nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2026-3-4-13nnp-2852Research ArticleEXPERT RECOMMENDATIONSРЕКОМЕНДАЦИИ ЭКСПЕРТОВDiscogenic lumbosacral radiculopathy. Recommendations of the Russian Association for the Study of Pain, the Russian Society of Neurologists, the Russian Association of Neurosurgeons, the Interventional Pain Management Association, and the All-Russian Public Organisation for the Promotion of Rehabilitation 'Union of Rehabilitators of Russia'Пояснично-крестцовая дискогенная радикулопатия. Рекомендации Российского общества по изучению боли, Всероссийского общества неврологов, Ассоциации нейрохирургов России, Ассоциации интервенционного лечения боли, Общероссийской общественной организации содействия развитию реабилитологии «Союз реабилитологов России»https://orcid.org/0000-0002-1992-7960ПарфеновВ. А.ParfenovV. A.

119021, Москва, ул. Россолимо, 11 

11, Rossolimo St., Build. 1, Moscow 119021 

https://orcid.org/0000-0002-6715-6021ЕвзиковГ. Ю.EvzikovG. Yu.

119021, Москва, ул. Россолимо, 11 

11, Rossolimo St., Build. 1, Moscow 119021 

https://orcid.org/0000-0002-9406-5846КукушкинМ. Л.KukushkinM. L.

125315, Москва, ул. Балтийская, 8 

8, Baltiyskaya St., Moscow 125315 

https://orcid.org/0000-0001-9719-6772БеловаА. Н.BelovaA. N.

603005, Нижний Новгород, пл. Минина и Пожарского, 10/1

10/1, Minina and Pozharskogo Sq., Nizhny Novgorod 603005 

https://orcid.org/0000-0002-0338-4236АчкасовЕ. Е.AchkasovE. E.

119435, Москва, ул. Большая Пироговская, 2, стр. 9 

2, Bolshaya Pirogovskaya St., Build. 9, Moscow 119435 

https://orcid.org/0000-0002-5629-9860ГеновП. Г.GenovP. G.

123182, Москва, ул. Пехотная, 3 

3, Pekhotnaya St., Moscow 123182 

https://orcid.org/0000-0002-2752-4109ГоловачеваВ. А.GolovachevaV. A.

Вероника Александровна Головачева 

119021, Москва, ул. Россолимо, 11 

Veronika Aleksandrovna Golovacheva 

11, Rossolimo St., Build. 1, Moscow 119021 

xoxo.veronicka@gmail.comhttps://orcid.org/0000-0003-3515-8329ГриньА. А.GrinA. A.

129090, Москва, Большая Сухаревская пл., 3, стр. 1 

3, Bolshaya Sukharevskaya Sq., Build. 1, Moscow 129090 

https://orcid.org/0000-0003-3252-4311ДавыдовО. С.DavydovO. S.

125315, Москва, ул. Балтийская, 8 

8, Baltiyskaya St., Moscow 125315 

https://orcid.org/0000-0003-1496-8576ИвановаГ. Е.IvanovaG. E.

117997, Москва, ул. Островитянова, 1 

117997, Москва, ул. Островитянова, 1, стр. 10 

1, Ostrovityanova St., Moscow 117997 

https://orcid.org/0000-0003-4950-144XИсайкинА. И.IsaikinA. I.

119021, Москва, ул. Россолимо, 11 

11, Rossolimo St., Build. 1, Moscow 119021 

https://orcid.org/0000-0001-6747-3476КамчатновП. Р.KamchatnovP. R.

117997, Москва, ул. Островитянова, 1 

1, Ostrovityanova St., Moscow 117997 

https://orcid.org/0000-0002-9976-948XКоноваловН. А.KonovalovN. A.

125047, Москва, ул. 4-я Тверская-Ямская, 16 

16, 4th Tverskaya-Yamskaya St., Moscow 125047 

https://orcid.org/0000-0002-2570-3066КрутькоА. В.KrutkoA. V.

127299, Москва, ул. Приорова, 10 

10, Priorova St., Moscow 127299 

https://orcid.org/0000-0001-7206-8926КрыловВ. В.KrylovV. V.

129090, Москва, Большая Сухаревская пл., 3, стр. 1 

117997, Москва, ул. Островитянова, 1 

3, Bolshaya Sukharevskaya Sq., Build. 1, Moscow 129090 

1, Ostrovityanova St., Moscow 117997 

https://orcid.org/0000-0001-6542-1963ЧурюкановМ. В.ChuryukanovM. V.

