Radical syndrome

Radical syndrome - a pathological condition, accompanied by pain as a result of the lesion of the roots of the spinal nerves (radiculitis) or combined lesions of the spinal formations and their roots (radiculoneuritis).

The roots of the lumbosacral spine are more often affected, more rarely the cervical, very rarely - the thoracic parts. Therefore, the radicular syndrome, depending on the level of the lesion is divided into: lumbosacral, cervico-thoracic radiculitis or radiculoneuritis and polyradiculoneuritis with total damage to the roots of all parts of the spine.

[1], [2], [3], [4], [5], [6]

What causes the radicular syndrome?

Radicular syndrome develops mainly due to osteochondrosis of the spine; but its development can provoke and its other diseases, accompanied by deformation and instability of discs, which, when squeezed, squeeze the roots or nerves.

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

Lumbosacral radicular syndrome

It is often noted at the age of 30-50 years, but can be in the other, mainly in individuals experiencing static-dynamic loads or, conversely, hypokinesia. There can be a one-sided and two-sided process.

Clinically accompanied by pain in the lumbar spine in the form of lumbago or lumbargia and leg (legs), mainly along the sciatic nerve (ischialgia).

Lumbago occurs with awkward or abrupt movement, lifting of gravity, accompanied by sharp pains and restriction of mobility in the lumbar spine, the attempt of movements causes a sharp increase in pain. It lasts from several hours to several days.

Lumbalia occurs after considerable physical exertion, a long uncomfortable posture, a jolting ride, and cooling. It is accompanied by blunt aching pains, which is strengthened by bending, sitting, walking. Mobility in the spine is difficult, but limited to a small extent. Often carries a subacute or chronic form.

Ishalgia is manifested by pain along the sciatic nerve, muscle hypotrophy with a decrease in strength, Achilles reflex. The same picture can give neuritis of the sciatic nerve (sciatica) in which the painful sensations are paroxysmal, sharp, burning, forcing to take an easing posture, usually on the side with a bent leg.

Characteristic changes in the configuration of the lumbar region: lordosis is flattened, there is kyphosis and scoliosis, muscles of the lumbar region are strained, especially paravertebral - a symptom of the reins (Korneev). Typical pain symptom Rose - twitching of individual muscle fibers of the gluteus maximus with percussion in the sacrum. Typical pain points of Vale, Gar, Dezherin, Bekhterev, and Schudel are revealed.

Radical syndrome is characterized by the presence of tension symptoms.

• Lasega: if a person lying on his back, lift a straight leg, sharply increased pain in the spine and along the sciatic nerve, with her bending pain subsiding.
• Lasega's symptom is amplified when the thigh is rotated inwards, or when the foot is flexed and bent. Standing this symptom is revealed when the trunk is tilted forward, and along with the pain, the leg bends in the knee, rotates outward and is retracted.
• Bechterew: if a patient is lying down lying down, the affected leg will bend in the knee, if it is straightened, a healthy leg is bent.
• Neri: in a sedentary patient, the inclination of the head to the chest, causes pain in the lower back, or even in the leg.
• Dezherika: when coughing, sneezing, pain in the lower back increases.
• Nuffziger: when pressing on the cervical veins, painful sensations appear or increase in the lower back.
• Bonn:
  • the appearance of pain in the lower back and leg with forced bending and bringing to the stomach;
  • smoothness or disappearance of the gluteal fold on the affected leg.
• Lerrey - a sharp increase in pain in the lower back with a rapid transition to a sitting position.
• Alauguinik-Tyurel - the patient is not able to walk on his heels, the foot on the affected side falls off.
• Amos - when moving from a lying position to a sitting patient, he leans behind him with his hands on the bed or the floor,
• Significantly less common are other symptoms.
• Firestein: when standing on the affected leg, pains appear on the back surface in response to shaking with a healthy leg.
• Krola: strengthened hair, or, conversely, baldness of the affected leg.
• Ozhekhovsky: cooling of the rear of the foot of the affected limb.
• The barrels on the inside of the thigh are much more painful on the side of the lesion.
• Pain often determines protective antalgic postures when sitting, walking, rising, and reflex-tonic reflexes are formed:
  • when Lasega's symptom is evoked, a reflexive flexion of the healthy leg occurs; when a healthy leg is raised, the patient bends;
  • when the head is bent to the trunk, the affected leg is bent.

Disturbance of sensitivity is variable: paresthesia, sometimes hyperesthesia, or complete loss of skin sensitivity in the form of tape along the sciatic nerve, which differs from spinal pathology.

One-sided radiculitis should be differentiated from the lesion of psoas muscles: pain in the lumbar region, curvature of the spine in the direction of pain, painful contracture. It can develop with parainfrites, pleurisy, diseases of internal organs. It is distinguished by the complete absence of local changes in the spine.

Cervico-thoracic radicular syndrome

The defeat from V cervical in the first thoracic spine of the spinal nerves is more often noted. The cervico-thoracic radicular syndrome is manifested by pain in the neck with irradiation into the zones of the affected roots, sometimes numbness in these zones. Painful sensations are amplified by the movement of the head and neck, often extending to the back of the neck and chest. Movement in the neck is limited, especially back 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. Disorder of sensitivity 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 by numbness of the IV-V fingers of the hand. Movement disorders are usually not expressed. There may be reflex-painful disorders, vegetative disorders, Bernard-Horner, very rarely Brown-Sekar when the spinal cord is compressed.

[7], [8], [9], [10]

How to recognize a radicular syndrome?

The volume of instrumental examination in each case is individual. Usually it is sufficient to perform X-ray or magnetic resonance imaging of a particular spine. If there is a need to investigate the function of the spine, X-ray film is performed. If there is a cervico-thoracic radicular syndrome, it may be possible to supplement the study with ultrasound dopplerography of brachiocephalic arteries and rheoplethysmography of the brain. After the examination of the patients, it is better to transfer it to the neuropathologist for treatment.