MARKER INDICATORS OF DEGENERATIVE-DYSTROPHIC PROCESSES OF THE SPINE, PELVIS AND HIP JOINTS OF DYSPLASTIC GENESIS

Degenerative and dystrophic diseases of the spine, pelvis and hip joints are considered as a single pathogenetically conditioned process with an interdependent condition. The significance of the problem is determined by the high incidence of spinal and hip dysplasia, the syndrome of mutual burdening, the diversity and polymorphism of clinical manifestations, the growth of disability, the difficulties of diagnosis and treatment. Questions remain about the root cause of the occurrence of combined lesions, their mutual influence. The aim of the work was to identify the most common, diagnostic, pathognomonic signs of dysplastic syndrome. The patients were examined according to a single diagnostic algorithm, including clinical and neurological examination, plain radiograph of the pelvis; spondylography, MSCT, MRI of the lumbar and lumbosacral spine; study of the locomotion act of walking, anthropometric measurements; statistical methods. We analyzed the results of treatment of 39 patients (26 women and 13 men; mean age – 53 years) with dysplastic syndrome including degenerative-dystrophic changes in the spine, pelvis and hip joints. The most common diagnostic signs of combined degenerative-dystrophic diseases of the spine and pelvis have been established, among which pain syndrome, noted in varying degrees in all patients. The established diagnostic indices, supplementing existing knowledge of the problem studied, will allow to specify diagnostics and optimize the treatment of combined degenerative-dystrophic diseases of dysplastic genesis

Significance of EMG and ENMG in the Diagnosis and Treatment of Degenerative-Dystrophic Diseases of the Spine (Literature Review)

The article presents the review of domestic and foreign literature on the use of neurophysiological diagnostic methods – electroneuromyography (ENMG) and electromyography (EMG) in degenerative-dystrophic diseases of the spine. The ENMG method is of great importance for theoretical neurology, obtaining new data on the structural and functional organization of the central and peripheral nervous system in the process of individual development. Electromyography as a diagnostic method studies the electrical activity of the peripheral apparatus of the nervous system. With these methods we directly evaluate both voluntary bioelectric activity of muscles at rest and during their activation (EMG), and caused by stimulation (ENMG). Most authors believe that modifications of stimulation electromyography are objective diagnostic methods that allow to assess the functional state of the peripheral nervous system. Interesting is the fact that changes in EMG and ENMG parameters for osteochondrosis of the spine are recorded even in the absence of external manifestations of the disease. At the same time, for patients with myofascial syndrome in lumbar osteochondrosis, a bilateral decrease in the direct and reflex excitability of motoneurons is characteristic, a slowing down of the pulse along the arc of the H-reflex on the side of the pain and a two-sided local acceleration of the pulse on the distal part of the efferent part of the H-reflex arc from the popliteal pits to soleus muscle. Noteworthy is the fact that the pathological process in the nervous tissue according to ENMG in patients with osteochondrosis of the spine with unilateral radicular syndromes is bilateral. The work of our clinic has shown that diagnostic electroneuromyography can be considered as a medical procedure – electropuncture, according to its results, tactics of both surgical and conservative treatment can be determined. Data of EMG and EMG, carried out after the end of any of the listed types of treatment, serve as an objective control of their effectiveness

CONTRIBUTION OF T.D. ZYRYANOVA TO THE STUDY OF THE PROBLEM OF PELVIC BONES INJURIES AND ASSOCIATED COMPLICATIONS

The article presents the results of scientific fundamental and applies researches of Tatyana Dmitrievna Zyryanova on the problem of study of pelvic bones and coxal cavity fractures complicated and non-complicated with bladder, urethra and rectum injuries. T.D. Zyryanova studied and systematized problems on the statistics of this incapacitating pathology, its clinic and diagnostics. She determined indications for conservative and surgical treatment of certain pelvic bones and pelvic waist injury and an algorithm of rehabilitation measures after the treatment. T.D. Zyryanova and co-authors proposed system of transport immobilization at the injuries of pelvic bones and concomitant injuries of internals of cavity of the lesser pelvis

