What is lumbago with sciatica: how to treat the disease and prevent its further development. What is lumbago, treatment with medication and at home Diagnosis 11.8 m 54.4 transcript

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2017

Pain in the thoracic spine (M54.6), Pain in the lower back (M54.5), Other dorsalgia (M54.8), Sciatica (M54.3), Lumbago with sciatica (M54.4), Lesions of the thoracic roots, not classified in other sections (G54.3), Lesions of the intervertebral discs of the lumbar and other parts with radiculopathy (M51.1), Lesions of the brachial plexus (G54.0), Lesions of the lumbosacral plexus (G54.1), Lesions of the lumbosacral roots, not classified elsewhere (G54.4), Cervical root lesions not elsewhere classified (G54.2), Radiculopathy (M54.1), Cervicalgia (M54.2)

Neurology

general information

Short description

Joint Care Quality Commission approved
Ministry of Health of the Republic of Kazakhstan
dated November 10, 2017
Protocol No. 32

Damage to nerve roots and plexuses can have both vertebrogenic(osteochondrosis, ankylosing spondylitis, spondylolisthesis, ankylosing spondylitis, lumbarization or sacralization in the lumbosacral region, vertebral fracture, deformities (scoliosis, kyphosis)), and non-vertebrogenic etiology(neoplastic processes (tumors, both primary and metastases), damage to the spine by an infectious process (tuberculosis, osteomyelitis, brucellosis) and others.

According to ICD-10 vertebrogenic diseases are designated as dorsopathies (M40-M54) - a group of diseases of the musculoskeletal system and connective tissue, in the clinic of which the leading one is pain and/or functional syndrome in the area of ​​the trunk and extremities of non-visceral etiology [ 7,11 ].
According to ICD-10, dorsopathies are divided into the following groups:
· dorsopathies caused by spinal deformation, degeneration of intervertebral discs without their protrusion, spondylolisthesis;
· spondylopathies;
· dorsalgia.
Damage to the nerve roots and plexuses is characterized by the development of so-called dorsalgia (ICD-10 codes M54.1- M54.8 ). In addition, damage to nerve roots and plexuses according to ICD-10 also includes direct damage to roots and plexuses, classified in headings ( G 54.0- G54.4) (lesions of the brachial, lumbosacral plexus, lesions of the cervical, thoracic, lumbosacral roots, not classified elsewhere).
Dorsalgia is a disease associated with back pain.

INTRODUCTORY PART

ICD-10 code(s):

Classification

By localization:

· cervicalgia;
· thoracalgia;
· lumbodynia;
· mixed localization (cervicothoracalgia).

According to the duration of the pain syndrome :
acute - less than 6 weeks,
· subacute - 6-12 weeks,
· chronic - more than 12 weeks.

According to etiological factors(Bogduk N., 2002):
· trauma (muscle overextension, rupture of fascia, intervertebral discs, joints, sprained ligaments, joints, bone fractures);
· infectious lesion (abscess, osteomyelitis, arthritis, discitis);
· inflammatory lesion (myositis, enthesopathy, arthritis);
· tumor (primary tumors and sites);
· biomechanical disorders (formation of trigger zones, tunnel syndromes, joint dysfunction).

Diagnostics

DIAGNOSTIC METHODS, APPROACHES AND PROCEDURES

Diagnostic criteria

Complaints and anamnesis
Complaints:
· for pain in the area of ​​innervation of the affected roots and plexuses;
· for disruption of motor, sensory, reflex and autonomic-trophic functions in the area of ​​innervation of the affected roots and plexuses.

Anamnesis:
· long-term physical static load on the spine (sitting, standing);
physical inactivity;
· sudden lifting of weights;
· hyperextension of the spine.

Physical examination
· in andzualinspection:
- assessment of the statics of the spine - antalgic posture, scoliosis, smoothness of physiological lordosis and kyphosis, defence of the paravertebral muscles of the affected part of the spine;
- assessment of dynamics - limitation of movements of the arms, head, various parts of the spine.
· PalpaciI: pain on palpation of paravertebral points, spinous processes of the spine, Valle points.
· PerkussiI hammer of the spinous processes of various parts of the spine - positive Razdolsky's symptom - the "spinous process" symptom.
· positive tonut samples:
- Lassegue's symptom: pain appears when bending the straightened leg at the hip joint, measured in degrees. The presence of Lasegue's symptom indicates the compressive nature of the disease, but does not specify its level.
- Wasserman's symptom: the appearance of pain when raising a straight leg back while lying on the stomach indicates damage to the L3 root
- Matskevich’s symptom: the appearance of pain when bending the leg at the knee joint while lying on the stomach indicates damage to the L1-4 roots
- Bekhterev's symptom (Lasègue's cross symptom): the appearance of pain in the supine position when bending the straightened healthy leg at the hip joint and disappearing when it bends at the knee.
- Neri's symptom: the appearance of pain in the lower back and leg when bending the head while lying on the back indicates damage to the L3-S1 roots.
- cough impulse symptom: pain when coughing in the lumbar region at the level of the spinal lesion.
· OpriceAmotorfunctions for the study of reflexes: decrease (loss) the following tendon reflexes.
- flexion-ulnar reflex: a decrease/absence of the reflex may indicate damage to the CV - CVI roots.
- ulnar extension reflex: a decrease/absence of the reflex may indicate damage to the CVII - CVIII roots.
- carpo-radial reflex: a decrease/absence of the reflex may indicate damage to the CV - CVIII roots.
- scapulohumeral reflex: a decrease/absence of the reflex may indicate damage to the CV - CVI roots.
- upper abdominal reflex: a decrease/absence of the reflex may indicate damage to the DVII - DVIII roots.
- average abdominal reflex: a decrease/absence of the reflex may indicate damage to the DIX - DX roots.
- lower abdominal reflex: a decrease/absence of the reflex may indicate damage to the DXI - DXII roots.
- cremasteric reflex: a decrease/absence of the reflex may indicate damage to the LI - LII roots.
- knee reflex: decreased/absent reflex may indicate damage to both the L3 and L4 roots.
- Achilles reflex: a decrease/absence of the reflex may indicate damage to the SI - SII roots.
- Plantar reflex: decreased/absent reflex may indicate damage to the L5-S1 roots.
- Anal reflex: decreased/absent reflex may indicate damage to the SIV - SV roots.

