Radicular syndrome

Radicular syndrome is a pathological condition accompanied by pain as a result of damage to the spinal nerve roots (radiculitis) or combined damage to the spinal structures and their roots (radiculoneuritis).

Most often, the roots of the lumbosacral region are affected, less often the cervical region, and very rarely the thoracic region. Therefore, depending on the level of damage, radicular syndrome is divided into: lumbosacral, cervicothoracic radiculitis or radiculoneuritis and polyradiculoneuritis with total damage to the roots of all parts of the spine.

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What causes radicular syndrome?

Radicular syndrome develops mainly as a result of osteochondrosis of the spine; but its development can also be provoked by other diseases, accompanied by deformation and instability of the discs, which, when displaced, compress the roots or nerves.

But the clinical picture is mainly not related to the severity of the disc deformation, but depends on the degree of involvement in the process of certain neurovascular formations that determine the swelling and irritation of the roots and nerves. Cooling, infectious and toxic agents play the role of only a provoking factor. Radicular syndrome is prone to recurrence.

Lumbosacral radicular syndrome

It is most often observed at the age of 30-50 years, but can also occur at other ages, mainly in people experiencing static-dynamic loads or, conversely, hypokinesia. It can be a unilateral or bilateral process.

Clinically, it is accompanied by pain in the lumbar spine in the form of lumbago or lumbodynia and the leg(s), mainly along the sciatic nerve (sciatica).

Lumbago occurs with awkward or sudden movements, lifting weights, accompanied by sharp pains and limited mobility in the lumbar spine, an attempt to move causes a sharp increase in pain. It lasts from several hours to several days.

Lumbago occurs after significant physical exertion, prolonged uncomfortable posture, bumpy ride, cooling. Accompanied by dull aching pain, increasing with bending, sitting, walking. Spinal mobility is difficult, but slightly limited. Often has a subacute or chronic form.

Ischialgia manifests itself in pain along the sciatic nerve, muscle hypotrophy with decreased strength, and the Achilles reflex. The same picture can be given by neuritis of the sciatic nerve (sciatica), in which the pain is paroxysmal, sharp, burning, forcing one to take a relieving position, usually on the side with a bent leg.

The change in the configuration of the lumbar region is characteristic: the lordosis is flattened, there is kyphosis and scoliosis, the muscles of the lumbar region are tense, especially the paravertebral ones - the symptom of reins (Korneev). The pain symptom of Rose is typical - twitching of individual muscle fibers of the gluteus maximus during percussion in the sacrum area. Typical pain points of Vale, Gara, Dejerine, Bekhterev, Schudel are revealed.

Radicular syndrome is characterized by the presence of tension symptoms.

• Lasega: if a person lying on his back lifts his straight leg, the pain in the spine and along the sciatic nerve increases sharply; when he bends it, the pain subsides.
• Lasegue's symptom is aggravated by internal rotation of the hip or extension and flexion of the foot. When standing, this symptom is revealed when the body is tilted forward, and together with the increase in pain, the leg is bent at the knee, rotated outward and moved back.
• Bekhtereva: if a bedridden patient is sat up, his affected leg will bend at the knee; if it is straightened, the healthy leg will bend.
• Neri: in a sitting patient, tilting the head towards the chest causes increased pain in the lower back, and even in the leg.
• Dezherika: when coughing and sneezing, the pain in the lower back increases.
• Naffziger: when pressing on the jugular veins, pain in the lower back appears or intensifies.
• Bonnet:
  • the appearance of pain in the lower back and leg during forced bending and bringing to the stomach;
  • flattening or disappearance of the gluteal fold on the affected leg.
• Lerrea is a sharp increase in pain in the lower back when quickly moving into a sitting position.
• Alajuanica-Turelya - the patient is unable to walk on his heels, the foot on the affected side drops.
• Amosa - when moving from a lying to a sitting position, the patient rests his hands behind him on the bed or floor,
• Other symptoms are much less common.
• Fayerstein: when standing on the affected leg, pain appears along the back surface in response to swinging the healthy leg.
• Rabbit: increased hair growth or, conversely, baldness of the affected leg.
• Ozhekhovsky: coldness of the dorsum of the foot of the affected limb.
• Barre - a pinch on the inner thigh is significantly more painful on the affected side.
• Pain often causes protective antalgic postures when sitting, walking, standing up, and also forms reflex-tonic reflexes:
  • When Lasegue's symptom is evoked, a reflex flexion of the healthy leg occurs; when the healthy leg is raised, the diseased leg flexes;
  • When bending the head towards the body, the affected leg bends.

Impaired sensitivity is variable: paresthesia, sometimes hyperesthesia, or complete loss of skin sensitivity in the form of a band along the sciatic nerve, which distinguishes it from spinal pathology.

Unilateral radiculitis must be differentiated from damage to the psoas muscles: pain in the lumbar region, curvature of the spine in the direction of pain, pain contracture. It can develop with paranephritis, pleurisy, and diseases of internal organs. It is distinguished by a complete absence of local changes in the spine.

Cervicothoracic radicular syndrome

The lesions from the 5th cervical to the 1st thoracic roots of the spinal nerves are most often observed. Cervicothoracic radicular syndrome manifests itself as neck pain radiating to the areas of the affected roots, sometimes numbness in these areas. The pain intensifies with head and neck movements, often spreading to the back of the head and chest. Neck movements are limited, especially backwards and to the affected side. Axial load on the neck and palpation are painful, tense muscles of the neck and shoulder girdle are revealed. Characteristic pain points: vertebral and paravertebral. Sensitivity disorder in the form of hyperesthesia, and then hypesthesia goes through the brachial plexus and then along the radial nerve, which is often accompanied by pain, and then numbness of the IV-V fingers. Movement disorders are usually not expressed. Reflex pain disorders, autonomic disorders, Bernard-Horner syndrome, and very rarely Brown-Sequard syndrome with spinal cord compression may occur.

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How to recognize radicular syndrome?

The scope of instrumental examination is individual in each case. Usually, X-ray or magnetic resonance imaging of a particular section of the spine is sufficient. If there is a need to examine the function of the spine, X-ray cinematography is performed. If there is a cervicothoracic radicular syndrome, the examination can be supplemented with ultrasound Dopplerography of the brachiocephalic arteries and rheoplethysmography of the brain. After examination, it is better to transfer patients to a neurologist for treatment.