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

Comparative analysis of electroneuromyographic values in patients with scapulohumeral pain syndrome of degenerative genesis and cervical osteochondrosis

The aim of the research was to study electrophysiological values in patients with blade-humerus pain syndrome at cervical osteochondrosis and posttraumatic shoulder injuries. We managed 71 patients: 33 patients with cervical osteochondrosis and brachialgia getting conservative treatment in the neurosurgical unit of Irkutsk Scientific Center of Surgery and Traumatology (group 1) and 38 patients with injuries of shoulder joint capsules and ligaments getting treatment in the unit of traumatology and orthopedics (group 2). Comparison of electroneuromyographic values in patients of both groups showed unidirectional changes in the values and accentuated decrease in electroneuromyographic parameters on both affected and unaffected extremities. In both cases median nerve was affected most. We registered the decrease in conduction velocity of motor fibers of intact nerves in patients of both groups. Lack of clinical signs of lesion of these nerves can be indicative of functional changes in nerve conduction which reflect generalized reaction on the lesion of certain nerve stems

DIAGNOSTICS OF OSTEOPOROSIS IN PATIENTS WITH DEFORMING DISEASES OF LOWER EXTREMITIES’ LARGE JOINTS AND SPINE

With the purpose of studying of bone tissue state at the degenerative dystrophic changes of musculoskeletal system, of the 3—4th degree densitometry with use of ultrasonic densitometer Sunlight Omnisens was carried out in preoperative period, in patients in the age from 50 to 72 years. These patients had. diskogenic lumbosacral radiculitis, one-sided. L—St radiculoneuritis, one-sided, degenerative coxarthrosis of the III degree and one-sided deforming gonarthrosis of the III degree. As the results in examined, groups of patients high percent of osteoporosis and ostheopenia was revealed. It was registered that intensity of osteoporotic changes on diseased. and. healthy extremities was different and. to a greater extent they showed, up on a diseased, extremity. This data confirmed, opportunities of ultrasonic densitometer Sunlight Omnisens to diagnose of ostheoporosis at earlier stages

DYNAMICS OF PERIPHERAL BLOOD CIRCULATION IN TREATMENT OF RADIAL BONE FRACTURES WITH THE METHOD OF PEROSSEOUS OSTEOSYNTHESIS

To study the parameters of peripheral blood circulation of upper extremity in patients with fractures of radial bone at perosseous osteosynthesis we studied the group of patients with fractures externally fixed by apparatus with pin arrangement and the group of patients treated by apparatus of rod arrangement. Rheovasographic examination of upper extremities was performed before the surgery, the day after it, on the 7th, 14th and 21st day after the surgery. In all patients during preoperational period we revealed disturbances of blood circulation in distal parts of upper extremities of angiospastic type giving evidence of sympathicotonia. Having analized the results of clinical and rheovasographic researches in established terms of observation we were able to mark gradual improvement of arterial and venous blood flow in forearm in examined groups. In the group with rod fixation positive dynamics occurred 5-7 days earlier than in the group with pin fixation. Original method was applied, consisting in rod fixation of apparatus of external fixation. Evaluation of clinical parameters marks good results in 97 % of cases. In early postoperative period improvement of rheovasographic parameters has been marked, which says about increased blood perfusion in tissues and about normalized vessel tone

ADVANTAGES OF ROD EXTERNAL FIXATION AT DIAPHYSEAL FRACTURES OF FOREARM BONES ACCORDING TO THE DATA OF RHEOVASOGRAPHY

The authors present the result of the research of peripheral blood flow of upper extremity in patients with diaphyseal fractures of forearm bones at transosseous osteosynthesis by external fixation devices of different set. Significant difference between rheographic indices and the set of external fixation device: greater effectiveness of transosseous osteosynthesis by rod external fixation devices with saving of moves in joints interfacing with injured segments was determined

Relationship of Cerebral Hemodynamics and Cerebral Bioelectrical Activity in Patients with Cervical Osteochondrosis

