm in the form of a strip, stripe, along the nerve; is persistent and intense in nature and can intensify with movement in the cervical spine; The pain is especially alarming at night; the pain exhausts the patient, bringing severe physical and moral suffering, sleep is disturbed;
• weakness in the hand, the patient has difficulty holding a bag, spoon, pen, fine movements in the fingers, handwriting are impaired; difficulty using the computer keyboard;

MRI of the spine

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• There is numbness in the fingers of the hands, for example, the little finger and half of the ring finger or in the II, III and half of the ring finger, a feeling of decreased sensitivity in the forearm, elbow, shoulder;
• curvature in the cervical spine, the head is tilted to the side, it hurts less;

Diagnosis and treatment of vertebrogenic cervical radiculopathy

O.S. Levin Department of Neurology, Russian Medical Academy of Postgraduate Education, Moscow During the year, approximately 20-40% of adults report neck pain, while during their lifetime at least one episode of neck pain occurs in 2/3 of adults. Neck pain, which is a reason to consult a doctor, periodically occurs in 10-12% of elderly people, and approximately 5% of the population experiences more or less long-term disability. In most cases, persistent intense pain in the neck and arm is associated with vertebrogenic cervical radiculopathy. Although the incidence of all types of neck pain in women is 1.5-2 times higher than in men, the incidence of cervical radiculopathy in men is higher than in women [1-4]. Etiology

The most common causes of vertebrogenic cervical radiculopathy are herniated intervertebral discs and cervical spondylosis. In general, the role of disc herniation in lesions of the cervical roots is less significant than in lesions of the lumbosacral roots. As at the lumbar level, there are medial hernias, which can cause compression of the spinal cord, but relatively rarely cause pain, and lateral hernias, directed towards the intervertebral foramen and capable of compressing the spinal root, leading to intense pain. More often, disc herniations are detected at the C5-C6 and C6-C7 levels, leading to damage to the C6 and C7 roots, respectively. Cervical spondylosis includes arthrosis and hypertrophy of the intervertebral joints, the formation of “uncovertebral joints”, uniform protrusion of the intervertebral discs, hypertrophy of the ligaments, the formation of osteophytes, and inflammatory damage to the periarticular tissues. All these changes can not only be a source of pain, but can also cause narrowing of the intervertebral foramina or spinal canal, leading to compression of the spinal root, spinal ganglion or spinal cord [5-7].

Pathogenesis of pain syndrome in radiculopathy

In the development of pain in vertebrogenic radiculopathy, a key role may be played by: mechanical compression of the root and/or spinal ganglion and inflammatory changes in the perineural tissue, which are triggered by the insertion of the disc into the epidural space and exposure to material released from the nucleus pulposus [8, 9]. The development of inflammatory changes in the compressed root can be mediated by the release of phospholipase A2, nitric oxide, prostaglandin E2, tumor necrosis factor-a, interleukins, etc. It cannot be excluded that the inflammatory processes are triggered by an immune reaction, which in turn is initiated by the contact of two foreign tissues (disc, perineural tissue), which normally do not contact each other. The result is irritation of nerve fibers, impaired microcirculation, intra- and extraneural edema, changes in the neurophysiological characteristics of the root or blockade of conduction along it, axonal degeneration and damage to Schwann cells. It is as a result of inflammation that the nerve fibers of the roots can become sensitive to mechanical stress [5, 10]. Radicular syndrome is often accompanied by the formation of painful and trigger points on the periphery (in the muscles of the neck, shoulder girdle, arm), which can play an independent role in maintaining the pain syndrome [6]. The pain syndrome with vertebrogenic radiculopathy is of a mixed nature. The nociceptive mechanism is associated with irritation of nociceptors in the outer layers of the damaged disc and surrounding tissues, including the dura mater, as well as in spasmodic muscles. The neuropathic component of the pain syndrome is associated with damage and irritation of the nerve fibers of the root due to its compression, inflammation, edema, ischemia, demyelination and axonal degeneration [11-13]. Clinical picture

Radicular syndrome is primarily characterized by irradiation of pain into the distal zone of the dermatome innervated by the affected root; often it also spreads to the scapula, back of the head, interscapular region, shoulder girdle, and along the anterior surface of the chest. With radiculopathy, radicular pain is accompanied by other signs of root dysfunction in the form of sensory disturbances in the corresponding dermatome, loss of deep reflexes, and muscle weakness [2, 5, 13].