Scheme for express diagnostics of root lesions :
· PL3 root lesion:
- positive Wasserman symptom;
- weakness in the leg extensors;
- impaired sensitivity on the anterior surface of the thigh;

· L4 root lesion:
- violation of flexion and internal rotation of the leg, supination of the foot;
- impaired sensitivity on the lateral surface of the lower third of the thigh, knee and anteromedial surface of the leg and foot;
- change in knee reflex.
· L5 root lesion:
- impaired heel walking and dorsal extension of the big toe;
- impaired sensitivity on the anterolateral surface of the leg, dorsum of the foot and fingers I, II, III;
· S1 root lesion:
- impaired walking on toes, plantar flexion of the foot and toes, pronation of the foot;
- impaired sensitivity on the outer surface of the lower third of the leg in the area of ​​the lateral malleolus, the outer surface of the foot, IV and V fingers;
- change in the Achilles reflex.
· OpriceAsensitive functionAnd(sensitivity study using cutaneous dermatomes) - the presence of sensory disorders in the area of ​​innervation of the corresponding roots and plexuses.
· laboratoryresearch: No.

Instrumental studies:
Electromyography: clarification of the level of damage to roots and plexuses. Detection of secondary neuronal muscle damage allows one to determine the level of segmental damage with sufficient accuracy.
Topical diagnosis of lesions of the cervical roots of the spine is based on testing the following muscles:
· C4-C5 - supraspinatus and infraspinatus, teres minor;
· C5-C6 - deltoid, supraspinatus, biceps humerus;
· C6-C7 - pronator teres, triceps muscle, flexor carpi radialis;
· C7-C8 - extensor carpi communis, triceps and palmaris longus muscles, flexor carpi ulnaris, abductor pollicis longus;
· C8-T1 - flexor carpi ulnaris, long flexor muscles of the fingers, intrinsic muscles of the hand.
Topical diagnosis of lesions of the lumbosacral roots is based on the study of the following muscles:
· L1 - iliopsoas;
· L2-L3 - iliopsoas, graceful, quadriceps, short and long adductor muscles of the thigh;
· L4 - iliopsoas, tibialis anterior, quadriceps, major, minor and short adductor muscles of the thigh;
· L5-S1 - biceps femoris, extensor toes longus, tibialis posterior, gastrocnemius, soleus, gluteal muscles;
· S1-S2 - intrinsic muscles of the foot, flexor digitorum longus, gastrocnemius, biceps femoris.

Magnetic resonance imaging:
MRI signs:
- protrusion of the fibrous ring beyond the posterior surfaces of the vertebral bodies, combined with degenerative changes in the disc tissue;
- protrusion (prolapse) of the disc - protrusion of the nucleus pulposus due to thinning of the fibrous ring (without its rupture) beyond the posterior edge of the vertebral bodies;
- disc prolapse (or disc herniation), the release of the contents of the nucleus pulposus beyond the annulus fibrosus due to its rupture; disc herniation with its sequestration (the fallen part of the disc in the form of a free fragment is located in the epidural space).

Consultation with specialists:
· consultation with a traumatologist and/or neurosurgeon - if there is a history of trauma;
· consultation with a rehabilitation specialist - in order to develop an algorithm for a group/individual exercise therapy program;
· consultation with a physiotherapist - in order to resolve the issue of physiotherapy;
· consultation with a psychiatrist - in the presence of depression (more than 18 points on the Beck scale).

Diagnostic algorithm:(scheme)

Differential diagnosis

Differential diagnosisand rationale for additional research

Table 1.

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Treatment

Drugs (active ingredients) used in treatment

Treatment (outpatient clinic)

OUTPATIENT TREATMENT TACTICS:

Non-drug treatment:
· mode III;
· Exercise therapy;
· maintaining physical activity;
· diet No. 15.
· kinesio taping;
Indications:
· pain syndrome;
· muscle spasm;
· motor dysfunction.
Contraindications:
· individual intolerance;
· violation of the integrity of the skin, sagging skin;

NB! In case of pain syndrome, it is carried out according to the mechanism of estero-, proprioceptive stimulation.

Drug treatment:
For acute pain ( table 2 ):


· non-narcotic analgesics - have a pronounced analgesic effect.
· opioid narcotic analgesic has a pronounced analgesic effect.

For chronic pain( table 4 ):
· NSAIDs - eliminate the effect of inflammatory factors during the development of pathobiochemical processes;
· muscle relaxants - reduce muscle tone in the myofascial segment;
· non-narcotic analgesics - have a pronounced analgesic effect;
· opioid narcotic analgesic has a pronounced analgesic effect;
· cholinesterase inhibitors - in the presence of motor and sensory disorders, improves neuromuscular transmission.

Treatment regimens:
· NSAIDs - 2.0 IM No. 7 e/day;
Flupirtine maleate 500 mg orally 2 times a day.
Additional drugs: in the presence of nociceptive pain - opioid narcotic analgesics (in transdermal and intramuscular form), in the presence of neuropathic pain - antiepileptic drugs, in the presence of motor and sensory disorders - cholinesterase inhibitors.

List of essential medications for acute pain(having a 100% probability of application):
Table 2.

Treatment (inpatient)

TREATMENT TACTICS AT THE INPATIENT LEVEL:
· leveling of pain syndrome;
· restoration of sensitivity and motor disorders;
· use of peripheral vasodilators, neuroprotective drugs, NSAIDs, non-narcotic analgesics, muscle relaxants, anticholinesterase drugs.

Patient observation card, patient routing: No.

