Sciatica – lesions of the spinal cord roots that cause motor, vegetative and pain disorders. Sciatica is manifested by an intense pain syndrome, a decrease in muscle strength, reflexes and sensitivity in the area innervated by the affected spinal nerve. Diagnosis of sciatica is carried out using radiography, CT and MRI of the spine, according to indications, it is possible to conduct myelography and lumbar puncture. Painkillers and anti-inflammatory drugs, blockades, physiotherapy procedures, manual techniques, spinal traction, physical therapy and massage are used in the treatment.
General information
Etiological factors of radiculitis are degenerative-dystrophic changes in the spine, such as osteochondrosis, deforming spondylosis, as well as various anomalies of spinal development (sacralisation, spondylolisthesis, additional ribs, vertebral aplasia). Hypothermia, injuries, infections (influenza, tuberculosis, syphilis, cerebrospinal meningitis), as well as root forms of neuroviral diseases (tick-borne encephalitis, etc.) can also provoke inflammatory processes in the spine.
Pain syndrome with sciatica can manifest itself as a result of heaviness, awkward movement, infection or a cold, when there is a stretching or rupture of the fibrous ring of the disc, the gelatinous disc extends beyond its boundaries, and an intervertebral hernia forms in its place. Often, the extended disc or osteophytes squeeze not only the spinal root, but also the nearby membranes and tissues, which in turn serve as an additional source of pain. In addition, two other factors play a role in its pathogenesis: dyscalgia and muscle-tonic pain.
Classification
Depending on the topography of the inflammatory process, radiculitis is divided into a number of forms: lumbosacral, thoracic, cervical, which in turn can be chronic or acute.
In addition, there are primary radiculitis (of toxic, infectious origin) and secondary, caused by abnormalities of the spine and spinal cord. In meningoradiculitis, the inflammatory process develops simultaneously in the roots of the spinal nerve. and the membranes of the spinal cord.
Sciatica symptoms
The main symptoms of sciatica are pain, decreased reflexes, partial sensitivity disorder, vegetative disorders. The first attacks of pain associated with tearing of the fibrous ring of the intervertebral disc are diffuse (resemble “myositis” or “lumbago”). And only with the formation of a herniated disc, which squeezes the root, the radiculopathy is formed when there are sensations of tingling and numbness. Innervation develops in the area of the affected root and, as a result, a decrease or complete absence of sensitivity (temperature, tactile and pain). Over time, the weakness of the muscles located in the area of the affected root increases, up to their complete atrophy.
Symptoms of primary radiculitis (infectious and toxic etiology) are manifestations corresponding to the disease that caused sciatica (in the case of acute respiratory infections – fever, chills, etc.). With lumbosacral sciatica, localization of pain, which increases with walking and coughing, is possible in the lumbar region, lower leg, hip or foot. At the initial stage, the disease proceeds according to the type of lumbago, lumbalgia and lumboishialgia.
The main symptom of lumbago is a sudden acute pain in the lower back, resulting from lifting weights, awkward movement or hypothermia. Irritation of the receptors of the fibrous ring of the disc or subluxation of the intervertebral joints plays a role in the initiation of pain syndrome. Mobility in the lumbar spine is limited, the tone of the lumbar muscles is increased, they are painful on palpation. In most cases, severe pain (“lumbago”) does not allow patients to be in a standing position or walk.
Lumbalgia is a dull pain of a subacute nature in the lumbar region. It often recurs. The sitting position, walking and any movements in the lower back are difficult. In some cases, the symptoms of tension (Lasega, Wasserman) are weakly positive. With lumboishialgia, pain in the lumbar region (both acute and subacute) radiates into one or both legs. Neuromuscular, vegetative-vascular and trophic disorders develop in the lower limb. There is an increased tone of the lumbar muscles, restriction of movements and alignment of lumbar lordosis.
To partially relieve the pain syndrome with sciatica, patients take a “protective” pose: they sit with their legs bent under them and their hands on the bed, or lie with a pillow under their stomach. The gait changes: in motion, patients try to rely mainly on a healthy leg. Quite often there is an increased tone of the lumbar muscles, antalgic scoliosis, less often kyphosis. During palpation, the paravertebral points in the lumbar region, the posterior surface of the thigh, the popliteal fossa, the heel (Gar’s point) and the middle of the foot (Bekhterev’s medioplanatarnaya point) become painful, and this is almost the defining symptom complex of lumbosacral radiculitis.
The first symptoms of cervical sciatica are neck pain (unilateral), forced head position (hypoplastic torticollis), increased tone of the cervical muscles, pathological lordosis of the neck. The pain increases with coughing, sneezing and any movement of the head. With the formation of a herniated disc and compression of the roots, pain sensations extend to the arm (proximal parts), the anterior surface of the chest or shoulder blade. There is a decrease in deep reflexes and paresthesia (in the distal parts of the arm). The pain with sciatica can worsen at night, in such cases, patients are forced to walk for a long time, “rocking” the sick arm.
