Etiology
There are many causes of spinal radiculitis, and the causes of intradural and extradural radiculitis are not the same. Intradural radiculitis is often caused by infection, poisoning, and nutritional metabolic disorders; extradural radiculitis is often caused by local cold, moisture (causing neurotrophic enemy vasospasm, ischemia, and edema), muscle and transverse process trauma, and inflammation. The lesions of intramural spinal radiculitis are often more extensive and more often bilateral; the lesions of extramural segments are often more limited and more often unilateral.
Clinical manifestations
Cervicothoracic radiculitis is usually acute or subacute in origin, and is often characterized by pain, numbness, and weakness in one or both shoulders and arms, with pain often radiating along the lateral or medial distal part of the upper extremity, aggravated by coughing, straining, and defecation. The above symptoms are often obvious after cold and exertion, and alleviated after warmth and rest. Examination may reveal sensory hypersensitivity (early stage), hypoesthesia or disappearance (late stage) in the area innervated by the affected nerve roots; the biceps and triceps tendon reflexes are weakened or disappeared; there may be mild atrophy of the upper limb muscles; there may be pressure pain in the corresponding cervical and thoracic paraspinal vertebrae. In addition, the affected limb may have vegetative symptoms such as changes in skin temperature and color, nutritional and sweat gland secretion disorders. In the acute phase of intramural spinal radiculitis, there may be a mild increase in cerebrospinal fluid protein and cells.
Examination
1, laboratory tests have auxiliary significance for clinical diagnosis. The cerebrospinal fluid may have a mild increase in lymphocytes.
2. Evoked potentials. The muscles within the damaged area may show denervated EMG changes, and the peripheral nerve motor and sensory conduction velocity is slowed down. The latency of sensory nerve evoked potentials is prolonged.
3.Cranial CT and MRI.
Diagnosis
1.The onset of the disease can be acute or slow, and there is often a history of infection, intoxication, nutritional and metabolic disorders, spinal diseases, paravertebral muscle trauma and inflammation, and transverse synovial trauma.
2. There is radiating numbness and pain within the posterior root innervation of the damaged nerve root, such as thoracic radiculitis causing intercostal neuralgia; cervicothoracic radiculitis with pain from the shoulder and neck to the ulnar or (and) radial side of the upper extremity; lumbosacral radiculitis manifesting as pain from the lumbosacral to the medial or (and) lateral side of the lower extremity and foot pain, etc. It is often triggered or aggravated by cold, cough, defecation, etc.
3. In the area of anterior root distribution of the affected nerve roots, different degrees of lower motor neuron paresis are presented: muscle weakness, muscle atrophy, and diminished or absent tendon reflexes. For example, cervicothoracic nerve root inflammatory symptoms mostly occur in the scapular belt and upper limbs; lumbosacral nerve root inflammatory symptoms are seen in the lower limbs. Sacral nerve root damage is more severe fashion with dystonic bladder and sexual dysfunction.
4. Cerebrospinal fluid may have mild lymphocytosis. The muscles within the damaged area may show dystonic electromyographic changes, and the peripheral nerve motor and sensory conduction velocities may be slowed. The latency of sensory nerve evoked potentials is prolonged.
The lesion involving the arachnoid membrane is called spinal-radiculitis, and if the spinal cord is also involved, it is called spinal-spinal-radiculitis, which can produce spinal arachnoiditis symptoms.
6.Signs and symptoms of the primary etiology are present.
Differential diagnosis
1, cervical spondylosis
The symptoms are more similar to cervicothoracic radiculitis. However, it is usually seen in middle-aged and elderly people, and may manifest with vertigo or spinal cord involvement. Percussion on the top of the head or pressure from the top of the head to the neck can cause increased pain in the upper limbs (Spurling sign). Cervical spine x-ray or CT examination may show changes such as cervical spine osteophytes, narrowing of the intervertebral foramen or bone spurs extending into it, and disc degeneration. Cervical spine traction and other treatments can reduce the symptoms.
2.Cervical spinal cord tumor
Lumbar puncture can show subarachnoid obstruction, increased protein quantification in cerebrospinal fluid, and normal cell count. Myelography shows obstruction of contrast flow and filling defects at the lesion site.
3.Brachial plexus neuritis
It is usually seen in adults and has an acute or subacute onset. The pain is often located in the supraclavicular fossa or shoulder on one side, gradually extending to the ipsilateral upper arm, forearm and hand, and more so on the ulnar side. There is pressure pain in the brachial plexus nerve trunk (supraclavicular fossa), and the pain can be triggered or aggravated by pulling on the upper limb.
Treatment
The main treatment is to eliminate the cause of the disease, improve the nerve nutrient metabolism and promote the recovery of nerve function.
1.Treatment of etiology
Control various infections and diabetes mellitus, etc.
2.Medication
Prednisone or dexamethasone can be used, the length of treatment depends on the condition, generally 3 to 4 weeks as a course of treatment, while using B vitamins, coenzyme Q10, cytidylcholine and other drugs to promote nerve repair and improvement of function, or use dibazol plus lanthamine potassium iodide, etc., to improve circulation and promote the absorption of inflammation pain is obvious, can use aminometrazine or phenytoin sodium treatment.
3.Physiotherapy
Local hot compresses and massage are effective.