Spondylodiscitis: causes, symptoms, diagnosis, treatment

Lumbar radiculopathy (radicular syndrome) is a neurological condition caused by compression of one of the L1-S1 roots, which is characterized by low back pain radiating to the leg. Compression of the root can be manifested not only by pain (sometimes of a shooting nature), but also by impaired sensitivity, numbness, paresthesia or muscle weakness. Radiculopathy (radicular syndrome) can occur in any part of the spine, but it most often occurs in the lumbar region. Lumbosacral radiculopathy occurs in approximately 3-5% of the population, in both men and women, but, as a rule, the syndrome occurs in men at the age of 40 years, and in women the syndrome develops between the ages of 50 and 60 years. Treatment of radicular syndrome of the lumbosacral spine can be carried out using both conservative methods and surgical techniques.

Causes

Any morphological formations or pathological processes that lead to compression effects on the nerve root can cause radicular syndrome.

The main causes of lumbar radiculopathy are:

• A disc herniation or bulge can put pressure on the nerve root and lead to inflammation in the root area.
• A degenerative disease of the joints of the spine that results in the formation of bone spurs on the facet joints, which can lead to a narrowing of the intervertebral space, which will put compression on the nerve roots.
• Trauma or muscle spasm can put pressure on the root and cause symptoms in the area of ​​innervation.
• Degenerative disc disease, which leads to wear and tear of the intervertebral disc structure, and a decrease in the height of the discs, which can lead to a decrease in the free space in the intervertebral foramen and compression of the root as it exits the spinal column.
• Spinal stenosis
• Tumors
• Infections or systemic diseases

In patients under 50 years of age, the most common cause of radicular syndrome in the lumbar spine is a herniated disc. After 50 years of age, radicular pain is often caused by degenerative changes in the spine (stenosis of the intervertebral foramen).

Risk factors for developing lumbar radiculopathy:

• age (45-64 years)
• smoking
• mental stress
• Strenuous physical activity (frequent heavy lifting)
• Driving or vibration exposure

Symptoms

Symptoms resulting from radicular syndrome (radiculopathy) are localized in the area of ​​innervation of a particular root.

• Back pain radiating to the buttock, leg and extending down behind the knee, into the foot - the intensity of the pain depends on the root and the degree of compression.
• Disruption of normal reflexes in the lower limb.
• Numbness or paresthesia (tingling) may occur from the lower back to the foot, depending on the area of ​​innervation of the affected nerve root.
• Muscle weakness can occur in any muscle innervated by a pinched nerve root. Prolonged pressure on a nerve root can cause atrophy or loss of function of a specific muscle.
• Pain and local tenderness are localized at the level of the damaged root.
• Muscle spasm and postural changes in response to root compression.
• Pain increases with exercise and decreases with rest
• Loss of the ability to make certain movements of the body: inability to straighten back, bend towards the localization of compression, or stand for a long time.
• If the compression is significant, activities such as sitting, standing and walking may be difficult.
• Change in normal lordosis of the lumbar spine.
• Development of stenosis-like symptoms.
• Stiffness in the joints after a period of rest.

Patterns of pain

• L1 - back, front and inner surface of the thigh.
• L2 - back, front and inner surface of the thigh.
• L3 - back and front, and the inner surface of the thigh with a downward extension.
• L4 - back and front of the thigh, to the inner surface of the leg, into the foot and big toe.
• L5 – Along the posterolateral part of the thigh, the front part of the lower leg, the top of the foot and the middle toe
• S1 S2 – Buttock, back of the thigh and lower leg.

The onset of symptoms in patients with lumbosacral radiculopathy (radicular syndrome) is often sudden and includes low back pain.

Sitting, coughing or sneezing can aggravate the pain, which radiates from the buttock down the back of the leg, ankle or foot.

You need to be vigilant for certain symptoms (red flags). These red flags may indicate a more serious condition that requires further evaluation and treatment (eg, tumor, infection). The presence of fever, weight loss, or chills requires careful evaluation.

