Excludes: cervicalgia due to intervertebral disc damage (M50.-)

Excluded:

• sciatic nerve damage (G57.0)
• sciatica:
  • caused by intervertebral disc disease (M51.1)
  • with lumbago (M54.4)

Excludes: caused by intervertebral disc disease (M51.1)

Tension in the lower back

Excluded: lumbago:

• due to displacement of the intervertebral disc (M51.2)
• with sciatica (M54.4)

Excluded: due to damage to the intervertebral disc (M51.-)

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Causes and symptoms of radiculopathy

Almost every person, at least once, encounters such an unpleasant sensation as back pain. For more than half of all working people, these pains occur regularly and last more than a day. There are many causes of back pain, one of them is called radiculopathy (an outdated name) or radicular syndrome. This disease is also called radiculitis.

Radicular syndrome or radiculopathy, ICD code 10, is a neurological disease caused by degenerative processes in the spine. Symptoms of radiculitis are caused by damage, inflammation, and damage to the spinal nerve roots. The problem can occur in one spine or in several. The first manifestations of radicular syndrome are usually expressed by crippling pain along the entire length of the spine and even on the body and organs, weak muscle tone, tingling and/or numbness.

Causes of radicular syndrome

• The main cause of radiculopathy is osteochondrosis. But the following factors can also give rise to the disease:
• poor working conditions and hard physical labor;
• hypothermia of the body;
• heredity;
• flat feet;
• different leg lengths;
• excess weight
• incorrectly selected shoes;
• lack of proper nutrition.

The following back diseases can also cause radiculitis:

• osteochondrosis;
• intervertebral hernia;
• deforming spondyloarthrosis;
• compression fracture of the spine;
• spondylolisthesis;
• spondylosis with marginal osteophytes;
• spinal injuries;
• spinal tumors (osteosarcoma, hemangioma, neuroma, etc.)
• tuberculous spondylitis
• infectious processes of the body
• congenital vertebral anomalies.

Discogenic radiculopathy always appears as a consequence of intervertebral hernias.

Radicular syndrome does not develop immediately, but as a complication after a chain of factors or diseases of the body. There is also a possibility of the disease becoming chronic. In this form, the inflammatory process in the roots will be continuous and will end with loss of sensitivity and loss of functionality, atrophy of muscle mass.

Types of radiculopathy

Depending on the location of the affected nerve, several types of radiculitis are distinguished:

• Radicular syndrome of the cervical spine - occurs as a consequence of hernia, protrusion or degeneration of the disc, osteoarthritis, foraminal stenosis and other pathologies. It appears unexpectedly.
• Radicular syndrome of the thoracic spine - manifests itself in the chest area. The causes of thoracic radiculitis include degenerative transformations, protrusions and disc herniations, osteoartitis, osteophyte, and stenosis. It may be a consequence of infectious diseases, hypothermia, osteochondrosis, injury or sudden movements.
• Radicular syndrome of the lumbosacral spine is the most common case of the disease. May be chronic. Radiculopathy of this part of the spine is provoked, in most cases by destructive processes in the ligaments and articular lesions. May be a consequence of osteochondrosis, hernia and other diseases.
• Radicular syndrome of the lumbar spine - there are three types of lumbar radiculitis: lumbago, sciatica and sciatica. The cause of lumbar radiculopathy is improper treatment, arthritis, degenerative changes in the vertebrae, stenosis, compression fracture, disc herniation and protrusion, spondylolisthesis.
• Mixed radicular syndrome.

There is also a division of the disease depending on the lesion:

• Discogenic radiculopathy is a consequence of deformation of the cartilage tissue that has grown on the intervertebral discs, which infringes on the root. In the process, the roots become inflamed, causing severe pain and swelling.
• Vertebrogenic radiculopathy is necessarily a secondary disease. It appears in parallel with stenoses affecting the foraminal openings, where the nerve roots pass. Under the influence of destructive changes, the path along which the roots move becomes narrower and they are compressed, which leads to poor circulation and swelling.
• Mixed radiculopathy.

This classification of the disease makes it possible to accurately distribute the main features of radiculopathy in each individual patient.

Symptoms – what should you pay attention to?

The clinical picture of radiculitis combines various combinations of symptoms of irritation of the spinal roots and loss of its functionality. The severity of the disease depends on the degree of compression of the roots and on the individual characteristics of the structure of the roots.

There are several nuances of symptoms of radiculitis that are worth paying attention to:

1. Increasing pain syndrome:

• - When moving - walking, changing body position, bending and turning, lifting legs.
• - From vibration - coughing, laughter, traveling in transport.
• - When trying to apply pressure to the affected area.

Radiculopathy of the lumbosacral spine is manifested by the following features:

• - Combination of pain with symptoms of paresthesia (tingling, burning, numbness, etc.).
• - Relationship between pain symptoms and movements.
• - Presence of areas of muscle tightness and scoliosis deformities in the lumbar or lumbosacral region.

What you need to pay attention to to determine the type of radiculitis:

1. Painful sensations do not occur in one place, but can “wander” throughout the body. Depending on the location of the pain, the location of radiculitis can be determined:

Radiculopathy of the cervical spine is expressed by the following symptoms:

Symptoms of thoracic radiculopathy:

Symptoms for radiculopathy of the lumbar and lumbosacral regions:

• - lumbar and sacral areas;
• - buttocks and groin;
• - hips, lower legs.

1. Loss of sensitivity is a common symptom of radicular syndrome, indicating that the degenerative process in the nerve has been going on for quite a long time and the process of death has begun.
2. Muscle dystrophy is another characteristic symptom of radiculitis. And this is a sign that the nerve is already at the final stage of dying and the muscles cannot cope with their task, which leads to disruption of the harmony of movement.

If you experience these symptoms alone or in a group, you should definitely consult a doctor. This will help identify the disease in its infancy and prevent complications.

Diagnosis of radiculopathy

For treatment of radiculitis to be effective, it is necessary not only to make an accurate diagnosis, but also to determine the original source of the problem. Only after examining the patient by a doctor, analyzing the results of the necessary laboratory tests, and familiarizing himself with the results of radiography (a popular and accessible method) or MRI (a very accurate international method - shows the most informative and detailed result).

It must be remembered that only a qualified doctor can make a diagnosis, confirm or refute it. And only after this can treatment of radicular syndrome begin.

Treatment of radicular syndrome

Treatment of radiculitis requires serious, competent and properly selected treatment. To eliminate the disease, it is not enough to relieve the symptoms and eliminate the pain; it is also necessary to cure the source of the radicular syndrome.

Treatment is selected individually and depending on the severity of the patient’s condition and research results, its complexity and methods may vary:

• - conservative treatment with medications - painkillers, non-steroidal drugs, drugs to relieve spasms, vitamins D, etc.
• - additional treatment - exercise therapy, reflexology, massage and self-massage, physiotherapy, laser therapy, etc.
• - surgical intervention - is used only in severe cases, when treatment by other methods does not give the desired result or the patient’s condition requires drastic measures.

In no case should you self-medicate; all treatment, including traditional medicine, must be prescribed and agreed upon with a specialist.

What are the risks of radiculopathy?

The majority of spinal ailments occur in people of working age. Two thirds of them are faced with a destructive process in the intervertebral discs.

Its most painful complication is radiculopathy; with an unfavorable course of the disease with frequent long-term exacerbations and documented ineffectiveness of rehabilitation measures, the patient faces loss of ability to work and disability.

Radiculopathy can lead to disability

Most often, movement disorders caused by radiculopathy of the lumbosacral spine disable the work.

Radiculopathy - what is it?

In neurosurgery, the diagnosis of radiculopathy indicates symptoms associated with compression and injury to the nerve roots, which occurs in any part of the spine due to pathological changes in it.

Previously, such conditions were called radiculitis, which means inflammation of the nerve roots.

However, in the modern view (and this is confirmed by research), the main cause of intense burning pain is not inflammation, but compression-ischemic and reflex phenomena, the presence of which is more accurately characterized by the term radiculopathy, indicating a connection with diseases of the spine.

