Radicular syndrome — the simptomokompleks which is formed as a result of defeats of a spinal back, various on the etiology, and shown irritation symptoms (pain, muscular tension, an antalgichesky pose, paresteziya) and losses (paresis, decrease in sensitivity, muscular hypotrophies, a hyporeflection, trophic frustration). The radicular syndrome clinically is diagnosed, its reason is established by results of a X-ray analysis, backbone KT or MPT. Treatment more often conservative, according to indications is carried out surgical elimination of a factor of a compression of a back.
Radicular syndrome — the widespread vertebrogenny simptomokompleks having a variable etiology. Earlier concerning a radicular syndrome the term "radiculitis" — a back inflammation was used. However it not absolutely is true. The last researches showed that inflammatory process in a back often is absent, reflex and compression mechanisms of its defeat take place. In this regard in clinical practice the term "radikulopatiya" — defeat of a back began to be used. The most often radicular syndrome is observed in lumbar and sacral department of a spine column and is connected with defeat of 5th lumbar (L5) and 1st sacral (S1) of vertebras. Less often the cervical radikulopatiya meets, is even more rare — chest. The peak of incidence is the share of average age category — from 40 to 60 years. Problems of modern neurology and vertebrologiya is timely identification and elimination of the factor causing a back compression as the long sdavleniye involves degenerate processes in a back with development of persistent invalidiziruyushchy neurologic dysfunction.
Reasons of a radicular syndrome
From two parties 31 pairs of spinal nerves which originate in spinal backs depart from a spine column of the person. Each spinal (spinal) back is formed leaving a spinal cord a back (touch) and forward (motor) branch. It goes out of the vertebral channel through an intervertebral opening. It most a bottleneck where most often there is also a back sdavleniye. The radicular syndrome can be caused, both primary mechanical compression of the back, and its secondary sdavleniye owing to the hypostasis developing as a result of a compression of radicular veins. Sdavleniye of radicular vessels and the disorder of microcirculation arising at hypostasis in turn become additional factors of defeat of a back.
Backbone osteochondrosis acts as the most common cause provoking a radicular syndrome. Decrease in height of an intervertebral disk involves reduction of diameter of intervertebral openings and creates prerequisites for infringement of the backs passing through them. Besides, a factor of a compression can be formed as an osteochondrosis complication a hernia nuclei pulposi. The radicular syndrome is possible at a back compression the osteofita or parts of a dugootrostchaty joint changed owing to a spondiloartroz which are formed at a spondileza.
Traumatic damage of a spinal back can be observed at a spondilolisteza, spine injuries, a vertebra incomplete dislocation. Inflammatory defeat of a back is possible at syphilis, tuberculosis, spinal meningitis, backbone osteomyelitis. The radicular syndrome of neoplastic genesis meets at tumors of a spinal cord, a nevrinoma of a spinal back, tumors of vertebras. The instability of a backbone involving the shift of vertebras can also act as the reason of a radicular syndrome. To promoting development of a radikulopatiya by factors excessive loads of a backbone, hormonal failures, obesity, a hypodynamia, anomalies of development of a backbone, overcooling act.
Symptoms of a radicular syndrome
The Simptomokompleks of a radikulopatiya consists of various combinations of symptoms of irritation of a spinal back and loss of its functions. Expressiveness of signs of irritation and loss is defined by back sdavleniye degree, specific features of an arrangement, a form and thickness of spinal backs, interradicular communications.
Symptoms of irritation include a pain syndrome, motive violations as a krampa or fastsikulyarny muscular twitchings, touch frustration with a type of feeling of a pricking or crawling of goosebumps (paresteziya), local feeling of heat/cold (dizesteziya). Distinctive features of radicular pain is its burning, pekuchy and shooting character; emergence only in the zone innervated by the corresponding back; distribution from the center to the periphery (from a backbone to disteel departments of a hand or leg); strengthening at an overstrain, the sharp movement, laughter, cough, sneezing. The pain syndrome causes the reflex tonic tension of muscles and sheaves in the field of defeat which promotes strengthening of pain. For reduction of the last patients adopt the sparing provision, limit the movements in the struck department of a backbone. Musculotonic changes are more expressed on the party of the struck back that can lead to a trunk distortion, in cervical department — to formation of a wryneck, with the subsequent curvature of a backbone.
Symptoms of loss appear at far come defeat of a back. They are shown by weakness of the muscles innervated by a back (paresis), decrease in the corresponding tendinous reflexes (hyporeflection), reduction of sensitivity in a back innervation zone (gipesteziya). The site of skin for which sensitivity one back is responsible is called dermaty. He receives an innervation not only from the main back, but also partially from above - below - lying. Therefore even at a considerable compression of one back only the gipesteziya whereas at a poliradikulopatiya with pathology several a number of the bred backs notes full anesthesia is observed. Over time in innervated by the struck back of area the trophic violations leading to a muscular hypotrophy, thinning, the increased vulnerability and a bad zazhivlyaemost of skin develop.
