DISEASES OF THE NERVOUS SYSTEM : SCIATICA LUMBOSACRAL (RADICULITIS LUMBO-SACRALIS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
SCIATICA (wrong name: sciatica, lumboischialgia).
The disease most often occurs on the grounds of acute (flu, sore throat, undiagnosed viral infection) and chronic (tuberculosis, malaria) infections, rheumatism, gout. Often marked toxicoinfection foci:
When radiculitis frequent changes of the spine: condylarthra and spondylos, different etiology the spondylitis, sacralization, spina bifida, spondylolisthesis. Sometimes sciatica occurs after injury. Lumbosacral roots are affected very often, because there are the most favorable conditions for the introduction of infection; in addition, the lumbar-sacral region is the most vulnerable part of the spine and spinal cord.
Symptoms. The disease can develop in the subacute or acute form, accompanied by General symptoms (fever, weakness, fatigue) or without them; these symptoms are observed when sciatica occurs directly due to infection, sometimes with acute toxicoinfection foci. Patients experience pain in the lower back radiating down one or both legs. Notes typical forced posture: in a standing position, the patient leans to the side; in bed tends to lie on the healthy side; one leg is always slightly bent. In 60-70% of patients can be noted scoliosis convex to the side of the patient's legs (homological), then in a healthy way (heterologous). Always there is change sensitivity. Point Valle detected when the pressure in the course seduce nerve in upper and lower region, on the back of the thigh, popliteal fossa, at the outer ankle, point Garra - under pressure on both sides of the navel and on the transverse processes of the fourth and fifth lumbar vertebra.
Symptom Lasaga: raising an elongated leg, the patient is experiencing leg pain, radiating to the lumbar-sacral region. Sometimes there is a disappearance of pain when bending the knee.
Almost always a positive symptom of Cernica: the study limb is bent at right angles at the hip and knee; when you try to straighten the leg marked resistance due to a reflex-tonic muscle tension, bending his legs at the knee. At the same time observed a sharp pain radiating to the lumbar-sacral region.
Symptom Neri: when forced flexion of the head to the chest of the patient in the supine or standing position there is pain in the lumbar-sacral area.
Symptom severe-Feierstein: in the study of symptom Lasaga on the healthy side, a pain in the leg.
Symptom Wasserman: the patient lies on his stomach, the researcher raises up the thigh, this felt a sharp pain in the region of n. cruralis, pain with sciatica appears in the lumbosacral region.
Sometimes there and radicular disorders of sensitivity. Less common musculoskeletal disorders. When radiculoneuritis noted the disappearance or reduction of Achilles and knee reflexes. When myeloradiculitis can be increased tendon reflexes, and sometimes pathological reflexes. Sometimes there is light atrophy in the affected limb and autonomic disorders: hypertrichosis, impaired sweating.
In the blood there are no changes; in the cerebrospinal fluid sometimes bolkovitina dissociation. Disease after 2-3 weeks of the acute period may subside; more often it is delayed for months, gradually easing off. Relapses after a few years.
Should be excluded first of all diseases of the muscles, most often denoted by the term "lumbago". Usually find myositis, myalgia, neuromyositis. When lumbar myalgia process is localized in the following muscles: m. erector trunci (lower part), m.quadratus lumborum, often m. psoas. Typical sciatica symptoms for the most part absent, whereas the objective of the study observed various changes in the lumbar muscles, which are in a state of extreme tension. It is necessary to exclude diseases such as neurosyphilis, tumors of the spine and spinal cord, arachnoiditis, multiple sclerosis. In all these conditions, along with pain, there are other changes in the Central nervous system and the vertebrae. Due to the fact that sciatica often occurs when different, the above diseases of the spine, it is always necessary to make a careful x-ray examination. You should also exclude diseases of the urogenital disease Rota (neuritis of the external cutaneous femoral nerve), characterized by decreased sensitivity in the area of the nerve, along with the phenomena of hyperpathia, coccygodynia arising in the tailbone on the ground injured. Serious attention should be paid to the state of the hip joints and the sacroiliac joints, not to take coxit or sacroiliac for sciatica lumbar. It is also necessary to exclude varices venarum, flatfoot.
In acute cases - bed mode. The treatment of sciatica is best done in a hospital. Vaccine therapy: infectious etiology polyvalent streptococcal vaccine is injected subcutaneously in the area of the blades. Start with 0.1-0.2 ml (not more), then every 2 days add 0.1 ml to 1 ml Total 12-15 injection. In some patients, the injections are painful; in such cases should be topically applying a compress; sometimes good effect irradiation with ultraviolet rays. In some cases, the temperature rises; with a slight increase (up to 37,2-37,6°) it can be seen as a reaction to the vaccine. At very high and persistent increases in temperature treatment vaccine need some time to stop. There should be no vaccine therapy in TB patients with acute processes in the sinus cavities of the nose. It is also recommended that intravenous infusion of a 40% solution of urotropine 5 ml in 2-3 days, just 12-15 injections. Of the other methods used perineurally infusion and epidural injection; subcutaneous injections of novocaine Astvatsaturov: 0.5-1% solution of novocaine in the amount of 15-30 ml is injected bathrabbim injected intradermally. With each injection solution is injected in a quantity that may cause "blister" size 1.25-2 cm in diameter. Of these "blisters" is obtained in the desired location "cake". After the injection the skin smeared with iodine, and the whole "cake" cover with a thin layer of collodion. The best results are obtained when exacerbations of radiculitis; less effective is the treatment for acute radiculitis and neuralgia. Good results can be obtained from novocaine blockade on Vishnevskaya-Speransky. In cases of sciatica, in which there are changes from joints (spondylarthritis and spondylosis) and muscles, good effect often gives calcium and salicylic therapy. Calcium can be applied orally, intravenously in the form of calcium iontophoresis. When intake of calcium inside it is recommended to use 50% solution for his or pills of calcium phosphate with the addition of small quantities of arsenic, sometimes quinine, iron, and phytin. Intravenous infusion of calcium start with a dose of 2 ml to 5 ml of 2% sterile solution. In good health the dose can be increased to 15-20 ml per session. Just make 20 investments. Salicylic therapy: inside of 0.5 up to 5-6 times a day; salicylates have been successfully used as an external remedy, especially for muscle pain. Often radiculitis arise due to the presence of gout. In such cases, is the treatment Atofina with appropriate diet. In addition to the anesthetic methods are widely used in various pain relievers: antipyrine, piramidon, analgin, etc. With a very strong pain sometimes necessary to use pantopon. Of external funds, you should try fly or mustard on the path of the nerve, banks and warmth to the lumbar region.
Physiotherapy treatment: irradiation with ultraviolet rays, diathermy, galvanic, steam shower. The good effect gives Spa treatment, mud and paraffin.