Also in the medical literature it is often associated with radicular syndrome.

You will learn more about what radiculopathy is from the video:

Subtleties of classification

According to the international classifier ICD 10, radiculopathy has code M54.1.

The leading role in the etiology of most radiculopathies is assigned to damage to the intervertebral discs.

The most common is primary, or discogenic radiculopathy, which is associated with displacement of the gel-like contents of the intervertebral disc and its subsequent “falling out” into the spinal canal, that is, the appearance of a hernia. A “falling out” disc irritates the nerve sheath.

A peculiar continuation of the previous form is secondary, or vertebrogenic radiculopathy. In response to the formation of a hernia in the lower parts of the vertebral bodies, bone growths resembling an arch - osteophytes - form at the outer parts of the discs. Their task is to prevent complete “squeezing out” of the disc by sagging vertebrae. Overgrown osteophytes also put pressure on the nerve roots.

Almost always, vertebrogenic lumbosacral radiculopathy is accompanied by sensory disturbances with flaccid paralysis.

Further destructive processes lead to narrowing of the root canals. The flow of nutrients and oxygen becomes more complicated. Nutritional deficiency leads to ischemia of the nerve fiber - spondylogenic radiculopathy. If left untreated, irreversible damage to the nerve sheath occurs with blockade of its conductivity.

All nerve fiber lesions caused by intervertebral hernia are today called the general term compressive radiculopathy.

Compression radiculopathy affects nerve fibers

But there are nuances here too. Disc elements rarely directly “press” on nerve fibers. Compression with subsequent ischemia often occurs under the influence of edema, hemorrhage, in the presence of neoplasms, etc.

Such lesions of the spinal nerve roots, which are not inflammatory in nature, are classified as compression-ischemic radiculopathy.

Chronic radiculopathy is also distinguished separately, most often lumbosacral - an occupational disease that develops in people whose working conditions are associated with an unchanged working posture.

Hard case…

There is also a group of diseases in which multiple lesions of peripheral nerves and their endings occur. One of them is polyradiculopathy.

What is polyradiculopathy? Classic acute polyradiculopathy is a serious complication caused by pathogenic “provocateurs” diphtheria, typhus, hepatitis, etc. It appears 2-4, sometimes 7 days after the onset of infection. The patient complains of “cottoniness” of the skin of the legs, and then the arms. Sometimes pain occurs in the limbs, their strength decreases, and paresis and even paralysis may develop. In severe cases, when paralysis “rises” upward, involving the diaphragm, the patient requires intravenous administration of immunoglobulin and connection to an artificial respiration apparatus. The prognosis of the disease is usually favorable.

Polyradiculopathy has also been associated with HIV infection.

Where does it hurt?

The main signs of radiculopathy are severe pain and loss of tendon reflexes due to decreased sensitivity.

Compression of the nerve roots of the cervical spine is manifested by quite intense pain in the neck and upper extremities, decreased sensitivity of the fingers, weakness and a feeling of coldness in the hands.

Cervical radiculopathy manifests itself as pain in the arms

Thoracic radiculopathy is rare.

The clinical picture of lumbar radiculopathy is caused by compression of the spinal roots at the site of their exit and is an unexpected pain that is unbearable with physical effort.

Typical for sciatica, the pain caused by damage to the intervertebral discs of the lumbar region with radiculopathy literally “bends” the patient, becoming unbearable with any movement.

A lot of suffering is caused by lumbosacral radiculopathy, accompanied by pain that spreads from the buttock to the leg, intensifies when trying to walk, coughing and sneezing, and can be bilateral. Let's talk about it in more detail.

Walking through torment

The lumbosacral region, which is most susceptible to overload, most often suffers from processes that “start” after the intervertebral hernia enters the epidural space.

In 90% of cases of disability due to vertebrogenic syndromes in the sacrum and lumbar region, there is radiculopathy L5 - S1, the symptoms of which are persistent, sharp pain that persists for about 6 weeks and significantly complicates movement.

Contact of spinal structures with a harmful factor is the trigger of the disease. In the “pinched” nerve fiber, non-infectious inflammation develops, accompanied by severe pain and a sharp decrease in its functionality.

The lumbosacral region most often suffers from radiculopathy

Thus, radiculopathy of the 1st sacral root is characterized by the spread of pain from the lower back along the posterolateral parts of the thigh and lower leg, toes and foot. The patient's suffering is complemented by paresis of the foot, decreased rotation and the ability to flex. The tone of the calf muscle decreases.

If radiculopathy occurs simultaneously in zones L4, L5, S1, the symptoms will be as follows: pain from the middle of the back to the midline of the abdomen becomes unbearable with physical effort.

A medical examination for lesions of the lumbosacral roots shows fixation of the back in a slightly bent position and tension in the quadratus lumborum muscle. The patient cannot bend over. The Achilles reflex decreases.

How to break the vicious circle?

Radiculopathy requires a very clear identification of the pain source - only in this case treatment will bring long-term remission.

In general, how to treat radiculopathy depends on the phase of the disease.

It should be remembered that the most serious complication of discogenic radiculopathy is paralysis of the lower extremities, and therefore delay in its treatment is unacceptable.

What medications are used to treat discogenic radiculopathy?

Period of severe pain

The patient spends it in bed. In the acute phase, NSAIDs and muscle relaxants are used.

Local use of analgesic drugs also helps reduce pain. What ointments are effective for radiculopathy? The most effective are local preparations of complex action. Among them are capsicam, finalgon, nicoflex. They have anti-inflammatory, analgesic and distracting effects.

You can also reduce pain using a nanoplaster. The components of this modern dosage form produce infrared radiation, which permanently eliminates swelling and pain, relaxes muscles and normalizes blood supply to the “sick” area.

Nanoplast reduces pain in radiculopathy

If the pain is particularly severe, anticonvulsants may be required.

Prolonged inflammation can only be managed through epidural steroid injections.

Manipulation performed with a special needle makes it possible to deliver a drug with a very strong anti-inflammatory component under the membranes of the spinal cord.

Only in rare cases, with insufficient gross motor skills, when a person cannot turn, has difficulty moving, with a progressive decrease in the motor function of the limbs, treatment of lumbosacral radiculopathy may require the delicate work of a surgeon.

In the subacute phase, during the recovery period and to prevent exacerbations

Physiotherapeutic methods are used in combination with massage and therapeutic exercises. What matters here is their correct sequence.

Exercises for small joints of the legs and breathing exercises may be advisable from the first days of illness.

Later, when the pain subsides, exercise therapy for lumbar radiculopathy begins with special techniques to relieve muscle tension and stretch the spine. Special exercises are first performed during the massage, and then a minute after it in combination with a general strengthening and respiratory complex. The “dispenser” of their amplitude is the appearance of moderate fighting.

In the future, exercises are selected that help correct the curves of the cervical and lumbar spine, strength and resistance exercises, techniques that improve coordination and balance.

You will learn what exercises you can do from the video:

One of the conditions for recovery is slow and smooth exercise in water (water aerobics).

Depending on the characteristics of the disease, massage is prescribed.

Already in the stage of incomplete remission, with significant pain in the lumbosacral area, the combination of segmental massage with mud therapy is beneficial.

Always stay on track

Having long ceased to be the lot of elderly people, radiculopathy often makes one wonder whether people with such a diagnosis are accepted into the army?

The answer depends on the severity of the radicular syndrome and the degree of nerve injury.

Article 26 of the Schedule of Diseases spells out all the eligibility conditions for young men who want to “be in the ranks.”

A conclusion of unfitness is issued to conscripts with chronic, recurrent radiculopathy, requiring 2-3 months of continuous inpatient or outpatient treatment.

A long (more than 4 months) course of the disease with persistent pain, vegetative-trophic and motor disorders also “disables” the conscript.

Don’t put off taking care of your back health until tomorrow, and always stay in good shape!