Non-drug treatment:
Mode III
· diet No. 15,
· physiotherapy (thermal procedures, electrophoresis, paraffin treatment, acupuncture, magnetic, laser, UHF therapy, massage), exercise therapy (individual and group), kinesio taping

Drug treatment

Scroll essential medicines(having a 100% probability of application):

Hospitalization

INDICATIONS FOR HOSPITALIZATION, INDICATING THE TYPE OF HOSPITALIZATION

Indications for planned hospitalization:
· ineffectiveness of outpatient treatment.

Indications for emergency hospitalization:
· severe pain syndrome with signs of radiculopathy.

Information

Sources and literature

1. Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2017
   1. 1. Barulin A.E., Kurushina O.V., Kalinchenko B.M. Application of the kinesiotaping technique in neurological patients // RMZh. 2016. No. 13. pp. 834-837. 2. Belskaya G.N., Sergienko D.A. Treatment of dorsopathy from the standpoint of effectiveness and safety // Breast Cancer. 2014. No. 16. P.1178. 3. Danilov A.B., N.S. Nikolaeva, Efficacy of a new form of flupirtine (Katadolon forte) in the treatment of acute back pain //Manage pain. – 2013. – No. 1. – P. 44-48. 4. Kiselev D.A. Kinesio taping in the medical practice of neurology and orthopedics. St. Petersburg, 2015. –159 p. 5. Clinical protocol “Damage to nerve roots and plexuses” dated December 12, 2013 6. Kryzhanovsky, V.L. Back pain: diagnosis, treatment and rehabilitation. – Mn.: DD, 2004. – 28 p. 7. Levin O.S., Shtulman D.R. Neurology. Handbook of a practicing physician. M.: MEDpress-inform, 2012. - 1024s. 8. Neurology. National leadership. Brief edition/ed. Guseva E.I. M.: GEOTAR – Media, 2014. – 688 p. 9. Podchufarova E.V., Yakhno N.N. Backache. - : GEOTAR-Media, 2014. – 368 p. 10. Putilina M.V. Features of diagnosis and treatment of dorsopathies in neurological practice // Consilium medicum. – 2006.– No. 8 (8). – pp. 44–48. 11. Skoromets A.A., Skoromets T.A. Topical diagnosis of diseases of the nervous system. St. Petersburg “Polytechnics”, 2009 12. Subbotin F. A. Propaedeutics of functional therapeutic kinesiological taping. Monograph. Moscow, Orthodinamika Publishing House, 2015, -196 p. 13. Usmanova U.U., Tabert R.A. Features of the use of kinesio tape in pregnant women with dorsopathies // Materials of the 12th international scientific and practical conference “Education and Science of the XXI Century - 2016”. Volume 6. P.35 14. Erdes S.F. Nonspecific pain in the lower back. Clinical recommendations for local therapists and general practitioners. – M.: Kit Service, 2008. – 70 p. 15. Alan David Kaye Case Studies In Pain Management. – 2015. – 545 rub. 16. Bhatia A., Bril V., Brull R.T. et al. Study protocol for a pilot, randomized, double-blinded, placebo controlled trial of perineural local anaesthetics and steroids for chronic post-traumatic neuropathic pain in the ankle and foot: The PREPLANS study.// BMJ Open/ - 2016, 6(6) . 17. Bishop A., Holden M.A., Ogollah R.O., Foster N.E. EASE Back Study Team. Current management of pregnancy-related low back pain: A national cross-sectional survey of UK physiotherapists. //Physiotherapy.2016; 102(1):78–85. 18. Eccleston C., Cooper T.E., Fisher E., Anderson B., Wilkinson N.M.R. Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 8 Art. No.: CD012537. DOI: 10. 1002 / 14651858. CD 012537. Pub 2. 19. Elchami Z., Asali O., Issa M.B. and Akiki J. The efficacy of the combined therapy of pregabalin and cyclobenzaprine in the treatment of neuropathic pain associated with chronic radiculopathy. // European Journal of Pain Supplements, 2011, 5(1), 275. 20. Grant Cooper Non-operative Treatment Of The Lumbar Spine. – 2015. – 163 rub. 21. Herrmann W.A., Geertsen M.S. Efficacy and safety of lornoxicam compared with placebo and diclofenac in acute sciatica/lumbo-sciatica: an analysis from a randomized, double-blind, multicentre, parallel group study. //Int J Clin Pract 2009; 63 (11): 1613–21. 22. Interventional Pain Control in Cancer Pain Management/Joan Hester, Nigel Sykes, Sue Pea RUR 283 23. Kachanathu S.J., Alenazi A.M., Seif H.E., et al. Comparison between kinesio taping and a traditional physical therapy program in treatment of nonspecific low back pain. //J. Phys Ther Sci. 2014; 26(8):1185–88. 24. Koleva Y. and Yoshinov R. Paravertebral and radicular pain: Drug and/or physical analgesia. //Annals of physical and rehabilitation medicine, 2011, 54, e42. 25. Lawrence R. Robinson M.D. Trauma Rehabilitation. – 2005. – 300 rub. 26. McNicol E.D., Midbari A., Eisenberg E. Opioids for neuropathic pain. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006146. DOI: 10.1002/14651858.CD006146.pub2. 27. Michael A. Überall, Gerhard H.H. Mueller-Schwefe, and Bernd Terhaag. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study October 2012, Vol. 28, No. 10, Pages 1617-1634 (doi:10.1185/03007995.2012.726216). 28. Moore R.A., Chi CC, Wiffen P.J., Derry S., Rice ASC. Oral nonsteroidal anti-inflammatory drugs for neuropathic pain. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD010902. DOI: 10.1002/14651858.CD010902.pub2. 29. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tension. Results of a postmarket surveillance study].//Fortschr Med Orig. 2003;121(1):11-8. German. 30. Neuropathic pain – pharmacological management. The pharmacological management of neuropathic pain in adults in non-specialist settings. NICE clinical guideline 173. Issued: November 2013. Updated: February 2017. http://guidance.nice.org.uk/CG173 31. Pena Costa, S. Silva Parreira. Kinesiotaping in Clinical practice (Systematic review). - 2014. – 210p. 32. Rossignol M., Arsenault B., Dione C. et al. Clinic in low back pain in interdisciplinary practice guidelines. – Direction de santé publique. Montreal: Agence de la santé et des services sociaux de Montreal. – 2007. - P.47. 33. Schechtmann G., Lind G., Winter J., Meyerson BA and Linderoth B. Intrathecal clonidine and baclofen enhance the pain-relieving effect of spinal cord stimulation: a comparative placebo-controlled, randomized trial. //Neurosurgery, 2010, 67(1), 173.