Vertebrogenic cervical radiculopathy most often begins without clear provoking causes with neck pain that occurs in the morning and radiates to the arm. Pain can develop both acutely and subacutely. A characteristic symptom is also a feeling of stiffness in the neck muscles. The area of ​​pain irradiation and detection of symptoms of radicular dysfunction depends on the location of the lesion. In general, a feeling of numbness is detected in 50-80% of cases, muscle weakness - in approximately 1/3 of cases, changes in reflexes - in 70%. Upon examination, limited mobility of the cervical spine and tension in the neck muscles are revealed [4, 5, 7].

Damage to the C7 root is observed in approximately 60% of cases of cervical radiculopathy, most often in connection with a C6-C7 disc herniation. Damage to this root causes pain along the back of the forearm. Sensory disturbances are localized in the area of ​​the third and fourth fingers of the hand. Paresis primarily affects the triceps muscle, but the serratus anterior, pectoralis major, latissimus dorsi, pronator teres, flexor carpi radialis, extensor carpi radialis longus and brevis, and extensor digitorum muscles may be affected. One of the most reliable signs of root damage is a decrease in the reflex from the triceps brachii muscle. Damage to the C6 root is observed in approximately 20-25% of cases of cervical radiculopathy and is more often a consequence of a C5-C6 disc herniation. Radiculopathy C6 is manifested by pain along the outer edge of the shoulder and the posterolateral surface of the forearm to the I-II fingers. Sensory disturbances are detected on the lateral surface of the hand, especially in the area of ​​the 1st and 2nd fingers. Paresis may primarily affect the biceps brachii; much less commonly, the serratus anterior, pronator teres, flexor carpi radialis, brachioradialis, extensor carpi radialis longus, supinator and extensor carpi radialis brevis muscles are affected. A reliable sign of root damage is a decrease in reflexes from the biceps brachii and brachioradialis muscles. Damage to the C8 root is observed in approximately 10% of cases of cervical radiculopathy and is most often caused by a herniated C7-T1 disc. It manifests itself as pain along the medial surface of the shoulder and forearm. Sensitivity disorders in this case are mainly detected on the medial surface of the hand and little finger. Paresis can involve the flexor digitorum superficialis, flexor pollicis longus, flexor digitorum profundus I-IV, pronator quadratus, abductor pollicis brevis, opponens pollicis, all lumbrical muscles, flexor carpi ulnaris, abductor pollicis, muscle, Opposites little finger, flexor little finger, interosseous muscles, adductor pollicis, extensor of the little finger, extensor carpi ulnaris, abductor pollicis longus, extensor pollicis brevis and longus, and extensor of the index finger. In general, hand muscle weakness is observed only when the C8 root is affected. The reflex from the finger flexors may decrease. Due to damage to the sympathetic fibers following the superior cervical ganglion, ipsilateral Horner's syndrome is possible.

Damage to the C5 root is observed in approximately 5% of cases of cervical radiculopathy and is usually caused by a herniated C4-C5 disc. It manifests itself as pain in the neck, shoulder girdle and along the front surface of the upper shoulder. Sensory disturbances are detected on the outer surface of the shoulder. Paresis may affect the levator scapulae, rhomboids, serratus anterior, supraspinatus, infraspinatus, deltoid, biceps, and brachioradialis muscles, which may be involved in various combinations. Reflexes from the biceps brachii and brachioradialis muscles may be weakened. Signs of damage to the cervical roots are presented in Table. 1.

It should be taken into account that weakness of the extensors and flexors of the hand does not allow differentiating damage to the C6, C7 and C8 roots. The dorsal roots of adjacent cervical segments are often connected by intradural communication fibers. The connections between the dorsal root and the overlying cervical segment are especially constant [14]. In this regard, it is possible to erroneously localize the level of the lesion 1 segment higher than it actually is. Typical clinical signs that facilitate the diagnosis of cervical radiculopathy are summarized in Table. 2.