The development of thoracic radiculitis begins with reflex-irritative symptoms (soreness of paravertebral points, muscle-tonic disorders). At the radicular stage of thoracic radiculitis, sensitivity disorders in the area of the affected roots, motor disorders (paresis of the extensors of the fingers and the hand as a whole) are manifested. In cases when the inflammatory process affects the sympathetic formations of the hand, vegetative-vascular disorders (swelling, sweating, cold) are observed. Possible development of spondylocoronary syndrome. It is manifested by pain in the heart area during flexion and extension of the trunk, turns, bends, etc. such pains are difficult to treat with conventional coronary dilators.
Complications
Damage to the spinal roots and the formation of herniated intervertebral discs can lead to compression (or blockage) of large root veins and radiculomedullary arteries. A decrease in blood flow can lead to the development of ischemia of various etiologies and, as a consequence, a spinal cord infarction, in which the sensitive and motor functions of a person are disrupted. In this state, it is possible to determine the disability group.
Diagnostics
X-ray of the spine in various forms of sciatica usually reveals osteochondrosis, which is quite common. Therefore, the examination should be extensive. In order to exclude destructive processes in the spine, a spondylogram is shown. However, it is not able to verify the discogenic etiology of the disease. With lumbosacral radiculitis, a lumbar puncture is performed, which detects a slight increase in protein content.
To recognize the etiology of radiculitis, a thorough study of the anamnesis, clinic, as well as a large volume of paraclinical data (clinical blood test, myelography, spondylogram, examination of cerebrospinal fluid, MRI and CT of the spine, etc.) is necessary. It should be noted that with discogenic radiculitis, as a rule, only one or two roots suffer. And in cases of thoracic radiculitis, vertebrogenic osteochondrosis should be excluded, here the cause of compression of the roots lies in other diseases. In addition, sciatica must be differentiated from acute myositis of the back muscles.
Sciatica treatment
Treatment is carried out by a vertebrologist or neurologist. The leading triad in the treatment process is spinal immobilization (hard bed), heat and analgesics (diclofenac, indomethacin, etc.). It allows, first of all, to stop the exacerbation of pain. In cases of hyperalgic forms of sciatica, intramuscular administration of analgesics (amidopyrine + butadione, sodium metamizole) should be added. Local irritating agents are also recommended — pepper plaster, rubbing. Physiotherapy, blockades of spasmodic muscles, stretching are of great importance in the treatment of radiculitis. After partial removal of the pain syndrome, physical therapy, massage and manual therapy should be attached. With prolonged lumboishialgic syndrome, patients are prescribed injections of vitamins of group B. The use of vitamin B12 in large doses has a pronounced analgesic effect. In severe cases, it is possible to carry out novocaine blockades (with vitamin B12, hydrocortisone, etc.) or intravenous infusions of diazepam, diphenhydramine, eufillin.
In case of incessant pain (regardless of 3-4 months of therapy), it is recommended to offer the patient spinal surgery (removal of intervertebral hernia). A mandatory indication for surgical intervention in sciatica can serve as a paralyzing sciatica caused by compression of the ponytail, with the development of pelvic organ dysfunction. For the treatment of relapses, sanatorium-resort treatment with the use of mud applications, hydrogen sulfide and radon baths is recommended.
Forecast
A favorable prognosis is possible in case of timely diagnosis and extensive treatment, including all possible directions. Only with this approach can we expect recovery without fear of relapses. In the case of ischemia and, as a consequence, spinal cord infarction, it is impossible to predict a complete recovery, since the consequence of such complications is often a violation of the motor and sensory functions of the body.
Prevention
Prevention of radiculitis includes measures aimed at maintaining proper posture, strengthening the muscles of the back. It is recommended to avoid excessive loads on the spine. Proper posture during sleep and wakefulness minimizes the tension that the spinal column experiences. You should not sleep on too hard mattresses. Contrary to popular belief, they are able to distort the position of the spine and disrupt its function. To avoid this and preserve the natural curve of the spine, it is recommended to pin small pillows under the neck and lower back or use a semi-rigid mattress that is able to support the natural position of the spine.
Maintaining proper posture is also very important in everyday work. When lifting objects from the floor, it is recommended to bend your knees without bending your torso. Thus, the load will move from the back to the legs. It is recommended to avoid uncomfortable poses (prolonged sitting at the table with your head down, sitting in front of the TV, dropping your chin on your chest, etc.). In addition, gymnastics plays an important role in the prevention of sciatica, which helps strengthen the muscles of the back, as well as sports and hardening, which increase the body’s resistance to physical exertion and hypothermia.