What are the key symptoms of lumbar radiculopathy. How is lumbar radiculopathy diagnosed. What are the most effective treatments for lumbar radiculopathy. Can lumbar radiculopathy be prevented. When should you seek medical attention for lumbar radiculopathy.

Understanding Lumbar Radiculopathy: A Comprehensive Overview

Lumbar radiculopathy is a condition characterized by irritation or inflammation of a nerve root in the lower back. This condition can cause symptoms that radiate from the back down one or both legs. To fully grasp the nature of lumbar radiculopathy, it’s essential to understand the anatomy of the spine and its components.

Key Components of the Lumbar Spine

• Vertebrae: The stacked bones that form the spine, with the lumbar spine containing the five bottom vertebrae.
• Disks: Soft pads of tissue between the vertebrae that act as shock absorbers for the spine.
• Spinal canal: A tunnel formed within the stacked vertebrae through which nerves run in the lumbar spine.
• Nerves: Branch off and leave the spinal canal, traveling out to various parts of the body.
• Nerve root: The part of the nerve closest to the spinal canal.
• Sciatic nerve: A large nerve formed from several nerve roots in the low back, extending down the back of the leg to the foot.

In lumbar radiculopathy, the nerve roots in the lower back become irritated, leading to pain and other symptoms. When the sciatic nerve is involved, the condition is often referred to as sciatica.

Common Causes and Risk Factors of Lumbar Radiculopathy

Various factors can contribute to the development of lumbar radiculopathy. Understanding these causes can help in prevention and management of the condition.

Primary Causes of Lumbar Radiculopathy

• Disk damage in the lumbar spine, which may press on nearby nerve roots
• Degeneration from wear and tear and aging, leading to stenosis (narrowing of the openings between vertebrae)
• Unstable spine, where a vertebra slips forward and presses on a nerve root
• Less common causes such as diabetes, infection, or tumors

Risk Factors

Are certain individuals more prone to developing lumbar radiculopathy? Indeed, several factors can increase one’s risk:

• Age: As we get older, the spine naturally undergoes wear and tear
• Occupation: Jobs involving heavy lifting or prolonged sitting
• Obesity: Excess weight puts additional stress on the spine
• Genetics: Some people may be predisposed to spinal problems
• Smoking: Reduces blood flow to the spine and can accelerate degeneration

Recognizing the Symptoms of Lumbar Radiculopathy

Identifying the symptoms of lumbar radiculopathy is crucial for early diagnosis and treatment. The manifestation of symptoms can vary from person to person, but there are some common signs to watch out for.

Primary Symptoms

• Pain in the lower back
• Pain, numbness, tingling, or muscle weakness that radiates into the buttocks, hip, groin, or leg
• Muscle spasms

Is the pain associated with lumbar radiculopathy constant? The pain can vary in intensity and may be exacerbated by certain movements or positions. Some individuals experience intermittent pain, while others may have persistent discomfort.

Additional Symptoms

Beyond the primary symptoms, some individuals with lumbar radiculopathy may experience:

• Difficulty walking or standing for extended periods
• Increased pain when coughing, sneezing, or straining
• Weakness in the affected leg
• Changes in reflexes in the legs

Diagnosis and Assessment of Lumbar Radiculopathy

Accurate diagnosis of lumbar radiculopathy is essential for effective treatment. Healthcare providers use a combination of methods to assess the condition and determine its severity.

Diagnostic Procedures

1. Medical history review: The healthcare provider will inquire about symptoms, their onset, and any factors that worsen or alleviate the pain.
2. Physical examination: This may include tests to assess muscle strength, reflexes, and sensation in the affected areas.
3. Imaging tests: X-rays, MRI, or CT scans may be used to visualize the spine and identify any abnormalities.
4. Electromyography (EMG): This test measures electrical activity in muscles and can help determine which nerves are affected.
5. Nerve conduction studies: These tests assess how well electrical signals travel along the nerves.

How long does it typically take to diagnose lumbar radiculopathy? The diagnosis process can vary depending on the complexity of the case and the tests required. In some instances, a diagnosis can be made during the initial consultation, while in others, it may take several appointments and additional tests to confirm the condition.

Effective Treatment Approaches for Lumbar Radiculopathy

Treatment for lumbar radiculopathy aims to relieve symptoms and address the underlying cause. The approach may vary based on the severity of the condition and individual patient factors.

Conservative Treatment Options

• Pain management: Prescription and over-the-counter pain medicines to relieve pain, swelling, and irritation
• Activity modification: Limiting positions and activities that increase pain, while avoiding prolonged bed rest
• Physical therapy: Exercises and stretches to decrease pain and increase movement and function
• Steroid injections: Administered into the lower back to provide temporary relief
• Weight management: For overweight individuals, losing extra pounds may help alleviate symptoms

Advanced Treatment Options

In cases where conservative treatments are ineffective, more advanced options may be considered:

• Minimally invasive procedures: Such as epidural steroid injections or nerve blocks
• Surgery: In severe cases or when other treatments have failed, surgical intervention may be necessary to address the underlying cause
• Spinal cord stimulation: A device that sends electrical pulses to the spinal cord to mask pain signals

What is the success rate of treatment for lumbar radiculopathy? The success rate varies depending on the treatment approach and individual factors. Many patients experience significant improvement with conservative treatments, while others may require more advanced interventions. It’s important to work closely with a healthcare provider to determine the most appropriate treatment plan.

