Disease code 54.4. Features of the manifestation of lumboischialgia syndrome

Sciatica

ICD is an international classification of diseases, the codes of which are used for statistical reporting and indication of pathologies in official documentation. The general code for lumboischialgia according to ICD 10 is abbreviated M 54.4. As a clarification, additional figures can be used indicating the presence of complications, involvement in the pathological process of one or both lower extremities. In subdivision M 54, according to the international classification of diseases, all dorsalgias (back pain) associated with destructive lesions of cartilage tissue are included. The number 4 after the dot indicates the presence of symptoms of lumbago and possibly sciatica.

What does this code mean?

If lumboischialgia is diagnosed according to ICD 10 under code 54.4, then the patient is provided with a temporary disability sheet for a period of 10-14 days. After ascertaining the fact of recovery, it is not required to provide sparing working conditions. But the patient is recommended long-term course treatment of the underlying disease that caused the pain syndrome. Shown sanatorium treatment during remission (complete absence of pain and symptoms of infringement of the nerve fiber).

What does this code mean for a specialist in medical statistics? First of all, lumboischialgia indicates the presence of a chronic destructive process in the cartilaginous tissue of the intervertebral discs. Accordingly, the patient is at risk for the development of life-threatening complications in the future, such as disc herniation, dorsopathy.

It must be understood that such a complex of symptoms is only a consequence, therapy should be aimed at eliminating the immediate cause. For treatment, a pharmacological effect on the cartilage structure is recommended. For this, new generation chondroprotectors are used. They help to improve the structure of cartilage fibers, restore their depreciation ability. Physiotherapy is also useful, aimed at strengthening the muscular frame of the back. Manual therapy does an excellent job of completely restoring the process of diffuse nutrition of the spinal column, which eliminates the possibility of recurrence of lumboischialgia in the future.

Standards for the treatment of lumboischialgia

When diagnosing lumboischialgia, the following examinations are performed:

According to the standards of treatment for lumboischialgia, non-steroidal anti-inflammatory drugs and muscle relaxants are prescribed to reduce pain. The minimum course of therapy is 3 days. The maximum possible period of use is 14 days under the control of blood parameters.

To improve blood circulation in the area of ​​damage to the cartilaginous tissue of the intervertebral disc, a course of nicotinic acid, 2 ml subcutaneously, is prescribed for 10 days.

Chondroprotectors are used to restore cartilage tissue. The minimum course of injections is 14 days. Then reception in capsules within 40 - 60 days is appointed.

B vitamins allow you to restore the structure of the damaged nerve fiber. Can be used in injections and tablets.

Also, the mandatory course of therapy includes massage (10 sessions), physiotherapy (magnet, electrophoresis with lidase and novocaine, UHF, Bernard currents) and physiotherapy exercises.

Disability, sick leave

With lumboischialgia, a sick leave (temporary disability) is issued. Terms of disability depend on the underlying disease. The fact is that lyuboischialgia is a complication of other degenerative dystrophic and functional diseases of the spinal column.

There are contraindications, you need to consult a specialist.

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 spreads to the lower extremities. As the disease progresses, lumbago is added to the symptoms of sciatica (backache, acute pain appears suddenly with compression of the nerve roots), hence the name of the pathological process - lumboischalgia.

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

Reasons for the 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). Pain is aggravated in cases where the muscles in the damaged area are tense, the nutrition of the muscle tissue is disrupted, and nodules are formed.

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

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 zone;
• diseases of internal organs;
• ailments accompanied by circulatory disorders;
• rheumatism;
• severe infectious pathologies, which are characterized by damage to the nerve endings;
• systemic connective tissue diseases.

Several reasons make the situation worse:

• sedentary lifestyle, lack of regular physical activity, which leads to a weakening of the muscular corset;
• the course of pregnancy (carrying several fetuses at the same time is especially negative);
• stress;
• posture disorders;
• hypothermia;
• excessive physical activity (refers to professional athletes, people doing heavy physical work).

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

Classification

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

• muscular-tonic. The nerve root is irritated by the structures surrounding it. 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 form. Pathology is characterized by a change in the color of the epidermis, in some cases, the appearance of ulcers;
• vegetative-vascular. It is manifested by acute attacks of pain in both legs, the discomfort increases during a change in body position, with hypothermia.

