Lumbosacral radiculitis is a clinical symptom complex caused by degenerative-dystrophic changes and secondary inflammation of the spinal roots in the lumbar and sacral spine. It is manifested by variable pain syndromes: lumbalgia, lumbago and lumbago with sciatica. Diagnosis is based on complaints, the results of examination and palpation of the lumbar region, the presence of positive symptoms of Lasega, Neri, Bekhterev and typical trigger points, radiography data of the spine. Therapy is carried out with anti-inflammatory, analgesic, vitamin, vasoactive pharmaceuticals and physiotherapy.
General information
Lumbosacral radiculitis is the most common form of sciatica. The second place after it belongs to cervical sciatica. People get sick mainly after the age of 35, the peak incidence falls on the age period of 40-50 years. Lumbosacral radiculitis is associated with inadequate static-dynamic loads on the spine and ranks first among the causes of temporary disability due to damage to the peripheral nervous system.
The most susceptible to the disease are persons who, due to their professional activities, are forced to lift weights, be in a tilt position or sit for a long time, i.e. agricultural workers, movers, welders, builders, drivers, etc. Lumbosacral radiculitis is characterized, as a rule, by a prolonged remitting course with relapses from 1 time in 2-3 years to several times a year. Due to the widespread occurrence of sciatica of lumbosacral localization, the issues of its effective treatment are an urgent problem of modern neurology, vertebrology and manual therapy.
Causes
According to generally accepted ideas, the pathogenetic basis of radiculitis is degenerative-dystrophic processes (osteochondrosis, spondyloarthrosis, lumbar spondylosis) occurring in the spinal column. The main factors contributing to the development of these processes are:
- physical inactivity;
- metabolic disorders (obesity, diabetes mellitus);
- spinal injuries (lumbar spine fracture, spinal contusion);
- excessive static or dynamic load on the spinal column;
- spinal abnormalities or posture disorders that lead to curvature of the spine with the formation of scoliosis or lumbar hyperlordosis.
Triggers that provoke an exacerbation of sciatica of lumbosacral localization include: lifting of gravity, a sharp turn or tilt in the lower back, hypothermia, general infectious diseases (ARI, flu, bronchitis), prolonged static load on the lower back (for example, in truckers), intoxication. The combined effect of these factors is possible.
Pathogenesis
As a result of degenerative processes in the intervertebral discs, the height of the latter decreases, the ligamentous apparatus weakens, additional load falls on the muscles holding the spine. Muscle overstrain leads to pain syndrome. In addition, the growing osteophytes can irritatingly affect the nerve roots coming out of the spine, also provoking pain syndrome. Pain irrigation, in turn, causes spasm of the vertebral vessels of the lumbar region.
In conditions of impaired blood supply and venous stagnation, secondary inflammation occurs. An intervertebral hernia of the lumbar region can provoke lumbosacral radiculitis. At first, the symptoms of sciatica are caused by the irritating effect of an intervertebral hernia on the spinal root. As the hernia increases, it squeezes the root, causing a violation of its functions.
Symptoms
There are 3 main clinical syndromes: lumbalgia, lumbago and lumbago with sciatica. Lumbalgia is a subacute pain in the lower back, having a dull and prolonged character. Lumbalgia is enhanced by bending in the lower back and turning the trunk, prolonged walking, standing, sitting. The pain in the horizontal position decreases when the load is removed from the spine. Lumbago is an acute sharp pain in the lower back, described by patients as a “lumbago”. Occurs suddenly, usually when lifting heavy, turning or tilting the trunk. It often forces the patient to “freeze” in a certain position, since any movements cause sharp pain. Lumbago with sciatica is spoken of when lower back pain radiates into one or both legs and is accompanied by paresthesia, numbness and vegetative-trophic changes in the affected limb.
Each of the clinical syndromes is characterized by more or less pronounced objective changes recorded by a neurologist or a vertebrologist during the initial examination. First of all, attention is drawn to the arbitrary restriction of mobility in the lumbar spine and the antalgic posture of the patient. When examining the lower back, there may be a misalignment of the trunk to the healthy side, a tonic contraction of the long muscles of the back. Palpationally, the muscles are tense and painful.
