Radicular syndromes and back pain

Syndromes of radicular disorders are represented by segmentary radicular symptoms (pain or paresthesia in the dermatome zone, muscular weakness in the innervation zone of the rootlet). Diagnosis may require neuroimaging, electromyography and a systematic examination to determine the cause of the disease. Treatment depends on the cause, but includes symptomatic treatment of pain with NSAIDs and other analgesics.

Radicular syndromes (radiculopathy) occur when the roots are compressed within or near the vertebral column. The most common cause is a herniated intervertebral disc. Bony changes that occur with rheumatoid arthritis or osteoarthritis, especially in the cervical and lumbar regions, can also compress individual roots. Less often, carcinomatous meningitis causes a "spotty" radicular symptomatology. Rarely volumetric processes (for example, epidural abscess and tumor, spinal meningeomas, neurofibromas) can manifest with radicular symptoms instead of spinal symptoms. Diabetes often causes painful chest or limb radiculopathy. Infectious diseases, such as fungal (for example, histioplasmosis) and spirochetosis (for example, Lyme disease, syphilis) sometimes affect the nerve roots. Herpes zoster usually causes painful radiculopathy with a sensitivity disorder in the dermatome and a characteristic rash, but it can also be the cause of motor radiculopathy with weakness in the myotome and a decrease in reflexes.

[1], [2], [3], [4]

Symptoms of radicular syndromes

Radicular syndrome consists of pain and segmental neurological deficit, due to the level of damage. Muscles innervated by the affected spine become weak, undergo atrophy; they can also become flabby. The defeat of the sensory portion of the root causes sensory disturbances in the Lermatom. Tendon reflexes corresponding to the affected root can decrease or disappear.

Spinal roots and the main muscles, they are innervated

Spine	Muscle	Act
C5	Deltoid	Leaving shoulder
C5	Subacute	External shoulder rotator (check: the patient's ability to produce an external rotation of the shoulder with a hand pressed to the trunk and bent at the elbow joint)
C5, C6	The biceps brachialis muscle	Flexion and supination of the forearm
C6	Radial and ulnar extensors of the wrist	Extension of the wrist
C7	Extensor of fingers The triceps brachialis muscle	Extension of fingers Extension of the forearm in the elbow joint
C8, T1	Interosseous and vermiformes	Folding and dilating of the fingers (check: the ability of the patient to slide the fingers separately and together against the resistance)
L2, L3, L4	The quadriceps muscle of the thigh, the ilio-lumbar muscle. Adductors group	Extension in the knee joint, flexion of the hip Hip reduction
L5	Anterior tibialis and extensor of the thumb	Extension (dorsiflexia) of the foot and thumb (check: the ability of the patient to walk on his heels)
S1	Calf	Flexion (plantar flexion) of the foot (check: the patient's ability to walk on the socks)

The four main reflexes

Reflex	Roots realizing the reflex	Muscle-executing reflex
Flexion of the foot (Achilles reflex)	S1	Calf
Knee extension (knee reflex)	L2, L3, L4	Quadriceps femoris
Shoulder biceps reflex	C5, C6	The biceps brachialis muscle
Reflex of triceps brachialis muscle	С7, С8	The triceps brachialis muscle

Pain can increase with movements that transmit pressure to the spine through the subarachnoid space (for example, spinal motion, coughing, sneezing, Valsalva test). The defeat of the horse's tail causes radicular symptoms in both lower limbs and can be accompanied by sphincter and sexual dysfunctions. Signs of compression of the spinal cord include the presence of a level of sensory disorders (sudden changes in sensitivity below the horizontal level through the spinal cord), flaccid paraparesis or tetraparesis, reflex disorders below the level of compression, early hyporeflexia, later replaced by hyperreflexia and sphincter disorders.

Diagnosis and treatment of radicular syndromes

Radicular symptoms require a CT scan or an MRI scan of the affected level. Myelography is rarely used at multiple lesion levels. The level of research depends on the symptoms; if the level of lesion is not clear, it is possible to use electromyography, which helps to stamp the affected root, but does not allow to establish the cause.

To affect individual peripheral nerves, sensitivity disorders in the corresponding zones are characteristic, as well as other associated signs.

Characteristic distinctive features of the lesion of various nerves

Nerve	Symptoms
The Middle Loktevoy	The thumb and the elevation of thenar the little finger and the hypothenar
Ray	Falling Brush
Femoral	Otsustvie knee reflex, weakness of flexion of the hip and extension of the shin
Peroneal	Falling foot (steppe)
Sciatic	Pain over the external surface of the thigh and lower leg with no Achilles reflex.

If neuroimaging does not reveal anatomical abnormalities, it is necessary to perform an analysis of cerebrospinal fluid to exclude infectious and inflammatory causes and an urgent determination of blood glucose level to exclude diabetes.

Specific causes of radicular syndromes are treated according to their etiology. Acute pain requires the appointment of analgesics (eg, NSAIDs, sometimes opioids). Using low doses of antidepressants and bed rest can be helpful. Muscle relaxants, sedatives and topical treatments sometimes benefit.

[5], [6], [7]