Prevention Strategies and Lifestyle Modifications

While not all cases of lumbar radiculopathy can be prevented, certain strategies and lifestyle changes can help reduce the risk of developing the condition or experiencing recurrent symptoms.

Preventive Measures

• Maintaining good posture: Proper alignment of the spine can reduce stress on the lower back
• Regular exercise: Strengthening core muscles and maintaining flexibility can support the spine
• Ergonomic adjustments: Ensuring proper workplace ergonomics, especially for those with desk jobs
• Healthy weight management: Maintaining a healthy weight reduces stress on the spine
• Smoking cessation: Quitting smoking can improve overall spine health

Lifestyle Modifications

Incorporating certain habits into daily life can contribute to long-term spine health:

• Proper lifting techniques: Bending at the knees and using leg muscles when lifting heavy objects
• Regular stretching: Incorporating stretching exercises into daily routines
• Stress management: Chronic stress can contribute to muscle tension and exacerbate pain
• Adequate sleep: Ensuring proper sleep hygiene and using supportive mattresses and pillows
• Balanced nutrition: A diet rich in anti-inflammatory foods may help reduce inflammation in the body

Can lifestyle changes alone prevent lumbar radiculopathy? While lifestyle modifications can significantly reduce the risk of developing lumbar radiculopathy, they may not completely prevent it in all cases. However, these changes can contribute to overall spine health and may help manage symptoms if they do occur.

When to Seek Medical Attention for Lumbar Radiculopathy

Recognizing when to consult a healthcare provider is crucial for proper management of lumbar radiculopathy. Certain symptoms warrant immediate medical attention to prevent potential complications.

Red Flag Symptoms

Seek immediate medical care if you experience any of the following:

• Sudden onset of severe back pain
• New or worsening weakness, tingling, or numbness in the leg or foot
• Loss of bladder or bowel control
• Unexplained weight loss or fever accompanying back pain
• Pain that worsens despite conservative treatment

Monitoring and Follow-up

Even if symptoms are not severe, it’s important to monitor your condition and maintain regular follow-ups with your healthcare provider. This allows for adjustments to your treatment plan as needed and helps prevent potential complications.

How often should you follow up with your healthcare provider for lumbar radiculopathy? The frequency of follow-up appointments depends on the severity of your condition and the treatment plan. Initially, you may need more frequent visits, which can be reduced as symptoms improve. Always consult with your healthcare provider to determine the appropriate follow-up schedule for your specific case.

Living with Lumbar Radiculopathy: Coping Strategies and Support

Managing lumbar radiculopathy extends beyond medical treatments. Developing effective coping strategies and seeking appropriate support can significantly improve quality of life for those living with this condition.

Coping Strategies

• Pain management techniques: Such as relaxation exercises, meditation, or mindfulness practices
• Adaptive equipment: Using tools like back supports or ergonomic chairs to reduce strain
• Activity pacing: Balancing periods of activity with rest to avoid overexertion
• Heat and cold therapy: Applying heat or cold packs to alleviate pain and reduce inflammation
• Alternative therapies: Some individuals find relief through acupuncture, massage, or chiropractic care

Support Systems

Building a strong support system can be invaluable for individuals dealing with lumbar radiculopathy:

• Support groups: Connecting with others who have similar experiences
• Family and friends: Educating loved ones about the condition and how they can help
• Mental health support: Addressing the emotional impact of chronic pain through counseling or therapy
• Occupational therapy: Learning techniques to perform daily activities with less pain and strain
• Patient education programs: Participating in programs that provide in-depth information about managing the condition

How can family members best support someone with lumbar radiculopathy? Family members can offer both emotional and practical support. This may include helping with tasks that exacerbate symptoms, accompanying the individual to medical appointments, and providing understanding and encouragement throughout the treatment process. Open communication about needs and limitations is key to effective support.

Lumbar Radiculopathy – Symptoms, Causes and Treatments

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To schedule an appointment, please call the UC Health Neuromuscular team at 513-475-8730.

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More about these conditions

Lumbar radiculopathy is irritation or inflammation of a nerve root in the low back. It causes symptoms that spread out from the back down one or both legs. To understand this condition, it helps to understand the parts of the spine:

• Vertebrae. These are bones that stack to form the spine. The lumbar spine contains the 5 bottom vertebrae.

• Disks. These are soft pads of tissue between the vertebrae. They act as shock absorbers for the spine.