Often, lumboischialgia includes symptoms of several forms (a 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

It is possible to suspect the presence of lumboischialgia by several specific clinical signs:

• gradually appear pain in the lumbar region of varying severity (pulsating, acute, burning);
• discomfort extends to one or two limbs, affecting the buttock, thigh, reaching the feet and toes;
• the area of ​​localization of pain - next to 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 you try to change the position of the body, discomfort in the lower back increases;
• in the absence of treatment, there is a loss of control over the act of urination, defecation. In advanced cases, the patient becomes disabled.

Note! The duration of the pain attack in each case is individual. Discomfort can 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 neuropathologist, who prescribes a number of special studies that allow to identify the pathology, the degree of damage to the nerve roots.

Research:

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

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

Effective Treatments

On the page, learn about 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 with 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 material per liter of boiling water).

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

To prevent the appearance of lumbago with sciatica, preventive recommendations from leading experts will help:

• Refuse to stay in one position for a long time. If this is not possible, then take regular breaks, do light gymnastics;
• wear heels no higher than 4 cm, give preference to comfortable shoes;
• normalize weight, include foods rich in nutrients in the diet;
• get rid of addictions, try to play sports several times a week (a strong muscular corset is the key to a successful recovery, excellent health);
• treat pathologies associated with joints and blood vessels in time.

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

In more detail about what lumbago with sciatica is, the doctor of the highest category tells in the following video:

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

What is cervicalgia syndrome?

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

According to statistics, more than 70% of people experience neck pain. The term "cervicalgia" refers to pain that is localized in the neck and radiates to the shoulder, back of the head and arms. According to ICD-10, the disease has the code M54.2 "Cervicalgia: description, symptoms and treatment."

It is possible to suspect the presence of this pathology when a person experiences difficulties with head movements - they are limited, often cause pain or are accompanied by muscle spasms.

If you have been prescribed the drug Allopurinol, the instructions for use are mandatory for study, since the drug 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 stretching of muscles or ligaments, myositis, neuralgia of the occipital nerve. Sometimes this pathology has a psychogenic origin. It may be due to epidural abscess, meningitis, subarachnoid hemorrhage.

Vertebrogenic cervicalgia

Neck pain or vertebrogenic cervicalgia

Vertebrogenic cervicalgia is pain in the neck, accompanied by limitation of 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. As a result, pain occurs that is difficult to eliminate. Usually this type of cervicalgia occurs in case of damage to bone structures as a result of osteoma, radiculopathy, osteomyelitis.
2. Discogenic - develops in the case of degenerative processes occurring in the cartilaginous tissue of the spine. This form of pathology most often becomes the result of osteochondrosis, intervertebral hernia, etc. It is accompanied by a persistent pain syndrome, and sometimes requires surgical intervention.

At the same time, pain in the neck is not always the result of a serious disease of the spine.

Usually, cervicalgia occurs as a result of a high load on the spine and muscles. That is why the disease, depending on the characteristics of the course, happens:

• acute - it is characterized by pronounced pain when turning the neck, movements, 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.

Gradually, a hernial protrusion is formed, which first irritates 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 cause the following pathologies:

• tumor formations;
• autoimmune pathologies - in particular, Bechterew's disease;
• 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, airways, muscles.

In addition, cervicalgia may be due to the following factors:

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

Symptoms and signs

Pain in the neck can be shooting, throbbing, tingling. Even slight movement, physical exertion, or a simple cough can lead to flare-ups. The following symptoms are usually characteristic:

• dizziness;
• numbness in the neck or upper limbs;
• 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 of the muscles of the neck, as well as limitation of its mobility.

Diagnostic methods

To diagnose cervicalgia, the following examinations are usually performed:

1. Radiography. Although this study can only examine the bones, it makes it possible to identify the causes of pain in the neck. The picture will show damaged joints, broken bones, age-related changes.
2. Magnetic resonance imaging. This study allows you to assess the condition of soft tissues - nerves, muscles, ligaments, intervertebral discs. With the help of MRI it is possible to detect tumors, infectious lesions, hernias.
3. Electromyelography and nerve conduction velocity analysis. These studies are carried out in case of suspicion of a violation of the functioning of the spinal cord. Usually 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 the treatment of the disease must be comprehensive.