ICD code: M54.1

Radiculopathy

Radiculopathy

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Lumbosacral radiculopathy

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Associated diseases

Titles

Description

RCC occurs in approximately 3–5% of individuals in the population. The incidence in men and women is approximately equal, but its peak in men is between 40 and 50 years of age, and in women between 50 and 60 years. The risk of developing vertebrogenic radiculopathy is increased in those who engage in heavy physical labor, smoking, and a family history. Regular physical activity may reduce the risk of radiculopathy, but the risk may be increased for those who begin physical activity after an episode of discogenic back pain.

Symptoms

On examination, the back is often fixed in a slightly flexed position. Scoliosis is often detected, worsening when bending forward, but disappearing in the supine position. It is most often caused by contraction of the quadratus lumborum muscle. With a lateral hernia, scoliosis is directed towards the healthy side, while with a paramedian hernia, it is directed towards the diseased side. The anterior tilt is sharply limited and is carried out only by the hip joint. The tilt towards the painful side is also sharply limited. There is pronounced tension in the paravertebral muscles, which decreases in the supine position.

Characterized by impaired sensitivity (pain, temperature, vibration, etc.) in the corresponding dermatome (in the form of paresthesia, hyper- or hypalgesia, allodynia, hyperpathia), reduction or loss of tendon reflexes closing through the corresponding segment of the spinal cord, hypotonia and weakness of the muscles innervated by this root . Since in the lumbar spine in approximately 90% of cases, disc herniation is localized at the levels L4–L5 and L5–S1, in clinical practice radiculopathy is most often detected at L5 (about 60% of cases) or S1 (about 30% of cases). In older people, intervertebral disc herniations often develop at a higher level; therefore, they often have L4 and L3 radiculopathies.

The relationship between the affected root and the location of the hernia is complex and depends not only on the level of the disc herniation, but also on the direction of the protrusion. Lumbar disc herniations are most often paramedian and put pressure on the root emerging through the intervertebral foramen one level below. For example, with a herniation of the L4–L5 disc, the L5 root will most often be affected. However, if the herniation of the same disc is directed more laterally (towards the radicular canal), it will cause compression of the L4 root, if more medially, it can lead to compression of the S1 root (Figure) . Simultaneous involvement of 2 roots on one side with a herniated disc is a rare occurrence; it is more often observed with a herniated L4–L5 disc (in this case, the L5 and S1 roots are affected).

The presence of tension symptoms and, above all, Lasegue's symptom is typical, but this symptom is not specific for radiculopathy. It is suitable for assessing the severity and dynamics of vertebrogenic pain syndrome. Lasègue's symptom is checked by slowly (!) lifting the patient's straight leg upward, waiting for the reproduction of radicular irradiation of pain. When the L5 and S1 roots are involved, pain appears or sharply intensifies when the leg is raised to 30–40°, and with subsequent flexion of the leg at the knee and hip joints, it goes away (otherwise it may be caused by pathology of the hip joint or be psychogenic in nature).

When performing the Lasègue maneuver, pain in the lower back and leg can also occur when the paravertebral muscles or the posterior muscles of the thigh and lower leg are tense. To confirm the radicular nature of Lasegue's symptom, the leg is raised to the limit above which pain occurs, and then the foot is forced to flex at the ankle joint, which in radiculopathy causes radicular irradiation of pain. Sometimes with a medial disc herniation, Lasegue's cross symptom is observed, when pain in the lower back and leg is provoked by raising the healthy leg. When the L4 root is involved, an “anterior” tension symptom is possible - Wassermann's symptom: it is checked with the patient lying on his stomach, raising the straight leg up and straightening the thigh at the hip joint or bending the leg at the knee joint.

With compression of the root in the radicular canal (due to lateral hernia, hypertrophy of the articular facet or the formation of osteophytes), the pain often develops more slowly, gradually acquiring radicular irradiation (buttock–thigh–leg–foot), often persists at rest, but increases with walking and staying in in an upright position, but unlike a herniated disc, it is relieved when sitting. It does not get worse with coughing and sneezing. Symptoms of tension are usually less severe. Forward bending is less limited than with a median or paramedian disc herniation, and pain is more often provoked by extension and rotation. Paresthesia is often observed, less often decreased sensitivity or muscle weakness.

Muscle weakness in discogenic radiculopathies is usually mild. But sometimes, against the background of a sharp increase in radicular pain, severe paresis of the foot (paralyzing sciatica) may occur acutely. The development of this syndrome is associated with ischemia of the L5 or S1 roots, caused by compression of the vessels supplying it (radiculoischemia). In most cases, the paresis regresses safely within a few weeks.

Acute bilateral radicular syndrome (cauda equina syndrome) occurs rarely, usually due to a massive median (central) herniation of the lower lumbar disc. The syndrome is manifested by rapidly increasing bilateral asymmetric pain in the legs, numbness and hypoesthesia of the perineum, lower flaccid paraparesis, urinary retention, and fecal incontinence. This clinical situation requires urgent consultation with a neurosurgeon.

Causes

In older people, radiculopathy is most often caused by compression of the root in the area of ​​the lateral recess or intervertebral foramen due to the formation of osteophytes, hypertrophy of the articular facets, ligaments, or other reasons. Rarer causes - tumors, infections, dysmetabolic spondylopathies together explain no more than 1% of cases of radiculopathy.

Treatment

Corticosteroids are the most effective means of suppressing the inflammatory response, and their epidural administration is preferable, creating a higher local concentration. The administration of corticosteroids causes a significant reduction in pain, although apparently does not affect the long-term outcome of radiculopathy. The effectiveness of corticosteroids is higher when the exacerbation lasts less than 3 months. They can be administered at the level of the affected segment (translaminar or transforaminal method) or through the sacrococcygeal or first sacral foramen. The translaminar approach, in which the needle is inserted through the paravertebral muscles (with a paramedian approach) or the interspinous ligament (with a median approach), is safer than the transforaminal approach, in which the needle is inserted through the intervertebral foramen. It is better to administer epidurally corticosteroids that form a depot at the injection site, for example, a suspension of hydrocortisone (100 mg), a prolonged preparation of methylprednisolone (40 mg) or diprospan. The corticosteroid is administered in the same syringe with a local anesthetic (for example, a 0.5% solution of novocaine). The volume of solution administered interlaminarly is usually up to 10 ml, transforamally - up to 4 ml, into the sacrococcygeal and first sacral foramen - up to 20 ml. Depending on the effectiveness, repeated injections are given at intervals of several days or weeks. Blocking painful points and inactivating trigger points may be important in the presence of concomitant myofascial syndrome. For vertebrogenic radiculopathy, there is no sufficient basis for the use of diuretics or vasoactive drugs. However, the use of pentoxifylline is possible, given its ability to have an inhibitory effect on the production of tumor necrosis factor-a.

Considering the mixed nature of the pain syndrome, it seems promising to influence not only the nociceptive, but also the neuropathic component of pain. Until now, the effectiveness of drugs traditionally used for neuropathic pain, primarily antidepressants and anticonvulsants, remains insufficiently proven. Only a few small studies have shown a positive effect of gabapentin, topiramate, and lamotrigine. A condition for the effectiveness of these drugs may be the early start of their use. A positive effect is also obtained with topical application of lidocaine plates.

Bed rest is often unavoidable in the acute period, but should be kept to a minimum whenever possible. With radiculopathy, as with other types of back pain, a faster return to daily activities may be a factor in preventing the pain from becoming chronic. When the condition improves, therapeutic exercises, physiotherapeutic procedures and gentle manual therapy techniques are added, aimed at mobilizing and relaxing muscles, which can help increase mobility in the spine. Traditionally used, popular lumbar traction has been found to be ineffective in controlled studies. In some cases, it provokes deterioration, since it causes stretching not of the affected blocked segment (and decompression of the root), but of the segments located above and below.

Absolute indications for surgical treatment are compression of the roots of the cauda equina with paresis of the foot, anesthesia of the anogenital area, and dysfunction of the pelvic organs. An increase in neurological symptoms, such as muscle weakness, may also be an indication for surgery. As for other cases, questions about the feasibility, optimal time and method of surgical treatment remain the subject of debate.