Pain from a disc herniation intensifies with increased pressure in the epidural space (with coughing, sneezing, straining, compression of the jugular veins). Pain in the neck and arm with typical irradiation (and sometimes with the appearance of paresthesia) occurs or intensifies when the head is rotated to the side with its tilting back and an axial load on it (Spurling’s symptom), sometimes with flexion of the neck and tilt of the head to the side, but is relieved by traction of the head or placing a hand behind the head (due to expansion of the intervertebral foramen). The sensitivity of the Spurling test, traction and hand-over-the-head maneuvers is 40-50%, and their specificity for cervical radiculopathy reaches 90-100%.

In contrast to disc herniation, spondylosis often affects the upper cervical (C2-C4), predominantly posterior rather than anterior roots (therefore, motor disturbances are less common), pain usually increases with extension rather than with flexion, and the prognosis is less favorable. Damage to the upper cervical roots is also possible with rheumatoid arthritis and pathology of the atlantoaxial joint. Pain with damage to the upper cervical roots can radiate to the occipital, temporal and periorbital region, to the neck and shoulder girdle. If the C2 root is affected, the pain is localized in the occipital region from the foramen magnum to the vertex; if the C3 root is affected, the pain is localized in the area of ​​the auricle, mastoid process, angle of the lower jaw, and the outer part of the back of the head. Pain caused by damage to the C4 root radiates mainly to the neck and shoulder girdle; when this root is damaged, sensory disturbances may be observed on the lateral surface of the neck.

In C7 radiculopathy, the phenomenon of pseudomyotonia, characterized by the inability to quickly unclench a fist, has been described. Unlike true myotonia, the process of muscle relaxation itself is not affected, but when trying to unclench the fingers, paradoxical flexion occurs, probably associated with abnormal regeneration of root fibers [14]. Additional research methods

X-ray of the cervical spine can reveal a decrease in the height of the intervertebral discs, sclerosis of the end plates, hypertrophy of the articular processes, osteophytes, and uneven narrowing of the spinal canal. Oblique films may reveal narrowing of the intervertebral foramina. However, identifying radiological signs of degenerative-dystrophic changes in the spine most often has no clinical significance, since they can be found in the vast majority of mature and elderly people. At the same time, in young people with a herniated disc there may be no radiological changes. The main purpose of a cervical x-ray is to rule out causes of pain such as tumor, spondylitis, or osteoporosis.

A disc herniation can be verified using computed tomography (CT) and especially magnetic resonance imaging (MRI). At the same time, CT better reveals stenosis of the intervertebral foramen, osteophytes, and ossification of the posterior longitudinal ligament. However, when interpreting imaging data, it is important to consider that in approximately 2/3 of people who have never experienced pain, these research methods reveal certain changes in the spine, often at several levels. In 57% of those examined who do not have neck pain, a disc herniation is detected, in 26% of cases - spinal canal stenosis, in 7% - neuroimaging signs of spinal cord compression. In this regard, it is important to evaluate the relationship between clinical and neuroimaging data [11, 15]. MRI of the cervical spine is absolutely indicated only when planning surgical intervention (usually no earlier than 6 weeks), there are signs of spinal cord compression, as well as when an infectious, tumor, or inflammatory lesion of the spine is suspected.

Electroneuromyography (ENMG) data rarely have practical significance in vertebrogenic radiculopathy, but are sometimes important in the differential diagnosis of damage to a peripheral nerve or plexus. The conduction velocity of motor fibers in patients with radiculopathy usually remains normal even when weakness is detected in the affected myotome, since only a portion of the fibers within the nerve are damaged. If more than 50% of motor axons are affected, there is a decrease in the amplitude of the M-response in the muscles innervated by the affected root. Vertebrogenic radiculopathy is especially characterized by the absence of F-waves with a normal amplitude of the M-response from the corresponding muscle. The conduction velocity of sensory fibers in radiculopathy also remains normal, since the root lesion (as opposed to the nerve or plexus lesion) occurs proximal to the dorsal ganglion. Needle electromyography data are of some value in differentiating radiculopathy and peripheral nerve damage. For example, C7 radiculopathy is characterized by denervation of the triceps brachii muscle, while adjacent muscles innervated from adjacent segments (eg, biceps brachii, innervated by the C6 root, and extensor index finger, innervated by the C8 root) remain intact. Lesions of the C8 root, in contrast to lesions of the ulnar nerve, are characterized by involvement of the flexor pollicis longus and extensor of the index finger [15]. Differential diagnosis

Four key questions need to be answered: 1. Is the pain musculoskeletal in nature or related to neural involvement (i.e., does it have a neuropathic component)? 2. If the pain is neuropathic, is it associated with damage to the root, plexus or peripheral nerve? 3. If the pain is associated with damage to the root, is it caused by degenerative-dystrophic changes in the spine or another pathological process? 4. Do patients have symptoms of spinal cord involvement in addition to signs of root involvement?