Introduction. Osteochondrosis of the cervical spine is a very common disease that causes a significant decrease in the quality of life of patients. In the case of pronounced changes in the cervical spine with osteochondrosis, there is a violation of blood circulation in the cerebral cortex, which leads to pronounced clinical symptoms.The aim of this study was to identify a correlation between bioelectrical activity and cerebral hemodynamics in patients with osteochondrosis of the cervical spine.Materials and methods. The examination involved 25 patients of the neurosurgical department who received conservative treatment for exacerbation of osteochondrosis of the cervical spine, and 25 volunteers without a history of diseases of the spine and joints. The cerebral bioelectrical activity and blood flow indicators were recorded in the pool of the common carotid and vertebral arteries.Results. In the main group and the clinical comparison group, the rheographic index and the peripheral vascular resistance index were studied, which characterize both the volume pulse blood filling of the vascular bed and the tone of small and medium caliber arteries. At the same time, the EEG rhythm indices were analyzed: а-, в-, S-, and в-waves. An analysis of the intersystem interaction of bloodflow indices and the biopotentials of the cortical rhythm of the brain in the main group showed a mismatch in the intra-system connections, which corresponds to the period of the general stress of the body. An analysis of the correlation between the indicators of electroencephalography and rheoencepha-lography in the control group revealed a stable system of correlation between the indicators, showing intersystem and intrasystem consistency and reflecting a high level of reserve capacity of the body and the state of steady adaptation to adverse factors.Conclusion. The use of simultaneous recording of cerebral hemodynamics and brain biopotentials in patients with osteochondrosis of the cervical spine will allow clinicians to correctly assess the functional state of the central nervous system and to prescribe adequate treatment in a timely manner

SOME FEATURES OF ELECTRONEUROMYOGRAPHY AND DENSITOMETRY IN PATIENTS WITH CERVICAL OSTEOCHONDROSIS

Manifestations of cervical osteochondrosis are largely predetermined by degenerative changes in the most mobile lower cervical spine (CV-CVI, CVI-CVII). Clinical picture of cervical osteochondrosis depends not so much on the presence of hernial protrusions as on the changes in bone structures with the formation of arthrosis with pain syndrome. In this regard, we found interesting to study relation of electroneuromyographic parameters and bone mineral density in patients with cervical osteochondrosis. A survey of 38 patients with cervical osteochondrosis localized predominantly in the segments CIII-CIV, CIV-CV, CV-CVI CVI-CVII there were 20 men and 18 women. Subjective and objective examinations showed pronounced muscular-tonic syndrome (with cervicalgia, cervicocranygia, cervicobrachialgia) in all patients. We studied threshold values, M-response amplitude, nerve conduction in motor fibers of the axillary, radial, medial and ulnar nerves, as well as amplitude and frequency indices characterizing the functional state of the deltoid and trapezius muscles. When studying the state of bone tissue, we measured the speed of sound velocity (SV, m/sec) in the radial bones, determined the T-index - the number of standard deviations from mean for healthy young people, and the Z-index - the number of standard deviationsfrom mean for the age group. Comparative analysis of the results of studies by electroneuromyography and osteodensitometry in patients with cervical osteochondrosis of I-II periods, in the presence of neurotrophic disorders have not revealed changes in bone density. At the same time, in patients with cervical osteochondrosis of the III period in the presence of both protrusions and hernias of CVI-CVII CVII-CVIII discs, a reduction in threshold values of direct muscle response, an increase in the amplitude of evoked potentials, and a shortening of the latent period were recorded in the ENMG. Mineral density in patients with this pathology differed from the norm, indicating the presence of osteopenia

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

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

THE PECULIARITIES OF DISTRACTION REGENERATE BONE IN EXPERIMENT WHILE CHRONIC STIMULATION OF BIOLOGICALLY ACTIVE POINTS

In experiment the forming and remodeling of distraction regenerate in rabbits Shinshila while conducting transosseous elements through the acupuncture points were studied. One of the rabbit's forearm was stretched by Hizarov's method for 10 mm. Multidetector CT gave the results of mineral density of the bone distraction regenerate. To the 10th day of fixation of bone fragments by the external fixation device the distraction regenerate with a clear zonal structure formed. To the 20th day of fixation in the middle zone there were clear signs of the formation of the medullary canal, that proves the decrease of mineral density to negative values. The prolonged stimulation of acupuncture points by introduced transosseous elements leads to formation of the structure and properties of bone regenerate, which are close by the characteristics to the parameters of the intact bone