Radiculitis — (Latin radicula — a back) — the defeats of backs of a spinal cord causing motor, vegetative and painful violations. Radiculitis is shown by an intensive pain syndrome, decrease in muscular force, reflexes and sensitivity in the zone innervated by the affected spinal nerve. Diagnosis of radiculitis is performed by means of a X-ray analysis, backbone KT and MPT, according to indications carrying out a miyelografiya and lyumbalny puncture is possible. In treatment apply anesthetics and anti-inflammatory medicines, blockade, physiotherapeutic procedures, manual technicians, extension of a backbone, physiotherapy exercises and massage.
Radiculitis — (Latin radicula — a back) — the defeats of backs of a spinal cord causing motor, vegetative and painful violations. Etiologichesky factors of radiculitis are degenerate and dystrophic changes in a backbone, such as the osteochondrosis deforming and also various anomalies of development of a backbone (a sacralization, , additional edges, an aplaziya of vertebras). Also overcoolings, injuries, infections (flu, tuberculosis, syphilis, tserebrospinalny meningitis), and also radicular forms of neuroviral diseases are capable to provoke inflammatory processes in a backbone (tick-borne encephalitis, etc.).
The pain syndrome at radiculitis can be shown as a result of a raising of weight, the awkward movement, an infection or cold when there is stretching or a rupture of a fibrous ring of a disk, the jellylike disk moves forward out of limits of the borders, and on its place the hernia nuclei pulposi is formed. Often the put-forward disk or osteofita squeeze not only a spinal back, but also nearby covers and fabrics which in turn are an additional source of a pain syndrome. Besides, in its pathogenesis two more factors play a role: diskalgiya and musculotonic pain.
Classification of radiculitises
Depending on topography of inflammatory process radiculitises subdivide into a number of forms:
- lumbar and sacral,
which in turn can have the chronic or sharp form. Besides, distinguish primary radiculitises (a toxic, infectious origin) and secondary, caused by anomalies of a backbone and spinal cord. At a meningoradikulita inflammatory process develops at the same time in backs a spinal nerve. and covers of a spinal cord.
The main symptoms of radiculitis — pain, decrease in reflexes, partial disorder of sensitivity, vegetative violations. The first attacks of pain connected with an anguish of a fibrous ring of an intervertebral disk have diffusion character (remind "miozita" or "lumbago"). And only with formation of hernia of a disk which squeezes a back the radicular syndrome when there are feelings of a pricking and a sleep is formed. In the field of the struck back the innervation and, as a result, decrease or total absence of sensitivity develops (temperature, tactile and painful). Over time weakness of the muscles located in a zone of the struck back up to their full atrophy increases.
Symptoms of primary radiculitises (infectious and toxic etiology) are the manifestations corresponding to the disease which caused radiculitis (in case of a SARS – temperature increase, a fever etc.). At lumbar and sacral radiculitis localization of the pain amplifying during the walking and cough is possible in lumbar area, a shin, a hip or foot. At an initial stage the disease proceeds on type , lyumbalgiya and lyumboishialgiya.
The main symptom — the sudden acute pain in a waist resulting from a raising of weight, the awkward movement or overcooling. In initiation of a pain syndrome the irritation of receptors of a fibrous ring of a disk or an incomplete dislocation of intervertebral joints plays a role. Mobility in lumbar department of a backbone is limited, the tone of lumbar muscles is raised, they are painful at a palpation. In most cases the most severe pains ("lumbago") do not allow patients to be in a standing position or to go.
Lyumbalgiya — dull ache of subacuity in a waist. Often recurs. The sitting position, walking and any movements in a waist is complicated. In some cases tension symptoms (Lasega, Wasserman) slabopolozhitelny. At a lyumboishialgiya pain in a waist (both sharp, and subacuity) irradirut in one or both legs. Neuromuscular, vegeto-vascular and trophic violations in the lower extremity develop. The raised tone of muscles of a waist, restriction of movements and alignment of a lumbar lordoz is observed.
For partial removal of a pain syndrome at radiculitises patients accept a "protective" pose: sit, having turned in under themselves a leg and hands in a bed, or lie, having enclosed a pillow under a stomach. Gait changes: in the movement patients try to lean mainly on a healthy leg. The raised tone of lumbar muscles, antalgichesky scoliosis are quite often noted, is more rare . At a palpation painful are paravertebralny points in lumbar area, the back surface of a hip, a popliteal pole, a heel (Gar's point) and the middle of foot (a medioplanatarny point of Bekhterev), and it is nearly the defining simptomokompleks of lumbar and sacral radiculitis.
The first symptoms of cervical radiculitis — neck pain (unilateral), the compelled position of the head (a hypoplastic wryneck), the raised tone of cervical muscles, pathological necks. Pain accrues at cough, sneezing and any movement of the head. At formation of hernia of a disk and squeezing of backs pain extends also to a hand (proximal departments), the forward surface of a thorax or a shovel. Decrease in deep reflexes and a paresteziya is observed (in disteel departments of a hand). Pain at radiculitises can become aggravated at night, in such cases patients are forced to go long, "rocking to sleep" a sore hand.