Pain in the neck and arm associated with damage to the spinal root or other neural structures is primarily characterized by special pain descriptors indicating its possible neuropathic nature (pain can be acute paroxysmal piercing or persistent burning, itching, cold, sometimes deep and aching , may be accompanied by a sensation of current passing and paresthesia). In addition, it is localized in the zone of innervation of the corresponding structure (in case of damage to the root - in the dermatome zone) and is accompanied by changes in sensitivity (such as hypesthesia, hyperalgesia, allodynia, hyperpathia) in the same zone. Pain in the neck that does not radiate to the arm, as well as pain in the shoulder girdle and proximal arm, are not typical for cervical radiculopathy. Pain in the arm, not accompanied by changes in sensitivity and other neurological symptoms, is more often caused by damage to the articular and soft tissues, vessels of the upper extremities, as well as somatic diseases that cause referred pain.

Pain in lesions of the intervertebral joints is predominantly felt in the projection of the involved joint, but can spread diffusely due to multisegmental innervation. It often intensifies with extension, but the main criterion for its connection with joint pathology is the disappearance of pain after its blockade. It should be taken into account that pain associated with the pathology of the intervertebral joints, as well as with the formation of myofascial zones in some muscles (for example, scalene or scapular), can imitate radicular (pseudoradicular pain).

Pain in the arm, combined with impaired sensitivity, paresis, amyotrophy and/or vegetative-trophic disorders, may be associated with damage to the brachial plexus, compression neuropathies, and reflex sympathetic dystrophy. Common causes of brachial plexus lesions, for example, include thoracic outlet syndrome and neuralgic amyotrophy, which can mimic manifestations of cervical radiculopathy. However, in all these cases, a different localization of the pain syndrome, a different pattern of the muscles involved (which can be objectified using ENMG), and additional symptoms (in particular, Phalen’s sign in carpal tunnel pathology or local osteoporosis in reflex sympathetic dystrophy) are observed.

More rare causes of cervical radiculopathy are herpes zoster, diabetes mellitus, extra- and intraspinal tumors, vasculitis, sarcoidosis, which can be excluded with a thorough general and neurological examination, but sometimes only with the help of additional research methods. For example, a primary spinal nerve tumor may present with radicular pain, but this usually occurs in the presence of severe sensory loss in the corresponding dermatome. The C8 and T1 roots are rarely involved in degenerative-dystrophic lesions of the spine, therefore, when their lesion is detected, cancer of the apex of the lung should first be excluded (especially if Horner's syndrome is present on the affected side).

Compression of the spinal cord and the development of spondylogenic cervical myelopathy may be indicated by paresis and conduction-type sensory disturbances in the arms and legs, revitalization of tendon reflexes and spasticity in the lower extremities, pathological hand and foot reflexes, pelvic disorders, Lhermitte’s symptom (feeling of current passing through the spine and legs when bending the neck). Course and prognosis The prognosis is generally favorable - in most cases there is complete recovery, which, however, may take several months. Unfavorable factors are old age, prolonged static or phasic load or whiplash injury, smoking, developmental anomalies (narrow spinal canal, Klippel-Feil anomaly), somatoform disorders. Relapse within the first 2 years is observed in 32% of patients. At 5-year follow-up, 90% of patients develop stable or almost stable remission [4]. Principles of treatment In the vast majority of patients with discogenic cervical radiculopathy, conservative therapy can achieve a significant reduction and regression of pain [15]. The basis of conservative treatment of radiculopathy, as well as other types of back pain, are non-steroidal anti-inflammatory drugs (NSAIDs), which have both analgesic and anti-inflammatory effects, which are important from the point of view of the mechanisms of development of pain syndrome. NSAIDs should be used from the first hours of the development of the disease; in case of intense pain, parenteral administration is preferable. The choice of drug is determined by the ratio of its effectiveness and safety. The “gold standard” NSAID is diclofenac (Voltaren), against which it is customary to determine the effectiveness of other drugs [16]. Although controlled comparative studies usually fail to detect a significant difference in the group average analgesic activity of different NSAIDs, practical experience shows that the use of non-selective NSAIDs leads to a more guaranteed clinical effect in vertebrogenic pain syndromes.