Recent large-scale studies have shown that although early surgical treatment undoubtedly leads to faster pain relief, after six months, a year or two it has no advantages in terms of the main indicators of pain syndrome and degree of disability over conservative therapy and does not reduce the risk of chronic pain. It turned out that the timing of surgery in general does not affect its effectiveness. In this regard, in uncomplicated cases of vertebrogenic radiculopathy, the decision on surgical treatment can be delayed for 6–8 weeks, during which adequate (!) conservative therapy should be carried out. The persistence of intense radicular pain syndrome, severe limitation of mobility, and resistance to conservative measures during these periods may be indications for surgical intervention.

In recent years, along with traditional discectomy, more gentle surgical techniques have been used; microdiscectomy, laser decompression (vaporization) of the intervertebral disc, high-frequency ablation of the disc. For example, laser vaporization is potentially effective in radiculopathy associated with a herniated disc while maintaining the integrity of the fibrous ring, bulging it by no more than 1/3 of the sagittal size of the spinal canal (about 6 mm) and in the absence of movement disorders or symptoms of compression of the cauda equina roots in the patient. The minimally invasive nature of the intervention expands the range of indications for it. Nevertheless, the principle remains unchanged: surgical intervention should be preceded by optimal conservative therapy for at least 6 weeks.

Osteochondrosis with radicular syndrome is also called radiculitis or radiculopathy. Pinched nerves can occur in any part of the spine, causing severe pain and temporarily rendering the patient completely unable to work. According to ICD-10, the pathology does not have its own code (osteochondrosis of the spine - M42, radicular syndrome in the neck, chest and lower back with the sacrum, respectively - G54.2 - 54.4 and 54.1)

What is radicular syndrome? This is a consequence of advanced osteochondrosis, as well as intervertebral disc herniation and other pathologies. The mechanism of formation is simple - nerves are pinched by the vertebral bodies due to drying out of the intervertebral discs due to degenerative processes in them. Radiculopathy usually affects older people, but a sedentary lifestyle, weak muscle corset around the spine and other reasons often provoke the onset and progression of osteochondrosis in young people.

Clinical manifestations by group

The nerve can be pinched in any part of the spine, and the symptoms will vary accordingly. The only common pain will be directly at the site of compression of the nerve bundle.

Symptoms of radicular syndrome of the cervical spine:

• Weakness of the muscles of the upper extremities, which is expressed in the inability to hold more or less heavy objects - the fingers simply unclench.
• Constant “tracking” of hands during sleep, “goosebumps”, local freezing (cold hands, although the room is hot).
• Unreasonable headaches, dizziness.
• Persistent increase in blood pressure.
• Pain in the shoulder girdle and neck.

Symptoms of radicular syndrome of the thoracic spine are disguised as other pathologies. When nerves are pinched in this area, the following are observed:

• discomfort in the esophagus and stomach;
• allegedly a foreign body in the throat;
• pain behind the sternum, under the shoulder blade(s), under the arms, girdles;
• weakness of the muscles of the upper limbs;
• pain in the heart area.

On a note. Cervicothoracic osteochondrosis is a combined pathology in which both the cervical and thoracic spine are simultaneously affected. Accordingly, the likelihood of pinching nerves in two places at once is quite high.

Symptoms of radiculitis in the lumbar spine (lumbar and lumbosacral osteochondrosis) are familiar to most. This:

• pain in the lower back, shooting into the buttock and radiating to the leg along the nerve (with pinching of the sciatic nerve);
• urination disorder (too frequent or, on the contrary, extremely rare);
• increased pain when bending over and lifting heavy objects;
• pain in a horizontal position when changing body position, which is often accompanied by sweating, redness and hyperthermia of the skin.

Diagnostics

Before sending the patient for hardware tests, the doctor carefully examines him, talks to him, clarifying his medical history. Next, an x-ray is taken in two projections. If an accurate diagnosis cannot be established from the images (infringements are not visible), the patient is sent for an MRI. Magnetic resonance imaging identifies problem areas very accurately and is the best diagnostic method for radicular syndrome in osteochondrosis.

Therapy

Standard recommendations for the treatment of radiculitis are rest. However, according to some doctors - authors of therapeutic exercises - this only aggravates the situation. You can and should move, but you need to do it correctly so that the pain does not intensify, but rather gradually subsides, and without the help of potent analgesics.

However, official medicine does not listen to the opinions of such doctors. Standard treatment regimen for radicular syndrome:

• rest - until the pain subsides;
• taking a certain set of pills;
• physiotherapeutic procedures;
• massage;
• visiting a chiropractor's office;
• physiotherapy.

Tablets and ointments

The main emphasis is on drug therapy, which includes several groups of drugs:

• non-steroidal anti-inflammatory external drugs - Nimesil, Nise, Diclofenac;
• muscle relaxants - drugs that relieve muscle spasms;
• B vitamin complex – to improve nerve conduction;
• chondroprotectors – nourish cartilage and promote its regeneration at a young age.

As an additional effect, external agents are used - ointments, gels, creams. They are usually based on NSAIDs. There are also combined and warming agents. Menovazin can be used as an ambulance for muscle spasms in the cervical-collar area.

On a note. In case of severe pain, novocaine blockade is used to alleviate the patient's condition.

Physiotherapy

This is electrophoresis with Novocaine or Prednisolone (or Kenalog-40). Magnetic therapy and vibroacoustic effects have a good effect. In medical centers where there is a SCENAR therapy room, patients are provided with quite effective assistance by influencing the pain area and as it spreads with the SCENAR device.

Pain from radiculitis is well relieved with dry heat, but not everyone can warm their lower back or chest. This is why it is so important to see a doctor rather than treating yourself.

Massage

It can bring relief or, on the contrary, worsen the situation. It is important that the massage therapist has a medical education and knows how to treat the patient’s back. The consequence of improper massage can be increased pain or complete immobilization of the patient.

Manual therapy

The main task of a chiropractor is to relieve pain, muscle tension and, if possible, free the pinched nerve. The influence is carried out in three different ways - it is done:

• segmental massage, which relaxes tight and tones relaxed muscles;
• mobilization - the spine in the area of ​​pinched nerve is stretched using various techniques; traction can be used (natural - under the weight of your own body, and forced - using additional weights).
• forceful impact – activity returns to the spine.

On a note. Manual therapy is contraindicated for oncological diseases of the spine, infectious diseases of any etiology, high blood pressure, pathologies of the hematopoietic system, during pregnancy, after operations.

Physiotherapy

Aimed at strengthening the muscles that support the spine. There are several sets of exercises - Peter Popov and Yuri Popov. Due to the same surnames, the methods are often confused, although they are completely different. Interestingly, both of them are effective and have proven themselves in the treatment of radicular syndrome in osteochondrosis. Gymnastics by Peter Popov is based on micro-movements. Yuri Popov believes that upright walking is the source of all troubles with the human spine. His set of exercises is performed lying down.

ethnoscience

Here, external agents are mainly used - rubbing, ointments, compresses. It is clear that only the symptoms of infringement, such as pain and inflammation, are eliminated, but the cause itself remains. However, some folk remedies can be used as an ambulance:

1. Grate the black radish on a fine grater. Place the paste on gauze and form something like mustard plaster. Place on the sore spot, secure and wrap with a scarf. Keep it as it is. Change the compress once a day.
2. Take a relaxing bath. Then ask one of your relatives to massage your back with fir oil. This is an effective remedy for radiculitis and inflammatory joint diseases, such as arthritis and arthrosis.
3. Ask your family to supply the jars. Just not on the spine, but next to it, along the course of the inflamed nerve. Usually, several procedures are enough for the radicular syndrome to disappear for a long time.

Only a doctor can tell you how to treat radicular syndrome. Self-medication is not recommended, since it is impossible to independently determine the cause of back pain. An accurate diagnosis is made based on hardware studies. The doctor prescribes treatment, which, among other methods, may include traditional recipes - as an adjuvant to relieve pain and inflammation.

