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

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

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

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

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

A Clinical Case of Surgical Treatment of the Adjacent Segment of the Spine during Fusion

Every year, the number of operations on the lumbar spine with the use of various spinal fusion techniques increases, which leads to an increase in the number of cases in the long-term period of surgical treatment, the formation of pathology of the adjacent segment (ASP), which is part of the structure of the failed back surgery  syndrome (FBSS). It is known that the pathology of the adjacent segment is a general term and covers two concepts: the degeneration of the adjacent segment (ASDeg) and the disease of the adjacent segment (ASDis). ASDeg is represented by radiographic changes occurring in the adjacent spinal motion segments during spinal surgery with spinal fusion, and ASDis refers to the clinical symptoms that develop during radiographic changes in these segments. With the pathology of an adjacent segment, clinically significant degenerative changes in it are not always formed. If these X-ray changes are formed and correlate with clinical and neurological manifestations, then surgical treatment is indicated. This pathology can be treated with repeated surgical intervention, which this article demonstrate with the clinical example of surgical treatment of the adjacent segment of the spine during fusion

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

Acupunctures in Complex Treatment of Cervical Pain Syndromes

To evaluate the effectiveness of the developed method of acupuncture in the complex of conservative treatment of pain in patients with osteochondrosis of the cervical spine in the neurosurgical Department of Irkutsk Scientific Centre of Surgery and Traumatology, 58 patients were under observation, 38 of whom were treated with acupuncture. The results of treatment were evaluated by the applying VAS testing and conducting stimulation electroneuromyography. The patients had 9–10 sessions of corporal and auricular acupuncture. Acupuncture was carried out according to 1st or 2nd variants of inhibitory action. When selecting points, the locally segmental principle was used, and the effect was carried out on symmetric points of general action (P7, GI4, GI 11 , E36 , RP6, VB34), on local pain ah shi points, in “near” and “far” points from the pain zone; on standard points of meridians of calming action: sympathetic, sedative and analgesic (points-cracks). Specific pain points were used: in pain in the area of the shoulder girdle – R5, E37, R4: in the rear surface of the chest and region of the scapula – T26, V43, V11; in neuralgia – V60, TR5, VB41. Corporal reflexology “enhance” auricular, we used impact on АТ55, АТ13, АТ22, АТ51, АТ34. In cases of severe pain and musculotonic syndromes, treatment was initiated with effects on auricular points: АР37 point of the cervical spine and АР55 point Shen Men. When comparing the results of VAS testing before and after the treatment, in all patients we noted a decrease in the intensity of pain, and 16 of patients went into the category of “mild cases”. The positive dynamics is confirmed by the data of electroneuromyographic studies: an increase in the amplitude of the M-response and a decrease in latency, a change in the characteristics of the F-wave. The obtained data indicate the high efficiency of acupuncture in the treatment of pain and muscle-tonic syndromes in patients with spinal osteochondrosis

Secretion of hormones of hypophysis, sexual gland and adrenals in patients with postoperative cicatricial-commissural epiduritis

The article is devoted, to the study of secretion of hormones of hypophysis, sexual gland and adrenals in patients with postoperative cicatricial-commissural epiduritis. Concentration of some hormones of hypophysis, sexual glands and adrenals in blood serum of 45 patients with postoperative cicatricial-commissural epiduritis before and. after standard conservative treatment was defined. Typical changes in secretion of studied hormones at postoperative cicatricial-commissural epiduritis were revealed. It was showed that standard scheme of treatment partly grades revealed endocrine disorders. Appropriateness of including research of hormonal profile for solving the problem of its possible correction in the complex of examination of patients with postoperative cicatricial-commissural epiduritis and. of calling endocrinologist for the examination of patients and further enhancement of the scheme of their treatment was proved