NSAIDs are characterized by a relatively high risk of side effects such as dyspepsia, gastrointestinal bleeding, liver dysfunction, headache, kidney dysfunction, etc. Until recently, it seemed that the disadvantages of traditional NSAIDs could be eliminated by creating drugs with a more selective effect, in particular selective inhibitors of cyclooxygenase (COX) type 2, however, when using existing drugs of this group, the risk of gastrointestinal complications is not completely eliminated, and the risk of damage kidney function remains the same as with non-selective COX inhibitors. Moreover, selective COX-2 inhibitors were characterized by a higher risk of cardiovascular complications, and according to some experimental data, the analgesic effect of drugs in this group may be lower than that of non-selective COX inhibitors, since blockade of both types of COX is necessary to obtain maximum analgesia . From this point of view, diclofenac, which has a balanced effect on 2 types of COX, seems to be the drug of choice for the treatment of vertebrogenic pain syndromes, also taking into account the acceptable frequency of side effects. The effective dose can range from 75 to 200 mg/day. The use of the original drug Voltaren can give a more guaranteed result, since the bioequivalence of many generics has not been proven, meanwhile, differences in the composition of auxiliary compounds often have a critical impact on the analgesic activity of the drug [16, 17].

Selective COX-2 inhibitors are recommended to be prescribed only if traditional NSAIDs are poorly tolerated or if there is a history of gastric and duodenal ulcers. It should be noted that patients are individually sensitive to NSAIDs; therefore, if the optimal therapeutic doses of one of the drugs are ineffective, another drug may be tried for several days. In general, the duration of use of 1 drug should not exceed 10-14 days. When prescribing non-selective NSAIDs (regardless of the route of administration), it is advisable to prescribe a proton pump inhibitor. For intense pain, it is possible to add tramadol to NSAIDs at a dose of up to 300 mg/day or a combination of tramadol and paracetamol. An obligatory component of treatment should also be a short (7-10 days) course of muscle relaxants.

Corticosteroids are the most effective means of suppressing the inflammatory response, which may be involved in the development of pain. As with lumbosacral radiculopathy, epidural administration is preferable, especially transforaminal, which creates the highest local concentration of the drug. It is preferable to administer corticosteroids epidurally, forming a depot at the injection site, usually in 1 syringe with a local anesthetic (for example, 0.5% novocaine solution) [18, 19]. However, given the technical complexity of this manipulation, which must be carried out under fluoroscopic control, it seems advisable to administer a short course of corticosteroids administered orally or parenterally (for example, 60-100 mg/day of prednisolone for 7-10 days, followed by rapid discontinuation of the drug).

