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What is lumbar radicular syndrome
Radicular syndrome (radiculopathy or, more simply, “pinched nerve”) is a syndrome of compression of one of the spinal roots L1-S1 by surrounding altered structures, tissues, which is accompanied by severe pain, impaired sensitivity, numbness or muscle weakness.
Radiculopathy can occur in any part of the spine, but the most common is the lumbar – that is, radicular syndrome of the lumbar spine. The disease is quite common, it occurs both in men (more often at the age of 40 years) and in women (more often at the age of 50-60 years).
Causes of lumbar radicular syndrome in adults
The cause of the development of radicular syndrome of the lumbar spine in adults can be spinal injuries, as well as a number of diseases in which the nerve roots are compressed:
- herniated disc;
- compression fractures and displacement of the vertebral bodies;
- spondylarthrosis;
- spondylolisthesis;
- tumor, metastases in the spine;
- infectious lesions of the vertebrae due to tuberculosis or osteomyelitis;
- compression of the spinal roots by osteophytes (bone “thorns”, “growths” on the vertebrae).
Symptoms of lumbar radicular syndrome in adults
Any “pinching” of the nerve gives a pronounced pain syndrome, which can be accompanied by numbness, burning sensation, tingling, “crawling”, muscle weakness, convulsions, etc. With radicular syndrome, movements in the lumbar spine are very often limited – tilts, turns of the torso, extension in the lower back causes severe pain. Coughing and sneezing in such cases significantly exacerbate the pain.
Most often, intervertebral hernias of the lumbar spine “compress” the L5 root (coming out from under the 5th lumbar vertebra) and the S1 root (coming out of the sacrum through the first sacral foramen).
With inflammation of the L5 root, the pain mainly goes along the lateral surface of the leg, then goes to the front of the lower leg and to the big toe. The L5 root also innervates the muscles that lift the foot, so when it is clamped, not only pain occurs in this area, but also weakness when lifting the foot.
When pinching the S1 root, the pain goes along the back of the thigh and goes to the heel or along the outer part of the foot. The S1 root also innervates the gastrocnemius muscle, so weakness occurs when walking on toes.
In addition, when these roots are “squeezed” in painful areas, numbness may occur or vice versa – increased sensitivity. In this case, the zone of numbness or hypersensitivity will go in a strip along the leg.
Treatment of lumbar radicular syndrome in adults
Treatment for lumbar radiculopathy will depend on the severity of the symptoms and clinical manifestations. Most often, conservative treatment is used, but sometimes surgery is necessary. Indications for it are a disorder of pelvic functions (urinary and fecal incontinence), as well as progressive muscle weakness and persistent pain syndrome that is not amenable to drug therapy.
Diagnostics
Diagnosis of radicular syndrome of the lumbar spine in adults begins with the collection of anamnesis, listening to complaints and examining the patient by a neurologist. If the patient complains of severe lower back pain radiating to the leg, and there is also one or more positive results of a neurological test, then it is very likely that this is a radicular syndrome.
Also, the doctor may prescribe such additional studies, such as radiography (to exclude fractures and displacement of the vertebrae, it also helps to detect degenerative changes in the spine, tumors), MRI (allows you to detect changes in soft tissues, including intervertebral discs, spinal cord and nerve roots) , as well as CT (gives a complete picture of the morphology of the bone structures of the spine).
Modern treatments
As mentioned above, the treatment of radicular syndrome of the lumbar spine in adults is possible with both conservative and surgical methods. At the same time, the size of the hernia that compresses the roots is not at all the factor on which the choice of treatment will depend. Much more important is how the patient feels, how severe the pain syndrome is, whether he can move independently, whether he has a decrease in muscle strength in his legs.
Conservative treatment includes NSAIDs (non-steroidal anti-inflammatory drugs), drugs for neuropathic pain (gabapentinoids in an adequate dose, antidepressants with analgesic activity), maintenance of motor activity (if possible), epidural blocks with short-acting corticosteroids.
In acute pain, you should try to avoid movements in which the pain intensifies: bending, lifting, twisting, and generally keep calm. Sometimes the doctor may advise wearing a special corset to reduce pressure on the roots, facet joints and muscles of the lower back, while keeping in mind that prolonged wearing of the corset can lead to muscle atrophy.
Indications for surgery are considered symptoms such as urinary incontinence, numbness in the perineum, progressive weakness in the leg, pain and weakness in both legs. The absence of positive dynamics within a month after the prescribed treatment or pain that persists for three months after the start of treatment can also be indications for surgery.
Prevention of lumbar radicular syndrome in adults at home
Prevention of lumbar radicular syndrome in adults is quite simple. You need to watch your posture, especially if you spend a lot of time sitting at a computer or driving a car.
It is also necessary to monitor weight in order to eliminate unnecessary stress on the spine, stop smoking, lead an active lifestyle, move more so that the muscles remain elastic and strong. If you play sports, it is better to do it under the supervision of a trainer to avoid injury.