Treatment of radicular syndrome is carried out by a neurologist

Radicular syndrome , otherwise called radiculopathy, is a set of symptoms that occur when the spinal nerves are compressed in the radicular part.

Radiculopathy accompanies many diseases of the spine and significantly worsens the patient’s well-being.

Without treatment, long-term radicular syndrome leads to muscle wasting and disruption of the functioning of internal organs.

Classification

The classification of radicular syndrome takes into account the topography of the pinched nerves (cervical, thoracic, lumbar, etc.).

Depending on the nature of the lesion, there are three main types of radiculopathy:

• discogenic - the most common type, occurs with disc hernias, with a long course there is a high risk of paralysis;
• vertebrogenic - pinched nerve in stenotic foraminal openings, requires urgent medical attention;
• mixed - the nerve is pinched due to deformation of the intervertebral disc and osteophytes on the vertebral bodies.

Treatment methods

When determining the treatment regimen, the doctor takes into account the cause of the development of CS, the degree of damage, and the severity of neurological disorders. In most cases, conservative treatment is carried out - a course of medications, physiotherapeutic and massage procedures, exercise therapy. Surgical intervention is indicated for patients with pain that cannot be eliminated with medication, detection of neoplasms, or the development of complications that threaten loss of ability to work.

From the first days of treatment, it is recommended to wear orthopedic devices, usually Shants collars. They stabilize vertebral structures, preventing their displacement and infringement of sensitive nerve endings. Wearing collars allows you to avoid awkward, sudden movements that can provoke a painful attack. They are worn for several hours during the day and must be removed before bed.

Drug treatment

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first choice drugs for cervical CS. Acute pain is eliminated by intramuscular administration of Movalis, Diclofenac, Ketorolac or their structural analogues.

For pain of moderate severity, NSAIDs in tablets are prescribed - Ketorol, Nise, Celecoxib, Ibuprofen, Ketoprofen.

They are combined with proton pump inhibitors (Omeprazole, Esomeprazole, Pantoprazole), which reduce the production of gastric juice. The local application of NSAID gels and ointments helps to get rid of weak aching, pulling, pressing pains that usually occur during the remission stage. These are Voltaren, Fastum, Indomethacin, Finalgel, Artrosilene.

To strengthen the ligamentous-tendon apparatus and partial regeneration of the cartilage of the intervertebral discs, patients are prescribed a long-term (up to 2 years) course of chondroprotectors: Artra, Structum, Teraflex, Chondroxide.

The therapeutic effect of the drugs appears after a couple of weeks, when a sufficient amount of active ingredients accumulates in the damaged vertebral structures. Chondroprotectors also have analgesic and anti-inflammatory properties, which makes it possible to reduce doses of glucocorticosteroids and NSAIDs.

Surgical intervention

If the symptoms of loss of function progress or a tumor is discovered that impinges on the spinal roots, then the neurosurgeon immediately performs an operation. Surgical intervention consists of eliminating compression and removing the cause of its occurrence. In case of intervertebral hernia, the protrusion is excised, usually together with the destroyed disc, in the process of open or endoscopic discectomy, microdiscectomy. Then the spinal column is fixed or B-Twin implants are installed. For decompression, a laminectomy, or removal of the vertebral arch, is performed.

Laminectomy methods (removal of the vertebral arch).

Surgical treatment can be performed using intradiscal electrothermal therapy. Recently, nucleoplasty has been used to remove a hernia - a puncture surgical intervention to remove (vaporize) a fragment of the nucleus pulposus of the intervertebral disc.

Physiotherapy

Some physiotherapeutic measures are indicated for patients in the subacute stage to relieve pain. These are electrophoresis and ultraphonophoresis with glucocorticosteroids, anesthetics, and NSAIDs. Under the influence of electric current, most of the drugs penetrate into the foci of pathology, which makes it possible to reduce the doses of systemic drugs and reduce the pharmacological load on the patient’s body. Subsequently, electro- and ultraphonophoresis are carried out with chondroprotectors to restore damaged vertebral structures. During the rehabilitation period, other physical procedures are also used - magnetic therapy, diadynamic currents, laser therapy, shock wave therapy.

Treatment of cervical spine pathologies with laser.

