Radiculopathy, radiculitis, radiculitis - these are various terms denoting diseases of the nerve roots, caused by chronic pressure in the spine or its vicinity. What are the causes and symptoms of radiculopathy? How is her treatment going?

Radiculopathy( radiculitis ,radiculitis , radiculitis) is irritation or damage nerve roots as a result of pathological changes in the spine. What are nerve roots? Spinal nerves depart from the spinal cord, each of them made up of nerve roots ( radix nervi spinalis ), often called "nerve roots". At the height of each intervertebral space, four roots depart: two ventral roots (contain motor fibers) and two dorsal roots (contain sensory fibers). There are 31 pairs of spinal nerves:

  • cervical nerves C1-C8 (8 pairs)
  • thoracic nerves Th1-Th12 (12 pairs)
  • lumbar nerves L1-L5 (5 pairs)
  • sacral nerves S1-S5 (5 pairs)
  • Co1 coccygeal nerves (1 pair)

Radiculopathy: causes

  • herniation of the intervertebral disc is the most common cause of radiculopathy
  • bone changes in the course of rheumatoid arthritis or osteoarthritis, osteophytes, tumors
  • diabetic patients may complain of nagging pain in the thoracic spine, which is a radiculopathy
  • tinea, borreliosis, syphilis
  • herpesvirus infection ( Herpesvirus varicella zoster ) - causes usually painful radiculopathy with loss of sensation

Radiculopathy: symptoms

Depending on the location of the pathology, the symptoms affect different areas of the body, they include:

  • pain of a sharp and penetrating nature, usually one-sided, that radiates along the dermatome
  • sensory disturbances (paraesthesia, dysaesthesia)
  • traffic deficits

Radiculopathy: types

Division of radiculopathy by localization:

  • lumbar radiculopathies

We can often come across the term "sciatica", which covers a set of symptoms related to compression / irritation of the sciatic nerve or nerve roots, the connection of whicharises (radiculopathy L4, L5, S1). Patients complain of pain in the area of ​​the back, lower limb, numbness in the lower leg or foot, and weakness in the muscles of the lower limb. There may also be a weakening of the knee or ankle reflex. Buttock pain and muscle cramps are common. Patients also have a tendency to reflexively move the torso to one side in order to relieve the spine. On physical examination, most show a positive Lasegue symptom (inability to raise the straight lower limb while lying down). When there is pressure at the level of the cauda equina, it is called "cauda equina syndrome" and the symptoms are accompanied by bowel and bladder symptoms of varying severity. Such a condition requires urgent treatment, often neurosurgical! In the differential diagnosis, the following should be considered: lumbar bursitis, lumbar fibromyalgia, arthritis, pathologies of the lumbar spinal cord, sacro-lumbar spine pain.

  • cervical radiculopathies

Symptoms include neck pain, depending on the level of damage, it can radiate to the upper limb. Patients also often report pain in the interscapular region. In addition, there is numbness, sensory losses, and movement disorders in the neck and upper limbs. The neck straightening and rotation maneuver, by reducing the size of the intervertebral foramen, may exacerbate the symptoms (Spurling's symptom). Pain in the neck and upper limb should be differentiated from: cervical myelopathy, carpal tunnel syndrome, rotator cuff disorder, neoplastic process, herpes zoster, upper thoracic outlet syndrome, neuralgic muscle atrophy, and myocardial ischemia. When collecting the medical history, careful attention should be paid to the presence of alarm symptoms that may suggest a serious pathology. Accompanying general symptoms: fever, weight loss may be a symptom of an ongoing neoplastic process. On the other hand, neurological symptoms from the upper motor neuron, such as Babiński's, Hoffman's symptom, and gait disturbances, may be a manifestation of pressure on the cervical spinal cord, which requires surgical decompression. Specific forms of radiculopathy:

  • infectious radiculopathies

-spinal cord pruritusis the most common form of syphilis in the nervous system. Initially, it develops as meningitis, then after 10-20 years of persistent infection, it leads to extensive destruction of the posterior roots. The result is a number of characteristic symptoms: shooting pains especially expressed in the lower limbs, ataxia, bladder disorders, pupilsArgyle Robertson, areflexia, loss of proprioceptive sensation, Charcot's joints, trophic ulcers, sensory disturbances (freezing, numbness, tingling). The diagnosis is confirmed by the presence of antibodies to T. pallidum, which can be found in all patients with CNS syphilis. Treatment consists of the intravenous administration of Penicillin G in a dose of 2-4 million units every four hours for 10-14 days -polyradiculopathy in HIV-infected patients- in the late stage of HIV infection, when CD4 lymphocyte counts decline below 200 cells / µl, the patient develops life-threatening opportunistic infections. They allow for the diagnosis of the acquired immune deficiency syndrome - AIDS. One of the pathogens causing such infections is cytomegalovirus (CMV). May lead to polyradiculopathy. The clinical picture includes: rapid onset of pain and paresthesia in the lower limbs and perineal region, urinary retention, progressive paresis of the lower limbs. If no treatment is taken, death occurs within 6 weeks of onset of symptoms. The use of ganciclovir may improve, but only if we start treatment early enough.

  • Traumatic Radiculopathy

Compared to other spinal nerve structures, the roots contain less collagen and no perineural and epineural sheaths. This is due to their low tensile strength. A nerve root may be severed from a severe pull trauma. The front roots are more susceptible to damage due to the thinner dura mater sheath. Most often, there is a detachment in the cervical region. In most cases, it leads to the occurrence of one of the two clinical syndromes: -Erb-Duchenne palsy- related to the paralysis of muscles innervated by C5 and C6 roots (supraspinatus, subspecific, deltoid, biceps) , the effect is the sag of the arm along the chest in internal rotation and extension in the elbow joint, the most common cause is motorcycle accidents, but such paralysis is also observed in newborns as a result of obstetric procedures. -Dejerine-Klumpke palsy - muscles innervated by the roots of C8 and Th1 are paralyzed, there is paresis and atrophy of the internal muscles of the hand with the characteristic "clawed hand", such an injury may occur as a result of a fall from a height while grasping a protruding object in order to avoid falling.

Radiculopathy: diagnosis

Tests that may be helpful in diagnosing radiculopathy:

  • X-ray - the usefulness of X-ray examination islimited, often it is not possible to visualize changes, however, it is worth considering X-ray if a fracture or metastatic lesions are suspected
  • EMG (electromyographic examination) - allows you to assess the condition of each of the spinal nerves and plexuses, indicates the location of the changes and allows you to determine whether acute changes are progressing
  • MRI (magnetic resonance imaging) - is highly effective in patients with pronounced radicular symptoms and can usually find the structural cause of radiculopathy
  • myelography followed by CT (computed tomography) - is the most sensitive method, but due to its invasiveness it should not be a first-line examination and is mainly performed with contraindications to MRI

Radiculopathy: treatment

The first step is to control pain and the inflammation process. Non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants are used. The patient's comfort is improved by avoiding positions that increase pain. When the phase of acute inflammation is over, the therapy can be extended with stretching exercises and exercises improving the range of motion, massages, and warm and cold compresses. If treatment is not working, epidural nerve blocks (using local anesthetics and corticosteroids) may be used. The next step is surgery. However, it should be remembered that in order to qualify a patient for neurosurgical treatment, clinical symptoms must be consistent with the results of imaging tests.

Category:

Spine, bones, joints