• Spinal canal. This is a tunnel formed within the stacked vertebrae. In the lumbar spine, nerves run through this canal.

• Nerves. These branch off and leave the spinal canal, traveling out to parts of the body. As they leave the spinal canal, nerves pass through openings between the vertebrae. The nerve root is the part of the nerve that is closest to the spinal canal.

• Sciatic nerve. This is a large nerve formed from several nerve roots in the low back. This nerve extends down the back of the leg to the foot.

With lumbar radiculopathy, nerve roots in the low back become irritated. This leads to pain and symptoms. The sciatic nerve is commonly involved, so the condition is often called sciatica.

What causes lumbar radiculopathy?


Aging, injury, poor posture, extra body weight, and other issues can lead to problems in the low back. These problems may then irritate nerve roots. They include:

• Damage to a disk in the lumbar spine. The damaged disk may then press on nearby nerve roots.

• Degeneration from wear and tear, and aging. This can lead to narrowing (stenosis) of the openings between the vertebrae. The narrowed openings press on nerve roots as they leave the spinal canal.

• Unstable spine. This is when a vertebra slips forward. It can then press on a nerve root.

Other, less common things can put pressure on nerves in the low back. These include diabetes, infection, or a tumor.

Symptoms of lumbar radiculopathy


These include:

• Pain in the low back.
• Pain, numbness, tingling, or muscle weakness that travels into the buttocks, hip, groin, or leg.
• Muscle spasms.

Treatment for lumbar radiculopathy


In most cases, your healthcare provider will first try treatments that help relieve symptoms. These may include:

• Prescription and over-the-counter pain medicines. These help relieve pain, swelling, and irritation.

• Limits on positions and activities that increase pain. But lying in bed or avoiding all movement is only recommended for a short period of time.

• Physical therapy, including exercises and stretches. This helps decrease pain and increase movement and function.

• Steroid injections into the lower back. This may help relieve symptoms for a time.

• Weight-loss program. If you are overweight, losing extra pounds may help relieve symptoms.

In some cases, you may need surgery to fix the underlying problem. This depends on the cause, symptoms, and how long the pain has lasted.

Possible complications


Over time, irritated and inflamed nerves may become damaged. This may lead to long-lasting (permanent) numbness or weakness in your legs and feet. If symptoms change suddenly or get worse, be sure to let your healthcare provider know.

When to call your healthcare provider


Call your healthcare provider right away if you have any of these:

• New pain or pain that gets worse.

• New or increasing weakness, tingling, or numbness in your leg or foot.

• Problems controlling your bladder or bowel.

At UC Health, we lead the region in scientific discoveries and embrace a spirit of purpose – offering our patients and their families something beyond everyday healthcare. At UC Health, we offer hope.

Call for more information.

513-475-8000

Lumbar Spondylosis Treatment | SPORT Orthopedics

Lumbar Spondylosis, Arthritis of the Lower Back, Lumbosacral Spondylosis, Lumbosacral Spondylosis Without Myelopathy

Chronic lower back pain is a frustrating thing to live with. It can limit your ability to enjoy life to the fullest and prevent you from engaging in activities you once enjoyed. Lumbar spondylosis is one source of back pain that is unfortunately common in adults aged 60 and over. Even generally healthy people experience the degenerative process in their spine over time. This happens due to the normal wear and tear on the body’s systems.

At SPORT, we have extensive experience treating a number of degenerative conditions, including the following.

• Spinal stenosis
• Cervical stenosis
• Degenerative disc disease
• Chronic low back pain
• Herniated disc
• Spinal cord compression
• Cervical spondylosis
• Spinal osteoarthritis
• Pinched nerves

If you fear you may be suffering from lumbar spine spondylosis, please contact our Dallas orthopedic specialists and physical therapists. We can both diagnose and treat your condition with only the best in medical technology. Contact our office today at 469-200-2832 to schedule with us.

What Is Lumbar Spondylosis?

The age-related degeneration of the spine in the lower back is called lumbar spondylosis. Specifically, the degeneration occurs in the vertebral bodies and intervertebral discs in the spinal canal. This condition is often confused with or interchangeably referred to as degenerative disc disease and osteoarthritis. 

One notable attribute of lumbar spondylosis is the breakdown of one intervertebral disc or multiple discs. Because these discs provide cushioning for the spinal nerves, the degenerative changes in these discs can lead to back pain. 

How Common Is Spondylosis?

According to the American Academy of Orthopaedic Surgeons, approximately 85% of adults over 60 will experience symptoms of spondylosis, whether cervical or lumbar. That’s an alarming percentage of the general population. However, it does make sense. Lower back pain and neck pain are common reasons for missed work in the United States. This applies to both blue-collar jobs and white-collar jobs.

Types of Lumbar Spondylosis

Spondylosis generally affects the facet joints, nerve roots, sacroiliac joints, and other parts of the lumbar anatomy. In other words, it is more common to experience spondylosis in the lower back than in the upper back and neck. Below, we list two specific types of spondylosis that affect the lumbar supports in the spine.