Radicular syndrome does not occur immediately; as a rule, it is caused by a long-term degenerative process in the intervertebral discs, which ends in the formation of a hernia. In turn, the hernia, growing and displacing, can damage the spinal root and ganglion, which leads to its compression and the development of an inflammatory reaction, ultimately developing radiculopathy and radicular syndrome.
The standard instrumental method for diagnosing radicular syndrome includes radiography of the spine in anterior and lateral projections. Today, the most sensitive and informative method for diagnosing spinal pathology is magnetic resonance imaging. However, when making a diagnosis of radicular syndrome, clinical symptoms play an important role.
The first and most characteristic sign of radicular syndrome is pain along the affected nerve. Thus, the process in the cervical spine causes pain in the neck and arm, in the thoracic spine - in the back, sometimes there are sensations of characteristic pain in the heart or in the stomach (such pain disappears only after treatment of the radicular syndrome), in the lumbar spine - in the lower back, buttocks and lower extremities and so on. When moving or lifting something heavy, the pain intensifies. Sometimes the pain occurs in the form of lumbago, radiating to different parts of the body in accordance with the location of the corresponding nerve; in the lumbar region such a lumbago is called lumbago. The pain may be constant, but it still intensifies with any careless movement (for example, lumbodynia - pain in the lumbar region). Attacks of pain can be provoked by physical or emotional stress, hypothermia. Sometimes pain occurs at night or during sleep, accompanied by redness and swelling of the skin, and increased sweating.
Another sign of radicular syndrome is a violation of sensitivity in the zone of innervation of this nerve: with a slight tingling with a needle in this zone, a sharp decrease in sensitivity is observed in comparison with a similar area on the opposite side.
The third sign of radicular syndrome is a violation of movements that appear as a result of changes in the muscles that occur against the background of damage to the nerves that innervate them. The muscles dry out (atrophy), become weak, sometimes this can be seen even by eye, especially when comparing two limbs.
The pain is localized in the area of ​​compression of the root and in those organs that are innervated by the damaged spinal nerve. For example, when the root is affected at the level of the 5th lumbar vertebra (L5), pain is detected in the lumbar region (lumbodynia), when walking - in the upper outer quadrant of the buttock, radiating along the outer surface of the thigh and lower leg to the II-IV toes (lumboischalgia). When the L4 root is damaged, pain spreads from the buttock through the anterior surface of the thigh and the anterior-inner surface of the lower leg to the inside of the foot.
Since the spinal root includes motor processes of the neuron and sensory nerve fibers, with radicular syndrome there may be a disturbance (reduction) in the sensitivity of the tissue. For example, with L5 radicular syndrome, skin sensitivity (hypoesthesia) in the area of ​​the outer surface of the thigh and lower leg decreases.

Osteochondrosis of the spine is an insidious disease and, perhaps, one of the most common. Very often, people do not suspect that they are sick, and attribute pain in the lumbar region, in the thoracic region or in the neck to a variety of causes. However, osteochondrosis can be so different, with so many manifestations, that it is worth treating it with due attention; it is especially often observed in women. An experienced doctor can accurately determine the cause of the disease, using the ICD code and signs of osteochondrosis. The disease is divided into 3 degrees, each of which has its own characteristics.

1. Osteochondrosis of the 1st degree is characterized by pain in the muscles, this is caused by damage to the capsule of the intervertebral disc, and the load on the spine is redistributed. This leads to constant irritation of the above area and, as a result, to periodic pain.
2. Osteochondrosis of the 2nd degree is characterized by the presence of constant pain, that is, the disease becomes chronic, and the pain intensifies with exercise. The intervertebral disc wears out, ceases to fully perform its functions and as a result; peripheral parts of the nervous system are affected.
3. Stage 3 is the most difficult, as a hernia may form. This occurs due to disruption and displacement of the collagenous capsule, the pulp penetrates through the gaps and very severe pain occurs. The disc may fall out, then the patient becomes practically inactive, unable to straighten up.

Radicular syndrome

This common disease is characterized by several symptoms that occur due to compression of roots or nerves, they are called spinal. It provokes this compression, and the reason may also be due to the presence of:

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• hernias;
• tumors;
• spinal injury, vertebral fracture;
• infectious disease of the spine;
• spondyloarthrosis;
• compression by lateral osteophytes.

It takes a long time before such a syndrome can develop and a hernia forms. It is this that, when growing, compresses, causes inflammation and the development of radiculopathy, which is what is called osteochondrosis with radicular syndrome. X-rays of the spine in two projections help identify the disease. The most complete picture appears after an MRI, but when diagnosing it is important to take into account the symptoms, as they play an important role.

The main complaint with which patients come to a medical institution, assuming that they have osteochondrosis with radicular syndrome, is pain and numbness, these are the signs of osteochondrosis. The concentration of pain occurs in places where the root is compressed and in the organs that are innervated by the affected spinal nerve. The following relationship is defined:

• the root in the fifth vertebra is damaged - pain in the lumbar region, called lumbodynia;
• root at the level of the fourth vertebra - pain is felt starting from the buttock and passes along the thigh, ending in the lower leg;
• the eighth cervical root affects the shoulder area;
• the sixth extends from the neck and shoulder blades to the hand.

With radicular syndrome, there may be the following signs of osteochondrosis:

• decreased sensitivity of the skin;
• sharp or aching pain in the lumbar region, it is important not to confuse it with kidney or other pain.

In the ICD, osteochondrosis corresponds to a specific code. M51.1, for example, degeneration of intervertebral discs of the lumbar and other parts with radiculopathy. Thus, each disease has its own code, which helps doctors navigate the terms, reduces time, and eliminates sometimes inappropriate explanations to a suspicious patient. ICD is a convenient system that has been tested and shows excellent results.

Here are some codes for spinal diseases that correspond to the ICD:

• M41.1 – adolescent idiopathic scoliosis;
• M41 – scoliosis;
• M42 - code for spinal osteochondrosis;

The code carries certain information that only a specialist can understand. ICD codes for the vertebral region, or for diseases associated with the spine, are located in the dorsopathy section in the range from M-40 to M-54. Not all diseases are associated with osteochondrosis; the signs of osteochondrosis must be correctly interpreted.

Osteochondrosis with radicular syndrome, treatment

First of all, bed rest is necessary, and strict. The bed must have a hard surface. Painkillers and anti-inflammatory drugs are prescribed. You can use local irritants, that is, ointments and pepper plaster.

Since osteochondrosis with radicular syndrome often becomes chronic, it is important to adhere to a certain regimen; the course should not be long-term. Side effects occur when taking such medications, so emphasis should be placed on gentler methods, such as:

• physiotherapy;
• massage;
• electrophoresis;
• physiotherapy;
• diet.

In more severe cases, a decision is made about surgical intervention. Prevention has proven itself well; the main element is therapeutic exercises aimed at strengthening the back muscles.

There is such a thing as the international classification of diseases, ICD. Each disease corresponds to a specific code, which is easy to navigate; the ICD code significantly simplifies the doctor’s work. In the international classification ICD-10, osteochondrosis has its own code. Next, each type of disease that is related to this disease is assigned a different code, following the ICD.

No need to treat joints with pills!

Have you ever experienced unpleasant discomfort in your joints or annoying back pain? Judging by the fact that you are reading this article, you or your loved ones have encountered this problem. And you know firsthand what it is.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Titles

Description

Symptoms

The standard instrumental method for diagnosing radicular syndrome includes radiography of the spine in anterior and lateral projections. Today, the most sensitive and informative method for diagnosing spinal pathology is magnetic resonance imaging. However, when making a diagnosis of radicular syndrome, clinical symptoms play an important role.

The first and most characteristic sign of radicular syndrome is pain along the affected nerve. Thus, the process in the cervical spine causes pain in the neck and arm, in the thoracic spine - in the back, sometimes there are sensations of characteristic pain in the heart or in the stomach (such pain disappears only after treatment of the radicular syndrome), in the lumbar spine - in the lower back, buttocks and lower extremities and so on. When moving or lifting something heavy, the pain intensifies. Sometimes the pain occurs in the form of lumbago, radiating to different parts of the body in accordance with the location of the corresponding nerve; in the lumbar region such a lumbago is called lumbago. The pain may be constant, but it still intensifies with any careless movement (for example, lumbodynia - pain in the lumbar region). Attacks of pain can be provoked by physical or emotional stress, hypothermia. Sometimes pain occurs at night or during sleep, accompanied by redness and swelling of the skin, and increased sweating.