Information

ORGANIZATIONAL ASPECTS OF THE PROTOCOL

List of protocol developers with qualification information:
1) Tokzhan Tokhtarovna Kispaeva - Doctor of Medical Sciences, neuropathologist of the highest category of the RSE at the National Center for Occupational Health and Occupational Diseases;
2) Aigul Serikovna Kudaibergenova - Candidate of Medical Sciences, neuropathologist of the highest category, Deputy Director of the Republican Coordination Center for Stroke Problems of JSC National Center for Neurosurgery;
3) Smagulova Gaziza Azhmagievna - Candidate of Medical Sciences, Associate Professor, Head of the Department of Propaedeutics of Internal Diseases and Clinical Pharmacology of the West Kazakhstan State Medical University named after Marat Ospanov.

Disclosure of no conflict of interest: No.

Reviewer:
Baymukhanov Rinad Maratovich - Associate Professor of the Department of Neurosurgery and Neurology of the FNPR RSE at the Karaganda State Medical University, a doctor of the highest category.

Specifying the conditions for reviewing the protocol: review of the protocol 5 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

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As a rule, this pathology is the first and most common sign of cervical osteochondrosis.

What is cervicalgia syndrome?

This pathology is included in the category of the most common diseases of modern people.

If you have been prescribed the medicine Allopurinol, the instructions for use are required to be studied, since the medicine has many side effects. What can cause spastic torticollis in adults and children and methods of treating the disease.

Classification of pathology

Currently, it is customary to distinguish two main types of cervicalgia:

1. Vertebrogenic. It is associated with disorders in the cervical spine and is a consequence of spondylosis, intervertebral hernia, rheumatoid arthritis and other inflammatory processes.
2. Vertebral. This form of the disease develops as a result of muscle or ligament sprains, myositis, and occipital neuralgia. Sometimes this pathology has a psychogenic origin. It can be a consequence of epidural abscess, meningitis, subarachnoid hemorrhage.

Vertebrogenic cervicalgia

Neck pain or vertebrogenic cervicalgia

Vertebrogenic cervicalgia is neck pain accompanied by limited muscle mobility and, often, autonomic dysfunction. The disease is caused by

In turn, the vertebrogenic form is divided into several types:

1. Spondylogenic – is a consequence of irritation of the nerve roots. The result is pain that is difficult to eliminate. Typically, this type of cervicalgia occurs in case of damage to bone structures as a result of osteoma, radiculopathy, or osteomyelitis.
2. Discogenic - develops in the case of degenerative processes occurring in the cartilage tissue of the spine. This form of pathology most often becomes a consequence of osteochondrosis, intervertebral hernia, etc. It is accompanied by persistent pain and sometimes requires surgical intervention.

However, pain in the neck area is not always the result of a serious spinal disease.

Typically, cervicalgia occurs as a result of high stress on the spine and muscles. That is why the disease, depending on the characteristics of its course, can be:

• acute - it is characterized by severe pain when turning the neck, moving, tilting the head;
• chronic - may be accompanied by various pain sensations that radiate to the back of the head and upper limbs.

Causes of the syndrome

Discomfort in the neck area appears due to irritation of the nerve fibers that are located in this area.

A hernial protrusion gradually forms, which irritates first the longitudinal ligament, and then the roots of the spinal nerves.

However, osteochondrosis is not the only disease that leads to the appearance of the disease. The development of pain in the neck area can be caused by the following pathologies:

• tumor formations;
• autoimmune pathologies - in particular, ankylosing spondylitis;
• infectious diseases – retropharyngeal abscess, epiglottitis;
• spondylosis – degenerative arthritis and osteophytosis;
• stenosis – narrowing of the spinal canal;
• disc herniation - protrusion or protrusion of the disc;
• mental disorders.

The cause of pain can be hidden in any of the structures in the neck area, including blood vessels, nerves, digestive organs, respiratory tract, and muscles.

In addition, cervicalgia can be a consequence of the following factors:

• pinched nerve;
• stressful situations;
• prolonged stay in an uncomfortable position;
• uncomfortable head position during sleep;
• minor traumatic injuries;
• hypothermia.

Symptoms and signs

Pain in the neck area can be shooting, throbbing, or tingling. Even slight movement, physical stress or a normal cough can lead to exacerbations. The following symptoms are usually characteristic:

• dizziness;
• numbness in the back of the head or upper extremities;
• noise in ears;
• pain in the back of the head.

Cervicalgia with muscular-tonic syndrome also occurs. This condition is characterized by soreness and tension in the neck muscles, as well as limited mobility.

Diagnostic methods

To diagnose cervicalgia, the following examinations are usually performed:

1. Radiography. Although this test can only look at bone tissue, it can help identify the causes of neck pain. The image will show damaged joints, broken bones, and age-related changes.
2. Magnetic resonance imaging. This study allows you to assess the condition of soft tissues - nerves, muscles, ligaments, intervertebral discs. MRI can detect tumors, infectious lesions, and hernias.
3. Electromyelography and nerve conduction velocity analysis. These studies are carried out in cases of suspected dysfunction of the spinal cord. Typically indications are weakness and numbness of the hands.

How to treat the manifestation of the syndrome?

To eliminate the manifestations of the disease, the approach to treating the disease must be comprehensive.