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

The main goals of treatment are as follows:

• increased mobility of the cervical region;
• elimination of pain;
• release of the clamped root;
• prevention of progression of cervical osteochondrosis;
• muscle strengthening.

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

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

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

In some cases, a neck collar should be used - it should be worn for 1-3 weeks. To reduce pain, traction treatment can be prescribed, which consists in stretching the spine.

Of no small importance for the successful treatment of cervicalgia is therapeutic exercises. Also, many patients are prescribed physiotherapy procedures - massage, compresses, mud baths.

Surgery

In some cases, there is a need for surgical treatment of pathology. The indications for the operation are as follows:

• acute and subacute lesions of the cervical spinal cord, which are accompanied by impaired sensitivity, pelvic pathologies, central paresis;
• an increase in paresis in the region 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 the following rules:

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

Cervicalgia is a rather serious pathology, which is accompanied by severe pain in the neck area and significantly worsens the quality of human life.

To prevent its development, you need to play sports, eat a balanced diet, properly organize the regime of work and rest. 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 “osteochondrosis of the spine” still used in our country.

M40 Kyphosis and lordosis (excluded osteochondrosis of the spine)

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 Juvenile osteochondrosis of the spine (Scheuermann's disease)

M42.1 Osteochondrosis of the spine in adults

M43 Other deforming dorsopathies

M43.4 Habitual atlanto-axial subluxations.

As you can see, this section of the classification contains various deformations associated with pathological installation and curvature of the spine, degeneration of the disc without its protrusion or hernia, spondylolisthesis (displacement of one of the vertebrae relative to the other in its anterior or posterior variant) or subluxations in the joints between the first and second cervical vertebrae. On fig. 1 shows the structure of the intervertebral disc, which consists of the nucleus pulposus and the annulus fibrosus. On fig. 2 shows a severe degree of osteochondrosis of the cervical intervertebral discs with their degenerative damage.

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

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

Rice. 3. MRI for osteochondrosis of the intervertebral discs (arrows show degenerative discs).

Rice. 4. Idiopathic scoliosis of the spine.

Rice. 5. Vertebral motor segment at the thoracic level.

Rice. 6. Neck dorsopathy.

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

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

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

M50 Cervical intervertebral disc degeneration (with pain syndrome)

M51.4 Schmorl's nodes [hernia]

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

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

Rice. 11. Variants of displacement of intervertebral discs.

Rice. 12. Morphology and radiation methods of diagnostics in case of displacement of the intervertebral disc.

The section “Other dorsopathies” under heading M53 includes sympathetic syndromes associated with irritation of the afferent sympathetic nerve with posterolateral displacement of the cervical disc or spondylosis. On fig. Figure 14 shows the peripheral cervical nerve (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. Figure 14a

Rice. 13. MRI for Schmorl's hernia.

Rice. 14. Neck sympathetic nerves.

Cervical-cranial syndrome (M53.0) corresponds to the term "posterior cervical sympathetic syndrome" widely used in our country, the main clinical manifestations of which are repercussive (common) 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 have a violation of the sympathetic innervation of the eyeball with Horner's syndrome, often partial.

M54.1 Radiculopathy (shoulder, lumbar, lumbosacral, thoracic, not specified)

M54.4 Lumbodynia with sciatica

M54.8 Dorsalgia other

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

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

4 comments

“Dorsopathy” is not actually a PAIN SYNDROME (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 limbs of non-visceral etiology.

neurologist Kiev

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The structure of the vertebroneurological diagnosis

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

Non-vertebrogenic dorsalgia caused by sprains and muscles, myofascial syndrome, fibromyalgia, somatic diseases, psychogenic factors, etc.

Cervicalgia - pain in the neck;

Cervicobrachialgia - pain in the neck that spreads to the arm;

Thoracalgia - pain in the thoracic back and chest;

Lumbalgia - pain in the lower back or lumbosacral region;

Lumboischialgia - low back pain that spreads to the leg;

Sacralgia - pain in the sacral region;

Coccygodynia - pain in the coccyx.

