Sciatica
Sciatica is an inflammatory disease of the spinal roots, which is accompanied by their dysfunction and severe pain syndrome. In some cases, sensitivity disorder is combined with peripheral paresis. The lesion of the spinal nerves together with their roots is represented by radiculoneuritis. When the spinal membranes are involved in the inflammatory process, meningoradiculitis occurs. Pathologies of the spinal roots are also referred to as spondylogenic radiculopathy (radiculoishemia) or spondylogenic damage. In case of damage to the spinal node, radiculoganglionitis develops.
The content of the article:
Classification of radiculitis
Symptoms of sciatica
Diagnosis of radiculitis
Complications of sciatica
Treatment of radiculitis
Prognosis for sciatica
Prevention of sciatica
Sciatica
Pathological changes can occur not only in one spinal root, but also in several at the same time. Based on the level of spinal lesion, cervical, thoracic and lumbosacral radiculitis in the form of lumbalgia and ischealgia or lumbago are distinguished. In addition, it is possible to defeat all parts of the spine at the same time. Often, the cause of radiculitis is compression processes in the area of spinal roots, which provoke intervertebral hernias.
Classification of radiculitis
Lumbosacral sciatica
The main reflex syndromes of lumbosacral inflammation of the spinal roots are lumbago, lumboishialgia, piriformis syndrome, as well as periarthrosis of the ankle, hip, knee joints.
The development of lumbago is often caused by a rise in severity, a sharp or awkward movement, its first sign is a sudden shooting pain that patients feel for a short moment or several minutes, the pain can also have a “tearing” or pulsating character and increase during sneezing and coughing. Lumbago provokes impaired mobility in the lumbar region. At the same time, the sensitivity and reflexes of the tendons remain normal. The patient is concerned about discomfort, pain, sometimes this phenomenon lasts for several days.
Lumbalgia occurs against the background of hypothermia, jolting driving, prolonged uncomfortable posture, significant physical exertion. A symptom of lumbalgia will be a dull aching pain that gradates when changing the position of the body (walking, sitting, bending). The pain may radiate to the leg or buttock. There is pain during palpation of the interosseous ligaments and spinous processes in the affected area. When leaning forward, the muscles of the patient’s back tighten sharply, and when leaning back, the pain is eliminated. Reflexes from the heel tendons and knee reflexes are preserved. Often the process has a subacute or chronic nature of the course.
With lumboishialgia, deep compression pain develops in the joint and buttock, radiating into the leg. The pain may increase with sneezing, coughing, changing the position of the body. In addition, patients feel fever or chilliness in the leg. When palpating these areas, painful neuroosteofibrosis is noted, in the process of probing muscle tissue, formations of dense consistency that do not have clear boundaries are diagnosed.
The clinical sign of sciatica in this form of sciatica is pain localized in the sciatic nerve, as well as muscle hypotrophy with a decrease in the Achilles reflex. Similar symptoms may indicate another disease — sciatic nerve neuritis, a distinctive feature of this disease is the nature of pain, since with sciatica they are sharp, paroxysmal, burning, accompanied by a forced position (usually on the side with a bent leg).
Thoracic sciatica
In the clinical practice of neurology, the thoracic form of radiculitis is much less common compared to cervical and lumbosacral radiculitis. The thoracic form of sciatica can occur due to damage to the pleura, ribs and vertebrae, infectious diseases, diseases of the mediastinal organs, and also have an isolated character. Paroxysmal or aching pains in the intercostal nerves are often symptoms of this form of sciatica. Palpation diagnoses soreness in the intercostal and paravertebral points, anesthesia or hyperesthesia of the radicular innervation, in some cases bullous rashes in these areas are noted.
Cervical sciatica
In the case of cervical sciatica, patients feel sharp pains in the cervical and occipital region, which can move to the shoulder blade, arm, sometimes to the third or fifth fingers. Pain often radiates to the back of the head and chest, and is also prone to increase when moving the neck and head. The most limited movements are noted in the neck area, in particular in the direction of inflammatory changes. As a result of the tension of the neck muscles, a forced position of the head develops. There are characteristic pain points — paravertebral and vertebral, the pain in which increases when the head is tilted. If both sides of the neck are involved in the pathological process, the patient’s head assumes a characteristic “hanging” position. A sensitivity disorder develops (at first it increases and then decreases), which manifests itself along the radial nerve and brachial plexus, while there is pain in these areas. Sensitivity dysfunction leads to numbness of the upper extremities.
The disorder of motor function usually does not manifest itself. The level of inflammation in the roots depends on the violation of certain muscle structures. In this case, the lesion of the anterior cervical roots is accompanied by violations of the functionality of the diaphragm, and in some cases causes dysfunction of the shoulder girdle, muscle structures of the shoulder and hand muscles.