Another sign of radicular syndrome is a violation of sensitivity in the zone of innervation of this nerve: with a slight tingling with a needle in this zone, a sharp decrease in sensitivity is observed in comparison with a similar area on the opposite side.

The third sign of radicular syndrome is a violation of movements that appear as a result of changes in the muscles that occur against the background of damage to the nerves that innervate them. The muscles dry out (atrophy), become weak, sometimes this can be seen even by eye, especially when comparing two limbs.

The pain is localized in the area of ​​compression of the root and in those organs that are innervated by the damaged spinal nerve. For example, when the root is affected at the level of the 5th lumbar vertebra (L5), pain is detected in the lumbar region (lumbodynia), when walking - in the upper outer quadrant of the buttock, radiating along the outer surface of the thigh and lower leg to the II-IV toes (lumboischalgia). When the L4 root is damaged, pain spreads from the buttock through the anterior surface of the thigh and the anterior-inner surface of the lower leg to the inside of the foot.

Since the spinal root includes motor processes of the neuron and sensory nerve fibers, with radicular syndrome there may be a disturbance (reduction) in the sensitivity of the tissue. For example, with L5 radicular syndrome, skin sensitivity (hypoesthesia) in the area of ​​the outer surface of the thigh and lower leg decreases.

Causes

Treatment

Since radicular syndrome is accompanied not only by acute, but also by chronic aching pain, the duration of the course of NSAIDs and analgesics should be taken into account when treating this disease. As a rule, drugs in this group have a number of side effects that increase with long-term use, therefore, when treating chronic pain, more gentle methods should be used - reflexology, manual manipulation, physiotherapy (electrophoresis, phonophoresis), massage, therapeutic exercises, diet (aimed at reducing weight and salt excretion).

Medication measures consist of prescribing B vitamins (B6, B12, B1, Neuromultivit complex, Magne-B6), chondroprotectors (Structum, Chondroxide (tab.), Chondrotek, Teraflex, Artra), NSAIDs for external use (Mataren plus cream, Ketonal cream, Fastum-gel).

Sometimes patients suffering from radicular syndrome take muscle relaxants in the hope that the drugs will relieve muscle spasms and accompanying pain. However, it should be remembered that muscle relaxants can only be used as prescribed by a doctor, otherwise the medicine may do more harm than good.

In some cases, surgical intervention is indicated to treat radicular syndrome.

Measures to prevent the development of radicular syndrome include primary prevention of degenerative processes in the spine, strengthening the muscular frame of the back with the help of exercise therapy and massage, as well as normalization of weight.

Lesions of nerve roots and plexuses

Brachial plexus lesions

Lesions of the lumbosacral plexus

Lesions of the cervical roots, not classified elsewhere

Lesions of the thoracic roots, not classified elsewhere

Lesions of the lumbosacral roots, not classified elsewhere

Neuralgic amyotrophy

Phantom limb syndrome with pain

Phantom limb syndrome without pain

Other lesions of nerve roots and plexuses

Damage to nerve roots and plexuses, unspecified

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International statistical classification of diseases and related health problems.

Radicular syndrome

Neuralgic syndrome that develops as a result of compression of the initial sections of the spinal nerves or nerve roots in the area of ​​their branch from the spinal cord is called radicular syndrome or radiculopathy in medicine. The pain that accompanies this pathology is localized in various parts of the human body, depending on the location of the lesion. Thus, pain can occur in the lower back, limbs, neck, and even radiate to the area of ​​internal organs, for example, to the stomach, heart, and intestines.

Causes of radicular syndrome

Radicular syndrome is a very common disease and has quite a few causes. The occurrence of the disease is primarily facilitated by various degenerative diseases of the spine. Most often this is osteochondrosis, spondylosis or intervertebral hernia. In addition, radicular syndrome can be a consequence of:

• All kinds of injuries and scar changes;
• Osteoporosis (as a result of vertebral fractures);
• Osteomyelitis or tuberculosis (as a result of infectious damage to the vertebrae);
• Changes in hormonal status;
• Spondyloarthrosis;
• Various congenital spinal defects;
• Oncological diseases of the spinal cord;
• Regular loads on the spinal column;
• Sedentary lifestyle;
• Hypothermia.

It should be noted that radicular syndrome does not occur immediately after exposure to one of the above causes. As a rule, disturbances initially occur in the area of ​​the intervertebral discs, which provokes the formation of hernias. After this, the hernia gradually shifts, beginning to put pressure on the nerve root, which prevents the outflow of venous blood from it. This leads to the development of this disease.

Lumbar radicular syndrome

Most often, radicular spine syndrome affects the lumbar region. This is due to the fact that this area, as a rule, experiences maximum loads compared to other parts of the spine. In addition, the muscles and ligaments of the lower back are relatively weak, and the openings for the exit of the nerve roots from the vessels are quite large.

With radicular syndrome of the lumbar region, severe unilateral pain of various types is usually observed (aching, sharp, dull, shooting, cutting, etc.). The nature of pain depends on the intensity of damage to the nerve root and related factors. Attacks in this case can be triggered by sudden movements or hypothermia. Localization of pain is caused by damage to specific lumbar roots:

• Lumbar radicular syndrome, affecting 1-3 roots, is characterized by pain in the lower back, lower abdomen, front and inner thighs, in the groin and pubic area. They are often accompanied by numbness of the skin and a sensation of pins and needles in these areas;
• When the 4th lumbar root is affected, pain is observed in the lower back and hips, radiating to the knee and lower leg. There is noticeable weakness in the knee when moving;
• Radicular spinal syndrome, affecting the 5th root of the lumbar spine, is manifested by pain in the area of ​​the inner thighs and lower legs, reaching the foot and big toe. The foot muscles become weak, often leading to difficulty standing on the affected foot.

It is worth noting that pain with radicular spinal syndrome in the lumbar region, as a rule, stops or decreases at rest or when lying on the healthy side.

Symptoms of radicular syndrome

The very first symptom of radicular syndrome is pain along the damaged nerve. So, if the disease affects the cervical region, then pain is observed in the neck and arms, the chest - in the back, sometimes the stomach or heart, the lower back - in the lower back, buttocks and lower extremities. Almost any sudden, careless movements or heavy lifting can contribute to pain.

At the same time, the painful symptoms of radicular syndrome can often make themselves felt at night during sleep, which is often accompanied by increased sweating, as well as swelling and redness of the skin. The cause of attacks of pain can be hypothermia or emotional stress.

Another common symptom of radicular syndrome is sensory disturbance in the area of ​​the affected nerve. For example, tingling with a needle in this area is accompanied by a significant decrease in sensitivity compared to a similar procedure performed on the opposite healthy side.

In addition, an additional sign of radicular syndrome may be impaired movement as a result of gradual weakness, shrinkage and atrophy of muscles, which occurs due to damage to the nerves that innervate them.

Treatment of radicular syndrome

Diagnosis of the disease is made using the person's medical history, physical examination, anterior and lateral x-rays of the spine, and magnetic resonance imaging. Treatment of radicular syndrome can be divided into the following methods:

• Bed rest;
• Drug therapy;
• Muscle relaxants;
• Chondroprotectors;
• Vitamins;
• Physiotherapy;
• Therapeutic exercise and massages.

Drug treatment of radicular syndrome involves the use of painkillers and non-steroidal anti-inflammatory drugs. The first ones are aimed at eliminating pain, the second ones are aimed at relieving inflammation in the area.

Muscle relaxants help relieve muscle spasms, and chondroprotectors slow down the destruction of cartilage in the intervertebral joints, activating the process of their restoration. Vitamins for the disease are aimed at improving metabolic processes in nerve tissues, as well as maintaining the general condition of the patient.

