Several aspects of conservative treatment of patients with cervical osteochondrosis

The aim of the research was to develop an algorithm of complex conservative treatment of patients with cervical osteochondrosis. We examined and provided conservative treatment to 40 patients with cervical osteochondrosis in periods 1-11 with severe pain syndrome. The treatment was mainly aimed at pain management. For this purpose, we assigned non-steroidal anti-inflammatory drugs (NSA1D) to the patients. NSA1D are the most effective medicinal agents, first of all due to their analgesic effect. Also, the treatment included physiotherapy and acupuncture. As a result of the treatment, neurological manifestations were reduced. Number of cervicalgia cases decreased from 12 (before the treatment) to 6 (after the treatment), number of cervical cranialgia cases - from 12 to 7, number of cervicobrachialgia cases - from 16 to 8 correspondingly. Developed complex of conservative treatment measures allows to obtain successful treatment results in most cases. 1t is important to note that proposed treatment regimen is available, simple and can be applied in all neurological and neurosurgical units and hospitals

Our experience of using laser vaporization for treatment of lumbar disc herniation

The article presents the analysis of effectiveness of laser vaporizationfor treatment of pain syndrome caused by lumbar disc herniation. We treated 149 patients (average age - 40 years). 62 (41.7 %) patients had lumbodynia, 67 (45.2 %) patients had lumbar ischialgia. Nerve root disorders (radiculopathy, radiculoneuritis) are found in 20 (13.1 %) patients. 86 (57.4 %) patients had median hernias of intervertebral disc (disc bulging for 0.6 ± 0.2 cm), 36 (24.3 %) patients had intervertebral disc protrusion and 27 (18.3 %) patients had lateral intervertebral hernia (disc bulging for 0.55 ± 0.15 cm). Satisfactory and good results of laser vaporization are registered in 140 (94 %) patients with circular protrusion and median hernias with disc bulging up to 7-8 mm. Also the decrease in VAS scores of pain syndrome by 2-5 points in comparison with initial condition is found. Unsatisfactory results are registered in 9 (6 %) patients with lateral hernias of more than 5 mm and with disease duration more than 6 months. Prospective (from 3 to 13 months) follow-up was conducted in 49 patients. 5 patients from the group with lateral hernias needed open surgeries

MODERN IDEAS ABOUT EPIDURAL FIBROSIS (LITERATURE REVIEW)

Epidural fibrosis is formed around the dural sac and the neurovascular structures of the vertebral canal in the postoperative period. It is one of the common causes of Failed Back Surgery Syndrome (FBSS) syndrome. It occurs in 100 % with repeated surgical interventions, in connection with which the operational technique of working with the dural sac and on neurovascular structures of the vertebral canal becomes more complicated and sometimes leads to their damage. Despite the development of modern technologies, in medicine, there are no specific and sensitive methods for diagnosing epidural fibrosis, which would help to establish the correct diagnosis in 100 % of cases. The review summarizes and systematizes domestic and foreign literature data on etiology, pathogenesis and pathophysiology of cicatricial and epidural adhesion. The analysis includes 22 sources of Russian literature and 28 sources of foreign literature

Functional diagnostics and acupuncture in patients with cervical osteochondrosis

We developed an algorithm for spinal diagnostics to optimize the diagnosis and treatment of patients with cervical osteochondrosis. This algorithm includes physical and neurological examination of a patient, radiological methods, multi-layer spiral CT (MRI) of cervical spine, densitometry and electroneuromyography (ENMG) and is used in practical work of neurosurgical unit of Irkutsk Scientific Center of Surgery and Traumatology. We managed 40 patients with cervical osteochondrosis in period I-III localized in CIII-CIV, CV-CV CV-CW Cn-CVIl segments and with severe muscular tonic syndrome (cervicalgia, cervical cranialgia, cervicobrachialgia). Patients with osteochondrosis in period I-II had medium decreased conduction of peripheral nerve motor fibers on both sides of spine, which indicates the lesion of some motor fibers. In patients with osteochondrosis in period III in case of protrusion and herniation of intervertebral discs the ENMG values corresponded to the increase in neurility and conduction velocity of motor nerve and muscle fibers in diseased segment. Conservative treatment was conducted up to the Standard approved by the Ministry of Health of the Russian Federation and was supplemented with acupuncture (9-10 sessions) based on the changes in ENMG values. Performed treatment caused significant decrease in pain syndrome, reduction of neurological manifestations and, as a consequence, positive dynamics of ENMG values. Proposed algorithmfor management of patients with osteochondrosis allowed to diagnose the localization of diseased functional spinal unit, to reveal problem peripheral nerves and, as a result, to choose adequate treatment tactics and to estimate its effectiveness