The patient's age is also a factor when looking for other possible causes of the patient's symptoms. People under 20 years of age and over 50 years of age are at increased risk for more serious causes of pain (eg, tumors, infections).

Neurological manifestations of back pain: problems and solutions

M.V.Putilina

Department of Neurology, Federal University of Internal Medicine, Russian State Medical University, Moscow

Neurological manifestations of back pain (dorsalgia) account for 71-80% of all diseases of the peripheral nervous system. Dorsalgia is characterized by a chronic course and periodic exacerbations of the disease, in which various pain syndromes are leading.

Moreover, according to a number of researchers, in 80% of cases acute pain regresses on its own or as a result of treatment within 6 weeks, but in 20% of cases it takes a chronic course [1, 2]. Hereditary predisposition, microtrauma, and incorrect motor stereotype lead to degeneration of the vertebral motor segment.

The degenerative process may involve various structures of spinal motion segments: intervertebral disc, facet joints, ligaments and muscles. Tissue deformations arising under the influence of static-dynamic loads are the cause of constant irritation of pain receptors.

In cases of concomitant damage to the spinal roots or spinal cord, focal neurological syndromes may appear [3, 4]. In dorsalgia, the determining factor is the appearance of severe pain syndromes associated with irritation of the nerve endings of the sinuvertebral nerves located in the soft tissues of the spine [5].

Currently, the pathogenesis of spinal pathology as the main cause of pain has been well studied, but many problems associated with dorsalgia have not been solved [6, 7].

Clinical manifestations

The initial stage of degenerative-dystrophic diseases of the spine has scanty clinical signs. Patients complain of moderate pain in the corresponding part of the spine, which occurs or intensifies with movement, changes in statics (flexion, extension, rotation), physical activity, and prolonged stay in one position [8].

During this period, it is difficult to make a correct diagnosis and prescribe adequate therapy; very often, doctors’ prescriptions are limited to the use of anti-inflammatory drugs and analgesics [6, 9]. Currently, there is an obvious overdiagnosis of spinal pathology as the main cause of pain. The role of myofascial syndromes in the origin of pain is usually underestimated (from 35 to 85% of the population suffers) [10]. The essence of myofascial pain syndrome is that the muscle suffers primarily, and not after morphological or functional disorders in the spine. Any muscle or muscle groups can be involved in the pathological process. Muscle spasm leads to increased stimulation of the nociceptors of the muscle itself. A spasmed muscle becomes a source of additional nociceptive impulses (the so-called vicious circle “pain - muscle spasm - pain”).

Several years after the first exacerbation, the pain has a clear localization, patients note heaviness, stiffness and stiffness in the affected segment of the spine, and there is pronounced tension in the back muscles. Subsequently, periods of activation of the process are observed more often and become longer [11, 12]. In cases of recurrent course, clinical manifestations during the exacerbation period are characterized by severe pain, sharp symptoms of tension, due to which the patient is unable to care for himself. During the period of regression, neurological manifestations begin to decrease, but the pain continues to be intense, there remains a significant limitation in the range of motion in the corresponding part of the spine, and the symptoms of tension are less pronounced than in the acute stage. As a rule, the patient is not able to fully care for himself and cannot perform work. During the period of incomplete remission, the pain is moderate, sometimes intermittent, the limitation of the range of motion of the corresponding area of ​​the spine can be significant, a forced posture remains, the patient is able to care for himself, but his ability to work is limited. During the period of complete remission, periodic mild pain and a slight limitation in the range of motion of the corresponding area of ​​the spine, the absence of tension symptoms, are noted, while the patients’ ability to work is preserved.

Clinically, the disease manifests itself in the form of a reflex syndrome (occurs in 90% of cases) and compression syndrome (detected in 5-10% of cases) [2, 4]. Reflex syndromes arise due to irritation of pain receptors (nociceptors) of the posterior longitudinal ligament as a result of one or more pathological factors and are accompanied by reflex blocking of the corresponding vertebral motor segment due to muscle tension (in particular striated muscles) with the creation of a muscle “corset”. Compression syndromes are caused by the mechanical effect of a hernial protrusion, bone growths or other pathological structure on the roots, spinal cord or arteries. Compression syndromes, in turn, are divided into radicular (radiculopathy), spinal (myelopathy) and neurovascular (for example, vertebral artery syndrome).