Lumbosacral Spondylosis


This is lumbar spondylosis that also affects the lumbar region and the sacrum, as well as the associated nerves and associated joints. It does not involve nerve compression (myelopathy) but still produces pain symptoms.

Lumbosacral Spondylosis Without Myelopathy


This is lumbar spondylosis that affects the lumbar spine and the sacrum. However, this does involve nerve compression or myelopathy. This compression of the sacroiliac and facet joints can produce chronic pain in the spinal nerve roots of the lower back.

Lumbar Spondylosis Symptoms

It’s important to understand what your symptoms mean when you experience back pain, neck pain, spine pain, or other spinal problems. Lumbar spondylosis produces many symptoms that are similar to other back problems. It can even cause radiculopathy, which is pain that radiates from one part of the body to another. These symptoms are as follows.

• Neck pain
• Leg pain
• Back pain
• Cauda equina syndrome
• Muscle spasm
• Grinding or popping feelings in the back when you sit or stand
• Feelings of numbness or tingling in the toes, feet, legs, or lower back
• Pain radiating to the buttocks
• Sciatic nerve pain

One rarer, more severe symptom is a loss of bladder or bowel control. If you experience this symptom, we recommend seeking a clinical diagnosis for your pain. Patients suffering from spinal cord pain deserve to have their symptoms evaluated by a qualified pain physician. 

What Causes Lumbar Spondylosis?

For the most part, spine degeneration is a normal part of the aging process. However, the side effects of this degeneration can produce pain and stiffness in the lower back. Some of these side effects include bone spurs, ligament stiffening, herniated or bulging discs, and dehydrated discs. All of these side effects can send pain signals to the back, legs, and buttocks. 

Risk Factors for Lumbar Spondylosis

As we stated before, spondylosis of all types occurs mostly due to either age-related degeneration or degenerative conditions affecting the spine. However, each individual has certain risk factors that may apply to them. These factors include the following.

• Genetic predisposition
• Being overweight or carrying excess weight from pregnancy
• Engaging in a sedentary lifestyle
• Having sustained a spinal cord injury or having undergone spine surgery
• Smoking cigarettes
• Working a job that requires you to perform repetitive or weight lifting movements
• Anxiety or depression
• Psoriatic arthritis

How to Prevent Lumbar Spondylosis

Now that you understand how spondylosis happens, you can take steps to reduce or eliminate your risk of lumbar spondylosis. We recommend the following preventative measures.

• After you visit with your doctor, follow their treatment plan and physical therapy recommendations as closely as possible.
• Practice proper posture and positioning of your body
• Learn to lift heavy objects with your legs, not your back
• Regularly engage in exercise
• Eat a well-balanced diet
• Maintain a healthy weight
• If you are a smoker, try to stop smoking.
• Avoid consuming an excessive amount of alcohol
• Rest for an appropriate amount of time each day

How to Diagnose Lumbar Spondylosis

In order to achieve an accurate clinical diagnosis of your condition, we recommend seeing a musculoskeletal medicine specialist. When you come to SPORT for diagnosis and treatment, we will begin by taking a medical history. Then, we will perform a physical exam. This exam may involve spinal manipulation or moving the spine around to assess pain sources. We may also order the following imaging tests.

• X-rays
• CT scans
• Magnetic resonance imaging (MRI) tests

Treatment Options for Lumbar Spondylosis

The good news is that any disability and pain symptoms resulting from spondylosis can be treated with conservative methods in most cases. However, the treatments that we recommend for you will be largely based on your symptom severity. They will also be based on how your condition responds to non-invasive treatments. Below, we list the most popular ways to treat spondylosis.

Non-Surgical Treatments for Lumbar Spondylosis


Most patients experiencing lumbar spondylosis can achieve relief with the following treatment methods.

• Muscle relaxants
• Pain medications
• Heat and cold therapy
• Physical therapy
• Trigger point injections

Surgical Treatments for Lumbar Spondylosis


If conservative treatments aren’t enough to provide pain relief, surgical intervention may be necessary. Patients who still experience pain or restricted mobility may find relief in the following ways.

• Surgery to remove bone spurs
• Spinal fusion, which will limit spine motion
• Diskectomy of the affected disc
• Fracture surgery to repair damaged vertebrae
• Bone graft surgery, which often goes along with the fusion of the spinal column

Speak with your trusted orthopedic surgeon to determine which treatment plan is right for you.

Contact SPORT Orthopedics and Physical Therapy Today

At SPORT Orthopedics and Physical Therapy, we take great pride in our ability to help patients suffering from leg pain, bone spurs, and spinal canal pain. We understand that pain around or in the spinal cord can greatly affect how you live your life. That’s why we’re here to offer only the best in diagnostic and treatment care. To schedule an appointment with our Dallas physical therapists and surgeons, please call 469-200-2832 today.