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

Vertebral syndrome at a distance; the spine is a single kinematic chain, and dysfunction of one segment can lead to deformation, pathological fixation, instability or other change in the state of the higher or lower parts through a change in the motor stereotype;

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

Compression (compression-ischemic) radicular syndromes: mono-, bi-, multiradicular, 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).

The course of the disease: acute, subacute, chronic (remitting, progredient, stationary, regredient);

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

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

The severity of the pain syndrome: mild (not interfering with the daily activities of the patient), moderately pronounced (limiting the daily activities of the patient), pronounced (sharply impeding the daily activities of the patient), pronounced (making the daily activities of the patient impossible);

The 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 the formulation of the diagnosis

ICD-10: M54 - Dorsalgia

Chain in classification:

5 M54 Dorsalgia

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

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

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Sciatica is a pain syndrome that occurs in the gluteal region due to inflammation, compression or other type 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 lesions of the lumbosacral spine. In this case, the pain can spread to one or both legs at once. Therefore, for vertebrogenic sciatica, a separate code for ICD-10 - M54.4 is provided.

This disease does not occur on its own. Most often, the symptoms of sciatica are manifested due to complications of other diseases:

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

In some cases, symptoms may occur due to injuries, hypothermia, pregnancy, alcohol intoxication, prolonged sitting or lying down. Thus, this ailment 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 (there is inflammation of the trunk of the sciatic nerve and its branches);
• medium (lesion at the level of the nerve plexus);
• upper (inflammation of the nerve cords and roots).

Symptoms

The main symptom of this disease is pain that occurs in the buttocks, and then "goes down" to the leg. The nature of the pain can vary from sharp to dull, there may be a burning sensation. With vertebrogenic sciatica, the described pains are preceded by a feeling of "lumbago" in the lower back. Then the discomfort descends along the sciatic nerve. In addition to pain, sensory disturbances, paresthesias, loss of reflexes and movement disorders in the corresponding lower limb are detected.

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

• tension of the pelvic muscles;
• increased sweating;
• anxiety, depression.

Quite rarely, there are symptoms of fecal and urinary incontinence (vertebrogenic sciatica).

The diagnosis is made on the basis of subjective and objective examination methods. The first step is a survey and examination of the patient, and then there are additional methods of examination.

Subjective Methods

It turns out the nature of the pain, how often they appear and in what place. Particular attention is paid to irradiation (where pain is given). Be sure to specify the presence of diseases of the spine or its injuries. This approach allows you to determine the 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 the diagnosis. Methods of getting rid of pain are specified. That is, does the patient do any exercises, does he use medication, or does he get by with the usual rubbing of the sore spot.

Objective Methods

For an accurate diagnosis according to ICD-10, an examination and additional examination methods are required. On examination, the doctor evaluates the sensitivity, strength and safety of the reflexes. In addition, when pressing, the presence and nature of pain is clarified. X-ray examination is necessary to rule out trauma. If symptoms persist for six weeks, additional methods are used, which are carried out in a certain order.

1. CT and MRI. Structural abnormalities (eg, spinal stenosis) are identified. Rarely X-ray.
2. Electromyography.
3. General (clinical) blood test.
4. General urine analysis.

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

Treatment

With the manifestation of the above symptoms, 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 life.

Sources:

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

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

In the vast majority of cases, vertebral neurological pathology is associated with degenerative-dystrophic changes in the spine. In these cases, in practice, it is customary to diagnose "osteochondrosis of the spine", which is based on primary dystrophic lesions of the intervertebral discs, however, in recent years, thanks to the introduction of CT and MRI into practice, myelography with water-soluble contrast, it has been shown that pain syndromes and neurological symptoms can be associated not only with the pathology of the intervertebral discs, but also with spondylarthrosis. stenosis of the spinal canal and mesvertebral foramina, spondylolisthesis, pathology of muscles and ligaments. which may not be directly related to osteochondrosis, but even with osteochondrosis of the spine at various stages of the “degenerative cascade”, various factors play a leading role in the development of pain syndrome - protrusion or hernia of the disc, instability or blockade of the spinal motion segment, arthrosis of the intervertebral joints. narrowing of the spinal or radicular canals, etc. In each of these cases, the pain syndrome and accompanying neurological symptoms have a clinical peculiarity, different temporal dynamics, prognosis, and require a special approach to treatment. thus. when formulating a diagnosis and coding it in accordance with ICD-10, the features of both neurological and vertebral manifestations should be taken into account as much as possible.