Symptoms of defeat of separate backs
C1 back. Pain is localized in a nape, often against the background of pain there is dizziness, nausea is possible. The head is in the provision of an inclination in the struck party. Tension of suboccipital muscles and their palpatorny morbidity is noted.
C2 back. Pain in occipital and parietal area on the party of defeat. Turns and inclinations are limited to the head. The nape skin gipesteziya is observed.
C3 back. Pain covers a nape, the lateral surface of a neck, area of a mastoidal shoot, irradiates in language, an orbit, a forehead. In the same zones paresteziya are localized and the gipesteziya is observed. The radicular syndrome includes difficulties of inclinations and extension of the head, morbidity of paravertebralny points and a point over an awned shoot of C3.
C4 back. Pain in a nadplechya with transition to the forward surface of a breast reaching the 4th edge. Extends on the back and lateral surface of a neck to her average 1/3. Reflex transfer of a pathological impulsation on a diafragmalny nerve can lead to emergence of a hiccups, frustration of a fonation.
C5 back. The radicular syndrome of this localization is shown by pain in a nadplechya and on the lateral surface of a shoulder where touch frustration are also observed. Assignment of a shoulder is broken, the hypotrophy of a deltoid muscle is noted, the reflex from a biceps is lowered.
C6 back. Pain from a neck extends through area of a biceps to the external surface of a forearm and reaches a thumb. The gipesteziya of the last and an external surface the lower 1/3 forearms comes to light. Paresis of a biceps, a humeral muscle, instep supports and pronator of a forearm is observed. The reflex from a wrist is lowered.
C7 back. Pain goes from a neck on the back surface of a shoulder and forearm, reaches a middle finger of a brush. In view of the fact that the back of C7 innervates a periosteum, this radicular syndrome differs in the deep nature of pain. Decrease in muscular force is noted in a triceps, a big pectoral and broadest muscle, flexors and extensors of a wrist. The triceps reflex is lowered.
C8 back. The radicular syndrome at this level meets rather seldom. Pain, a gipesteziya and paresteziya extend to the internal surface of a forearm, a ring finger and a little finger. Weakness of flexors and extensors of a wrist, muscles-razgibateley of fingers is characteristic.
T1-T2 backs. Pain is limited to a shoulder joint and area of an armpit, can extend under a clavicle and to the medial surface of a shoulder. Is followed by weakness and a hypotrophy of muscles of a brush, its sleep. Horner's syndrome, gomolateralny to the struck back is typical. The dysphagy, peristaltic dysfunction of a gullet is possible.
T3-T6 backs. Pain has the surrounding character and goes on the corresponding mezhreberye. Can be the cause of painful feelings in a mammary gland, at localization at the left — to imitate a stenocardia attack.
T7-T8 backs. Pain starts from a backbone below a shovel and on a mezhreberye reaches to an epigastriya. The radicular syndrome can become the reason of dyspepsia, a gastralgiya, fermental insufficiency of a pancreas. Decrease in a verkhnebryushny reflex is possible.
T9-T10 backs. Pain from a mezhreberye extends in the top departments of a stomach. Sometimes the radicular syndrome should be differentiated from a sharp stomach. There is a weakening of a srednebryushny reflex.
T11-T12 backs. Pain can irradiate in nadlobkovy and inguinal zones. The reflex is lowered nizhnebryushny. The radicular syndrome of this level can become the intestines dyskinesia reason.
L1 back. Pain and a gipesteziya in inguinal area. Pains extend to a verkhnenaruzhny quadrant of a buttock.
L2 back. Pain covers the forward and internal surface of a hip. Weakness when bending a hip is noted.
L3 back. Pain goes through a podvzdoshny awn and a big spit on the forward surface of a hip and reaches the lower 1/3 medial parts of a hip. Gipesteziya is limited to the area of an internal surface of a hip located over a knee. The paresis accompanying this radicular syndrome is localized in the four-head a muscle and adductors of a hip.
L4 back. Pain extends on the forward surface of a hip, a knee joint, the medial surface of a shin to a medial anklebone. Hypotrophy four-head of a muscle. Paresis of tibial muscles leads to external rotation of foot and its "prikhlopyvaniye" when walking. The knee reflex is lowered.
L5 back. Pain irradiates from a waist through a buttock on the lateral surface of a hip and shin in the first 2 fingers of foot. The zone of pain coincides with area of touch frustration. Hypotrophy of a tibial muscle. Paresis of extensors of a thumb, and sometimes and all foot.