119021, Москва, ул. Россолимо, 11 

119991, Москва, Абрикосовский пер., 2 

11, Rossolimo St., Build. 1, Moscow 119021 

2, Abrikosovsky Lane, Moscow 119991 

Кафедра нервных болезней ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)»РоссияDepartment of Nervous Diseases I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)Russian FederationКафедра нейрохирургии ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)»РоссияDepartment of Neurosurgery I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)Russian FederationЛаборатория фундаментальных и прикладных проблем боли ФГБНУ «Научно-исследовательский институт общей патологии и патофизиологии»РоссияLaboratory of Fundamental and Applied Problems of Pain, Research Institute for General Pathology and PathophysiologyRussian FederationКафедра медицинской реабилитации ФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава РоссииРоссияDepartment of Medical Rehabilitation, Privolzhsky Research Medical University, Ministry of Health of RussiaRussian FederationКафедра спортивной медицины и медицинской реабилитации Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)»РоссияDepartment of Sports Medicine and Medical Rehabilitation, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)Russian FederationОтделение лечения пациентов с хроническими болевыми синдромами ГБУЗ «Московский клинический научно-исследовательский центр Больница 52 ДЗМ»РоссияDepartment for the Treatment of Patients with Chronic Pain Syndromes, Moscow Clinical Research Center Hospital No. 52Russian FederationОтделение неотложной нейрохирургии ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияDepartment of Emergency Neurosurgery, N.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationКафедра медицинской реабилитации ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России ; Научно-исследовательский центр медицинской реабилитации ФГБУ «Федеральный центр мозга и нейротехнологий ФМБА России»РоссияDepartment of Medical Rehabilitation N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia ; Research Center for Medical Rehabilitation, Federal Center of Brain Research and Neurotechnologies, FMBA of RussiaRussian FederationКафедра неврологии, нейрохирургии и медицинской генетики ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияDepartment of Neurology, Neurosurgery and Medical Genetics N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian FederationФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н.Н. Бурденко» Минздрава РоссииРоссияN.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of RussiaRussian FederationОтделение хирургии позвоночника ФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Н.Н. Приорова» Минздрава РоссииРоссияDepartment of Spine Surgery, N.N. Priorov National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of RussiaRussian Federationотделение неотложной нейрохирургии ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ» ; Кафедра фундаментальной нейрохирургии Института нейронаук и нейротехнологий ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияDepartment of Emergency Neurosurgery, N.V. Sklifosovsky Research Institute for Emergency Medicine ; Department of Fundamental Neurosurgery, Institute of Neurosciences and Neurotechnologies, N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian FederationКафедра нервных болезней ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)» ; Клиника изучения и лечения боли ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского»РоссияDepartment of Nervous Diseases I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University) ; Pain Research and Treatment Clinic, Acad. B.V. Petrovsky Russian Research Center of SurgeryRussian Federation202620062026183413Copyright © Parfenov V.A., Evzikov G.Y., Kukushkin M.L., Belova A.N., Achkasov E.E., Genov P.G., Golovacheva V.A., Grin A.A., Davydov O.S., Ivanova G.E., Isaikin A.I., Kamchatnov P.R., Konovalov N.A., Krutko A.V., Krylov V.V., Churyukanov M.V., 20262026Парфенов В.А., Евзиков Г.Ю., Кукушкин М.Л., Белова А.Н., Ачкасов Е.Е., Генов П.Г., Головачева В.А., Гринь А.А., Давыдов О.С., Иванова Г.Е., Исайкин А.И., Камчатнов П.Р., Коновалов Н.А., Крутько А.В., Крылов В.В., Чурюканов М.В.Parfenov V.A., Evzikov G.Y., Kukushkin M.L., Belova A.N., Achkasov E.E., Genov P.G., Golovacheva V.A., Grin A.A., Davydov O.S., Ivanova G.E., Isaikin A.I., Kamchatnov P.R., Konovalov N.A., Krutko A.V., Krylov V.V., Churyukanov M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/2852

When examining a patient with lumbosacral pain (lower back pain), it is necessary to rule out any specific underlying causes. The diagnosis of discogenic lumbosacral radiculopathy (DLR) is based on clinical examination; magnetic resonance imaging (MRI) is useful for ruling out other causes of radiculopathy and assessing the characteristics of a herniated intervertebral disc. There is insufficient justification for early MRI (within the first 4 weeks) unless there are signs of cauda equina syndrome, or epidural glucocorticoid injection or urgent surgical treatment is planned. It is recommended that patients with DLR be informed about the possibility of disc herniation regression and recovery, and the advisability of maintaining physical activity. Non-steroidal anti-inflammatory drugs may be used to relieve pain; if these are ineffective, epidural administration of local anaesthetics and glucocorticoids under X-ray or ultrasound guidance may be considered. During the acute phase, it is advisable to perform therapeutic exercises under specialist supervision and to attend educational sessions on movement ergonomics. For subacute and chronic DLR, therapeutic exercises, manual therapy and psychological therapy are recommended. Consultation with a neurosurgeon regarding a possible microdiscectomy is indicated as a matter of urgency in the presence of cauda equina syndrome, as well as if there is no response to conservative treatment within 4–8 weeks. For preventive purposes, the patient is advised to undertake therapeutic exercises and an educational programme on avoiding excessive physical and static loads.

При обследовании пациента с пояснично-крестцовой болью (болью в нижней части спины) необходимо исключить специфическую причину заболевания. Диагноз пояснично-крестцовой дискогенной радикулопатии (ПКДР) основывается на клиническом обследовании, для исключения других причин радикулопатии и оценки характеристик грыжи межпозвоночного диска информативна магнитно-резонансная томография (МРТ). Раннее (в течение первых 4 нед) проведение МРТ не имеет достаточных оснований, если нет признаков компрессии конского хвоста, не планируется эпидуральное введение глюкокортикоидов или неотложное хирургическое лечение. Рекомендуется информировать пациента с ПКДР о возможности регресса грыжи межпозвоночного диска и выздоровлении, целесообразности сохранения физической активности. Для облегчения боли могут быть использованы нестероидные противовоспалительные препараты, при отсутствии эффекта – эпидуральное введение местных анестетиков и глюкокортикоидов под рентгенологическим или ультразвуковым контролем. В остром периоде целесообразно использовать лечебные упражнения под контролем специалиста, проводить образовательные занятия по эргономике движений. При подострой и хронической ПКДР рекомендуются лечебные упражнения, мануальная терапия, психологические методы терапии. Консультация нейрохирурга для проведения возможной микродискэктомии показана экстренно при наличии синдрома поражения конского хвоста, а также при отсутствии эффекта от консервативной терапии в течение 4–8 нед. В профилактических целях пациенту рекомендуются лечебная гимнастика, образовательная программа по предупреждению чрезмерных физических и статических нагрузок.

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The authors declare that there are no conflicts of interest present.