Radiculitis is a disease of the roots of the spinal cord. Distinguish radiculitis primary (infectious, toxic) and secondary, most often associated with the pathology of the spine and spinal cord. There are also meningoradiculitis - an infectious disease of the roots with the spread of the pathological process to the spinal cord; occurs with rheumatism , brucellosis , syphilis and is manifested by multiple lesions of roots and meningeal symptoms.
Secondary radiculitis can be caused by neurinomas of roots, spine tumors , tuberculosis spondylitis , osteomyelitis, osteochondrosis, traumatic spine injury . Radicular pain in neurinomas is permanent, does not respond to drug therapy and is combined with signs of compression of the spinal cord and an increase in protein content in the cerebrospinal fluid (see Spinal cord, tumors ). In women, lumbosacral radiculitis is often due to inflammation or tumors of the ovaries and uterus.
The most common cause of secondary radiculitis is osteochondrosis of the spine ( spondylosis , spondylarthrosis), ie age-related degenerative changes in the intervertebral discs, joints and ligaments of the spinal column. The process begins with dehydration of discs, the pulpous nucleus of which loses its elasticity and through cracks in the fibrous ring can bulge outward, which is accompanied by the formation of a herniated intervertebral disc (see Lumbago). As the discs degenerate, bone spines develop at the edges of the vertebral bodies - osteophytes. Herniated discs and osteophytes most often occur in the lumbar and cervical spine, mainly between the IV and V lumbar, the V lumbar and I sacral and between the V-VI and VII cervical vertebrae. Discogenic radiculitis develops in persons engaged in heavy physical labor, or in untrained people with congenital weakness of the ligamentous-articular apparatus of the spine.The
The clinical picture of primary and secondary radiculitis has a number of similar features, but secondary radiculitis is more common.
With the flow, acute and chronic radiculitis are distinguished, the latter often being recurrent. Radiculitis is manifested by local pain along the course of one or more closely located posterior nerve roots. Along with pain, there are disorders of sensitivity, less often - motor disorders. In the course of lumbosacral radiculitis , two stages are distinguished: lumbar and radicular.
Lumbalia is a dull aching or sharp pain in the lumbar region that occurs after prolonged physical work, especially in an uncomfortable position of the body and in the cold, or with awkward movement. The lumbar stage is associated with reflex or mechanical stimulation of nerve endings in the ligamentous apparatus of the spine. To reduce pain, the patient takes a forced fixed position with the torso tilted forward or sideways, avoiding even the slightest movements of the spine, especially in the lumbar region. When examining a patient in the lower thoracic and lumbar region, a sharp strain of the long back muscles is determined, which are painful, especially on the affected side. The duration of this stage ranges from several days to several weeks, after which the pain subsides.
If the disease progresses and passes into the radicular stage, the pain spreads from the lumbar region to the buttock, the posterior-external surface of the thigh and lower leg and can "give" in the heel or thumb. The pain is both unilateral and bilateral. Discogenic radicular pains often occur after cooling, colds that cause edema of the root and its infringement in the narrowed disc herniation or osteophyte intervertebral foramen. Radicular pains are blunt and sharp, accompanied by a burning sensation, "creeping craw", "passing an electric current" in the area innervated by the affected rootlet. Pain increases with walking, sitting, in an upright position, decreasing when lying down. In bed, the patient usually takes a forced position on his side or on his back with a leg bent and brought to the stomach or a knee-elbow position on the abdomen, as in these poses the intervertebral foramen widens, the tension of the roots decreases and the pain subsides. Sitting on a chair, the patient rests solely on the healthy side, and when walking, pulls his aching leg, avoiding sudden movements.The
When examining the lumbar spine during the radicular stage of radiculitis, the lateral curvature of the spine is determined. The calf muscles of the diseased leg lose their tone and become soft, later the slimming of the leg and thigh muscles develops, the paralysis of the extensor muscles of the foot and fingers may appear, the Achilles reflex decreases or is absent. In the course of the affected roots, a decrease in sensitivity is determined. Stretching of the nerve trunks causes painful tonic reflexes. These include: Lasega's symptom, that is, the appearance of pain when lifting a straightened leg in the position of the patient on the back, while flexing the leg in the knee joint leads to a reduction in pain; a symptom of Bonnet-a pain when the leg is bent at the knee and hip joint ; Bechterew's symptom is the pain on the side of the lesion when lifting a healthy leg in the position on the back (cross-symptom Lasega); Neri symptom - pain along the course of the affected root when the head is bent in the position of the patient on the back. The spinous processes of the IV and V lumbar vertebrae (posterior points of the Gar) are painful when pressed, and pain occurs along the midline of the abdomen below the navel (the front points of the Gar).