Development of chest radiculitis begins with a reflex irritativnykh of symptoms (morbidity of paravertebralny points, musculotonic violations). At a radicular stage of chest radiculitis disorders of sensitivity in the field of the struck backs, motive frustration are shown (paresis of razgibatel of fingers and a brush in general). In cases when inflammatory process affects sympathetic formations of a hand, vegeto-vascular disorders (puffiness, perspiration, a cold snap) are observed. Development of a spondilokoronarny syndrome is possible. It is shown by pains in heart during bending and extension of a trunk, turns inclinations etc. such pains will badly respond to treatment usual koronarorasshiryayushchy means.
Complications at radiculitises
Defeat of spinal backs and formation of hernia of intervertebral disks can lead to a sdavleniye (or obstruction) large radicular veins and radikulomedullyarny arteries. Reduction of a blood-groove can cause development of ishemiya of various etiology and, as a result, a heart attack of a spinal cord at which sensitive and motive functions of the person are broken. In such state definition of group of disability is possible.
Diagnosis of radiculitises
The radiological research of a backbone at various forms of radiculitis usually reveals osteochondrosis which quite often meets. Therefore inspection has to be developed. For an exception of destructive processes in a backbone the spondilogramma is shown. However it is not capable to verify a diskogenny etiology of a disease. At lumbar and sacral radiculitises the lyumbalny puncture which finds small increase in protein content is carried out.
Recognition of an etiology of radiculitises requires careful studying of the anamnesis, clinic, and also large volume of paraclinical data (clinical blood test, a miyelografiya, a spondilogramma, a research of tserebrospinalny liquid, backbone MPT and KT etc.). It should be noted that at diskogenny radiculitises only one-two backs, as a rule, suffer. And in cases of chest radiculitises it is necessary to exclude vertebrogenny osteochondrosis, here the reason of a sdavleniye of backs is covered in other diseases. Besides, radiculitis needs to be differentiated from a sharp miozit of muscles of a back.
Treatment of radiculitises
Treatment is carried out vertebrology or the neurologist. The leading triad in medical process — a backbone immobilization (hard bed), heat and analgetics (diclofenac, indometacin etc.). She allows to stop an exacerbation of pains first of all. In cases of giperalgichesky forms of radiculitis it is necessary to add intramuscular introduction of analgetics ( + , sodium metamizol). It is recommended also mestnorazdrazhayushchy means — a pepper plaster, grindings. In treatment of radiculitises the physical therapy, blockade of spazmirovanny muscles, extension are of great importance. After partial removal of a pain syndrome it is necessary to attach LFK, massage and manual therapy. At a long lyumboishialgichesky syndrome sick appoint injections of vitamins of group B. Use of B12 vitamin in high doses renders the expressed soothing effect. In hard cases carrying out novokainovy blockade (about B12 vitamin, a hydrocortisone etc.) or intravenous infusions of diazepam, a difengidramin, eufillin is possible.
In case of ongoing pains (without regard to 3-4 months of therapy), it is recommended to offer the patient backbone operation (removal of a hernia nuclei pulposi). As the obligatory indication to surgery at radiculitis can serve the paralyzing sciatica caused by a sdavleniye of a horse tail with development of violations of functions of pelvic bodies. For treatment of a recurrence sanatorium treatment with application of mud applications, hydrosulphuric and radonic bathtubs is recommended.
The forecast at radiculitis
The favorable forecast is possible in case of timely diagnostics and the developed treatment including all possible directions. Only at such approach it is possible to expect recovery, without being afraid of a recurrence. In case of development of ischemia and, as a result, a heart attack of a spinal cord it is impossible to predict an absolute recovery as often become a consequence of such complications violation of motive and sensitive functions of an organism.
Prevention of radiculitises
Prevention of radiculitises includes the measures directed to maintenance of a correct posture, strengthening of muscles of a back. It is recommended to avoid excessive loads of a backbone. The correct posture and wakefulnesses minimizes during sleep tension which tests a spine column. It is not necessary to sleep on too rigid mattresses. Contrary to the occurring opinion they are capable to distort position of a backbone and to break its function. To avoid it and to keep a natural bend of a backbone it is recommended to pin up small pillows under a neck and a waist or to use a semifixed mattress which is capable to support natural position of a backbone.
Maintenance of a correct posture is very important also in daily work. Lifting objects from a floor, it is recommended to bend legs in knees, without inclining at this trunk. Thus, loading will move from a back to legs. It is recommended to avoid inconvenient poses (long sitting at a table with the hung head, sitting in front of the TV, having dropped a chin on a breast, etc.). Besides, in prevention of radiculitis the gymnastics promoting strengthening of muscles of a back, and also sports and a hardening which increase resistance of an organism to physical activities and overcoolings has a big role.