Typically, therapy includes medications, therapeutic exercises, and physiotherapy. Sometimes there is a need for surgical intervention.

The main goals of treatment are as follows:

• increased mobility of the cervical spine;
• elimination of pain;
• releasing a jammed spine;
• preventing the progression of cervical osteochondrosis;
• muscle strengthening.

For pain relief, non-steroidal anti-inflammatory drugs are usually used - paracetamol, ibuprofen, nimesulide.

This therapy should not last very long as it can lead to problems with the digestive organs. In especially severe cases, the use of muscle relaxants is indicated - Baclofen, Tolperisone, Cyclobenzaprine.

If there is severe muscle tension, local anesthetics - novocaine or procaine - can be prescribed.

In some cases, a cervical collar should be used - it should be worn for 1-3 weeks. To reduce pain, traction treatment may be prescribed, which involves stretching the spine.

Therapeutic gymnastics is of no small importance for the successful treatment of cervicalgia. Also, many patients are prescribed physiotherapeutic procedures - massage, compresses, mud baths.

Surgery

In some cases, there is a need for surgical treatment of the pathology. Indications for the operation are the following:

• acute and subacute lesions of the cervical spinal cord, which are accompanied by sensory disturbances, pelvic pathologies, and central paresis;
• an increase in paresis in the area of ​​innervation of the spinal root in the presence of a danger of its necrosis.

The main methods of surgical treatment in this case include the following:

Preventive measures

To prevent the onset of the disease, you should be very careful about the condition of your spine. To keep it healthy, you must follow these rules:

1. When working sedentarily, it is necessary to take breaks. It is very important to properly equip your workplace.
2. Do not jerk heavy objects.
3. The bed should be quite hard, in addition, it is advisable to choose an orthopedic pillow.
4. It is very important to eat properly and balanced. If you have excess weight, you need to get rid of it.
5. To strengthen your muscle corset, you should play sports. It is especially important to train the muscles of the back and neck.

Cervicalgia is a fairly serious pathology, which is accompanied by severe pain in the neck area and significantly worsens a person’s quality of life.

To prevent its development, you need to exercise, eat a balanced diet, and properly organize your work and rest schedule. If signs of the disease still appear, you should immediately consult a doctor.

Thanks to adequate and timely treatment, you can quickly get rid of the disease.

Dorsopathies (classification and diagnosis)

Anatoly Ivanovich Fedin

The term “dorsopathies” refers to pain syndromes in the trunk and extremities of non-visceral etiology and associated with degenerative diseases of the spine. Thus, the term “dorsopathies” in accordance with ICD-10 should replace the term “spinal osteochondrosis”, which is still used in our country.

M40 Kyphosis and lordosis (spinal osteochondrosis excluded)

M41.1 Juvenile idiopathic scoliosis

M41.4 Neuromuscular scoliosis (due to cerebral palsy, poliomyelitis and other diseases of the nervous system)

M42 Osteochondrosis of the spine M42.0 Youthful osteochondrosis of the spine (Scheuermann's disease)

M42.1 Osteochondrosis of the spine in adults

M43 Other deforming dorsopathies

M43.4 Habitual atlantoaxial subluxations.

As you can see, this section of the classification contains various deformations associated with pathological alignment and curvature of the spine, disc degeneration without protrusion or herniation, spondylolisthesis (displacement of one of the vertebrae relative to the other in its anterior or posterior version) or subluxations in the joints between the first and second cervical vertebrae. In Fig. Figure 1 shows the structure of the intervertebral disc, consisting of the nucleus pulposus and the fibrous ring. In Fig. Figure 2 shows a severe degree of osteochondrosis of the cervical intervertebral discs with their degenerative lesions.

Rice. 1. The structure of the intervertebral disc (according to H. Luschka, 1858).

Rice. 2. Severe degeneration of cervical intervertebral discs (according to H. Luschka, 1858).

Rice. 3. MRI for osteochondrosis of intervertebral discs (arrows indicate degeneratively changed discs).

Rice. 4. Idiopathic scoliosis of the spine.

Rice. 5. Spinal motion segment at the thoracic level.

Rice. 6. Cervical dorsopathy.

With degeneration, spondylosis with compression syndrome of the anterior spinal or vertebral artery (M47.0), with myelopathy (M47.1), with radiculopathy (M47.2), without myelopathy and radiculopathy (M47.8) are distinguished. The diagnosis is established using radiation diagnostics. In Fig. Figure 6 shows the most characteristic changes on a spondylogram with spondylosis.

Rice. 7. X-ray computed tomography (CT) for lumbar dorsopathy, arthrosis of the left facet (facet) joint of the L5–S1 spine.

Rice. 9.Stenosis of the intervertebral foramen with compression of the L5 root

M50 Degeneration of intervertebral discs of the cervical spine (with pain)

M51.4 Schmorl's nodes [hernia]

When formulating diagnoses, one should avoid terms that frighten patients such as “disc herniation” (it can be replaced with the term “disc displacement”, “disc damage” (synonymous with “disc degeneration”). This is especially important in patients with a hypochondriacal personality and anxiety-depressive conditions In these cases, a carelessly spoken word by a doctor can be the cause of long-term iatrogenicity.

Rice. 10.Topography of the spinal canal and protrusion of the intervertebral disc.

Rice. 11.Options for displacement of intervertebral discs.

Rice. 12.Morphology and radiation diagnostic methods for displaced intervertebral disc.

The section “other dorsopathies” in heading M53 includes sympathalgic syndromes associated with irritation of the afferent sympathetic nerve during posterolateral displacement of the cervical disc or spondylosis. In Fig. Figure 14 shows the peripheral cervical nervous system (plexus of the somatic nervous system, cervical ganglia of the sympathetic nervous system and its postganglionic fibers located in the soft tissues of the neck and along the carotid and vertebral arteries. In Fig. 14a

Rice. 13.MRI for Schmorl's hernia.

Rice. 14.Cervical sympathetic nerves.