In ICD-10 vertebrogenic neurological syndromes are presented mainly in the section “Diseases of the musculoskeletal system and connective tissue (M00-M99), subsection “Dorsopathies” (M40-M54). Some neurological complications of vertebral pathology are also indicated in the section "diseases of the nervous system" (G00-G99), however, the codes corresponding to them are marked with an asterisk (for example, G55 * - compression of the roots of the spinal nerves and nerve plexuses in diseases classified elsewhere) and, therefore , can only be used as additional codes in the case of double coding.

The term " dorsopathy» (from the Latin dorsum - back) includes not only all possible variants of the pathology of the spine (spondylopathy), but also the pathology of the soft tissues of the back - the paravertebral muscles. ligaments, etc. The most important manifestation of dorsopathy is dorsalgia - pain in the back. (cm.. )

Distinguished by origin:
vertebrogenic (spondylogenic) dorsalgia associated with the pathology of the posterior spine (degenerative, traumatic, inflammatory, neoplastic and other);
non-vertebrogenic dorsalgia caused by sprains and muscles, myofascial syndrome, fibromyalgia, somatic diseases, psychogenic factors, etc.

Depending on the localization of pain, the following variants of dorsalgia are distinguished:
cervicalgia - pain in the neck;
cervicobrachialgia- pain in the neck extending into the arm;
thoracalgia - pain in the thoracic back and chest;
lumbalgia - pain in the lower back or lumbosacral region;
lumboischialgia - pain in the lower back, spreading to the leg;
sacralgia - pain in the sacral region;
coccygodynia - pain in the coccyx.

In acute intense pain, the terms “cervical backache” or “lumbar backache” (lumbago) are also used.

By severity, acute and chronic dorsalgia are distinguished. The latter continue without remission for more than 3 months, that is, in excess of the usual period of soft tissue healing.

However, the clinical picture of spinal lesions is not limited to pain; it may include:
local vertebral syndrome , often accompanied by local pain syndrome (cervicalgia, thoracalgia, lumbalgia), tension and soreness of adjacent muscles. soreness, deformity, limitation of mobility or instability of one or more adjacent segments of the spine;
vertebral syndrome at a distance ; the spine is a single kinematic chain, and dysfunction of one segment can lead to deformation, pathological fixation, instability or other change in the state of the higher or lower parts through a change in the motor stereotype;
reflex (irritative) syndromes : referred pain (for example, cervicobrachialgia, cervicocranialgia, lumboischialgia, etc.), muscular-tonic syndromes, neurodystrophic manifestations, autonomic repercussion (vasomotor, sudomotor) disorders with a wide range of secondary manifestations (enthesiopathies, periarthropathies, myofascial syndrome, tunnel syndromes and etc.);
compression (compression-ischemic) radicular syndromes : mono-, bi-, multiradicular, 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).

It is important to single out each of these syndromes, which require special treatment tactics, and reflect them in the formulated diagnosis; differentiation of reflex or compression syndromes has an important prognostic and therapeutic value.

According to the classification of I.P. Antonova when formulating a diagnosis neurological syndrome should be put in the first place, since it is he who decisively determines the specifics of the patient's condition. However, given that the coding in accordance with ICD-10goes according to the primary disease, then another sequence of formulating the diagnosis is allowed, in which the vertebral pathology is indicated first(herniated disc, spondylosis, spondylolisthesis, spinal stenosis, etc.). Spinal nerve root compression may be coded as G55.1* (for compression by a herniated disc), G55.2* (for spondylosis) or G55.3* (for other dorsopathy coded under M45-M46, 48, 53-54 ). In practice, clinical and paraclinical data (CT, MRI, etc.) often do not allow unambiguous resolution of the issue of whether the neurological syndrome is caused by a disc herniation or sprain of muscles and ligaments - in this case, coding should be carried out according to the neurological syndrome.

