Avtor/Urednik		Zidar, Janez
Naslov		Bolnik za radikulopatijo - obravnava na sekundarni ravni
Prevedeni naslov		When do patients with radiculopathy need assessment at the secondary referral centers
Tip		članek
Vir		Zdrav Vars
Vol. in št.		Letnik 39, št. 7-8
Leto izdaje		2000
Obseg		str. 156-9
Jezik		slo
Abstrakt		The lifetime prevalence of radiculopathies (mainly due to sciatica) is about 40%. Radiculopathies may mimic other diseases that cause neck, trunk or back pain and can be divided into cervical, thoracic and lumbosacral radiculopathies. In the lumbosacral region L5 and S1 roots are most commonly affected by the herniated discs. C7, C6 and C8 are compressed in the order of decreasing frequency, mainly by osseoligamentous hypertrophy. Thoracic radiculopathies are rare and are more frequently found in diabetic patients. This paper emphasises that simple treatment is sufficient for most patients with back pain and sciatica. The condition is most often self-limited. Admission to the hospital for further evaluations and treatment are usually not necessary. In patients with most severe acute lower back pain, an intraabdominal or vascular condition should be suspected. When a patient reports unrelenting pain at rest, cancer or an infectious process must be ruled out, particularly in drug addicts, diabetic and immunosupressed patients, and in those with pyelonephritis and recent spinal surgery. Patients with an evolving neurologic deficit or caudal anaesthesia and urinary incontinence or retention will perhaps need an urgent surgery. Acute pain in patients with osteoporosis or with known cancer is suggestive of pathologic fracture. Acute sciatica rarely requires surgical treatment. Since more than 50% of patients recover in 6 weeks, delaying surgical treatment is appropriate in most patients. At this stage a definitive diagnosis should be made (e.g. ducs protrusion, spondylosis, synovial cysts, tumors, epidural abscesses). Involvement of the lumbosacral plexus or of the sciatic nerve can also resemble subacute sciatica. (Abstract truncated at 2000 characters).
Izvleček		V življenju naj bi kar 40% ljudi zbolelo za radikulopatijo, ki pa je ne smemo enačiti z bolečino v križu ali v vratu. Velja namreč, da ima samo 1% vseh bolnikov z akutno nastalo bolečino v križu znake okvare živčne korenine. Radikulopatije delimo na vratne, prsne in ledvenokrižne. Daleč najpogostejše so slednje. Najobičajnejši vzrok je kompresija živčnih korenin L5 in S1, ki jo povzroči herniiran medvretenčni disk. V vratu so pogosteje od drugih prizadete korenine C7, C6 in C8, običjani vzrok pa so spondilotične spremembe hrbtenice. Vzrok redkih prsnih radikulopatij pa je največkart sladkorna bolezen. V prispevku želimo poudariti, da so radikulopatije v veliki večini primerov benigne bolezni, ki se pozdravijo spontano in ne zahtevajo obravnave na sekundarni ravni. Slednja je potrebna zaradi natančnejše opredelitve vzroka ali zaradi operativnega ali drugega načina zdravljenja. Pri akutno nastali neznosni bolečini v križu moramo biti pozorni na možnost procesa v trebuhu ali na žilno bolezen. Kadar je bolečina neprestano prisotna tudi v mirovanju, je treba izključiti neoplastične in vnetne vzroke (diskitis, epiduralni absces, oesteomielitis). Na te vzroke smo posebej pozorni pri odvisnikih od drog, pri sladkornih bolnikih in pri bolnikih z imunsko motnjo ter pri bolnikih s pielonefritisom ali pri tistih, ki so bili pred kratkim operirani na mokrilih ali na hrbtenici. Kot posebej nujne je treba obravnavati tiste, pri katerih se nevrološka prizadetost z anestezijo v križničnih dermatomih in z uhajanjem ali z retenco urina hitro slabša, ker potrebujejo operacijo. Pri bolnikih z arakom ali z osteoporozo lahko akutna bolečina pomeni patološki zlom vretenca. Akutne radikulopatije redko zahtevajo operativno zdravljenje. O tem je treba razmišljati pri tistih, pri katerih se stanje tudi v subakutni fazi (po mesecu in pol) ne popravi. (Izvleček prekinjen pri 2000 znakih).
Deskriptorji		RADICULITIS NERVE COMPRESSION SYNDROMES BACK PAIN POLYRADICULITIS LOW BACK PAIN