Formation of Adhesive Arachnoiditis with Epidural Fibrosis as a Cause of Repeated Surgical Interventions (Clinical Case)

The work presents a rare clinical case of adhesive arachnoiditis, which developed against the background of epidural fibrosis during repeated surgical interventions. The cicatricial adhesion in the epidural space is formed in 100% of cases after surgery and is a frequent cause of intraoperative complications during repeated surgical interventions (bleeding, damage to the spinal cord and the dura mater with subsequent outflow of cerebrospinal fluid) and, therefore, an unsatisfactory result of surgical treatment with the formation of constant pain of various intensity, pseudomeningocele, commissural arachnoiditis, etc. The cicatricial adhesion in the epidural space is the main reason for the development of failed back surgery syndrome (FBSS), which today is an important and unresolved problem in spinal surgery. The epidural, as well as the subdural and subarachnoid space of the operated spinal motor segment of the spinal canal can be involved in the cicatricial adhesion, as it is shown in our clinical example. In this regard, it is important to prevent the development of the cicatricial adhesion in the epidural space during primary spinal surgeries, since with the increase in life expectancy of the population and increase in surgical activity during spinal surgeries, the patient can be operated repeatedly. Consequently, the question arises of preventing the formation of the cicatricial adhesion in 100% of cases with each surgical intervention, since the formed cicatricial adhesion in the epidural space does not have effective methods of conservative and surgical treatment and worsens favorable and satisfactory forecasts of surgical treatment for repeated surgical interventions

Surgical treatment of facet syndrome in segmental instability of the lumbar spine

A clinical example shows a rare case of surgical treatment of facet syndrome, which is formed against the background of instability of the spinal motion segment of the spine at the LIV-LV level using the method of laser vaporization  and denervation of the facet joints.The aim of the work is to consider the clinical and diagnostic indicators of facet syndrome and to assess the role of imaging research methods in the diagnosis of this syndrome. At the outpatient stage, with long-term persistent pain syndrome in the lumbar spine, non-stop conservative methods of treatment, the patient underwent survey radiography and MRI examination of this area in order to exclude a specific process (oncopathology, pathological fracture against the background of osteoporosis, spondylitis, etc.) Chronic pain syndrome with its ineffective conservative treatment leads to maladjustment of the psychoemotional and professional-labor state of the patient. Determining the source of pain impulses in the lumbar spine can be difficult, since pain can cause degenerative and pathological changes in various anatomical structures of the spine (intervertebral disc, facet joints, ligaments, muscles, etc.), which can form a clinical picture of pain syndrome with its various manifestations and symptoms, which do not always clearly determine the level and structure of the affected spine. In this connection, for the timely and correct determination of the diagnosis of all patients with chronic pain syndrome in the lumbar spine, it is necessary to be sent to specialized neurosurgical institutions, in which patients undergo a set of necessary medical and diagnostic procedures to determine the further management tactics and treatment algorithm for this category of patients

EVALUATION OF THE DEGREE OF STENOTIC PROCESS (STENOSIS) OF THE SPINAL CANAL AT THE LUMBAR LEVEL

In the article the evaluation of the degree of stenotic process in the spinal canal in 48 patients with stenosis of the spine judging by the morphometric measurements of vertebrae, dural sac and spinal canal. The authors improved and supplemented the morphometric technique of measurements of a number of parameters, on their basis the mathematical model was worked out and mathematical calculations to determine the coefficient of stenotic process in the spinal canal at the lumbar level were hold (Zn). The diagnostics of stenosis of spinal canal basing on worked out clinic ray criteria using mathematical modeling can help more complete diagnostics and evaluation of the degree of stenotic process of the spinal canal at the lumbar level and let choose appropriate prevention and treatment of this pathology. The calculated ratio of stenotic process (Zn) and its values let clinicians choose tactics of conservative or surgical treatment in time and choose the way of prevention of complications of stenotic process of the spinal canal