Considering the importance of the neuropathic component of pain, it seems advisable to introduce into the treatment complex drugs that relieve neuropathic pain: antidepressants, anticonvulsants, lidocaine, opioids. Empirically, combination preparations of B vitamins, magnesium sulfate, and pentoxifylline can be used as adjuvants. In the acute period, immobilization of the neck with a soft or semi-rigid collar is indicated (primarily at night), the duration of which should be limited to several days. According to some studies, traction contributes to the regression of pain, but the level of evidence regarding the effectiveness of this method remains insufficient [20]. Reflexotherapy can be used both in the acute phase and at later stages of patient management. Subsequently, gradual mobilization of the neck, post-isometric relaxation, physiotherapeutic procedures, and therapeutic exercises are carried out [21]. Surgical intervention Surgical intervention is indicated for symptoms of spinal cord compression (spondylogenic cervical myelopathy) and severe pain syndrome (clear signs of radiculopathy, confirmation of root compression using MRI or CT myelography and ineffectiveness within 8 weeks of the entire arsenal of conservative treatment). According to various studies, the need for surgical treatment occurs in 10-30% of cases of cervical radiculopathy [22]. Literature 1. Veselovsky V.P. Practical vertebroneurology and manual therapy. Riga, 1991; With. 30-145. 2. Levin O.S. Diagnosis and treatment of pain in the neck and upper extremities. Rus. honey. magazine 2006; 9: 713-9. 3. Popelyansky Ya.Yu., Shtulman D.R. Pain in the neck, back and limbs. Diseases of the nervous system. Ed. N.N.Yakhno, D.R.Shtulman. M.: Medicine, 2001; With. 293-316. 4. Radhakrishnan K, Litchy WJ, O'Fallon WM et al. Epidemiology of cervical radiculopathy. Brain 1994; 117: 325-35. 5. Popelyansky Ya.Yu. Orthopedic neurology. T. 1, 2. Kazan, 1997. 6. Maigne R. Diagnosis and treatment of pain of vertebral origin. Baltomore. Williams & Wilkins, 1996. 7. Polston DW. Cervical radiculopathy. Neurol Clin 2007; 25: 373-85. 8. Levin O.S. Diagnosis and treatment of neurological manifestations of spinal osteochondrosis. Cons. Med. 2004; 6:547-54. 9. Osna A.I., Putintseva L.S., Atuchina S.I. Autoimmune reactions in the pathogenesis of spinal osteochondrosis. Journal neuropathol. and a psychiatrist. 1970; 11: 1621-5. 10. Rhee JM, Yoon T, Riew KD. Cervical radiculopathy. J Am Acad Orthop Surg 2007; 15: 486-94. 11. Levin O.S. Modern approaches to the diagnosis and treatment of back pain. M., 2006. 12. Adams AC. Neurology in Primary Care. FA Davis, Philadelphia, 2000. 13. Levine MJ, Albert TJ, Smith MD. Cervical radiculopathy: diagnosis and nonoperative management. J Am Acad Orthop Surg 1996; 4: 305-16. 14. Brazis P.W., Masdew D.K., Biller H. Topical diagnostics in clinical neurology. Per. from English M.: Medpress-inform, 2009. 15. Eubank JD. Cervical Radiculopathy: Nonoperative Management of Neck Pain and Radicular Symptoms. Am Fam Physician 2010; 81: 33-40. 16. Ananyeva L.P., Podchufarova E.V. Modern painkillers. M.: 2005. 17. Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine 1996; 21: 1877-83. 18. Anderberg L, Annertz M, Persson L et al. Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomized study. Eur Spine J 2007; 16 (3): 321-8. 19. Ma DJ, Gilula LA, Riew KD. Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections. J Bone Joint Surg Am 2005; 87 (5): 1025-30. 20. Graham N, Gross A, Goldsmith CH et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database Sys Rev 2008; 3: CD006408. 21. Hurwitz EL, Aker PD, Adams AH et al. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996; 21 (15): 1746-59. 22. Albert TJ, Murrell SE. Surgical management of cervical radiculopathy. J Am Acad Orthop Surg 1999; 7 (6): 368-76. SOURCE CONSILIUM-MEDICUM NEUROLOGY No. 1/2010

Diagnostics

Treatment of the symptoms of cervical radiculitis is possible only after making a correct diagnosis. It is this area that receives special attention. The patient is examined by a neurologist, pain clinic specialists, and neurosurgeons who check reflexes and motor and sensory disorders. In addition, diagnostic studies are carried out, which include:

• radiography;
• magnetic resonance imaging;
• computed tomography;
• radiography;
• electrodiagnostics of peripheral nerves;

Reviews of doctors providing the service – Cervical radiculitis

In 2000, Andrei Arkadyevich performed spinal surgery on me.
Four days in the clinic and I have been living a full life for 20 years without restrictions on movement and I remember with gratitude Dr. A.A. Khodnevich. God bless him. And in 2000 he could walk no more than 10 meters. Read full review Viktor Alexandrovich

20.05.2020

Low bow to Alexander Semenovich Bronstein and Andrei Arkadyevich Khodnevich. I arrived at CELT on July 2, 2021 with extreme pain that I endured for 10 days. Hernia C6-C-7. I was given two blockades in Ivanovo, about 9 complex IVs, I lost 6 kg in a week and was in a panic, I didn’t see a way out and nothing happened to me... Read full review

Elena Nikolaevna L.