Treatment of radicular syndrome with physiotherapy may include radon baths, magnetic therapy, mud therapy, ultrasound, etc. However, physiotherapeutic procedures are usually used after the end of the acute period of the disease.

Physical therapy and massages for the syndrome strengthen the spinal muscles, improve blood circulation and restore the patient’s motor activity. In the most severe cases of the disease, surgery may be necessary.

In the treatment of radicular syndrome, medications are used:

©g. ICD 10 - International Classification of Diseases, 10th Revision

Radicular-vascular syndromes (ICD-10 code: G54)

The cause of the syndromes is often mechanical compression of the root and radicular artery, which may be located inside or near the root. Clinically, the syndrome is expressed by radiculoischemia or radiculomyeloischemia, ischemia of the lumbar enlargement of the spinal cord, ischemia of the conus and epiconus of the spinal cord.

The patient's complaints and neurological symptoms depend on the level of spinal cord damage and the rate of development of ischemia. Most often, such patients are sent to the neurosurgical department to remove the intervertebral hernia, after which the patients are treated by a neurologist or physiotherapist.

Treatment of such patients is labor-intensive; the effectiveness of the therapy depends on the duration of the process. The earlier treatment is started, the more extensive the recovery process. It was noted that the best dynamics were observed when the disease was less than 1 year old.

IR spectrum lasers are used on the segment and on the radiculomedullary arteries, at the level of the L5-S1 roots. The neurovascular bundle of the affected limb, the area of ​​the neck of the fibula, and the tibialis anterior muscle are also subject to laser treatment. Laser therapy should be combined with drug treatment.

It should be remembered that spinal osteochondrosis is a rare cause of back pain (10%). Most often, the cause of such pain is functional blockades, inflammatory-dystrophic changes in the musculoskeletal system: damage to the intervertebral joints - spondyloarthrosis, ligaments (anterior and posterior longitudinal, yellow, interspinous, intertransverse, sacrospinous, sacrotuberous and iliopsoas), fascia, back muscles and limbs (myofascial syndrome). Rare causes of back pain and therefore poorly diagnosed are fibromyalgia, spinal osteoporosis, instability of individual vertebrae, lateral recessive stenosis, and rigid filum terminale syndrome.

Myofascial syndrome manifests itself as non-generalized, non-specific muscle pain and is non-segmental in nature. This pain is caused by dysfunction of myofascial tissues and the appearance in the muscle of foci of increased irritability (trigger points, when pressed, pain occurs in a distant part of the body) or foci of myogenesis. It is believed that this pain occurs when the facet joints are damaged, as well as when the muscles are overstrained and overstretched due to an uncomfortable posture during work, when the leg is shortened, an oblique pelvis, flat feet, or stress.

Mythoascial pain syndromes should be treated comprehensively, first magnetic laser therapy with an infrared laser is carried out at the points of maximum pain for 1-3 minutes, then after 5-10 minutes.

For the treatment of myofascial lumboischialgic syndromes, it is recommended to use IR lasers. The exposure time to the pain trigger zone is minutes, the total exposure time is up to 15 minutes, it is practiced during the procedure to change the frequency values.

On the first day, a frequency of 80 Hz is selected,

on the second day 150 Hz,

on the third day - 300 Hz,

on the fourth day - 600 Hz,

on the fifth day –1500 Hz,

on the sixth day - 3000 Hz,

on the seventh day – 1500 Hz,

on the eighth day – 600 Hz,

on the ninth day – 300 Hz,

on the tenth day – 150 Hz,

on the eleventh day - 80 Hz.

The procedure covers no more than the impact area. The trigger zone and the area around the zone are irradiated with slow circular movements, pressing the emitter tightly against the surface of the body. The projection of the area of ​​the spinal motion segments at the L3-S1 level is necessarily irradiated, 2 minutes for each zone.

Preference is given to the BIM block emitter with maximum radiation power.

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ICD-10: G54 - Lesions of nerve roots and plexuses

Chain in classification:

4 G54 Lesions of nerve roots and plexuses

Diagnosis with code G54 includes 10 clarifying diagnoses (ICD-10 subheadings):

The diagnosis does not include:

– current traumatic lesions of the nerve roots and plexuses - see nerve trauma by area of ​​the body lesions of the intervertebral discs (M50-M51) neuralgia or neuritis NOS (M79.2) neuritis or radiculitis:

Thoracic NOS (M54.1) radiculitis NOS radiculopathy NOS spondylosis (M47.-)

Radicular syndrome: types of disease and their symptoms

In modern conditions, the intensification of industry, the complication of production and educational processes require more physical and psycho-emotional stress from a person than before.

Stress factors affecting the body cause its responses, manifested in rational and irrational forms of adaptation.

The consequence of this is the development of a number of pathological processes, including spinal ailments.

Radicular syndrome is a symptomatic manifestation of changes affecting the bone and cartilage tissue of the spine, and is one of the most famous chronic recurrent human diseases.

What it is?

Radicular syndrome is a fairly common phenomenon of neuralgic etiology in vertebrological practice. The nerves running in the canals, their anatomical containers, are protected from external influences.

Due to deterioration of blood supply and tissue nutrition, pathological changes and deformations of the tunnel walls occur, which leads to compression (compression) of the nerve roots.

Radicular syndrome occurs when the spinal nerves are compressed

Less commonly, the syndrome is the result of swelling of the nerve itself against the background of general intoxication of the body, for example, during long-term drug therapy for a disease. As a result, a symptomatic pain complex develops with localization in the part of the spine where the source of the pathology is located. There may also be irradiation of painful impulses into internal organs - the heart, gastrointestinal tract.

Clinical picture

The onset of the disease is characterized by a sudden sharp pain of a shooting nature. The symptomatic picture is complemented by changes in the sensitivity of the skin: numbness, a sensation of “goosebumps”. Depending on the location of the focus of degenerative or inflammatory changes, clinical signs manifest themselves differently.

With radicular syndrome of the cervical spine, the pain spreads to the anterior surface of the chest, radiates to the scapula and forearm, neck movements when tilting and turning the head are stiff and painful, raising the arm to the usual level is difficult.

When the source of inflammation is localized in the thoracic region, the clinical picture is similar to intercostal neuralgia: pain appears in the heart area, radiating to the scapula and intensifying with deep inspiration and movement.

With lumbosacral radicular syndrome, pain can be bilateral and spread along the nerves from the buttock to the leg, intensifying with coughing, sneezing, and walking.

All parts of the spine are susceptible to pinched nerves

When several roots with different localizations are involved in the pathological process, the symptoms are summed up. A complicated course of the disease is simultaneous damage to the roots in all parts of the spine (polyradiculopathy).

The clinical picture is characterized by:

• severe pain syndrome;
• mixed flaccid paresis (weakening of motor function), usually symmetrical;
• lack of manifestation of reflexes, in the later course of the disease - muscle atrophy;
• impaired or lack of skin sensitivity;
• changes in the cerebrospinal fluid as a result of protein-cell dissociation (usually 2-3 weeks after the onset of the disease).

The unfavorable course of the disease with frequent long-term exacerbations and the lack of effective therapy leads not only to a decrease in the patient’s quality of life, loss of ability to work, but also disability.

ICD-10 code

According to the international system of classification of diseases by letter codes, radicular syndromes are included in the class G00-G99 (“Diseases of the nervous system”), while the heading “damages of individual nerves, nerve roots and plexuses” (G50-G54) is highlighted.

For more detailed clarification, the diagnosis with code G54 “damage to the nerve roots and plexuses” includes 10 subheadings, including codes for radicular syndromes depending on their location:

Classification

There is no official classification of radicular syndrome. There is a conditional division in which clinicians proceed from the localization of the lesion in the anatomical areas of the spine and the presence of complications. Most often they talk about lumbar radicular syndrome, which can occur with or without complications.

Quite rarely, acquired and congenital forms of the syndrome are included in the classification, since in the vast majority of cases the pathology develops during life.

