Edema of the nerve root
The main sign of osteochondrosisare symptoms of lesion of roots. Osteochondrosis with radicular syndrome determines the features of discogenic radiculitis, which are not peculiar to the defeat of the nerve roots of another etiology:
- The severity, rate and structure of development of each discogenic syndrome are associated with primary or secondary lesion of the root (compression, dislocation, reactive changes).
- Development of radicular syndrome occurs in certain phases, which do not depend on whether it is gradual or acute.
- Radicular syndromes are characterized by irritation in the sensitive area, as well as loss of functions that are individual for each separate rootlet.
Pathogenesis of lesions of nerve roots
The task that is put before the doctor is reduced toprecise determination of which nerve roots are involved in the pathological process. The most frequently affected area is the root, which extends from the dura to the radicular nerve.
He undergoes compression in the epidural zonea bulging intervertebral disc, bony growths, hypertrophied ligaments, deformed processes of the vertebrae, etc. This pathology occurs in the most mobile parts of the spine - at the level of the 5th-6th cervical vertebrae.
The role of all factors of radicular syndromeis strengthened with a narrow vertebral canal, as well as narrowed intervertebral foramen. With rapidly developing root syndrome, ischemia often grows. Sometimes there may be a hemorrhage followed by swelling of the nerve root.
Nerve roots in osteochondrosis of the spinecan be subjected to compression by pathological altered structures both separately and together. In the cervical and thoracic parts, deformation of the root is accompanied by tension of the membranes of neighboring nerve roots. This tension is worse when coughing, tilting the head.
Radicular irritations decrease withdecompression in conditions of spinal column stretching to the sore side. Irritation of the nerve root is accompanied by shooting pain and disorders in the innervated zone: hypotension, hyporeflexia, hypotrophy. When the patient is examined, all the muscles in which pathological changes are detected are taken into account. So the nerve root supplies more than one muscle, there may be several.
Clinical picture of lesion of nerve roots
When the nerve roots are damaged in the cervicalosteochondrosis pain localized in the nape, the base of the neck, anterior thoracic wall, shoulder, interscapular area. The pains are burning, tearing, squeezing, which intensify by morning. In patients, sensitivity disorders can be identified as a "short-sleeved half-jacket".
With the defeat of the third spinal root,which lies between the 3rd and 4th cervical vertebrae, the patient complains of pain in the area of the shoulder and collarbone. In acute syndrome, the posterior muscles of the neck are atrophied. The patient has increased diaphragm tone, which leads to a shift of the liver down. Very often there may be pain, which will simulate an attack of angina pectoris. The difference between this pain and heart attacks is that the pain persists for several hours or days.
With the defeat of the 5th cervical root, whichlies between the 4th and 5th cervical vertebrae, the pain extends from the neck over the outer surface of the shoulder. The lesions of the 6th and 7th nerve root degenerative-dystrophic changes sometimes cause difficulty in swallowing. With the defeat of the 8th cervical spine, the pain spreads from the neck to the little finger.
Pain in the lesion of the 6th root is distributedfrom the neck and shoulder blade along the outer surface of the shoulder to the thumb. With arbitrary movements of the head, the symptoms intensify. There is no reflex of the biceps muscle. With the defeat of the 7th cervical spine, pain extends from the neck and shoulder blades to the index and middle finger. There is hypotrophy and absence of reflex of the triceps muscle.
Radicular syndrome in chest osteochondrosisis manifested by shingling acute or dull pain in the area of the affected nerve root. Since the rootlets are connected to capsules of the joints of the ribs, the pain can be worse by breathing, coughing, or sneezing. Some patients report numbness and pain in the leg. Objectively, there is a restriction of mobility in the thoracic region and local soreness in the region of the ribs and pectoral muscles. Such a syndrome is very often confused with intercostal neuralgia.
Diagnosis and treatment of radicular syndromes
Radicular syndrome requirescomputed tomography or MRI in the affected area. Assign also electromyography. The level of research depends on the symptoms of the lesion of individual peripheral nerves. To exclude infectious and inflammatory causes, you can prescribe an analysis of cerebrospinal fluid.
Treatment in an acute period is based on rest, avoiding sudden movements and painful postures. Bed rest and a hard bed are recommended until the pain subsides.
When treating radicular syndrome is effectivemultilevel approach. The patients are prescribed non-steroidal anti-inflammatory drugs (Indomethacin, Diclfenac, Naklofen, Movalis, etc.) in combination with muscle relaxants (Sirdalud, Midokalm). According to the indications, blockades may be used by local anesthetics and steroid hormones.
After stifling acute pain recommenda gradual increase in the motor load and exercises to strengthen the muscles of the back. Physiotherapy is prescribed, which includes thermal procedures and a deep relaxing massage, acupuncture.
Effective: diadynamic current, ultrasound, UV, electrophoresis and laser therapy on the affected area of the spine, radon and hydrogen sulphide baths. Locally used painkillers and anti-inflammatory ointments, compresses with a solution of dimexide and novocaine.
In sleep disorders, antidepressants are prescribed. Patients with severe radicular syndrome are treated with analgesics and large doses of B vitamins. They use agents to improve blood circulation in the vessels of the spinal root (Trental, Pentoxifylline, Vasonitis).
It is expedient to prescribe dehydrating(Furosemide, Lasix, Triampur), which reduce the swelling of the surrounding tissues of the affected root. Treatment with desensitizing drugs (Tavegil, Suprastin, Dimedrol) is shown.