The diagnosis must include secondary neurodystrophic and vegetative changes, local muscular-tonic syndromes with compression of the plexuses and peripheral nerves. However, in these cases, proving a causal relationship with spinal lesions is an extremely difficult task. Convincing criteria for the differential diagnosis of vertebrogenic and nonvertebrogenic variants of humeroscapular periarthropathy, epicondylosis, and other enthesiopathies have not been developed. In some cases, vertebrogenic pathology acts as a background process, being only one of the factors in the development of periarthropathy or enthesiopathy (along with limb overload, non-adaptive motor sitereotype, etc.). In this regard, it seems appropriate to resort to multiple coding, indicating the code of enthesiopathy and dorsopathy.

When formulating a diagnosis, it should be reflected:
course of the disease: acute, subacute, chronic (remitting, progredient, stationary, regredient);
phase: exacerbation (acute), regression, remission (complete, partial);
exacerbation frequency: frequent (4-5 times a year), medium frequency (2-3 times a year), rare (no more than 1 time a year);
severity of pain syndrome: mild (not interfering with the daily activities of the patient), moderately pronounced (limiting the daily activities of the patient), pronounced (sharply impeding the daily activities of the patient), pronounced (making the daily activities of the patient impossible);
state of spinal mobility(mild, moderate, severe limitation of mobility);
localization and expression motor, sensory, pelvic and other neurological disorders.

It should be emphasized that the course and phase of the disease are determined by its clinical manifestations, and not by radiographic or neuroimaging changes.

Neurological syndromes in herniated intervertebral disc see..

examples of the formulation of the diagnosis

Cervical myelopathy due to median hernia of the C5-C6 disc of the III degree with moderate flaccid paresis of the upper extremities and severe spastic paresis of the lower extremities, stationary phase.

C6 cervical radiculopathy due to second-degree lateral herniation of the C5-C6 disc, chronic relapsing course, exacerbation stage with severe pain syndrome and severe limitation of spinal mobility.

Chronic cervicalgia on the background of cervical osteochondrosis, stationary course, with a moderately severe pain syndrome, without limitation of spine mobility.

Thoracic myelopathy due to median Th9-Th10 disc herniation with moderate lower spastic paraparesis, pelvic disorders.

L5 radiculopathy due to L4-L5 disc herniation with severe pain syndrome, exacerbation phase.

L5 radiculoischemia (paralyzing sciatica syndrome) on the left due to lateral herniation of the L4-L5 disc of the third degree, regression stage, moderately pronounced paresis and hypoesthesia of the left foot.

Chronic lumbalgia on the background of osteochondrosis of the lumbar spine (L3-L4), recurrent course, phase of incomplete remission, mild pain syndrome.

Chronic lumbalgia due to multiple hernias of Schmorl, stationary course, moderate pain syndrome.

!!! NOTE

In the absence of reliable clinical and paraclinical data that unambiguously indicate the leading type of degenerative-dystrophic lesion of the spine, which determines the symptoms in this patient, the formulation of the diagnosis may include only an indication of vertebrogenic lesions, a coding should be done according to the leading neurological syndrome, reflex or compression. In this case, all specific spondylopathies, as well as non-vertebrogenic syndromes, should be excluded. The ICD-10 provides the ability to code for the leading neurological syndrome under headings M53("Other dorsopathies") and M54("Dorsalgia"). It is in this way that cases of “spinal osteochondrosis” should be coded in the absence of an indication of the leading role of disc herniation, spondylosis, or spondyloarthrosis.

Diagnosis examples:

M54.2 Chronic vertebrogenic cervicalgia with severe musculo-tonic and neurodystrophic manifestations, relapsing course, exacerbation phase, severe pain syndrome, moderately severe restriction of mobility of the cervical region.

M 54.6 Chronic thoracalgia due to damage to the vertebral costal joints THh11-Th12 on the right (posterior costal syndrome), recurrent course, exacerbation phase, severe pain syndrome.

M 54.4 Chronic vertebrogenic bilateral lumboischialgia with pronounced muscular-tonic and neurodystrophic manifestations, recurrent course, exacerbation phase. severe pain syndrome, moderately pronounced limitation of mobility of the lumbar spine.

M 54.5 Acute lumbalgia with pronounced tension of the pra-vertebral muscles and antalgic scoliosis, pronounced pain syndrome, limited mobility of the lumbar region.