Chapter 27. Neck, Back, and Limb Pain. Vertebrogenic Neurological Disorders
8 topics with a brief review: definitions, key facts, and classroom questions.
Pain in the back, neck, and limbs is one of the most common reasons for consulting a neurologist. In this chapter, we examine vertebrogenic neurological disorders: how spinal pathology leads to the compression of neural structures, reflex muscle spasms, and chronic pain.
The material in this section is structured by level of lesion. You will study in detail the specifics of cervical, thoracic, and lumbosacral vertebrogenic syndromes. The central theme of the chapter is radicular syndrome (radiculopathy), its clinical presentation, and the biomechanics of its development. Finally, we will cover modern standards for treating vertebrogenic neurological disorders, ranging from medicinal blocks to indications for neurosurgical intervention.
During practical classes, instructors most commonly ask about the topical diagnosis of specific nerve root lesions, the assessment of tension signs (Lasègue, Wasserman), and the ability to identify "red flags" in dorsalgia. Learn topography thoroughly—without it, substantiating a clinical diagnosis is impossible.
How to distinguish radiculopathy from lumboischialgia?
In lumboischialgia, pain is localized in the lower back, buttock, and posterolateral surface of the leg, but never reaches the foot and toes. In radiculopathy, pain radiates proximally-distally all the way to the foot.
What is the difference between specific and nonspecific back pain?
Nonspecific pain is mainly related to muscles and ligaments, accounting for the vast majority of cases. Specific pain is caused by serious conditions (tumors, infections, fractures) and requires a completely different treatment approach.
Can a disc herniation be seen on a regular X-ray?
No, radiography does not allow for the direct visualization of an intervertebral disc herniation. Its presence can only be inferred from an indirect sign—reduced distance between the bodies of adjacent vertebrae.
Is an MRI mandatory for any acute back pain?
No. In cases of nonspecific pain, instrumental examinations are not required. MRI or CT is indicated only when there is suspicion of a herniation with root compression, tumor, infection, or stenosis.
How to distinguish lumboischialgia from radiculopathy?
In lumboischialgia, pain radiates down the leg but never reaches the foot and toes. In discogenic radiculopathy, pain radiates distally right down to the toes.
Can a patient with acute back pain be prescribed strict bed rest?
In acute nonspecific pain, strict bed rest is strongly discouraged as it increases the duration of the illness; maintaining activity is important. However, in specific discogenic radiculopathy, short-term bed rest is acceptable to unload the affected segment.
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