Cervicocranial syndrome (M53.0) corresponds to the widely used term “posterior cervical sympathetic syndrome” in our country, the main clinical manifestations of which are repercussive (widespread) sympathalgia with cervicocranialgia, orbital pain and cardialgia. With spasm of the vertebral artery there may be signs of vertebrobasilar ischemia. With anterior cervical sympathetic syndrome, patients experience a violation of the sympathetic innervation of the eyeball with Horner's syndrome, often partial.

M54.1 Radiculopathy (brachial, lumbar, lumbosacral, thoracic, unspecified)

M54.4 Lumbodynia with sciatica

M54.8 Other dorsalgia

Rice. 15. Innervation of soft tissues of the spine.

Rice. 16. Fascia and muscles of the lumbar region.

4 comments

“Dorsopathy” is not a PAIN SYNDROME itself (as follows from the definition given at the beginning of the article), but a GROUP OF DISEASES of the musculoskeletal system and connective tissue, the leading symptom complex of which is pain in the trunk and extremities of non-visceral etiology.

neurologist, Kyiv

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Structure of vertebroneurological diagnosis

Vertebrogenic (spondylogenic) dorsalgia associated with the pathology of the lumbar spine (degenerative, traumatic, inflammatory, neoplastic and other nature);

Nonvertebrogenic dorsalgia caused by sprained ligaments and muscles, myofascial syndrome, fibromyalgia, somatic diseases, psychogenic factors, etc.

Cervicalgia – neck pain;

Cervicobrachialgia – pain in the neck spreading to the arm;

Thoracalgia – pain in the thoracic back and chest;

Lumbodynia – pain in the lower back or lumbosacral region;

Lumboischialgia – lower back pain spreading to the leg;

Sacralgia – pain in the sacral region;

Coccydynia - pain in the tailbone.

Local vertebral syndrome, often accompanied by local pain syndrome (cervicalgia, thoracalgia, lumbodynia), tension and soreness of adjacent muscles. pain, deformity, limited mobility or instability of one or more adjacent segments of the spine;

Remote vertebral syndrome; the spine is a single kinmatic chain, and dysfunction of one segment can, through a change in the motor stereotype, lead to deformation, pathological fixation, instability or other change in the state of the upper or lower sections;

Reflex (irritative) syndromes: referred pain (for example, cervicobrachialgia, cervicocranialgia, lumboischialgia, etc.), muscular-tonic syndromes, neurodystrophic manifestations, repercussion autonomic (vasomotor, sudomotor) disorders with a wide range of secondary manifestations (enthesiopathy, periarthropathy, myofascial syndrome, tunnel syndromes, etc.);

Compression (compression-ischemic) radicular syndromes: mono-, bi-, multi-radicular, including cauda equina compression syndrome (due to herniated intervertebral discs, stenosis of the spinal canal or intervertebral foramen or other factors);

Syndromes of compression (ischemia) of the spinal cord (due to herniated discs, stenosis of the spinal canal or intervertebral foramen or other factors).

Course of the disease: acute, subacute, chronic (remitting, progressive, stationary, regressive);

Phase: exacerbation (acute), regression, remission (complete, partial);

Frequency of exacerbations: frequent (4-5 times a year), moderate frequency (2-3 times a year), rare (no more than 1 time a year);

Severity of pain syndrome: mild (not interfering with the patient’s daily activities), moderately expressed (limiting the patient’s daily activities), severe (severely complicating the patient’s daily activities), severe (making the patient’s daily activities impossible);

State of mobility of the spine (mild, moderate, severe limitation of mobility);

Localization and severity of motor, sensory, pelvic and other neurological disorders.

examples of formulations and diagnoses

ICD-10: M54 - Dorsalgia

Chain in classification:

5 M54 Dorsalgia

Diagnosis with code M54 includes 9 clarifying diagnoses (ICD-10 subheadings):

Excludes: cervicalgia due to intervertebral disc damage (M50.-).

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Sciatica is a pain syndrome that occurs in the gluteal region due to inflammation, compression or other types of damage to the sciatic nerve. In addition to pain in the gluteal region, discomfort can spread along the sciatic nerve:

• back of the thigh;
• shin;
• foot.

According to the International Classification of Diseases (ICD-10), this disease refers to diseases of the musculoskeletal system and connective tissue. The exact disease code is M54.3.

Separately, it is worth mentioning vertebrogenic sciatica, which is associated with damage to the lumbosacral spine. In this case, the pain may spread to one or two legs at once. Therefore, a separate ICD-10 code is provided for vertebrogenic sciatica - M54.4.

This disease does not occur on its own. Most often, the symptoms of sciatica appear as a result of complications of other diseases:

• osteochondrosis;
• intervertebral hernia;
• as a manifestation of tunnel syndromes (piriformis syndrome);
• systemic connective tissue diseases;
• nephritis and kidney failure;
• scoliosis;
• oncological diseases;
• infectious diseases (tuberculosis, typhoid fever, malaria, syphilis, influenza);
• diabetes mellitus;
• constipation

In some cases, symptoms may occur due to injuries, hypothermia, pregnancy, alcohol intoxication, prolonged sitting or lying down. Thus, this disease can be classified as a consequence of other diseases or external influences. Depending on the level of damage to the sciatic nerve, the following types of sciatica are distinguished:

• lower (inflammation of the trunk of the sciatic nerve and its branches occurs);
• medium (damage at the level of the nerve plexus);
• upper (inflammation of nerve cords and roots).

Symptoms

The main symptom of this disease is pain that occurs in the buttocks and then “descends” to the leg. The nature of the pain may vary from sharp to dull, and a burning sensation may occur. With vertebrogenic sciatica, the described pain is preceded by a feeling of “lumbago” in the lower back. Then the unpleasant sensations descend along the sciatic nerve. In addition to pain, sensory disturbances, paresthesia, loss of reflexes and motor disorders in the corresponding lower limb are detected.

In addition to the main signs, there are additional symptoms of the disease:

• pelvic muscle tension;
• increased sweating;
• anxiety, depressed state.