In some cases, to clarify and detail the clinical picture, the syndrome is classified according to the duration of pain, which is defined as:

• acute - lasting up to 6 weeks;
• subacute - lasting from 6 to 12 weeks;
• chronic - manifesting itself over 12 weeks;
• recurrent - occurring no earlier than six months after the previous exacerbation.

Prevalence and significance

According to research results, radicular syndrome occurs in 25–30% of patients seeking medical help for back pain.

The prevalence of the pathology among people of working age is about 30%, among older people - about 70%. The disease occurs with approximately equal frequency among men and women.

Some types of work also affect the risk of developing radicular syndrome: machine operators, drivers of heavy equipment, farmers, and office workers are more susceptible to the disease than representatives of other professions.

According to statistics, back pain of neuralgic etiology ranks 3rd in the number of cases of temporary disability. Taking into account the tendency towards “rejuvenation” of the disease, radicular syndrome represents a significant medical and social problem.

Video: “3 main manifestations of osteochondrosis”

Symptoms and diagnostic methods

The main symptom of cervical radicular syndrome is paroxysmal pain. It can be felt constantly or appear during active movements and due to hypothermia. Depending on which vertebra is involved in the pathological process, symptoms may manifest as pain, numbness in the parietal and occipital areas with irradiation to the scapula and collarbone, and fingers on the affected side. The muscle tone of the upper limb is reduced.

Thoracic radicular syndrome is diagnosed quite rarely due to the fact that this area of ​​the spine is almost not subject to degenerative changes due to its immobility.

Regardless of the location, radicular syndrome is manifested by sharp and sudden pain. Symptoms characteristic of this localization of the syndrome:

• paroxysmal pain spreading from the shoulder blades to the lower back, in the axillary region, intercostal spaces, on the inner surface of the arm;
• decreased sensitivity of tissues and a feeling of numbness in these areas;
• an increase in pain when coughing, sneezing, laughing, or when lying on your back;
• pain in the heart, abdominal organs;
• increased sweating.

• sudden pain when bending and turning the body;
• increased pain when moving and decreased when lying on the healthy side;
• unilateral pain spreading to the gluteal region, thigh, lower leg and foot;
• impaired sensitivity of the skin and paresthesia in the affected area;
• decreased muscle tone of the lower limb, disruption of its support and motor functions;
• dysfunctions of the pelvic organs (constipation, urinary and fecal incontinence, manifestations of impotence in men);
• increased sweating.

When examining a patient, a specialist identifies the localization of the syndrome based on the symptoms of root tension. Electroneuromyographic diagnostics confirms the doctor’s conclusions about the radicular nature of the lesion and its level. In order to determine the cause of the development of radicular syndrome, X-ray examination of the spine, CT and MRI are performed. If it is necessary to diagnose the condition of internal organs, ultrasound and angiography are performed.

Risk factors, causes

As a rule, radicular syndrome is preceded by changes in the intervertebral discs, which are prerequisites for the occurrence of a hernia. As the hernia moves, it compresses the spinal root, making it difficult for the outflow of venous blood from it. Congestion that occurs in the tissues surrounding the nerve leads to the formation of adhesions.

Thus, the most common cause of radicular syndrome is degenerative changes in the spine (for example, as a result of osteochondrosis or spondylosis).

The syndrome can also develop due to:

• constant loads on the spinal column;
• injuries;
• the presence of tumors of the spine and spinal cord;
• vertebral fractures caused by osteoporosis;
• infectious lesions of the spine (for example, with HIV, tuberculosis or osteomyelitis);
• endocrine disorders;
• sedentary lifestyle;
• some types of birth defects that affect the structure of the spine;
• changes in hormonal status.

Risk factors for humans in this case are:

• types of production activities associated with heavy lifting and vibration processes;
• working in conditions that do not meet the ergonomic requirements for the workplace;
• violation of the biomechanics of the spine due to anatomical defects (scoliosis, anisomelia, flat feet);
• overweight;
• monotonous, unbalanced, vitamin-poor diet;
• frequent hypothermia.

Consequences

A selection of interesting facts:

Long-term symptoms of the pathology lead to the formation of a chronic, difficult-to-control pain syndrome. If compression of the nerve is not eliminated in a timely manner, it causes further development of the degenerative process in the tissues of the root, leading to permanent impairment of its functions. The result of this is irreversible paresis, dysfunction of the pelvic organs, and disability of the patient.

Treatment

The treatment method for radicular syndrome is determined primarily by considering the possible causes of the pathology and establishing the main one.

Drugs

Medicines are prescribed for:

• Baralgin
• Ketorol

• Diclofenac
• Movalis
• Nurofen

External agents - irritating ointments, gels (Capsicam, Finalgon) have a distracting and anti-inflammatory effect.

If there is no therapeutic effect of these medications, blockades are prescribed.

Surgery

If conservative therapy does not produce results, surgical intervention is possible.

The main indications for this are:

• intense pain that is not relieved by taking NSAIDs and analgesics;
• impaired motor function of the limb with complete loss of active movements;
• complicated intervertebral hernia;
• irreversible osteo-ligamentous changes leading to compression of the nerve root;
• complete loss of sensation (anesthesia) of the limbs.

The operations are performed under anesthesia. Access to the source of pathology is created and those fragments of the vertebra that cause compression of the nerve root are removed. Currently, in case of radicular syndrome due to a vertebral hernia, nucleoplasty is increasingly used as a minimally invasive intervention to reduce or excise a prolapsed disc.

This is what spinal nucleoplasty looks like

Exercises, exercise therapy, massage, physiotherapy

Effective therapeutic measures to slow down the development of the inflammatory process and neutralize its consequences, restore motor function of the limbs, and strengthen the muscle corset are:

They are prescribed after relief of acute pain. An important aspect of the effectiveness of therapy is the consistency and regularity of such sessions.

Treatment at home

Folk remedies that are used for radicular syndrome mainly exhibit a local effect and are aimed at maintaining the general tone of the body. Rubbing, compresses, applications with decoctions, tinctures of medicinal plants and fruits (chamomile, calendula, sea buckthorn, chestnuts) help reduce the manifestations of pain and inflammation, have a muscle relaxant effect, but do not eliminate the main cause of the disease - compression of nerve endings due to deformation of the vertebrae.

Video: “How to deal with radicular syndrome?”

Prevention

Pay attention to the principles of preventing radicular syndrome. The best measures to prevent radicular syndrome are:

• constant physical activity with proper distribution of the load on the spine;
• regular sports exercises that contribute to the formation of a muscle corset;
• rational nutrition and weight control;
• optimization of work and rest schedules;
• timely treatment of infectious diseases;
• sleeping on a hard surface using special orthopedic bedding.

Recovery prognosis

The prospect of recovery depends on the degree of compression of the root, as well as on the timeliness of therapeutic measures. In general, with proper diagnosis and adequate treatment, the prognosis is favorable. The patient should understand that incompletely cured radicular syndrome may take a chronic form, and with periodic exacerbations, resumption of the course of treatment may be required at any time. This cyclical process can continue for many years.

Conclusion

Radicular syndrome is one of the diseases that, due to the peculiarities of the clinical picture, are sometimes disguised as other ailments. In order for the course and outcome of the disease to be favorable, some recommendations should be followed.

• Symptoms characteristic of radicular syndrome can also appear in other pathological processes, including tumors. Therefore, the very first step in case of pain in the spine should be a medical examination for the purpose of diagnosis and treatment.
• Ignoring the manifestations of the disease, as well as self-medicating, is dangerous. The consequences of this can be severe irreversible complications, including disability.
• The recovery process will be accelerated by strict compliance with medical instructions: adherence to strict bed rest, if prescribed, lifestyle correction.
• You should take medications only as prescribed.
• The intended use of medicinal plants to alleviate the course of the disease should be discussed with a doctor: depending on the individual characteristics of the patient, side effects of such procedures are possible.
• After completing the course of treatment, in order to reduce the risk of relapse, you need to rationally distribute work and rest, adhere to physical activity and healthy eating habits.

Spinal diseases

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