РАЗВИТИЕ ФУНДАМЕНТАЛЬНОЙ НАУКИ: СТРАТЕГИИ И МЕХАНИЗМЫ ФОРМИРОВАНИЯ ПРИОРИТЕТОВ

Purpose: the aim of paper is comparison of various strategies for the development of fundamental science and the formation of procedures for selecting priorities for the development of fundamental scientific research for the strategies examined.Methods: the research is basedonasystematicapproachtoimprovingthestrategicmanagementofthedevelopmentofbasicscientificresearch. Methodical basis of the research are methods of systematization, synthesis, generalization, analogies, classification, situational analysis, analysis of empirical and expert data.Results: an analysis of four possible strategies for the development of fundamental scientific research in the Russian Federation was carried out. Their positive and negative sides are revealed, risks of their realization are highlighted. For each strategy, a procedure is proposed for selecting priorities for the development of basic scientific research. The possible impact of strategies on national security and economic development in the long term is shown. Comparison of these strategies is carried out.conclusions and relevance: according to the authors, the most favorable from the point of view of scientific, technological and socio-economic development of the country is the Strategy for the Development of Basic Research on a Broad Front. However, it requires an increase in the resource provision of science and a change in approaches to the management of science. Next on attractiveness is the compilation of two strategies – the Development Strategy for a narrow specialization and the Strategy of catching-up development for the rest of research. Depending on the chosen strategy for the development of fundamental science, it is necessary to give a different list of works on the formation of priorities for fundamental research, the description of which is given for each strategy considered.Цель: Цель исследования – сопоставление различных стратегий развития фундаментальной науки и формирование процедур выбора приоритетов развития фундаментальных научных исследований для рассмотренных стратегий.Методология проведения работы: В основу исследования положен системный подход к совершенствованию стратегического управления развитием фундаментальных научных исследований. Методической основой исследования являются методы систематизации, синтеза, обобщения, аналогий, классификации, ситуационного анализа, анализа эмпирических и экспертных данных.Результаты работы: Проведен анализ четырех возможных стратегий развития фундаментальных научных исследований в Российской Федерации. Выявлены их положительные и отрицательные стороны, выделены риски их реализации, и для каждой стратегии предложена процедура по выбору приоритетов развития фундаментальных научных исследований. Показано возможное влияние стратегий на обеспечение национальной безопасности и экономического развития страны в долгосрочной перспективе. Проведено сопоставление этих стратегий.Выводы: Наиболее благоприятной с точки зрения научно-технологического и социально-экономического развития страны является Стратегия развития фундаментальных исследований по широкому фронту, однако она требует увеличения ресурсного обеспечения науки и изменения подходов к управлению наукой. Следующей по привлекательности является компиляция двух стратегий – Стратегии развития по узкой специализации и Стратегии догоняющего развития по остальным направлениям исследований. В зависимости от выбранной стратегии развития фундаментальной науки, необходимо приводить разный перечень работ по формированию приоритетов фундаментальных научных исследований, описание которых дано для каждой рассмотренной стратегии

Functional State of the Bioelectrical Activity of the Brain in Cervical Osteochondrosis

Spinal osteochondrosis takes one of the first places among all chronic diseases, and every second osteochondrosis patient has dystrophic and degenerative changes in the spine in the cervical region. Manifestations of osteochondrosis of the cervical spine are diverse, which often interferes with the diagnosis and subsequent treatment. In osteochondrosis of the cervical spine, clinical symptoms may occur associated with insufficient blood supply to areas of the brain and that would require diagnostic methods that are not included in the standards for diagnosing the disease. In order to study the bioelectrical activity of the brain in 25 patients of the Department of Neurosurgery of Irkutsk Scientific Centre of Surgery and Traumatology with osteochondrosis of the cervical spine with cerebrovascular syndrome; a comparison was made of EEG indicators with a group of healthy volunteers that is representative by sex and age. Encephalogram indices were recorded using an EEG-21/26 Encephalan-131-03 encephalograph (Taganrog) with a standard installation of scalp EEG electrodes using the "10-20"system. An analysis of the rhythms of the bioelectrical activity of the brain in the clinical comparison group revealed a normal zonal distribution with an alpha rhythm dominating the EEG, which generally reflects a high degree of organization of neuroactivity and indicates the stability of cerebral homeostasis. At the same time, in the main group, EEG indicators significantly differed from the values of the norm and indicators of the control group. Analysis of the bioelectrical activity of the brain of patients with osteochondrosis of the cervical spine was characterized by disorganization of cortical rhythmics with a combination of moderate and diffuse disorders of varying severity. There was a shift in the frequency of bioelectric activity towards slow waves, which is a characteristic of dyscirculatory encephalopathy. Thus, the study of brain biopotentials (EEG) in patients with osteochondrosis of the cervical spine has diagnostic and prognostic significance, as well as a measure of the current clinical condition of the patient