In some cases, vegetative disorders, reflex pain syndromes, Brown-Secard and Bernard-Horner syndromes develop.
Symptoms of sciatica
Sciatica has a primary and secondary form. The etiology of primary sciatica is represented by infectious and viral diseases. The mechanism of development of secondary radiculitis is triggered by the processes of dystrophic changes in the spine (spondylolisthesis, deforming spondyloarthrosis, deforming spondylosis), pathological neoplasms in the spinal column, spinal injuries, spinal hemodynamic disorders, intoxication, hypothermia, etc.
The symptoms of radiculitis of various localization are represented by common features:
spontaneous pain in the area of the location of the affected nerve roots, which increases with coughing, sneezing, straining and movement;
forced (analgesic) pose of the patient;
limited mobility of the spine;
pain during palpatory examination of spinous processes and paravertebral points;
decrease or increase in sensitivity;
motor dysfunction — hypotrophy and weakness of muscle structures in the area of radicular innervation.
The radicular syndrome develops in stages. At the first stage (neurological, dyscalgic), symptoms of irritation develop, which are expressed in hypersensitivity, sharp pain, protective muscle tension, revival of tendon reflexes and soreness in paravertebral points.
The second stage (neurotic) is accompanied by less severe pain, extinction of the periosteal reflex, lack of sensitivity in the area of the affected root, local hypotrophy (atrophy), while pain persists in the paravertebral points and local muscle tension.
Symptoms of lumbar sciatica, as a rule, will be pain of an acute or burning nature in the lumbar region, as well as its spread to the buttock and back of the leg. When rising from a sitting or lying position, sneezing, coughing, pain increases. There is also scoliosis in the lumbar region and limited mobility of the spine, hypotension of the muscles of the lower leg and foot. Sometimes the disease is accompanied by paresis of the foot.
As a result of the gradation of the disease, vegetative and trophic dysfunctions are noted, which include: hypotrophy of the gluteal muscles; protective muscle tension on one side of the lower back; trophic ulcers on the heel. At the same time, the work of the pelvic organs remains normal.
In the area of the affected intervertebral discs, there is a sensitivity disorder.
The general term “sciatica” consists of reflex syndromes that develop against the background of irritation of the fibrous ring receptors in the intervertebral disc, ligaments that are located next to the affected disc, as well as involvement of joint capsules in the pathological process.
Diagnosis of radiculitis
Diagnostic measures aimed at identifying root syndromes are based on the analysis of anamnestic and clinical data. In addition, the results of additional studies are important — radiography or CT of the spine, myography. Through myography, the nature and level of the lesion is determined.
With cervical and thoracic radiculitis, it is advisable to perform additional Dopplerography of the brachiocephalic arteries, ultrasound examination, as well as rheopletismography of the brain.
In order to determine the functional state of the spine, X-ray imaging is shown. For difdiagnostics, other specialists are involved — a urologist, gynecologist, oncologist.
Complications of sciatica
The development of complications of sciatica depends on the severity of the pathological process. In most cases, inflammation of the spinal roots is not aggravated by severe complications, but in the absence of a competent approach to therapy, severe complications may develop. Violation of spinal hemodynamics on the background of herniated intervertebral discs can provoke a spinal cord infarction, after which there is a violation of motor and sensory functions of the body, which leads to its disability.
Treatment of radiculitis
The basic principle of first aid for radicular inflammation of the spinal nerves is the implementation of such measures: immobilization of the spine, anesthesia and application of dry heat to the area of the affected part of the spine. If sciatica is combined with hyperalgic phenomena, intramuscular injections of analgesics are indicated. In order to relieve the pain syndrome, distracting therapy (rubbing, pepper patches) sometimes helps. Treatment of all forms of sciatica (lumbar, cervical and thoracic) should be comprehensive, therefore, in addition to drug therapy, patients are often prescribed physiotherapy, in particular spinal traction (dry or water). In the case of prolonged lumboishialgic syndrome, vitamin therapy with group B vitamins is advisable .
The presence of severe radicular syndromes on the background of an intervertebral hernia is often an indication for surgical intervention, which consists in removing the pathological protrusion.
To prevent relapses of sciatica, rehabilitation in sanatoriums is recommended.
Prognosis for sciatica
The prognosis for inflammation of the spinal roots depends on the early diagnosis and therapy of the disease. Ischemia on the background of sciatica can provoke a spinal cord infarction, which triggers the mechanism of disorders of motor activity and sensitivity.
Prevention of sciatica
Prevention of sciatica implies the elimination of the causes that can provoke it, the number of preventive measures includes:
development of normal posture;
fighting physical inactivity;
prevention of hypothermia, elimination of prolonged static load;
development of normal posture;
organization of a normal schedule, which implies a competent alternation of work and rest;
treatment and prevention of diseases of infectious genesis that can provoke radicular syndrome.
