Why does it occur
Nerve roots emerge from the spinal cord through openings between the vertebrae. If the lumen of the hole narrows or the root is compressed, inflammation and pain occur along the nerve.
- Intervertebral disc herniation is the most common cause in young and middle age
- Degenerative changes and proliferation of bone tissue, narrowing holes - more often in the elderly
- Spondylolisthesis - displacement of a vertebra
- Spinal stenosis
- Less common: infections, tumors, consequences of fractures
How it manifests itself
The picture depends on the level of damage, but the general principle is the same: pain and sensory disturbances spread throughout the area for which a specific root is responsible.
- Lumbar radiculopathy: pain from the lower back to the buttock, along the back or outer surface of the thigh and lower leg, sometimes to the foot; worsens with coughing, sneezing, bending over
- Cervical radiculopathy: pain from the neck into the shoulder girdle and arm to the fingers, often with numbness of specific fingers
- Numbness and tingling in the spine area
- Weakness of certain muscles: difficulty standing on your toes or heels, weakened grip of the hand
- Decreased or lost reflexes
- Forced position in which there is less pain
Difference from muscle pain: with musculoskeletal pain it is local, dull, intensifies with palpation of the muscle and does not follow a clear line to the limb. Radicular pain is acute, “shooting”, spreads along a certain line and is accompanied by numbness.
Diagnostics
- Осмотр невролога: проверка рефлексов, силы, чувствительности, симптомов натяжения.
- МРТ или КТ соответствующего отдела позвоночника — при сохраняющейся боли, неврологическом дефиците и всегда при «красных флагах».
- Электронейромиография — при неясной картине и для оценки степени поражения.
- Анализы (общий и биохимический, СОЭ) — при подозрении на воспалительную или онкологическую причину.
With a typical picture without “red flags”, imaging in the first weeks is not necessary: in most patients the condition improves with conservative treatment, and the result of the image does not change the tactics.
Treatment
The goal is to relieve pain, restore mobility and prevent chronicity. Bed rest for more than 1–2 days is not recommended: prolonged lying down slows down recovery.
- Short course non-steroidal anti-inflammatory drugs
- Muscle relaxants for severe muscle spasms
- Drugs for neuropathic pain with a burning, “electric” nature of pain
- Therapeutic blockades for intense pain that cannot be relieved by medications
- Physical therapy is the main method after acute pain subsides and the main way to prevent relapses
- Physiotherapy: magnetic therapy, electrophoresis, ultrasound therapy as prescribed by a doctor
- Maintaining all possible activity instead of prolonged rest
Relapse Prevention
- Regular exercises to strengthen the back and abdominal muscles
- Correct weight lifting: with a straight back, using your legs, without twisting
- Weight control - every extra kilogram increases the load on the discs
- Breaks and changes in posture during sedentary work, lumbar support
- Quitting smoking: it impairs the nutrition of the intervertebral discs
- Swimming and walking as optimal types of exercise