There are a number of trigger points, pressure on which causes pain. The main clinical use was obtained by Gar points and Balle points. The first include a point in the area of the sacroiliac joint, points above the spinous and transverse processes of the IV-V lumbar vertebrae, a point above the posterior-upper spine of the ilium. The latter are represented by paravertebral points of the lumbar, sacro-gluteal, femoral, popliteal, as well as points on the lower leg and foot. The occurrence of pain when pressing on the points of the gluteal region and legs is characteristic of lumbago with sciatica and is not observed in lumbago and lumbalgia. It is also typical for lumbago with sciatica to spread pain along the nerves distally from the place of pressure.
In the acute period, lumbosacral radiculitis is also characterized by the presence of a number of specific symptoms. There is an increase in lower back pain when coughing and sneezing (Dejerin’s symptom), smoothness of the subclavian fold (Bonnet’s symptom), involuntary bending of the leg on the affected side when the patient sits down from a supine position (Bekhterev’s symptom), lower back pain when lifting a straight leg in a supine position (Lasega’s symptom), increased pain with a sharp tilt of the head forward (a symptom of Neri).
Diagnostics
As a rule, the above mentioned clinical symptoms allow the doctor to diagnose lumbosacral radiculitis. Conducting electromyography or electroneuromyography makes it possible to confirm the level of damage to the neuromuscular apparatus. Spine x-ray is necessarily performed in 2 projections. Often it reveals signs of osteochondrosis, subluxation of the vertebrae, curvature of the spine, anomalies of its development (lumbalization, sacralization, etc.).
A necessary point is to exclude such serious causes of lumbago with sciatica and lumbalgia as tumors of the spinal cord and spine, spinal blood supply disorders, intervertebral hernia, meningomyelitis. The doctor should be alerted by a pronounced radicular syndrome, occurring with sensitive and motor disorders, poorly amenable to therapy. If there are indications, patients are prescribed an MRI of the spine, if it is impossible to perform it, CT. MRI makes it possible to diagnose a hernia, tumor, inflammatory changes in the spinal substance; to determine the size of the lesion, the stage of hernia development; to assess the degree of compression of the spinal canal.
Treatment
Therapeutic tactics are based on the relief of pain syndrome and all its components (inflammatory, muscle-tonic, compression component). Pharmacotherapy is complex, consists of the appointment of anti-inflammatory and analgesic drugs (amidopyrine + butadione, metamizole sodium, diclofenac, nimesulide, etc.), muscle relaxants (tolperizone hydrochloride, baclofen), vitamins gr. B (thiamine, pyridoxine, cyanocobalamin), improving local blood circulation (nicotine k-you). With intense pain syndrome, therapeutic paravertebral blockades with the introduction of glucocorticosteroids are advisable. Local application of UFOs, electrophoresis, UHF, magnetotherapy has an anti-inflammatory and analgesic effect. Reflexotherapy can be used to relieve pain.
Effective means to eliminate or stop degenerative processes occurring in the spine do not yet exist. Some effect is noted when using chondroprotectors (glucosamine, Chondroitin sulfate, extract from marine fish, etc.). In order to eliminate subluxations of the vertebrae and to increase the intervertebral space, manual or traction therapy can be performed. In case of an intervertebral hernia causing a pain syndrome resistant to therapy or compression of the root with loss of its function, surgical removal of a herniated disc (discectomy, microdiscectomy) is possible.
After the acute period subsides, in which rest is recommended to patients, they gradually begin physical therapy classes in combination with myofascial massage of the lumbosacral spine and physiotherapy. Regular gymnastics helps strengthen the muscles of the spine and lower back, which helps to avoid further relapses. Swimming classes, water and mud therapy are also recommended for patients.
Prognosis and prevention
In most cases, lumbosacral radiculitis responds well to therapy. The acute period can be stopped within 5-7 days. The issue of subsequent relapses depends on how much it is possible to eliminate the factors provoking them (overload, weight lifting, overweight, etc.), as well as on the patient’s implementation of recommendations about regular physical therapy sessions, visits to the pool, periodic massage courses.
Prevention of lumbosacral radiculitis is reduced to observing an adequate work regime, avoiding lifting excessive weights and other loads on the spine, leading an active lifestyle, rational nutrition, timely correction of metabolic disorders, etc.