Acupuncture

After eliminating severe pain and inflammation, patients are recommended to undergo acupuncture sessions. During the procedure, thin steel, silver or gold needles are used. They are installed at acupuncture points located near damaged roots and on other parts of the body. Acupuncture is characterized by diverse effects:

• painkiller. Under the influence of needles, sensitive nerve endings are excited. Pain impulses from the surface of the skin enter the central nervous system faster than from the affected root, activating interneurons. The areas of the brain that perceive pain from the cervical segments are blocked;
• improvement of general condition. Bioactive points contain nerve endings - part of the endorphinergic system. When they are excited, the pituitary gland begins to release endorphins, which have a relaxing and analgesic effect.

Acupuncture session.

Acupuncture improves blood circulation in the area of ​​the cervical vertebrae and normalizes innervation. During the procedure there is no pain, a slight tingling and numbness is felt.

Manual therapy

Manual therapy is a treatment method that involves the influence of the doctor’s hands on the patient’s body. It eliminates muscle spasms, realigns displaced intervertebral discs and vertebrae, which relieves pressure on the spinal roots. One of the methods of manual therapy used for radicular syndrome is spinal traction (traction):

• dry - carried out on special tables located at a certain angle;
• underwater - carried out in deep baths or pools.

Underwater horizontal spinal traction.

Traction can be done with weights, that is, using loads up to 10 kg. After several sessions, the distance between the vertebrae increases. Their bodies stop squeezing sensitive nerve endings and pinching blood vessels.

Hirudotherapy

Hirudotherapy is a method of alternative medicine, one of the areas of naturopathy, which involves the treatment of cervical radicular syndrome with medicinal leeches. These are annelids that live in fresh water bodies and are specially grown for the needs of hospitals. The therapeutic effect of hirudotherapy is due to several factors:

• dosed bloodletting. Each leech, after being installed on certain areas of the body, sucks about 10 ml of blood. In case of radicular syndrome, bloodletting is used to eliminate intoxication of the body, high blood pressure, and inflammatory swelling;
• improvement of general well-being. The saliva of annelids contains a huge number of biologically active compounds, the most valuable of which is the anticoagulant hirudin. It reduces blood clotting and stimulates the blood supply to damaged vertebral structures with nutrients and oxygen.

Hirudotherapy session.

When choosing a place to install leeches, the severity of symptoms, the cause of cervical CS, and the general health of the patient are taken into account. Usually 5-8 worms are used, which are placed for 15 minutes. Some leeches, having had enough, fall off faster. Annelids are not reused; they are destroyed after each procedure.

Warming up

Thermal effects on the cervical spine stimulate blood circulation, normalize microcirculation, and promote the restoration of damaged connective tissue structures. For warming up, blue light lamps, heating pads, and linen bags with sea salt or flaxseeds are used.

Preparations for local application - ointments, gels, creams - also have a thermal effect on the cervical spine. In the treatment of CS, agents are used whose active ingredients are capsaicin (red hot pepper extract), snake and bee venom, and gum turpentine. These are Finalgon, Viprosal, Capsicam, Apizartron, Nayatox.

Magnetotherapy

The effect of a magnetic field on the body is practiced for almost all pathologies of the musculoskeletal system, including cervical knee joints. Positive changes are observed after 5-10 sessions of magnetic therapy. Physiotherapeutic procedures are indicated for patients with osteochondrosis, hernias, protrusions for the following purposes:

• acceleration of metabolism and recovery processes in cartilage tissues, muscles, ligaments;
• oxygen saturation of organs and tissues;
• detoxification of the body and removal of metabolic products;
• reduction of swelling, improvement of the condition of blood vessels;
• reduction in the severity of pain.

The magnetic field also affects nerve tissue, which is important in the treatment of radicular syndrome. After each procedure, the transmission of nerve impulses improves and innervation is normalized.

Home treatment

The patient is hospitalized only in case of acute pain and developed complications. And in most cases, treatment of radicular syndrome takes place at home. The patient is recommended to follow a gentle regimen, wear Shants collars, and take a course of medications.

Exercise therapy

To strengthen the muscular corset of the cervical spine, improve blood supply, increase the strength and elasticity of the ligamentous-tendon system, patients with CS are recommended to do daily gymnastics and physical therapy.

The most therapeutically effective exercises are:

• in a standing position, tilt the head from side to side;
• in a standing or sitting position with a straight back, tilting the head forward and then leaning back;
• in a sitting position, raising and lowering the shoulders.

