MODERN PRINCIPLES OF PATIENT MANAGEMENT WITH LUMBOSACRAL RADICULOPATHY (LITERATURE REVIEW)

Aim. Review of current literature on lumbosacral radiculopathy (LSR) and modern management of individuals with this condition. Materials and methods. A systematic review of literature on LSR was conducted using electronic resources Web of Science and PubMed, with the hashtag radiculopathy, for the last 5 years (2019-2023). This review was conducted according to PRISMA recommendations and PICOT search strategy. The initial electronic search in Web of Science yielded 1634 documents, and in PubMed - 2706 documents. Additionally, electronic archives of domestic medical journals for the last 7 years were reviewed, resulting in 16 articles that met the inclusion criteria. In the final result, 56 articles were selected. Results. The article highlights the main diagnostic and therapeutic aspects of LSR. A review of contemporary literature on pain in the lumbar spine with radiculopathy is presented. Conclusions. The most common cause of LSR is herniated intervertebral disc (HIVD), but there is no clear correlation between the size of HIVD herniation and the severity of neurological manifestations. The Lasègue test is not always perfect for diagnosis, so the use of other tests for stretching the sciatic nerve (Slump test, Bowstring test) may help identify lumbar root damage. MRI at 3 Tesla, electroneuromyography, and genotyping as a prognostic biomarker become common for diagnosing LSR. Treatment of LSR (conservative, minimally invasive) should be aimed at both HIVD herniation and radiculopathy itself, and a multidisciplinary team should be involved in restoring the patient's impaired functioning. Conservative treatment is preferred at the initial stage of LSR treatment. Manual therapy is used in the form of neuromuscular therapy (post-isometric muscle relaxation) and traction techniques on the spine. Hardware physiotherapy and traction for radicular syndromes are recommended by clinical experience. As studies have shown, lumbosacral injections of platelet-rich plasma (PRP therapy) initiate or accelerate the resorption of HIVD material, stimulate reparative and regenerative processes in peripheral nerves. Minimally invasive treatment tends to be ultrasound-guided and includes epidural steroids and immunosuppressants, injections of structure-modifying drugs in the area of disc-radicular conflict, and percutaneous endoscopic lumbar discectomy.