S1 back. Pain in the lower department a waist and a sacrum giving on zadnelateralny departments of a hip and shin to foot and the 3-5th fingers. Gip-and paresteziya are localized in the field of lateral edge of foot. The radicular syndrome is accompanied by hypotonia and a hypotrophy of a gastrocnemius muscle. Rotation and plantar bending of foot are weakened. The reflex is lowered akhill.
S2 back. Bol and paresteziya begin in a sacrum, covers a back part of a hip and shin, a sole and a thumb. Spasms in hip adductors are often noted. The reflex from Achilles is usually not changed.
S3-S5 backs. Sacral kaudopatiya. As a rule, the poliradikulyarny syndrome with defeat of 3 backs is observed at once. Pain and anesthesia in a sacrum and a crotch. The radicular syndrome proceeds with dysfunction of sphincters of pelvic bodies.
Diagnostics of a radicular syndrome
In the neurologic status existence of trigger points over awned shoots and paravertebralno, musculotonic changes at the level of the affected backbone segment attracts attention. Symptoms of a tension of backs come to light. In cervical department they it is provoked by a bystry ducking to opposite struck party, in lumbar — a leg raising in horizontal position on a back (a symptom of Lasega) and on a stomach (Matskevich and Wasserman's symptoms). On localization of a pain syndrome, zones of a gipesteziya, paresis and muscular hypotrophies the neurologist can establish what back is struck. Allows to confirm the radicular nature of defeat and its level an elektroneyromiografiya.
The major diagnostic task is identification of the reason which provoked a radicular syndrome. For this purpose carry out a backbone X-ray analysis in 2 projections. It allows to diagnose osteochondrosis, , , Bekhterev's disease, curvatures and anomalies of a spine column. More informative method of diagnostics is backbone KT. Apply backbone MRT to visualization of myagkotkanny structures and educations. MRT gives the chance to diagnose a hernia nuclei pulposi, extra-and intramedullyarny tumors of a spinal cord, a hematoma, meningoradikulit. The chest radicular syndrome with somatic symptomatology demands additional inspection of the corresponding internals for an exception of their pathology.
Treatment and forecast of a radicular syndrome
In cases when the radicular syndrome is caused by degenerate and dystrophic diseases of a backbone, use mainly conservative therapy. At an intensive pain syndrome rest, the anesthetizing therapy (diclofenac, to meloksika, an ibuprofen, , lidokaino-gidrokortizonovy paravertebralny blockade), knocking over of a musculotonic syndrome (, , , diazepam), antiedematous treatment (furosemide, etakrinovy acid), neurometabolic means is shown (vitamins . ). For the purpose of improvement of blood circulation and venous outflow appoint , a ksantinola , , , horse-chestnut extract. According to indications in addition use hondroprotektor (extract of cartilages and a brain of calfs with vitamin C, ), rassasyvayushchy treatment (gialuronidaza), medicines for simplification of neyronalny transfer ().
It is long the proceeding radicular syndrome with chronic pain is the indication to prescription of antidepressants (a duloksetina, an amitriptilina, a dezipramina), and at a pain combination to neurotrophic frustration - to application of ganglioblokator (a benzogeksoniya, a ganglefena). At muscular atrophies apply a nandrolon with vitamin E. The good effect (in the absence of contraindications) is rendered by the traction therapy increasing intervertebral distances and by that reducing negative impact on a spinal back. In the sharp period as an additional tool of knocking over of pain the reflexotherapy, UVCh, a hydrocortisone can act. In early terms begin to apply LFK, during rehabilitation — massage, a parafinoterapiya, an ozokeritolecheniye, medical sulphidic and radonic bathtubs, mud cure.
The question of surgical treatment arises at inefficiency of conservative therapy, progressing of symptoms of loss, existence of a spinal tumor. Operation is performed by the neurosurgeon and aims at elimination of a compression of a back, and also removal of its reason. At hernias of intervertebral disks the diskektomiya, a mikrodiskektomiya is possible, at tumors — their removal. If instability is the reason of a radicular syndrome, then fixing of a backbone is made.
The forecast of a radikulopatiya depends on the main disease, degree of a compression of a back, timeliness of medical actions. It is long the proceeding symptoms of irritation can lead to formation of difficult stopped chronic pain syndrome. In time not eliminated back sdavleniye which is followed by loss symptoms causes development of degenerate processes in the fabrics of a spinal back leading to permanent violation of its functions over time. Invalidiziruyushchy irreversible paresis of the patient, pelvic frustration (at a sacral kaudopatiya), sensitivity violations become result.