Other Conditions We Treat Include:

• Herniated discs
• Cervical stenosis
• Sciatic nerve pain
• Cervical spondylosis
• Spinal fractures
• Osteoarthritis
• Upper arm pain
• Leg pain

Cervical, thoracic and lumbosacral radiculopathy / Diseases / Clinic EXPERT

Radiculopathy (radicular syndrome) is a neurological syndrome caused by irritation of the spinal roots. Each root corresponds to the body of its vertebra and is located at the same level with it. It passes in a narrow intervertebral foramen, surrounded by muscles, ligaments and choroid plexuses. Problems with any of these formations can cause irritation and/or compression of the root.

Thus, the origin of radiculopathy and the occurrence of pain is due to the position of the roots.

Causes

Possible causes of radicular syndrome:

• mechanical injuries
• weak muscular frame of the back
• metabolic disorders
• hormonal disorders
• age degenerative changes
• chronic inflammatory process
• consequences of surgical interventions
• postural disorders (scoliosis, etc.)
• severe physical (dynamic and static) loads
• gravitational loads
• anomalies in the development of the spine
• tumor processes
• narrowing of the spinal canal ( due to displacement of the vertebrae)
• narrowing of the foraminal (intervertebral) holes
• protrusions and herniations of intervertebral discs

The development of degenerative-dystrophic changes in the intervertebral discs occurs over time as a result of a combination of factors. Changes in the intervertebral discs are manifested by thinning and loss of elasticity. In the absence of adequate treatment, their destruction occurs.

Thus, the conditions for disc protrusion are created. The process is carried out in the most thinned area of ​​the outer fibrous ring.

When the fibrous tunic ruptures, the nucleus of the disc protrudes.

The initial stage is characterized by the formation of a protrusion of the intervertebral disc. Rupture of the fibrous ring in this case does not occur.

Both in the case of a rupture of the annulus fibrosus and in the case of a protrusion, when the annulus remains intact, the vertebral disc acts on the nerve roots that are located on the sides of the spinal column. In the initial stage of the process, irritation affects only the membranes. In the future, if the process is not stopped, the roots are squeezed. This process is called discogenic radiculopathy.

Radicular syndrome proceeds in two stages:

• at the first, neurological stage, there is an increase in sensitivity, sharp and unexpected acute pain, characteristic muscle tension, pain in paravertebral points when pressed
• at the second, neurotic stage, there is a decrease in sensitivity in the area innervation of nerve bundles formed from damaged roots; during a medical examination, the extinction of the periosteal reflex is revealed and partial malnutrition is diagnosed. Muscle tension and intense pain characteristic of the first stage are preserved.

Types of radiculopathy

• cervical (common)
• thoracic (rare)
• cervicothoracic
• lumbar
• lumbosacral
• combined form (common)
• generalized form

Symptoms

Each type of radiculopathy is characterized by the presence of a specific set of symptoms.

The general symptom is pain of varying severity. The pain can range from not very intense to very significant. Acute pain often limits the mobility of the limbs and body and leads to the fact that it becomes impossible to lead a normal life, which affects the quality of life of the patient.

Symptoms of cervical radiculopathy

Most often, acute pain occurs in the morning. These could be:

• neck pain
• headache (sometimes very intense)
• shoulder pain
• arm pain
• neck pain and/or stiffness
• paresthesia (disturbance of sensitivity, accompanied by a burning sensation, tingling, numbness, cold)
• metabolic disorders (dry skin, peeling, cold skin when touching the affected area)

Important! If you find yourself with such symptoms, treatment should be started without delay. Do not rely on “home” methods. They are able to give only a temporary effect and will not eliminate the cause of the disease.

Only a qualified neurologist will accurately determine the type of disease, prescribe an examination and adequate treatment.

Symptoms of thoracic radiculopathy

Along with the general symptoms characteristic of all types of radiculopathy, the following are observed in the thoracic form:

• girdle pain, pain between the shoulder blades, behind the sternum and in the region of the lower ribs
• pain radiating to the shoulder and armpit
• pain radiating to the middle finger
• weakness of the triceps
• during a medical examination detection of decreased triceps reflex

It is difficult to self-diagnose the disease. It should be borne in mind that the symptoms of thoracic radiculopathy resemble those of angina pectoris and other dangerous diseases.

Self-treatment can cause irreparable harm!

Symptoms of lumbosacral radiculopathy

Lumbosacral neurological syndrome is characterized (along with similar symptoms in other types of radiculopathy):

• luma in the lower back radiating to the limb
• impaired motor function due to awkward bending or abrupt movement
• loss of sensation of the lower limb, weakening of the muscles of the lower limbs

Diagnostics

To make an accurate diagnosis and prescribe adequate treatment, a neurologist at the initial appointment conducts a neurological examination and finds out the nature, duration and intensity of pain, as well as the nature of sensory disorders and movement disorders. If necessary, additional instrumental studies can be prescribed in our clinic (X-ray examination, which determines the degree of deformation and degenerative-dystrophic changes, signs of instability and displacement of the vertebrae) or in the diagnostic centers of the city (magnetic resonance imaging, computed tomography, electromyography, etc. .)