20.10.2019

Treatment

Complex conservative treatment, which has been practiced by CELT doctors for several years, invariably gives positive results. It allows you to release pinched nerve endings and relieve pain, weakness and numbness of the upper extremities, eliminate inflammation and muscle spasms. Treatment is carried out using a number of modern techniques:

Operations for diseases of the spine

• Cost: 100,000 - 250,000 rubles.
• Duration: 40-60 minutes
• Hospitalization: 2-3 days in hospital

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It is worth noting that we resort to surgical intervention in extreme cases, if there are appropriate indications:

• lack of improvement with conservative treatment;
• intense pain symptoms;
• feeling of weakness in the hand;
• decreased hand sensitivity.

CELT neurosurgeons use minimally invasive techniques that involve small incisions or punctures. Before the operation begins, it is planned and a three-dimensional model is created. The process uses microsurgical and endoscopic techniques, ultrasound equipment and laser. The use of modern techniques makes it possible to make surgical intervention minimally traumatic and minimize the rehabilitation period. Our patients can go home the very next day and return to work two to three weeks after surgery.

Lumbar sciatica

Lumbar radiculitis means localization in the lower back (in the lumbar spine, consisting of 5 large and fairly mobile vertebrae), where the center of gravity of the human body is located. The signs of radiculitis are similar to other parts (pain, loss of sensitivity and muscle weakness) and the affected area corresponds to the zone of innervation (that is, pain and other symptoms accompany the nerve fiber along its course in the body). Lumbar radiculitis (radiculopathy) is often called sciatica. This term refers to irritation of the large sciatic nerve, which begins at the exit from L1-L5, passes through the pelvis into the legs and reaches the feet. The most striking symptom of sciatica is intense pain in the buttocks, hip and foot (usually unilateral). The main causes of lumbar radiculitis (radiculopathy) are: arthritis, degenerative changes in the vertebrae, spinal canal stenosis, foraminal stenosis, compression fracture, disc herniation, disc protrusion, spondylolisthesis.

Preventive measures

The best treatment for any disease is its prevention, and sciatica is no exception. You can minimize the risk of developing this disease by:

• to live an active lifestyle;
• regularly engage in sports and swimming;
• eliminate hypothermia and intense stress;
• correctly distribute loads when lifting and carrying heavy objects;
• Healthy food;
• organize the workplace taking into account all the rules and recommendations of ergonomics;
• promptly seek professional medical help for diseases of the musculoskeletal system.

Our specialists know how to return you to your normal lifestyle, relieving you of pain and inflammation.

Make an appointment through the application or by calling +7 +7 We work every day:

• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

The nearest metro and MCC stations to the clinic:

• Highway of Enthusiasts or Perovo
• Partisan
• Enthusiast Highway

Driving directions

Symptoms of radiculopathy

Doctors use the term radiculitis (radiculopathy) to describe a set of symptoms that appear when there is pressure on the roots of the spinal cord (which is a bundle of nerve fibers emanating from the spinal cord). However, radiculitis (radiculopathy) is not an independent disease, but only a complex of symptoms including pain, muscle weakness and sensory disturbances, which originate in the spine and go to the limbs. The human spine is divided into five sections and sciatica (radiculopathy) most often occurs in the cervical thoracic and lumbar spine. 31 pairs of roots arise from a long spinal cord in the rather narrow spinal canal of the spine. Various reasons can reduce the space where the roots are located and put compression on them - this is a disc herniation or protrusion, stenosis, tumor, infectious process, osteophyte. Despite all the variability of symptoms, the most common symptoms are the following:

• Pain (discomfort) from dull and intermittent to constant and debilitating with irradiation. Pain (as a protective factor in the body) indicates that there is a damaging effect on nerve fibers.
• Impaired sensitivity. It should be noted that the spine is a rather complex structure. We unconsciously carry out a huge number of movements, and this happens automatically. But in order for the movements to be harmonious, it is necessary that there is feedback from the brain to the muscles and sensory receptors. When the roots are compressed, the conduction of impulses in both directions is disrupted. Accordingly, both sensitivity (numbness, burning, tingling) and impulse transmission to the muscles are impaired.
• Muscle weakness. Sometimes muscle weakness occurs in isolation (with isolated compression of motor neurons). For normal muscle functioning, two-way communication is necessary, both with the spinal cord and the brain. When the root is compressed (by a disc herniation, osteophyte or something else), the supply of impulses is interrupted and the muscle stops working normally. With prolonged disruption of the normal conduction of impulses, muscle atrophy or even flaccid paresis occurs.