Modeling of Degenerative-Dystrophic Changes in the Lumbar Spine Intervertebral Disc in Experiment

The paper presents an experimental model of the development of degenerative-dystrophic processes in the intervertebral disc at LVI - St level, worked out by specialists of Irkutsk Scientific Centre of Surgery and Traumatology. For the purposes of the research we used the techniques of laminectomy and LVI facetectomy.Materials and methods. The experiment was conducted on ten Wistar male rats using microsurgical instruments and binocular optics with a 6-fold magnification. The reliability and effectiveness of the obtained model were evaluated by X-ray and histological research methods. Spondylograms assessed the level, volume of surgical intervention and the likelihood of LVI spondylolisthesis occurrence relative to St against the background of impaired spinal support function created surgically on the day 15 of the experiment. The histological picture of degenerative changes in the intervertebral disc was assessed on the week 16 and 24 after the animals were sacrificed.Results. An X-ray examination on the day 15 revealed LVI spondylolisthesis relative to SI in 4 out of 10 experimental animals. To assess the nature of degenerative-dystrophic changes in the intervertebral disc, five rats were sacrificed at the 16th week and five - at the 24th week. When analyzing the obtained histological data, we noted the progression of degenerative-dystrophic changes in the intervertebral disc occurring by the 24th week.Conclusion. The designed model for the development of degenerative-dystrophic changes in the intervertebral disc is in direct correlation with the violation of the integrity of the posterior supporting complex with the subsequent formation of spondylolisthesis and instability in this segment. Histological studies in the intervertebral disc reliably confirmed the formation and progression of degenerative-dystrophic changes in the intervertebral disc at the LVI-SI level from the 16th to the 24th week of the experiment. The obtained experimental model of the formation of degenerative-dystrophic changes without mechanical damage to the intervertebral disc will allow clinicians to obtain information about the primary changes in the intervertebral disc, to study the mechanisms of development and the course of degenerative changes in the intervertebral disc on the model of disturbance of the back supporting complex with pathological changes in the biomechanics of the spine after laminectomy and facetectomy. Understanding and knowledge of the pathogenesis of degenerative-dystrophic disease of the spine will allow specialists to exercise an etiopathogenically reasonably approach to the issues of prevention and treatment

Electroneuromyographic Parameters in Patients with Stenosing Process of the Cervical Spinal Canal

One of the main causes of pain in the cervical spine, which causes the development of neurological deficit, is the stenosing process of the spinal canal with compression of the neurovascular structures. To determine the tactics of treatment, to predict the consequences of the disease, timely diagnosis of the functional state of  neural structures is of great importance.Materials and methods. An informative method for diagnosing stenosing processes of the cervical spine, along with radiography and MRI, is electroneuromyography (ENMG). The analysis was based on 35 patients with a stenosing process of the spinal canal at the cervical level (17 men, 18 women), the average age of patients was 47.7 ± 9.9 years.Results. In the study of changes in the functional state of the axillary, radial, ulnar and median nerves, with stenosing processes, a unidirectional deviation of the entire ENMG complex of indicators of the limb with pain syndrome and contralateral limb was noted. A decrease in the amplitude of the maximum M-responses is recorded due to damage to the peripheral motor neuron and axon degeneration. Selective damage to the slow-conducting anterior motoneurons does not cause a decrease in the speed of impulse conduction due to demyelination. Bilateral changes in late electroneuromyographic phenomena (F-wave) are possibly caused by a  general reaction of the peripheral and central nervous systems.Conclusion. In patients with a stenosing process of the cervical spine with severe clinical manifestations, ENMG values can be used both to determine indications for surgical treatment and to assess the dynamics of changes in the postoperative period