All movements should be performed smoothly, slowly, with a small amplitude 20-25 times. In addition to the main exercises, the physical therapy doctor selects others individually for each patient, taking into account physical fitness, the cause of the development of CS, and the degree of damage to the spinal roots.

Massage

For cervical CS, classic massage of the cervical-collar area is more often used. At the initial stage of the procedure, tissues are warmed up, tense and sometimes spasmed muscles are relaxed. The increased tone of skeletal muscles, which often causes CS symptoms, is eliminated. Headaches, dizziness, arterial hypertension, limited mobility, and cerebrovascular accidents are eliminated.

Massage of the cervical-collar area.

Massage of the cervical-collar area improves sleep, normalizes the patient’s psycho-emotional state, and increases mental and physical performance.

Other types of healing procedures have also proven themselves well in CS therapy. This is a segmental, vacuum, Swedish massage. As a result of manual or instrumental mechanical action, the condition of the skin, muscles, blood vessels, spinal roots and peripheral nerve trunks improves.

Portable physiotherapy equipment

Pharmacies and medical equipment stores sell special devices for carrying out physiotherapeutic procedures at home - Teplon, Almag, AMT. They differ in the principle of action, therapeutic effectiveness, and frequency of use. The therapeutic activity of devices is determined by physical factors. This is a magnetic field, vibration, infrared radiation, heat. Representatives of official medicine are very skeptical about such methods of therapy.

Any device should be used only after consultation with a neurologist or vertebrologist, since during an exacerbation or in the subacute period, any impact on the neck area can provoke serious complications of radicular syndrome.

Traditional methods

These methods of treating radicular syndrome can only be used in consultation with a doctor at the stage of remission. Most folk remedies contain ingredients with a local irritating, warming effect. In the acute and subacute periods of warming up, they will cause progression of aseptic inflammation, increased severity of edema and even stronger compression of the spinal roots.

Folk remedies are used only as a prophylaxis for CS in osteochondrosis. Doctors may recommend taking rosehip decoction to strengthen the immune system, lemon balm tea and St. John's wort to improve the psycho-emotional state.

Tea made from lemon balm and St. John's wort.

Spa treatment

During the rehabilitation period, patients are indicated for sanatorium-resort treatment for recovery after conservative or surgical therapy. Rehabilitation doctors usually recommend clinics equipped with equipment for physiotherapy:

• applications with paraffin and ozokerite;

Neck applications made of ozokerite and paraffin.

• sulfide and radon baths;
• UHF therapy.

In Kislovodsk, Pyatigorsk, Essentuki, the use of mineral waters and medicinal mud is practiced. Such procedures stimulate trophism and blood supply to tissues, have a resolving, anti-inflammatory, analgesic, and antispasmodic effect.

Symptoms

The radicular symptom complex is manifested by pain, impaired sensitivity along the damaged nerve and malfunction of individual organs. The symptomatic picture depends on the damage to individual roots.

Radicular syndrome in the cervical spine provokes pain and loss of sensitivity in the back of the head, back/side surfaces of the neck, and in the arm to the fingertips. There is weakness in the pectoralis major, biceps/triceps, and finger extensor muscles. Limited mobility in the shoulder joint.

Radiculopathy in the thoracic region is manifested by pain of varying intensity in the shoulder joint, intercostal space, mammary glands, epigastrium, and groin. Often imitates angina pectoris, provokes symptoms of acute abdomen and biliary dyskinesia. Abdominal reflexes are reduced, hypotrophic changes and parasthesia of the hands are noted.

Pinched lumbar roots cause pain from the groin to the first two toes. Muscular wasting of the limb develops. Flexion of the hip is difficult, the knee reflex is weakened, and when turning the foot, a “slamming” effect occurs.

With sacral radiculopathy, pain and sensory disturbances spread from the sacrum along the posterior outer surface of the limb on the affected side to the foot.

The calf muscle is hypotrophied. The Achilles reflex is sometimes weakened. When three spinal nerves are damaged at once, involuntary acts of urination and defecation occur.

What is radiculopathy

Against the background of lumbar osteochondrosis, a disease such as radiculopathy of the lumbosacral spine very often develops.
This is a clinical syndrome that occurs due to compression and damage to the nerve roots. A synonym for radiculopathy is radiculitis. Radiculitis (radiculopathy, from the Latin radicula - root) is a disease of the human peripheral nervous system that occurs as a result of damage, inflammation or pinching of the spinal nerve roots.