Problems

The lack of sufficiently effective care for patients with spinal diseases, which are usually chronic in nature, with alternating remissions and exacerbations, leads to a loss of confidence in the doctor [13]. In this case, the following problem arises - the lack of doctor-patient interaction and the latter’s confidence in the incurability of his disease. The passivity of the doctor is unacceptable, as it can lead to the psychosocial death of the patient long before his biological death. At the same time, the task of conducting adequate outpatient treatment is of particular importance due to the fact that currently used methods do not always take into account etiopathogenetic factors, the characteristics of sanogenetic reactions in a particular patient, often lead to “failure of compensatory reactions” [8] and worsen the process of rehabilitation events [4]. To solve this problem, first of all, it is necessary to remember that back pain can be both primary, associated with degenerative changes in vertebral structures, and secondary, caused by pathological conditions. Therefore, the main task of the doctor when examining a patient with acute back pain is to separate musculoskeletal pain from pain syndromes associated with somatic or oncological pathology.

Diagnostics

Diagnosing the neurological manifestations of back pain is a difficult task for a doctor, but with the proper use of additional examination methods, it can be easily solved. We cannot abandon traditional methods of X-ray diagnostics and neuroimaging methods (computer and magnetic resonance imaging), laboratory tests (general blood and urine tests, biochemical tests) [6]. In case of difficulties, electroneuromyographic studies are used: lesions of the peripheral neuron corresponding to a given nerve and a decrease in the speed of impulse transmission along the nerve distal to the place of its compression are determined.

Therapy

Treatment of degenerative-dystrophic diseases of the spine is one of the most pressing problems of modern neurology. In patients with this type of pain syndrome, without identifying the pathophysiological mechanisms, it is impossible to choose the optimal treatment strategy. When determining treatment tactics, it is necessary to take into account the localization, nature and severity of clinical manifestations of pain. In recent years, the pharmacological arsenal of treatments for patients with vertebrogenic pathology has significantly improved [1, 14]. However, the problem of back pain is still far from being solved. Drug treatment of neurological manifestations of dorsalgia is a complex task that requires deep knowledge of the pathogenesis and clinical manifestations of the disease. Treatment of patients should be comprehensive, using medications and non-drug therapy methods.

Principles

The main principles of drug therapy are early initiation, pain relief, and a combination of pathogenetic and symptomatic therapy. Therapeutic measures differ in the acute and interictal periods of the disease. First of all, measures are taken to relieve or reduce pain [1, 3].

In case of acute pain, it is necessary to recommend the patient to bed rest for 1-3 days. Drug therapy should be started immediately in the form of nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and muscle relaxants, since the first and main task is rapid and adequate pain relief [9, 15]. When treating acute back pain, significant regression of pain should be expected within 1-2 weeks.

The long-standing policy of limiting physical activity, up to strict bed rest, has now been somewhat revised: for moderate pain, partial limitation is recommended, and for severe pain, the period of bed rest is reduced to 1-3 days. In this case, the patient must be taught the “correct” motor behavior: how to sit, how to stand up, how to walk, not to carry heavy objects, etc. If therapy is ineffective, other drugs in optimal doses can be tried within 1-2 weeks. Persistent pain for more than 1 month indicates a chronic process or an incorrect diagnosis of back pain.

The presence of compression syndrome is an indication for the prescription of anti-ischemic drugs: antioxidants, antihypoxants, vasoactin drugs. The issue of using antidepressants is decided individually for each patient.

