Cervical radicular syndrome: symptoms and treatment

Radicular syndrome is a complex pathology, the etymology of which can be different. Destructive changes in the vertebral discs occur in stages, so they are most often diagnosed when pain occurs.

Causes of radicular syndrome:

• pathological changes in the spine due to osteochondrosis;
• defect of the posterior wall of the spinal column cavity in the form of a hernia;
• hypoactivity due to sedentary work and refusal to exercise;
• significant deformation of the spine due to spondyloarthrosis;
• tumors, injuries and scars in the area of ​​the base of the axial skeleton;
• serious consequences of osteoporosis in the form of vertebral fractures;
• the course of infectious diseases: tuberculosis, osteomyelitis;
• excessive force on the spine for a long time;
• frequently repeated hypothermia of the body (working in the cold);
• genetic predisposition to the disease;
• feature of human age-related changes.

Location of pathology:

1. Cervical region. The main symptom of damage to this area is neck pain, felt in the subscapular region and shoulders. The patient regularly feels tingling in his hands, and he regularly has a desire to stretch his neck muscles. The patient's skin becomes pale and hair thins. It is easy to identify the problem yourself, because it is enough to raise your hand high from the side of the affected area. If the cervical spine is affected, then such manipulation will be difficult or impossible.

2. Thoracic region. When palpating this part of the body, the main lesions are easily identified. A common mistake people make is that they confuse the disease with intercostal neuralgia and begin to self-medicate. Symptoms of damage to the thoracic region are also similar to cardiac colic, so they try to eliminate them without consulting a doctor with Corvalol.

3. Lumbar region. The vulnerability of this zone is obvious. Radicular syndrome of the lumbar spine is characterized by exhausting pain and frequent complications of the pathology. As nerve compression progresses, it becomes difficult for a person to move without assistance.

Diagnosis of the disease:

1. X-ray. It is produced in a two-plane projection: oblique and straight.

2. MRI. If it is impossible to make a diagnosis of a spinal lesion, magnetic resonance imaging is used.

Disease prevention:

• a change in professional activity that involves regular stress on the spine;
• regular exercise without excessive strength exercises;
• visiting the swimming pool and massage sessions;
• eliminating signs of obesity with the help of exercise therapy and special diets;
• wearing clothes according to the season and weather conditions;
• choosing the right shoes and avoiding bulky models.

How do physiotherapy treatments work?

Electrophoresis. The method involves placing electrodes connected to a special device on the body. The supplied current, affecting the nerves and joints, acts along a fading trajectory without painful sensations for the patient.

Reflexology. Treatment with special needles is usually carried out by a chiropractor. The puncture sites are determined after identifying problem areas in the spine.

Ultrasound. It is especially effective in eliminating pain in the sacrolumbar area. The intensity of the waves is determined by a specialist. The patient may feel slight vibration. Contraindications for the procedure include malignant tumors, pregnancy and serious blood diseases.

Magnetotherapy. It is prescribed for swelling of areas of pinched nerves, inflammation and pain symptoms. A magnetic field created by special equipment affects problem points for 10-20 minutes. Features of the procedure include the possibility of carrying it out in clothing and a plaster cast.

Treatment with mud. Healing baths are necessary to calm the nervous system, which has suffered from periodic attacks of pain in the spine or neck.

Radon baths. Active treatment with their use eliminates inflammatory processes and solves neurological problems.

Massage. It is necessary to strengthen the spinal muscles and eliminate signs of poor circulation in the tissues.

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.

Physical therapy for nerve compression

It is better to prevent acute radicular syndrome than to eliminate its consequences. During the recovery period after a relapse, it is useful to perform the following exercises:

1. Lying down. Once on the mat, straighten your legs and place your arms along your body. The exercise consists of tensing and relaxing the abs at least 15 times. Next, the bent knees need to spring in the opposite direction from the upper body for a couple of minutes.

2. On all fours. After taking this position, you should, with leisurely movements, play like a cat, which arches and lowers its back. The exercise is performed until pleasant exhaustion occurs.

3. Roll on the ball. The item must not contain a traumatic surface. Having placed it behind your back, you should make smooth rolls on the ball back and forth on the floor.

4. Exercise with a hoop. The times of halahup have not yet come after the relapse. It is better to choose a light object with a flat surface. Spin the hoop for a couple of minutes.

5. Hanging on the horizontal bar. Ten minutes of this exercise twice a day is enough to strengthen the spine and obtain a positive result in case of frequent pain in its area.

Radiculopathy C6

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. C6 radiculopathy is manifested by the following clinical signs:

• pain along the outer edge of the shoulder and the posterolateral surface of the forearm to the I-II fingers
• impaired sensitivity on the lateral surface of the hand, especially in the area of ​​the 1st and 2nd fingers
• paresis may primarily affect the biceps brachii muscle, much less often - other muscles of the forearm and hand;
• possible decrease in tendon reflexes from the biceps brachii and brachioradialis muscles

Radiculopathy C7

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. C7 radiculopathy is manifested by the following clinical signs:

• 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, as well as the muscles of the forearm and hand may be affected;
• decreased tendon reflex from the triceps brachii muscle.

