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»

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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