NSAIDs

NSAIDs remain the first choice for pain relief. The main mechanism of action of NSAIDs is inhibition of cyclooxygenase (COX)-1, 2, a key enzyme in the arachidonic acid metabolic cascade, leading to the synthesis of prostaglandins (PGs), prostacyclins and thromboxanes [9, 14]. Due to the fact that COX metabolism plays a major role in the induction of pain at the site of inflammation and the transmission of nociceptive impulses to the spinal cord, NSAIDs are widely used in neurological practice. All anti-inflammatory drugs have anti-inflammatory, analgesic and antipyretic effects, are able to inhibit the migration of neutrophils to the site of inflammation and platelet aggregation, and also actively bind to serum proteins.

Features of the action

Differences in the action of NSAIDs are quantitative, but they determine the severity of the therapeutic effect, tolerability and side effects in patients. The high gastrotoxicity of NSAIDs, which correlates with the severity of their sanogenetic effect, is associated with non-selective inhibition of both COX isoforms. Currently, there are two groups of NSAIDs depending on their effect on COX. Non-selective NSAIDs block both constitutional COX-1, which is associated with the gastrointestinal side effects of these drugs, and inducible COX-2, the formation of which activates anti-inflammatory cytokines. Selective drugs act primarily on COX-2. Non-selective NSAIDs include: lornoxicam (Xefocam), ibuprofen, indomethacin.

Selective COX inhibitors include: nimesulide (Nise®), meloxicam, celecoxib.

Complications

At the same time, the use of NSAIDs is associated with a wide range of side effects, the risk of which seriously reduces their therapeutic value, primarily the problem of the negative impact of these drugs on the gastrointestinal tract (GIT), the development of NSAID gastropathy. In patients regularly taking NSAIDs, the risk of developing these complications is 4 or more times higher than in the population, and amounts to 0.5-1 cases per 100 patients. Moreover, according to long-term statistical data, every 10th patient who develops gastrointestinal bleeding while taking NSAIDs dies [12, 16].

In 20-30% of patients taking NSAIDs in the absence of significant damage to the gastrointestinal mucosa, various dyspeptic symptoms appear - gastralgia, nausea, a feeling of “burning” or “heaviness” in the epigastrium, etc. In addition, specific side effects of NSAIDs include increased the risk of developing cardiovascular accidents - myocardial infarction and ischemic stroke. However, the benefits of using NSAIDs as an effective and affordable treatment for dorsalgia significantly outweigh the harm associated with the risk of developing dangerous complications. First of all, this is due to the fact that specific complications can be successfully prevented. Most side effects occur in people with so-called risk factors. For NSAID gastropathy, this is age over 65 years, a history of peptic ulcers (the greatest danger is observed in patients who have previously suffered gastrointestinal bleeding), as well as concomitant use of drugs that affect the blood coagulation system [17]. Risk factors for cardiovascular complications are comorbid diseases of the heart and blood vessels - coronary heart disease, arterial hypertension not compensated by treatment. Taking these factors into account and using adequate preventive measures (prescribing proton pump inhibitors if there is a risk of developing NSAID gastropathy) can significantly reduce the risk of developing NSAID-associated complications.

Choosing a doctor

In recent years, on the Russian pharmacological market, a huge number of original drugs have been supplemented by an order of magnitude larger number of generics. It is not easy for a practicing doctor to make a choice among this variety, given the aggressive advertising, as well as the abundance of heterogeneous and sometimes biased information. When choosing an NSAID, your doctor should consider the following:

• Price/quality ratio of drugs.
• The spectrum of action of drugs in various forms of release.
• Background diseases of the patient.
• Patient finances.

Nise®

One of the most successful drugs available on our pharmacological market is the drug Nise® (nimesulide) produced by Dr. Reddy's Laboratories Ltd. (India). The drug is used for rapid relief of moderate or severe acute pain, has anti-inflammatory, analgesic and antipyretic effects [15]. Reversibly inhibits the formation of PGE2 both at the site of inflammation and in the ascending pathways of the nociceptive system, including the pathways of pain impulses in the spinal cord. Reduces the concentration of short-lived PGN2, from which PGE2 is formed under the action of prostaglandin isomerase.

