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significant role. Even small disc prolapses can cause 2. Violation of sensitivity. With prolonged lesion of SMN,
complete epidural vein block [4]. Indirect confirmation of there is a decrease in tone in the surrounding tissues,
these data was obtained when examining 9640 patients with hypo- or muscle atrophy;
back pain or lumboischialgia: 13 (0.13%) patients had 3. With a pronounced lesion of the SMN, peripheral paresis
radicular symptoms caused not by a herniated disc or develops.
stenosis of the spinal canal, but by occlusion of the inferior
vena cava leading to the expansion of the epidural veins; 12 Conclusion
of them managed to restore blood flow through the inferior The currently available evidence of the high efficacy of
vena cava, which led to the disappearance of radicular pregabalin for the treatment of NBS, both in monotherapy
symptoms [5, 6]. and in combination with other drugs, makes it possible to
use it as a drug of choice or a first-line agent, including in
However, the theory of compression impact cannot explain radiculopathy. The combination of pregabalin with other
all cases of radiculopathy with disc herniation, since drugs, in particular NSAIDs, contributes to more effective
sometimes the severity of the symptoms of neurological relief of pain syndrome, reduces the severity of anxiety-
deficit does not correspond to the size of the hernial depressive disorders, and also improves the quality of life of
protrusion. An inflammatory theory in the genesis of patients with radiculopathy.
radiculopathy caused by herniated discs has found
numerous confirmations. It is believed that inflammation can Literature
be either autoimmune, triggered by antigens of the nucleus [1] PopelyanskyYa.Yu., Shtulman D.R. Pain in the neck,
pulposus, or caused by the release of inflammatory back and extremities // Diseases of the nervous
mediators directly from the nucleus pulposus. In this case, system / ed. N.N. Yakhno, D.R. Shtulman. M., 2001.S.
the mediators of inflammation can be phospholipase A2, 293–316.
cytokines, especially interleukin 1, 6, prostaglandin E2, nitric [2] PopelyanskyYa.Yu. Orthopedic neurology. Kazan.
oxide, immunoglobulins. Phospholipase A2 regulates the
1997. T. 1–2. P. 7.
release of arachidonic acid from cell membranes and has a
direct damaging effect on cell membranes. With a herniated [3] Khabirov F.A. Clinical neurology of the spine. Kazan,
disc, stagnation and thrombosis in local venous vessels with 2003.
thickening of the basement membrane and fibrosis of the [4]
endothelium are found, accompanying severe perineural and Filippovich N.F. On the role of venous disorders in the
pathogenesis of neurological manifestations of
endoneural fibrosis and atrophy without signs of
lumbar osteochondrosis // Peripheral nervous
inflammation. These pathological deviations occur due to
system: collection of papers. scientific. tr. Minsk:
impaired venous outflow. Edema and root damage increase
with increasing speed and degree of compression, and Science and Technology, 1990. Issue. 13, pp. 143–150.
sensory fibers may be more vulnerable than motor fibers [7, [5] Benens A. L., Epifanov V. A. Hemodynamics in the
8]. vertebrobasilar basin in patients with complicated
trauma of the cervical spine // Pathologist. spine. L.,
Conservative therapy is ineffective only in a small group of 1982. S. 44–46.
patients; in this case, surgical treatment is required [9]. [6]
These findings are supported by neurophysiological Brasis PU, Masdue DK, Biller H. Topical diagnostics in
observations. In a chronic process, there is demyelination of clinical neurology, trans. from English. M., 2009. C.
736.
the SMC.
[7] Veselovsky V.P. Practical vertebroneurology and
Herniation at several levels is rare, therefore biradicular manual therapy. Riga, 1991, pp. 30–145.
syndrome in hernias is explained mainly by the compression
[8] Dadasheva M.N. The use of B vitamins for back pain
of two roots at the same time by large hernias. Reactive
// BC. 2008. Vol. 16.P. 35–39.
adhesion phenomena may develop in the roots, epidural
tissue, the membranes of the spinal cord, which may be [9] Narayan P. Treatment of degenerative disk disease //
associated with autoimmune inflammation in a herniated Neurologic Clinics. 2001. Vol. 19. (1). P. 217-229.
disc. [10]
Levin O.S. Diagnosis and treatment of neurological
Cervical, thoracic and lumbar radiculopathy is distinguished manifestations of osteochondrosis of the spine //
Consilium-medicum. 2004. No. 6. P. 547–54.
depending on the level of the lesion - they are equally
characterized by certain symptoms: [11] Baron R., Freynhagen R., Tulle T. et al. The efficacy
1. pain of varying intensity and frequency, radiating along and safety of pregabalin in the treatment of
the course of the SMN; neuropathic pain associated with chronic lumbosacral
radiculopathy. Pain 2010. doi:
10.1016/j.pain.2010.04.013.

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