BONE MINERAL DENSITY INDICES IN PATIENTS WITH CERVICAL OSTEOCHONDROSIS

According to the data of the World Health Organization, osteoporosis takes the fourth place among non-infectious diseases after cardiovascular, oncologic disorders and diabetes mellitus. Clinical manifestations of osteoporosis with the root syndrome are not that different from those of radicular symptoms at degenerative-dystrophic processes in the spine. Our purpose was to study the state of upper extremities bone tissue in patients with clinical manifestations of cervical osteochondrosis. There were 40 patients under our observation diagnosed with cervical osteochondrosis, 26 of them - with stages 1 and 2 of osteochondrosis development, and 14 patients - with stage 3. Conducted densitometry examinations of upper extremities bone tissue revealed correlation between bone tissue state and both the time of the onset of the pathological process and its severity. In patients with stage 3 osteochondrosis, bone tissue mineral density on the affected extremity was lowered down to osteoporosis, and naturally, such cases require further treatment

GENERAL CHARACTERISTICS OF PATIENTS WITH OSTEOCHONDROSIS OF THE CERVICAL SPINE WITH NECK AND UPPER EXTREMITY PAIN

1n 2015-2016 in Scientific-Clinical Department of Neurosurgery of 1rkutsk Scientific Center of Surgery and Traumatology, 22 patients (11 men and 11 women) were examined for osteochondrosis of the cervical spine and neck and upper extremity pain syndrome. Patients underwent clinical and neurological examination, radial methods of investigation (cervical survey radiography in the direct and lateral projections), functional tests (flexion and extension) and functional tests with weights, MSCT and MR1 of the cervical spine, radiographs of large joints of the upper extremities in two projections, stimulation electroneuromyography and osteodensitometry. The article presents the general clinical characteristics of the data of 22 patients with degenerative-dystrophic pathology of cervical spine and shoulder joint syndrome, and a moderate and severe neck and upper extremity pain syndrome. 1n the evaluation of clinical and neurological symptoms, unilateral cervicobrahialgia syndrome was detected in 19 (86 %) patients, cervicobrachialgia syndrome was noted on both sides in 3 patients, the syndrome of cervicocranialgia was noted in 4 patients. All radiographs showed deforming osteoarthritis of the clavicular-acromial joint (11 persons), shoulder (10 persons), elbow joint (4 persons). MR1 revealed a multilevel pathology of intervertebral discs. According to ENMG, there was a disturbance of the functional state of the peripheral nerves of the upper limbs, which manifested itself on both sides. The state of bone tissue of the limb with the pain syndrome was not significantly different from that of the healthy limb, and generally corresponded to the norm. Thus, the materials presented in the article represent the initial data of the examination of patients with the neck and upper extremity pain syndrome in the department of neurosurgery according to the algorithm developed in 1rkutsk Scientific Center of Surgery and Traumatology

ALGORITHM OF SURGICAL TREATMENT OF LUMBAR SPINAL AND DURAL SAC STENOSIS

A number of tasks were set: how to develop a morphometric method for diagnosing stenosing processes that would allow us to specify the localization of the pathological process, its volume and extent; to develop a classification of stenosing processes depending on the stenosis coefficient Zn; to develop a new method of latent instability of the vertebral-lumbar segment of the lumbar spine; to study the nature of multilevel lesions of intervertebral discs in osteochondrosis leading to stenosing processes of the spinal canal. Improvement of diagnostic methods in stenosing processes allowed the authors to develop new ways of diagnostics and surgical treatment of this pathology and to offer new medical technologies for practical health care. All of the above is the basis for the development of an algorithm for the surgical treatment of stenosing processes of the spinal canal and dural sac, which is the subject of this work. 416 patients underwent various surgical procedures depending on the severity of clinical and neurological disorders, the stenosis coefficient, the instability in the vertebral-motor segments, the magnitude of the extensional-flexion amplitude, the nature of the pathological process and the degree of its compensation. Of 416 patients, 179 patients underwent decompressive-stabilizing intervention with the installation of a dynamic system using a mini-invasive approach with a minimally invasive reconstruction of the spinal canal. Decompression-stabilizing intervention with rigid interspinous fixation, minimally invasive access to the vertebral canal with its minimally invasive reconstruction was performed in 96 patients. 141 patients underwent decompressive-stabilizing intervention with transpedicularfixation, with extended minimally invasive reconstruction of the spinal canal with its minimally invasive approach