A decrease in the concentration of PGE2 leads to a decrease in the degree of activation of EP-type prostanoid receptors, which is expressed in analgesic and anti-inflammatory effects. It has a slight effect on COX-1 and practically does not interfere with the formation of PGE2 from arachidonic acid under physiological conditions, thereby reducing the number of side effects of the drug. Nise® suppresses platelet aggregation by inhibiting the synthesis of endoperoxides and thromboxane A2, and inhibits the synthesis of platelet aggregation factor. It also reduces the release of histamine and reduces the severity of bronchospasm caused by exposure to histamine and acetaldehyde [15, 16, 18-21]. The drug inhibits the release of tumor necrosis factor a, which causes the formation of cytokines. It is able to slow down the synthesis of interleukin-6 and urokinase, thereby preventing the destruction of cartilage tissue. Blocks the synthesis of metalloproteases (elastase, collagenase), preventing the destruction of proteoglycans and collagen of cartilage tissue. It has antioxidant properties and inhibits the formation of toxic oxygen breakdown products by reducing the activity of myeloperoxidase. Interacts with glucocorticoid receptors, activating them through phosphorylation, which also enhances the anti-inflammatory effect of the drug.

Properties and effect

Due to its high bioavailability, already 30 minutes after oral administration, the concentration of the drug in the blood reaches ~50% of the peak, and a clear analgesic effect is noted. After 1-3 hours, the peak concentration of the drug occurs and, accordingly, the maximum analgesic effect develops [19-21]. When applied topically, it causes a weakening or disappearance of pain at the site of application of the gel, including pain in the joints at rest and during movement, reduces morning stiffness and swelling of the joints and helps to increase range of motion. The drug is effective both for short-term relief of acute dorsalgia and for long-term treatment of chronic pain syndrome over many months.

A study was conducted in Finland in which 102 patients with acute back pain received nimesulide 100 mg 2 times a day or ibuprofen 600 mg 3 times a day for 10 days. Nimesulide was superior to the control drug in terms of pain relief and effect on spinal function. Moreover, among patients receiving nimesulide, side effects from the gastrointestinal tract occurred in only 7%, and among those taking ibuprofen - in 13% [18]. Scientists have concluded that nimesulide is superior in its tolerability to traditional NSAIDs, since it relatively rarely causes dyspepsia and other gastrointestinal complications. The most important advantage of the drug Nise® is its affordable price and good tolerability, proven by a series of post-registration studies [17]. Thus, when using nimesulides, the frequency of such common side effects as ulcers of the upper gastrointestinal tract and drug-induced liver damage, and the cardiotoxic effect that some highly selective NSAIDs are “burdened” are minimized. This allows us to recommend Nise® for use in general medical practice. Moreover, this drug has several dosage forms. Nise® is available in tablet and form for topical use, which allows you to individualize and optimize the targeted therapeutic effect of the drug. Since the drug on a gel matrix penetrates tissues quickly and in greater concentration, it is possible to combine local and systemic forms of the drug to achieve a better (greater) therapeutic effect.

In conclusion, we note that the problems of neurological manifestations of back pain are still far from a final solution, but their further study will make it possible to develop new strategies for the diagnosis and treatment of dorsalgia.

Literature

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6. Levin O.S. Diagnosis and treatment of neurological manifestations of spinal osteochondrosis. Cons. Med. 2005; I (6): 547-55.
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Source consilium-medicum Neurology No. 1/2011

Diagnostics

The primary diagnosis of radicular syndrome of the lumbosacral spine is made based on the symptoms of the medical history and physical examination (including a thorough examination of the neurological status). A thorough analysis of motor, sensory and reflex functions allows us to determine the level of damage to the nerve root.

If the patient reports typical unilateral radiating leg pain and there are one or more positive neurological test results, then a diagnosis of radiculopathy is very likely.