Symptoms of fecal and urinary incontinence (vertebrogenic sciatica) are quite rare.

The diagnosis is made on the basis of subjective and objective examination methods. The first step is to interview and examine the patient, and then follow additional examination methods.

Subjective methods

The nature of the pain is determined, how often they occur and in what place. Particular attention is paid to irradiation (where the pain is sent). The presence of spinal diseases or injuries must be clarified. This approach allows you to determine a possible diagnosis in order to prescribe further examination and treatment.

The doctor also asks about the nature of work and life. Since sciatica can occur as a result of prolonged compression of the sciatic nerve, this is of considerable importance in diagnosis. Methods of pain relief are being clarified. That is, does the patient do any exercises, use medication, or just simply rub the sore spot.

Objective methods

An accurate diagnosis according to ICD-10 requires an examination and additional examination methods. During the examination, the doctor evaluates the sensitivity, strength and safety of reflexes. In addition, when pressing, the presence and nature of pain is clarified. To rule out injury, an x-ray examination is necessary. If symptoms persist for six weeks, additional methods are used and carried out in a specific order.

1. CT and MRI. Structural abnormalities (eg, spinal stenosis) are detected. Less commonly, radiography.
2. Electromyography.
3. General (clinical) blood test.
4. General urine analysis.

Only after the examination is a diagnosis of M54.3 or M54.4 (according to ICD-10) made and appropriate treatment prescribed.

Treatment

If the symptoms described above occur, you should contact a neurologist or vertebrologist as soon as possible. The doctor will conduct an examination and prescribe treatment, which is aimed at:

• to reduce and eliminate pain;
• to eliminate inflammation;
• to normalize muscle tone;
• to restore a normal lifestyle.

Sources:

1. Celecoxib, etoricoxib, meloxicam and nimesulide: advantages and disadvantages. D.M.Sc. A.E. Karateev. “EF. Rheumatology. Traumatology. Orthopedics." »» 1/2011

1. Sciatic nerve neuropathy. Piriformis syndrome. M.V. Putilin. Journal of the Attending Physician, 02/06;
2. Diclofenac in the treatment of pain syndromes. A.B. Danilov, Journal Attending Physician, 05/09.

Sciatica is a disease that is accompanied by damage to the sciatic nerve or other nerve roots in the lumbar region. Sciatica is manifested by severe pain in the thigh, buttock, discomfort extends to the lower extremities. As the disease progresses, the symptoms of sciatica are supplemented by lumbago (lumbago in the lower back, acute pain appears suddenly with compression of the nerve roots), hence the name of the pathological process - lumboischialgia.

The disease requires careful study, given that several unpleasant symptoms appear simultaneously. Lack of treatment leads to patient disability and loss of performance. It is important to consult a doctor at the first signs of pathology and begin adequate therapy.

Reasons for appearance

The sciatic nerve is the largest and longest in the human body. It originates in the lumbar region, its path lies through the buttock, thigh, and reaches the feet. Pinching is formed against the background of many pathologies (irritation, traumatic injuries in the lumbar region). The pain intensifies in cases where the muscles in the damaged area become tense, the nutrition of the muscle tissue is disrupted, and nodules form.

The disease is often disguised as lumbar radiculitis (and pinched nerve roots due to inflammatory processes), which leads to improper treatment and progression of the disease. Lumbago with sciatica is often diagnosed in men after 30 years of age, which is associated with the presence of addictions and sedentary work in this group of people.

Lumbago with sciatica appears against the background of the following negative factors:

• spine, presence of complications (,);
• arthrosis of intervertebral discs;
• spondylitis;
• congenital anomalies of the structure of the spine;
• abscesses, tumor formations in the lumbar area;
• diseases of internal organs;
• ailments accompanied by circulatory disorders;
• rheumatism;
• severe infectious pathologies, which are characterized by damage to nerve endings;
• systemic connective tissue diseases.

Several reasons aggravate the situation:

• sedentary lifestyle, lack of regular physical activity, which leads to weakening of the muscle corset;
• the course of pregnancy (bearing several fetuses at the same time is especially negatively affected);
• stress;
• posture disorders;
• hypothermia;
• excessive physical activity (applies to professional athletes, people doing hard physical work).

It is important to find out the cause of lumbago with sciatica and eliminate the negative factor.

Classification

Lumboischialgia is divided into several types, each characterized by specific clinical manifestations:

• muscular-tonic. The nerve root becomes irritated by the surrounding structures. This state of affairs leads to muscle tension, which causes compression of the sciatic nerve. The causes of the pathological process are undeveloped muscles, diseases of the gastrointestinal tract, hip joints;
• neurodystrophic. It is a kind of continuation of the above-described form. The pathology is characterized by a change in the color of the epidermis, in some cases the appearance of ulcers is observed;
• vegetative-vascular. It manifests itself as acute attacks of pain in both legs, discomfort intensifies during changes in body position, and during hypothermia.

Often, lumboischialgia includes symptoms of several forms (mixed type of disease). According to the nature of the course of the disease, acute and chronic forms of lumbago with sciatica are distinguished.

Characteristic signs and symptoms

The presence of lumboischialgia can be suspected based on several specific clinical signs:

• pain gradually appears in the lumbar region of varying severity (pulsating, sharp, burning);
• discomfort spreads to one or two limbs, affecting the buttock, thigh, reaching the feet and toes;
• area of ​​localization of pain - near the skin, inside the lower extremities discomfort is rarely felt;
• patients note limited mobility of the lower half of the body, itching along the sciatic nerve;
• the epidermis becomes pale;
• when trying to change body position, discomfort in the lower back increases;
• in the absence of treatment, there is a loss of control over the act of urination and defecation. In advanced cases, the patient becomes disabled.

Note! The duration of a painful attack is individual in each case. Discomfort may be felt for several minutes or a day, it all depends on the degree of damage to the sciatic nerve.