The thoracic radiculitis is shown by pains on a course of intercostal roots. When viral lesions of the intervertebral nodes develop " shingles " - sharp intercostal pains that increase with inspiration, and bubble rashes on the skin in the projection of the affected node.
Cervico-lateral sciatica is accompanied by pain along the posterolateral surface of the neck with spreading to the spine , shoulder blade, arm, axillary region. Pain increases with tilting and turning the head, raising the hand above the horizontal level and the lead behind the back. When you feel painful, the paravertebral points in the cervical spine, the region of the supra- and subclavian cavities, the inner surface of the shoulder and forearm along the course of the neurovascular bundle. There is a feeling of numbness, burning or tingling in the arm and shoulder girdle along the course of the affected roots, sensitivity decreases, and the reflexes from the biceps and triceps muscles decrease and atrophy in the muscles of the hand develops. The brush becomes swollen, cyanotic, cold, pulsation on the radial artery may decrease. Often develops a neurogenic lesion of the shoulder tissue, which is manifested by puffiness, pain and restriction of movements in the shoulder with the development of contracture in the adductor muscles of the shoulder.
Treatment of radiculitis : inside amidopirin (pyramidone) , analgin to 0.25 g 4 times a day, butadione 0.15 g 3 times a day, with infectious radiculitis penicillin intramuscularly 200 000 units 4 times a day; local application of dry heat in the form of heaters, bags with heated sand, ironing through a warm iron through the flannel; rubbing with alcohol, burning ointments (snake venom, bee venom , alcohol with chloroform ). When discogenic radiculitis recommended bed rest on a flat and hard mattress with a padded round bead under the waist; treatment by stretching, in which the patient is fixed with straps to the raised head end of the bed by the shoulders and chest. Extraction by own weight is carried out for 30-40 minutes. 3-4 times a day. In acute pain, subcutaneous and intramuscular injection of 0.25-2% novocaine solution at 2-3 ml places of greatest soreness, intramuscular administration of vitamins: thiamine chloride (B1) - 5% solution of 1 ml and cyanocobalamin (B12) 200 μg daily . Showing massage and therapeutic exercises (flexion, extension, lateral torso of the trunk - with lumbosacral radiculitis, shoulder removal, head turns - with cervico-thoracic radiculitis). Movements should be smooth, gradually increase in volume, do not leave after themselves painful sensations. Recommended treatment with quartz, ion-galvanization. With chronic recurrent radiculitis, spa treatment in mud and balneological resorts is necessary. Persistent and often recurrent radiculitis are treated promptly.
Radiculitis (from the Latin radicula - spine) - inflammation of the roots of the spinal cord.
The defeat of the roots can occur at different lengths on their way from the spinal cord to the exit from the spinal canal. The anterior and posterior roots on leaving the spinal cord pass through the subarachnoid space and converge on its lateral surface, where through special holes in the hard and arachnoid shells go farther, surrounded by vaginas, which are some kind of diverticula of the subarachnoid space; Both spines in this place are separated from each other. This part of the roots of Najott (J. Nageotte) called the radicular nerve. Subarachnoid vagina, deeper around the posterior root than around the anterior, reaches the sensory ganglion in the lumbar segments. In the further course of the course, the roots are separated from the subarachnoid space and radicular vaginas by the fibrous tissue of the dura mater. This part of the roots Najott calls a mixed radicular nerve. Sicard called this part of the nerve and its extension to the weave by a funiculus. The mixed radicular nerve is placed in the epidural space and the intervertebral foramen (Figure 1).
Fig. 1. Scheme of the cross section of the spinal cord with roots:
1 - the front spine;
2 - posterior spine;
3 - arachnoid membrane;
4 - the dura mater;
5 - subarachnoid space;
6 - epidural space;
7 - the spinal node.
The defeat of rootlets, surrounded by soft membranes and washed by cerebrospinal fluid, begins with a primary lesion of the membranes. Therefore, the defeat of this part of the roots is called meningoradiculitis . The defeat of the non-envelope part of the roots is called radiculitis. Sikar proposed an identical term for " funicular ". In Soviet medical literature both terms are used.
These localizations of the pathological process differ mainly in the etiology and frequency of damage to both segments of the roots, to a lesser extent in their symptomatology.