However, there are a number of conditions that may present with similar symptoms. Differential diagnosis must be carried out with the following conditions:

• Pseudoradicular syndrome
• Traumatic disc injuries in the thoracic spine
• Damage to discs in the lumbosacral region
• Spinal stenosis
• Cauda equina
• Spinal tumors
• Spinal infections
• Inflammatory/metabolic causes - diabetes, ankylosing spondylitis, Paget's disease, arachnoiditis, sarcoidosis
• Trochanteric bursitis
• Intraspinal synovial cysts

To make a clinically reliable diagnosis, as a rule, instrumental diagnostic methods are required:

• X-rays – can detect the presence of joint degeneration, fractures, bone defects, arthritis, tumors or infections.
• MRI is a valuable technique for visualizing morphological changes in soft tissues, including discs, spinal cord and nerve roots.
• CT (MSCT) provides complete information about the morphology of the bone structures of the spine and visualization of spinal structures in cross section.
• EMG (ENMG) Electrodiagnostic (neurophysiological) studies are necessary to exclude other causes of sensory and motor disorders, such as peripheral neuropathy and motor neuron disease

Types of neuralgia

Neuralgia is divided into:

• Neuralgia of the spinal (intercostal) nerves
• Neuralgia of the cranial (glossopharyngeal, trigeminal) nerves
• Neuralgia of the femoral nerves

In our clinic we treat all types of neuralgia, using the most modern means and methods.

Trigeminal neuralgia

Most often, this disease manifests itself in people after 40 years of age, women suffer more often. The symptom is acute pain that is difficult to tolerate. It appears in one half of the face (less often in two) and can last several minutes or appear in the form of separate “shooting” attacks. It may appear during chewing, brushing teeth, or during irritation of certain special points on the face. At the moment of pain, numbness of the facial skin and twitching of the muscles on the affected side are felt.

The cause is often compression of the nerve by surrounding tissues.

Causes of trigeminal neuralgia:

• Hypothermia of the face
• Aneurysm of one of the arteries of the skull
• Abnormal arrangement of cerebral vessels
• Removal of a tooth
• Chronic infections in the facial area (sinusitis, caries)
• Brain tumors

Intercostal neuralgia

The cause of acute chest pain is intercostal neuralgia. Its symptoms resemble an attack of myocardial infarction and often “scare” patients. The pain is often girdling in nature and can occur unexpectedly, but more often when changing body position, coughing, or taking a deep breath. There is numbness or “crawling” in the affected area.

The causes of intercostal neuralgia are:

• Chest injuries
• Hypothermia of the back or chest area
• Uncomfortable body position (which persists for a long time) or a sharp turn of the body
• Various diseases of the thoracic spine

If all the symptoms are present, and blisters with clear liquid appear on the skin, then the cause is shingles.

Occipital neuralgia

Occipital neuralgia manifests itself as acute pain in the neck and/or back of the head on one or both sides. It can occur suddenly, during some sudden movement. The pain may be felt behind the ears and even radiate into the eyes.

The main causes of the development of occipital neuralgia are:

• Osteochondrosis
• Tumors in the cervical vertebrae
• Hypothermia in the back of the head or neck
• Cervical spine injuries

It can occur during a sharp turn of the head against the background of absolute health.

Neuralgia of the external cutaneous nerve of the thigh

If you feel shooting pain along the outer surface of the thigh, then this is a manifestation of neuralgia of the external cutaneous nerve of the thigh. When moving, the attack intensifies, numbness and burning appear.

Neuralgia of the pterygopalatine ganglion

An attack of the pterygopalatine ganglion is difficult. It begins unexpectedly (often at night) and can last for several hours. It manifests itself as a burning pain that is difficult to endure in the area of ​​the eyes, temples, neck, and soft palate. The pain is bursting in nature.

Neuralgia of the glossopharyngeal nerve

Neuralgia of the glossopharyngeal nerve is not common. It manifests itself as pain in the throat, which spreads to the lower jaw and ear.