Treatment of radiculopathy

The beginning of treatment is the observance of complete rest and the use of various local remedies.

Since the effectiveness of treatment depends on establishing an accurate diagnosis and clarifying the cause that caused the compression of the nerve roots, contacting a qualified neurologist is a priority. In some cases, the severity of the consequences will be less after quick help, which can be provided by an osteopathic doctor using manual or traction therapy (traction).

The next stage of treatment is the removal of pain. To do this, various drugs are used, which can be prescribed in the form of injections, including intravenously, drip in the comfortable conditions of a day hospital.

The third stage is a recovery course that starts the processes of physiological restoration of nerves, spinal roots and cartilaginous tissue of intervertebral discs.

Patients are recommended massage, physiotherapy, reflexology.

Qualified neurologists of our clinic, who have extensive experience in the treatment of radiculopathy, will give you an individual consultation and develop an individual treatment plan for you with and subsequent rehabilitation.

Forecast

In most cases, the prognosis is favorable. However, in some cases, patients are referred for a consultation with neurosurgeons and orthopedists.

Adverse factors:

• advanced age
• prolonged static or physical activity
• whiplash
• smoking
• developmental anomalies

Prevention and recommendations

The recommendations are of a general nature and should not be used for self-treatment.

Psychotherapy, massage, exercise therapy, swimming, physiotherapy, spa treatment (balneological resorts). A good result is given by galvanization, phonophoresis, amplipulse therapy, magnetotherapy, laser therapy, laser magnetotherapy.

Radon, mineral and pearl baths are prescribed for aftercare and prevention of recurrent attacks.

There are many modern and effective methods. Only a qualified neurologist can determine the appropriateness of their appointment.

Don’t risk your health!

Frequently asked questions

Is it possible to heat the lower back with a heating pad in case of sciatica?

During an exacerbation of radiculopathy, it is recommended to keep the lower back warm. However, warming with a heating pad, a “blue lamp”, heated salt or sand is not recommended. This can increase the swelling of the roots and lead to increased pain. You can use special belts, including those made of dog hair, etc.

I have a stomach ulcer. What painkillers can I take for sciatica?

Many drugs used in exacerbation of radiculopathy are not recommended for patients with a history of gastric and duodenal ulcers. Only a doctor can prescribe adequate treatment after examination. Do not self-medicate!

MRI of the spine revealed a herniated disc. Do I need to delete it?

Indications for surgery to remove a herniated disc can be determined by a doctor during a consultation. Hernias most often do not require surgical intervention. It is necessary to observe a special protective regime, carry out preventive treatment and engage in physiotherapy exercises.

Treatment histories

Case №1

Patient S., 25 years old, after skiing and falling, she felt a sharp pain in the lower back and numbness in the right foot. She started taking painkillers. However, due to the appearance of pain in the abdomen and heartburn, she was forced to abandon them. On the second day, she turned to a neurologist at the EXPERT Polyclinic.

The patient was prescribed treatment and consultation with a gastroenterologist. The patient underwent a course of intramuscular and intravenous drip injections in the day hospital of the Polyclinic EXPERT. The pain syndrome completely regressed, numbness in the right foot disappeared.

Patient S. was consulted by a gastroenterologist. She underwent fibrogastroduodenoscopy (FGDS), which revealed an acute ulcer of the duodenal bulb. A gastroenterologist prescribed treatment for this.

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Spondylosis of the spine

Spondylosis is a dystrophic process in the spine, which, unlike osteochondrosis of the spine, begins with the outer sections of the fibrous ring and is manifested on radiographs by the presence of marginal bone growths (osteophytes) that surround the intervertebral disc. The size of the intervertebral disc in spondylosis does not change. The contours of the vertebral bodies in spondylosis of the spine remain even. Spondylosis is localized mainly in the thoracic spine. Slightly less often, spondylosis can be observed in the lumbar and cervical spine.

The term spondylosis refers to some similar degenerative diseases of the spine that result in compression of the cervical spinal cord and adjacent nerve roots. Cervical spondylosis with compression of the spinal cord and roots is more common in older men. It is characterized by:

• narrowing of the spaces of the intervertebral discs with the formation of a herniated nucleus pulposus or protrusion of the annulus fibrosus
• osteophyte formation from the posterior surface of the vertebral bodies
• partial subluxation of the vertebrae
• hypertrophy of the posterior longitudinal ligament and intervertebral (facet) joints

Typical changes in the bodies of the cervical vertebrae in spondylosis.