It is worth noting that with C7 radiculopathy, the phenomenon of pseudomyotonia has been described, which is characterized by the inability to quickly unclench a fist. Unlike true myotonia, the process of muscle relaxation itself does not suffer, but when you try to unclench your fingers, their paradoxical flexion occurs.

Radiculopathy C8

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. C8 radiculopathy is manifested by the following clinical signs:

• pain along the medial surface of the shoulder and forearm
• Sensitivity disorders are mainly detected on the medial surface of the hand and little finger
• paresis can affect all the muscles of the hand
• the reflex from the finger flexors may decrease;

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. In this regard, it is possible to erroneously localize the level of the lesion 1 segment higher than it actually is.

Manual therapy

With a mild effect on the muscles, radicular spine syndrome is treated as follows:

1. Warm up the muscles. To carry it out, they are initially relaxed, while acting on the trigger points of the back. The fascia is then released through myofascial release.

2. Treatment of the spinal column. It can be treated in this way using soft techniques (MMT), which are fundamentally different from classical methods. With the new approach, radicular nerve syndrome is blocked not by stretching the ligaments, but by bringing them closer together. In the same way, the effect on the muscle corset is carried out.

3. Impact on joints. Soft therapy techniques are also used to relieve pain. MMT according to the Mulligan system is carried out using a special belt. The advantages of the technique are the safe removal of load from problem areas during joint mobilization.

Kinds

Radicular syndromes are classified depending on the area of ​​localization of destructive and degenerative changes in the vertebral bodies and intervertebral discs. The division into types is based on the reasons for their development and the mechanism for the appearance of acute pain. This classification allows you to quickly determine a treatment regimen immediately after diagnosing inflammation, pinched spinal nerve endings or trophic disorders.

Cervical section

The diameter of the spinal canal in this section is relatively small, and the ligaments are strong and elastic. Therefore, when localized in the cervical region, the syndrome is rarely diagnosed and usually against the background of osteochondrosis of 2 and 3 degrees of severity. But the pathology of this localization is the most dangerous due to its proximity to the brain. Cervical CS is characterized by numerous and varied vertebrogenic and vascular syndromes. They can arise as a result of infringement:

• sensory nerve endings;
• blood vessels.

And with prolonged compression of soft tissues, an inflammatory process often develops, affecting healthy structures and aggravating the patient’s condition. Hypoxia (oxygen starvation), manifested by deterioration of vision, hearing, and arterial hypertension, is especially dangerous.

CS of the thoracic region

Radicular syndrome rarely develops in this region, but is clinically manifested most clearly. Spinal nerves are involved in the innervation of not only vertebral structures, but also internal organs. Therefore, when they are affected, pain is felt in the area of ​​the heart, kidneys and (or) gastrointestinal tract. Patients are referred to vertebrologists by a gastroenterologist, neurologist, or cardiologist. Patients turn to these doctors with complaints of discomfort masked as symptoms of pancreatitis, nephritis, and angina.

To diagnose thoracic CS, various instrumental differential studies are required. Persistent CS can cause dyspepsia, intestinal dyskinesia, difficulty swallowing, and pancreatic enzyme deficiency.

CS in the lumbar region

Damage to the roots in the lumbar and sacral area is manifested by symptoms of lumbago and lumboischialgia, making walking difficult. When hypothermia, sudden bending or turning occurs, acute pain occurs. It is so severe that a person may need assistance to get to bed. Pain syndrome is eliminated by drug blockades or narcotic analgesics.

CS in the lumbar region provokes changes in gait and posture, decreased muscle strength and sensitivity. In the absence of medical intervention, it often causes a person to become disabled due to complete or partial immobilization.

CT scan of the spine for osteochondrosis: on the left is a healthy spine, on the right is the affected one.

Lumbodynia with radicular syndrome

Lumbodynia - prolonged pain in the lumbosacral region. With a serious disorder of the innervation of the legs and internal organs due to compression of the nerves, it is complicated by radicular syndrome. Most often, this pathological condition is found in patients with severe forms of osteochondrosis, protrusions and hernial protrusions.

When the radicular nerves are pinched at the level of their exit from the spinal cord, intense pain occurs, quickly spreading to the hips, buttocks, pelvic area and perineum.

An attack of lumbodynia with CS can be provoked by even minor physical exertion, a fall, sudden movement, or lifting a heavy object.

Lumbar radicular syndrome.

Vertebrogenic radicular syndrome

Cervical vertebrogenic radicular syndromes include cervicalgia. Clinically, it appears as acute or subacute pain, constant or in the form of periodic attacks. Dull, aching, bursting discomfort is rarely localized only in the neck area. When moving the head, they spread to the shoulder girdle and the back of the head. The pain intensifies after waking up, when sneezing or coughing. Patients often describe it as a feeling of “a stake in the neck.”

Cervicalgia is caused by osteochondrosis of the CIV-CV, CV-CVI vertebrae. This degenerative-dystrophic pathology is characterized by destructive changes in the vertebral bodies and the formation of bone growths - osteophytes. When the head moves, their sharp edges put pressure on the spinal roots and provoke the development of aseptic inflammation. Vertebrogenic radicular syndrome often becomes an indication for surgery.