Conservative treatment:

• Rest: avoid activities that cause pain (bending, lifting, twisting, turning or bending backwards. Rest is necessary for acute pain syndrome
• Drug treatment: anti-inflammatory, painkillers, muscle relaxants.
• Physiotherapy. For acute pain syndrome, the use of procedures such as cryotherapy or chivamat is effective. Physiotherapy can reduce pain and inflammation of the spinal structures. After the acute period has stopped, physiotherapy is carried out in courses (ultrasound, electrical stimulation, cold laser, etc.).
• Corseting. The use of a corset is possible in case of acute pain syndrome to reduce the load on the nerve roots, facet joints, and lumbar muscles. But the duration of wearing a corset should be short, since prolonged fixation can lead to muscle atrophy.
• Epidural steroid injections or facet joint injections are used to reduce inflammation and control pain in severe radicular syndrome.
• Manual therapy. Manipulations can improve the mobility of the motor segments of the lumbar spine and relieve excess muscle tension. Using mobilization techniques also helps modulate pain.
• Acupuncture. This method is widely used in the treatment of radicular syndrome in the lumbosacral spine and helps both reduce symptoms in the acute period and is included in the rehabilitation complex.
• Exercise therapy. Exercise includes stretching and strengthening exercises. The exercise program allows you to restore joint mobility, increase range of motion and strengthen your back and abdominal muscles. A good muscle corset allows you to support, stabilize and reduce tension on the spinal joints, discs and reduce the compression effect on the spine. The volume and intensity of exercise should be increased gradually to avoid relapse of symptoms.

• In order to achieve stable remission and restore full functionality of the spine and motor activity, it is necessary for the patient, after completing the course of treatment, to continue independent exercises aimed at stabilizing the spine. The exercise program must be individual.

The treatment program for this disease at the Bone Clinic may include:

Shock wave therapy

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PRP therapy

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Acupuncture administration of ozone

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Teraquantum therapy

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Interference therapy

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Surgery

Surgical methods for the treatment of radicular syndrome in the lumbosacral spine are necessary in cases where there is resistance to conservative treatment or there are symptoms indicating severe compression of the root such as:

• Increased radicular pain
• Signs of increased root irritation
• Muscle weakness and atrophy
• Incontinence or bowel and bladder dysfunction

As symptoms worsen, surgery may be indicated to relieve compression and remove degenerative tissue that is affecting the root. Surgical treatments for radicular syndrome in the lumbosacral spine will depend on which structure is causing the compression. Typically, these treatments involve some way to decompress the spine or stabilize the spine.

Some surgical procedures used to treat lumbar radiculopathy are:

• Fixation of vertebrae (spinal fusion - anterior and posterior)
• Lumbar laminectomy
• Lumbar microdiscectomy
• Laminotomy
• Transforaminal lumbar
  intercorporeal fusion
• Cage implantation
• Correction of deformity

Forecast

In most cases, it is possible to treat radicular syndrome in the lumbosacral spine conservatively (without surgical intervention) and restore ability to work. The duration of treatment may vary from 4 to 12 weeks depending on the severity of symptoms. Patients should continue to perform exercises at home to improve their posture, stretching, strengthening, and stabilization. These exercises are necessary to treat the condition causing radicular syndrome.

Prevention

The development of radicular syndrome in the lumbosacral spine can be prevented. To reduce the likelihood of developing this condition you should:

• Practice good posture while sitting and standing, including while driving.
• Use proper body mechanics when lifting, pushing, pulling, or performing any activity that places additional stress on the spine.
• Maintain a healthy weight. This will reduce the load on the spine.
• No smoking.
• Discuss your profession with a physical therapy doctor, who can analyze work movements and suggest measures to reduce the risk of injury.
• Muscles should be strong and elastic. It is necessary to consistently maintain a sufficient level of physical activity.

What is sciatica

Radiculitis (radiculopathy, radicular syndrome) is an inflammatory lesion of the spinal roots, accompanied by severe pain.

In the public consciousness, this disease is inextricably linked with old age, which is generally true: according to statistics, every eighth person from the older age group suffers from acute or chronic radiculitis. However, people aged 30+ are not immune from this disease. We largely owe this “rejuvenation” of the disease to the increase in the number of office “sedentary” professions.

Pathological changes can occur in one spinal root or in several simultaneously.

1 Diagnosis and treatment of radiculitis

2 Diagnosis and treatment of radiculitis

3 Diagnosis and treatment of radiculitis