Diagnostics

If lumboischialgia is suspected, the patient is examined by a neurologist and prescribes a number of special studies that can reveal pathology and the degree of damage to the nerve roots.

Research:

• X-ray. Allows you to assess the condition of the spine, determine the area of ​​localization of the pathological process;
• MRI, CT. The methods are designed to study not only bone tissue, but also to assess the condition of nearby vessels, soft tissues, and nerve endings;
• Ultrasound of the abdominal and pelvic cavity (to exclude diseases of the internal organs in these areas);
• blood test, urine test, densitometry (intended to assess the condition of the body as a whole, identify infections and other lesions).

Based on the data obtained, the doctor chooses therapy and gives a lot of useful advice on changing the rhythm of life and following preventive recommendations.

Effective treatments

On the page, find out what absolute lumbar spinal stenosis is and how to treat the disease.

Folk remedies and recipes

Natural remedies have a positive effect on the patient’s well-being, trigger tissue regeneration, and relieve pain:

• rub the affected area with badger fat, wrap it in cellophane, leave for several hours;
• apply warming patches to the lumbar region;
• take baths with a decoction of pine and pine needles (200 grams of raw materials per liter of boiling water).

Pain in the lumbar region always indicates a pathological process. It is important to find out the root cause, visit a doctor in a timely manner for diagnosis, and prescribe the correct therapy.

Preventive recommendations from leading experts will help prevent the appearance of lumbago with sciatica:

• Avoid staying in one position for a long time. If this is not possible, then take regular breaks and do light exercises;
• wear heels no higher than 4 cm, give preference to comfortable shoes;
• normalize your weight, include foods rich in nutrients in your diet;
• get rid of bad habits, try to play sports several times a week (a strong muscle corset is the key to successful recovery and excellent well-being);
• Treat pathologies associated with joints and blood vessels in a timely manner.

It's easy to follow these rules. Remember: Your health, even your life, is at stake. Considering the danger of disability and constant discomfort, when the first signs of lumbar sciatica appear, consult a specialist.

A doctor of the highest category talks in more detail about what lumbago with sciatica is in the following video:

Under such an unpronounceable name as vertebrogenic lumboischialgia, there is a very common problem - pain in the lumbosacral spine. The pain radiates to the buttocks and back of the legs. In rare cases, it even reaches the fingers.

The common ICD-10 code is M54.4. Additional numbers can be used by doctors to clarify the patient's condition.

Pain in the back, called dorsalgia in international practice, manifests itself in various ailments of the musculoskeletal system. Many people are beginning to notice similar signs, especially males over 40 years of age. Often, a doctor cannot correctly diagnose a combination of diseases such as lumbago and sciatica, and this leads to incorrect treatment.

Sciatica is a disease that affects the sciatic nerve or nerve endings located close to the sacral spine. A sick person experiences significant pain in the hip area, extending to the ankle.

Gradually, lumbago is added to progressive sciatica. This disease is characterized by lumbago - acute attacks with pain that begin with even minor irritation of the nerve endings. This condition requires accurate diagnosis, since it can be caused by completely different pathological processes. They should be identified and treated.

Vertebrogenic lumboischialgia is a syndrome manifested by severe pain. It can affect either one of the parties or both parties at the same time. Pain varies in nature and intensity. It can be caused by some visible factors, and sometimes it can be spontaneous, appearing for no apparent reason.

Often the pain flares up only on the right or left, that is, on one side. Gradually spreads into the buttock and leg. A person has great difficulty straightening his limb. He tries to take care of it, tries not to step on the foot completely. As a result, he begins to limp. Even while standing, the patient does not find the opportunity to put his leg in such a position that it does not experience any load.

Causes and symptoms of the disease

Vertebrogenic lumboischialgia usually begins for the following reasons:

• osteochondrosis in the progression stage, hernias, osteophytes;
• intervertebral arthrosis;
• osteoporosis, vertebral scoliosis;
• congenital problems with the vertebrae;
• tumors in the lumbar region;
• tumors of internal organs;
• problems with blood circulation in the lumbar region;
• muscle lesions;
• lumbar injuries, including after incorrectly performed injections;
• rheumatoid tissue diseases;
• infections leading to damage to nerve trunks.

Causes such as age, obesity, multiple pregnancies, constant stress, incorrect posture, heavy physical labor, and frequent hypothermia also contribute to the onset of the disease.

In addition to pain, the following symptoms may occur with the disease:

• increased temperature - not in all patients;
• itching of the skin in the area of ​​the affected nerve;
• paleness of the skin and its coldness;
• in particularly severe cases, a person is unable to control urination and bowel movements.

An attack of lumboischialgia on the right or left (or on both sides) can last from a minute to a much longer time - more than a day. The attack may recur on the same day, or may not make itself felt for several months.

What treatment methods are used to combat the disease?

The doctor diagnoses the patient with lumboischialgia according to the international classification based on the following studies:

• X-ray of the spine;
• MRI and CT of the spinal column, if necessary, blood vessels and joints;
• Ultrasound of the peritoneum;
• blood tests for possible infectious and autoimmune diseases.

Vertebrogenic lumboischialgia is treated comprehensively. This includes the use of medications, physiotherapeutic procedures, physical therapy, and the use of orthopedic devices. During the acute period, the doctor tries to ease the pain. The patient needs bed rest. He takes nonsteroidal anti-inflammatory drugs, various analgesics, and muscle relaxants. Physiotherapeutic procedures are carried out, and sometimes reflexology is used. Once the acute phase passes, the task of restoring the back muscles appears. During this period, therapeutic exercises and massage begin. The patient is recommended to be treated by a chiropractor.

For patients with the chronic form, an individual treatment regimen is selected. Dangerous diseases such as tumors and infections must be excluded. In this case, physical activity increases, non-drug methods are used: exercise therapy, weight loss, massage.

Lumboischialgia can also be treated surgically, but very rarely. About 90% of all patients return to health with the help of conservative treatment. Surgery is used, for example, if pain cannot be relieved by therapeutic methods.