Spondylosis is usually regarded as a sign of the body’s natural aging. There are also other varieties of spinal spondylosis:

• static spinal spondylosis is a consequence of early wear of the intervertebral discs due to a violation of the normal axial load (for example, as a result of an improperly fused fracture of the spine, with kyphosis, structural scoliosis)
• Spontaneous spondylosis of the spine due to age-related and sometimes early wear of discs
• reactive spondylosis of the spine – due to inflammation of the vertebrae

Spondylosis can be combined with spinal osteochondrosis. In childhood and adolescence, spondylosis is relatively rare and does not play a significant role in the occurrence of diseases of the peripheral nervous system.

Bone changes occur as a result of inflammatory changes, while the patient does not have signs of true arthritis.

Degenerative cervical myelopathy.

“Spondylitis bar”, formed by osteophytes growing from the posterior surface of the vertebral bodies, causes symptoms of spinal cord injury. These osteophytes cause horizontal compression of the anterior surface of the spinal cord. The proliferation of osteophytes in the lateral direction, accompanied by hypertrophic changes in the intervertebral joints and its penetration into the exit points of the nerve roots of the spinal cord, often leads to the appearance of radicular symptoms.

The longitudinal size of the spinal canal can also decrease as a result of protrusion and extrusion of the disc, hypertrophy or protrusion of the posterior longitudinal ligament, which increases with neck extension. Despite the fact that signs of spondylosis are often found in the elderly on x-rays of the spine, in only a few patients they cause compression of the spinal cord and roots with the development of a clinical picture of myelopathy or radiculopathy. This may be the result of a congenital narrowing of the spinal canal.

Spondylosis is a symptom of the natural aging of the spine.

The first symptoms of compression of the spinal cord and roots in spondylosis are usually pain in the neck and shoulder. These complaints may be combined with limitation of head movements. Compression of the nerve roots is accompanied by radicular pains radiating in the arm along the nerves C5 – C7 . Compression of the cervical spinal cord causes slowly progressive spastic paraparesis of the arm muscles, sometimes asymmetrical. Compression of the cervical spinal cord is often accompanied by paresthesia in the feet and hands. Vibration sensitivity in the lower extremities in most patients is reduced. Sometimes the border of violation of this sensitivity in the upper part of the chest is determined. When coughing, sneezing and straining, the patient may be provoked by weakness in the legs and pain radiating to the arms or upper shoulder girdle.

Neurological examination of the patient can determine the loss of sensation in the arms, atrophy of the muscles of the hands, increased deep tendon reflexes in the legs and asymmetric Babinsky’s symptom. In the case of pronounced organic changes in spondylosis, the patient develops an imperative urge to urinate or urinary incontinence. With spondylosis of the cervical spine, patients tendon and periosteal reflexes on the hands are reduced. In case of nerve compression C5 – C6 and the spinal cord at this level will be reduced reflex from the biceps brachii. In neurological symptoms, radicular, myelopathic disorders will be expressed. The diagnosis of spondylosis is assumed in cases when myelopathy of the cervical spinal cord increases in patients, paresthesias in the feet and hands fall, atrophy of the muscles of the hands develops. Spondylosis often makes it difficult for the elderly to walk, causing an increase in tendon reflexes in the legs and Babinski’s reflexes.

Typical clinical symptoms and signs observed in patients with cervical spondylotic myelopathy:

Symptoms	Features
Weakness	Myelopathic signs
Gait disturbance	Hyperreflexia
Hand numbness	Reverse brachioradial reflex
Spasticity	Hoffmann’s symptom
Incontinence	Ankle clonus
Paresthesia	Babinski’s symptom
Neck pain	Motor deficit
Arm pain	Romberg’s symptom
	Lermitte’s symptom
	Thenar atrophy

Nurick (1972) myelopathy grade:

Grade	Signs and symptoms
0	Signs or symptoms of nerve root involvement but no evidence of spinal cord involvement
1	Signs of spinal cord injury, but without difficulty walking
2	Slight difficulty walking that does not interfere with full employment
3	Difficulty walking that interferes with full employment or the ability to do housework, but does not require someone else’s assistance with walking
4	Ability to walk only with assistance or with a walker
5	Attachment to chair or bedridden

Diagnosis of spinal spondylosis

Diagnosis of spinal spondylosis begins with a mandatory neurological and orthopedic examination by a doctor. During this examination, the neurological status of the patient is assessed, as well as possible violations in the biomechanics of the spine are identified with a mandatory assessment of the condition of the muscles of the back and gluteal region.

Computed tomography (CT) of the spine shows changes in spinal spondylosis.

Already at this stage of the study, a patient with spinal spondylosis and pain in the neck, chest or lower back can be diagnosed and treated.

Sometimes, based on the results of a neurological and orthopedic examination of a patient with a pain symptom associated with spinal spondylosis, the following additional diagnostic procedures may be prescribed:

• X-ray of the spine with functional tests
• CT spine
• MRI of the spine
• Electrophysiological tests (EMG, ENG, etc. )

Often, spondylosis is accompanied by muscle pain along the course of the nerve (along the arm or leg, in the neck or between the shoulder blades).