Radicular-vascular syndrome

Radicular syndrome develops against the background of destruction of the cervical vertebral structures. The vertebral bodies are deformed, bone growths form, and intervertebral discs are displaced into the spinal canal. Any of these conditions can cause compression of the vertebral artery, which supplies blood to parts of the brain. They experience a deficiency of oxygen and bioactive substances, which negatively affects the regulation of all life systems.

In addition to entrapment of the vertebral artery (syncope), radicular-vascular syndromes include:

• radiculoischemia - occurs due to compression of the radicular-spinal arteries, clinically manifested by gross motor disturbances;
• radiculomyeloischemia (cervical ischemic myelopathy with amyotrophic lateral sclerosis syndrome) is a variant of discogenic ischemia that extends only to the spinal nerve endings.

Any of the syndromes is a health-threatening condition, as it tends to progress. Prolonged compression of blood vessels leads to dizziness and dangerous falls, deterioration of concentration and memory.

Purpose of the bandage

A special corset is prescribed if necessary to reduce the load on the lumbar column. There are three types of therapeutic bandages:

1. Orthopedic. After surgery for radicular syndrome, you cannot do without such a supporting corset. If there are serious problems with the cardiovascular system, the use of an orthopedic design may be prohibited.

2. Radiculitis. When worn, the vertebrae will return to their correct positions. During the restoration of impaired blood circulation, muscle spasms will be eliminated.

3. Shants collar. This type of orthopedic neck brace does not cause allergies and is prescribed for neurological disorders. There is a choice between an inflatable version of the corset, a rigid design and a soft model.

Radicular osteochondrosis: preventive measures

It is almost impossible to completely cure osteochondrosis that has already developed. With adequate therapy, it is possible to achieve long-term remission, which can last for years or even decades. However, to avoid exacerbation of osteochondrosis, it is necessary to reconsider your lifestyle and strictly follow the doctor’s recommendations.

Measures to prevent osteochondrosis are:

• a rational balanced diet, including all the necessary microelements and vitamins for the normal functioning of the body;
• rejection of bad habits;
• dosed physical activity (therapeutic exercises, swimming, walks in the fresh air);
• reducing the load on the spine;
• if you have a sedentary job, take breaks every hour and change your position (you can do a simple set of exercise therapy exercises);
• normalization of body weight;
• use comfortable shoes (it is recommended to avoid high-heeled shoes).

Diet for illness

Compression of the nerve roots often occurs in those who like to eat quickly. It will not do any harm if we are talking about a light salad. The list of prohibited foods for the above-mentioned pathology includes fatty-based dishes flavored with seasonings and salt. The exceptions are bay leaves, dill and coriander.

Radicular syndrome symptoms will weaken if you fast for a couple of days at the peak of the disease. After the stated period of food abstinence, you can without fanaticism include berries, fruits and vegetable juices in your diet. When the manifestation of the disease significantly weakens, you should diversify the menu with fish, lean meat, and soups without legumes. With complete remission, you can eat everything except salty foods, which can cause swelling. As for drinks, it is recommended to opt for dried fruit compotes.

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.

Consultation with a specialist

During a patient’s visit, the doctor carries out the following work:

1. Conversation. By asking leading questions, the specialist finds out the history of the disease. Next, he clarifies the patient’s general condition and conducts a dialogue about current health problems.

2. Study of photographs. If the patient brought them with him, the doctor analyzes the information provided. Then, based on the data obtained, the patient’s individual card is filled out.

3. Palpation. It includes a careful examination of the affected areas of the spine. After a visual examination, the patient is offered to undergo muscle testing.

4. Selection of treatment option. All its principles are spoken out loud, and the patient’s questions are answered.

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.

Causes

The most common cause of cervical CS is osteochondrosis. Against the background of a decrease in the height of the intervertebral discs, the diameter of the intervertebral foramina decreases, which predisposes to pinching of the spinal roots. Another compression factor is intervertebral hernia. This is one of the complications of osteochondrosis, causing severe health consequences, for example, discogenic myelopathy. This syndrome also develops with spondylosis as a result of pinching of nerve endings by osteophytes or deformed structures of the facet joints. The prerequisites for the CS are:

• spinal cord injuries, severe bruises, vertebral subluxations;
• congenital and acquired spinal abnormalities, including kyphosis and scoliosis;
• osteomyelitis;
• benign and malignant neoplasms;
• hormonal imbalances.

Factors that provoke cervical CS include a sedentary lifestyle, excessive physical activity, and obesity. Inflammation of the spinal roots often occurs against the background of syphilis, tuberculosis, and spinal meningitis.

When to see a doctor

The pain that occurs when the cervical spinal nerves are damaged is so severe that immediate medical attention is necessary to relieve it. But neurologists and vertebrologists recommend contacting them at the first signs of the development of osteochondrosis. This is discomfort in the neck after physical activity, when the weather changes, or after intense sports training. If treatment is carried out at this stage, it will be possible to avoid severe, sometimes irreversible complications of osteochondrosis.