Radiculitis is a widespread disease, it affects more than 10% of the population of our planet over 40-50 years of age, and in the last decade, radiculitis has become younger, occurring in the young age group from 25 to 35 years old, people involved in professional sports, as well as those who are especially susceptible, are especially susceptible. who sits at a computer or driving a car for a long time.

Diagnostics

The clinical picture of the disease will force a person to see a doctor. Nerve plexus pathology is treated by a neurologist. Initially, studies are prescribed that can visualize the lumbar spine.

These include:

1. X-ray examination. The radiologist will describe the deformation of bone structures, pathological curvature of the lumbar spine, displacement of the vertebrae, a decrease in their density due to a decrease in the mineral component, and a decrease in the intervertebral space.
2. Myelography. An invasive method based on contrasting the subarachnoid space. The contrast penetrates along the roots, so you can very accurately determine at what stage the infringement occurred.
3. Magnetic resonance imaging. A method widely used in the diagnosis of neurological pathology. Recognized as the most informative for visualizing nervous tissue. You can also use it to look at the affected area in different sections and see hernias.

Also used in diagnosis are methods such as:

• Ultrasound of the abdominal cavity to exclude pathology of internal organs;
• Blood tests for acute phase indicators and rheumatic tests (to exclude an autoimmune process);
• Determination of the level of total and ionized calcium (diagnosis of osteoporosis);
• Determination of viral, bacterial or fungal agent and other tests.

Risk factors

Risk factors leading to lumbar radiculopathies include:

• Nutrition. A complete healthy diet is the key to a long life with a minimum of pathologies. This concept includes not only the intake of the required amount of proteins, vegetable and animal fats, simple and complex carbohydrates, microelements and vitamins, but also the regularity and frequency of meals. There should be at least 4-5 full meals a day, preferably at the same time, so that the gastrointestinal system adapts and is as ready as possible for the load.
• Adequate physical activity. The higher a person’s standard of living, the less time and opportunity for sports and necessary physical activity. People spend more and more time in public or private transport, sitting in front of a computer monitor at work, and when they come home, they forget that they need to walk at least seven kilometers every day, do morning exercises, strengthen and stretch the muscles of the back and neck.
• Sleeping mode. Sleeping for your posture and back should be done on a hard surface to prevent prolapse and curvature of the spinal axis.
• Hard physical labor. Most often, people in the following professions suffer from radiculitis of the lumbar region: builders; gardeners; miners; dentists who are forced to be in a bent position almost the entire working day; drivers and others.
• Genetic predisposition to connective tissue dysplasia: imperfection of collagen and elastic fibers, increased flexibility in joints, overstretching of the ligamentous apparatus.
• Hereditary and congenital pathology. Sometimes children are born with anomalies in the development of vertebrae, discs, and congenital hernias, which increases the possibility of developing radiculopathy.
• Tumors of the vertebrae, spinal cord, metastases of cancer in other locations.
• Flat feet and curvature of the pelvis. Violation of the spinal axis leads to a redistribution of the load on the intervertebral joints, thus, on some sides the load is greater, and on others less - which leads to dystrophies and deformations of the cartilage, and curvature of the spinal axis.
• Chronic depression, frequent stress and emotional shocks. All diseases are caused by nerves; with nervous overstrain, both hormonal levels and metabolic processes are disrupted, which negatively affects all systems and organs, including the musculoskeletal system.
• Frequent hypothermia and infectious diseases affecting the nervous tissue (herpes viruses: herpes zoster, cytomegalovirus) lead to inflammation of the nerve itself.
• Hormonal disorders, obesity.
• Infectious bone diseases: osteomyelitis and tuberculosis. Lead to destruction of bone structures.
• Injuries, including compression fractures due to osteoporosis and other factors.

Causes

Clinical manifestations of radiculopathy arise as a consequence of a number of diseases, which are characterized by damage to nerves and roots;

• osteochondrosis;
• protrusion, prolapse or herniated disc;
• spinal canal stenosis;
• piriformis syndrome;
• spondylosis;
• injuries accompanied by displacement of the vertebrae;
• osteoarthritis.
• infectious lesion;
• impaired blood supply to the nerve, radiculoischemia;
• systemic, autoimmune lesions of the nervous system;
• toxic damage to the nervous system
• metabolic, hormonal disorders;
• diabetes mellitus, diabetic neuro-, radiculopathy;