In addition to muscle tone, the stability of the spinal segment may also be affected. With spinal instability, the vertebrae move forward (anterolisthesis) or backward (retrolisthesis). To clarify the diagnosis, an x-ray of the spine with functional tests may be required.

Spinal stenosis in spondylosis with compression of the spinal cord at the level of the cervical spine with hypertrophy of the posterior longitudinal and yellow ligaments.

The focus of chronic inflammation in the lumen of the spinal canal can lead to the formation of its narrowing (stenosis of the spinal canal) and compression of the nerves and spinal cord passing through it. That is why in case of spinal canal stenosis, it is always necessary to carry out a full course of treatment using a whole arsenal of different treatment methods, and in case of ineffectiveness, surgical treatment.

An x-ray of the spine shows spondylitis “beams”, a decrease in the height of the intervertebral discs, subluxations (subluxations), a change in the physiological cervical lordosis (its straightening or kyphosis) and a decrease in the size of the canal to 11 mm or less or to 7 mm with extension of the cervical spine. The cerebrospinal fluid (CSF, cerebrospinal fluid) is not changed or contains a slightly increased amount of protein. In the study of somatosensory evoked potentials in patients with spondylosis, a normal rate of conduction of an uneven impulse along large peripheral sensory fibers and a delay in central conduction in the middle and upper cervical segments of the spinal cord are found.

Classification of cervical spondylotic myelopathy based on MRI studies:

MRI of the cervical spine. 0 degree – Physiological position of the spine and spinal cord.

MRI of the cervical spine. I degree – Pathology of the disc, narrowing of the spinal canal, no compression of the spinal cord.

MRI of the cervical spine. II degree – spondylosis, compression of the spinal cord in front.

MRI of the cervical spine. III degree – spondylosis, limitation of movement, anterior or posterior compression of the spinal cord.

MRI of the cervical spine. IV degree – cervical spondylotic myelopathy, anterior and / or posterior compression of the spinal cord.

Treatment of spinal spondylosis

Depending on the severity of the manifestations and the causes of pain in the neck, thoracic region or lower back against the background of spinal spondylosis, the patient may have the following therapeutic actions:

• drug therapy (NSAIDs, analgesics, hormones)
• blockades – injections of drugs into the cavity of the intervertebral joint, spinal canal, into trigger points in the muscles
• manual therapy (muscle, joint and radicular technique)
• physiotherapy (UHF, SMT, etc. )
• therapeutic gymnastics
• acupuncture
• surgical treatment

In the treatment of pain in the back and lower back on the background of spinal spondylosis, the elimination of swelling, inflammation, pain, restoration of range of motion in the joints and muscles of the lower back is accelerated by the use of physiotherapy.

Intervertebral joints (facet joints) can also be given therapeutic blocks when conventional treatment fails. Usually, low doses of an anesthetic and cortisone injected into the lumen of the affected joint are sufficient for this.

Cervical spondylosis is diagnosed frequently in patients. Many patients with spinal cord lesions at the cervical level, especially those with amyotrophic lateral sclerosis, multiple sclerosis, and subacute combined degeneration, undergo surgery to remove part of the vertebral arch (laminectomy). This operation is performed to decompress the spinal cord. Often after this operation, a temporary improvement in the neurological status occurs, which suggests a partial significance of spondylolytic compression. But if myelopathy was caused by an underlying disease, then it will again begin to progress. Slight increasing disturbances in gait and sensitivity in a patient can be mistaken for manifestations of polyneuropathy.

The use of acupuncture is very effective in the treatment of back and lower back pain due to spinal spondylosis.

In mild spondylosis, rest and immobilization of the cervical spine with a soft corset (collar or Shantz splint) are effective. Sometimes such patients are shown traction (traction) of the cervical spine with a loop of Glisson. Surgery for spondylosis is recommended when:

• severe gait disturbances appear
• there is significant weakness in the hands
• bladder dysfunction occurs
• a complete CSF (spinal) block is detected with myelography and MRI of the spinal cord

When combined with a properly selected physiotherapy regimen, these therapeutic blockades can give a good and long-term effect in relieving the exacerbation of pain in spondylosis.

In the treatment of pain in the leg and buttock on the background of spondylosis of the spine, the elimination of pain, tingling and restoration of sensitivity in the leg with neuritis of the sciatic nerve in case of its compression by a hernia or disc protrusion is accelerated by the use of physiotherapy.

Wearing a semi-rigid lumbosacral corset in the treatment of back and lower back pain due to spinal spondylosis helps to limit the range of motion in the lumbar spine. This primarily helps to reduce pain in the area of ​​inflammation of the intervertebral joints and relieve excessive protective tension and spasm of the back muscles.

A variant of a semi-rigid lumbosacral corset that helps in the treatment of pain in the back and lower back due to spinal spondylosis.

In such a corset, a patient with pain in the back and lower back due to spinal spondylosis can move independently at home and on the street, and even sit in the car and at the workplace.