Degenerative-dystrophic Lesions Research Articles

THE INFLUENCE OF THE CULTURE OF FIBROBLASTIC CELL ELEMENTS ON THE INDICATORS OF THE METABOLISM OF CONNECTIVE TISSUE IN EXPERIMENTAL ANIMALS

The number of patients with degenerative tendon disease affects millions of people both among athletes and the general population, causing significant socio-economic consequences. Despite the availability of various methods of conservative and surgical treatment, more than a third of patients experience constant pain. Objective. To study the indicators of the metabolism of connective tissue in animals with a model of degenerative damage to tendons against the background of the introduction of a culture of fibroblastic cell elements. Methods. Therefore, the development of methods for restoring the structure of tendons using cell cultures, in particular fibroblasts, will allow to optimize the course of reparative processes, reduce the risk of complications during surgical intervention and accelerate healing, and at the molecular level — to improve the structure of collagen fibers. Laboratory studies of biochemical markers of a tendon with a degenerative-dystrophic lesion and against the background of the introduction of cell culture can help in the differential diagnosis of its extracellular matrix. Results. The experimental data obtained by us indicate the presence of differences in the biochemical markers of tendons with degenerative-dystrophic lesions in rats 7, 21, and 45 days after the introduction of culture of fibroblastic cell elements. However, 45 days after the introduction of the culture of fibroblast cell elements, the normalization of metabolic processes in the extracellular matrix of connective tissue occurs, namely, the activity of collagenase and the concentration of protein-bound hydroxyproline approaches normal values. This indicates the predominance of the synthetic phase over the catabolic one in collagen metabolism. Conclusions. In this context, the introduction of culture of fibroblastic cell elements, as an alternative anti-inflammatory method, may provide another potential opportunity in the treatment of chronic degenerative-dystrophic lesions of the Achilles tendon.

ПРЕИМУЩЕСТВА СТРАТЕГИИ МАЛОИНВАЗИВНОЙ ТОРАКОЭНДОСКОПИЧЕСКОЙ ХИРУРГИИ ПРИ ОПЕРАТИВНЫХ ВМЕШАТЕЛЬСТВАХ НА ГРУДНОМ ОТДЕЛЕ ПОЗВОНОЧНИКА

The technology of video-assisted minimally invasive interventions on the thoracic spine is a promising direction in surgical endoscopy. Thoracic endoscopic spine surgery is effective for the diagnosis and treatment of various pathologies (tumors, inflammation, deformities, degenerative-dystrophic lesions, injuries). The advantages of thoracic endoscopic interventions are – trauma/injury reduction, reduced blood loss, full visualization of the operation area, the ability to control the allocation of surgical instruments, early activation and rehabilitation of patients as a result of minimally invasive technology, reduced hospital stay and treatment costs. Video-assisted minimally invasive interventions on the thoracic spine are a promising area of surgical endoscopy. The use of thoracoscopic technology allows us to move to a qualitatively new level of surgical interventions from anterior surgical approaches for various pathologies of the thoracic spine (tumors, deformities, degenerative-dystrophic lesions, injuries, inflammatory processes).

Densitometric correlates of degenerative-dystrophic processes in cervical vertebrae of humans and domestic animals

The cervical spine is the most mobile region with high work activity which constantly receives a heavy load. This region is the least protected from external influences, especially in cases of degenerative-dystrophic changes. A comparative analysis of clinical-morphological and morphometric data in degenerative-dystrophic lesions of the cervical spine in humans and domestic animals with secondary anatomical and physiological abnormalities was performed . The examined contingent of people was of young and middle age (average age equal to 41.5 ± 5.2 years). The examined animals had a similar age range recalculated to human age. The pathological changes in spinal cord configuration were registered in 84.6% of examined humans (n = 65) in the form of angular kyphosis or straightened lordosis (with the analogous relative distribution). In terms of gender, with the exception of the frequency of angular kyphosis, probable differences in the formation of lordosis, which is straightened (2.1 times more often), the indicators were the same while the normal configuration of the spine was more often registered in men against the women (20.0% vs 12.5%). Cervical spine deformations in different breeds of dogs and cats (n = 75) were observed in 34.7% of cases (angular kyphosis – 38.5%; straightened lordosis – 61.5%). Preservation of normal configuration of the cervical spine was recorded more often in cats – 78.6%, and in small breeds of dogs – 78.5%. In large breeds of dogs, these indicators were probably changed: the norm remained only in 26.3%, and the deformations exceeded the corresponding indicators in cats and small breeds of dogs by 2.7 or more times. The significant differences were found in cases of straightened lordosis formation which was registered more often in women than in men. The incidence of angular kyphosis was comparable in patients of both sexes. Cervical spine deformations in different breeds of dogs and cats were observed in 26 animals (34.6% cases: angular kyphosis – 13.3%; straightened lordosis – 21.3%). The densitry of vertebral bodies in all groups decreased in the caudal direction of the cervical spine. The differences in humans reached 18.1%, being higher in women than in men. Animals had a similar density distribution. This index was minimal in cats (2.7%), in small-breed dogs it increased significantly (7.5%) and in large-breed dogs it reached 14.3%, i.e. 5 times (compared to cats) and 2 times higher (compared to small breed dogs). A comparative analysis between humans and animals indicates that the maximal discrepancies in the studied indexes were found in humans and relatively coincided with those in large breed dogs. The presence of neurological deficit with cervical spine pain syndrome with lordosis distortion and the provocation of spinal canal stenosis was found in 73.7% of large adult dogs. The revealed regularities of cervical spine degenerative-dystrophic changes indicate that animals, especially large breeds of dogs, can serve as a model for investigation of etiopathogenetic factors, clinical course, prognosis and other risks of the bone-cartilage apparatus degeneration with both stenosis and vertebrogenic myelopathy development at the cervical level in humans The obtained clinical and morphometric data from comparative analysis in humans and domestic animals will serve as the basis of methods of prevention of degeneration in the bone-cartilage apparatus and the premature aging of the body in humans.

Low-Affinity NMDA Receptor Antagonist Hemantane in a Topical Formulation Attenuates Arthritis Induced by Freund's Complete Adjuvant in Rats.

N-methyl-D-aspartate (NMDA) receptors that are expressed by T-cells modulate T-cell proliferation, cytotoxicity and cell migration toward chemokines. Several studies have shown an anti-inflammatory effect of NMDA receptor antagonists. This study compares the effect of the noncompetitive low-affinity NMDA receptor antagonist N-(2-adamantyl)-hexamethyleneimine hydrochloride (hemantane) in a topical formulation (gel) with the cyclooxygenase (COX) inhibitor diclofenac in a topical formulation (gel) in rats with arthritis induced by Freund's Complete Adjuvant (FCA). On day 14 after an FCA injection into the left hind paw, rats with contralateral hind paw edema were selected for further investigation (29/65). They were treated with 5% hemantane gel or 1% diclofenac gel applied locally to hind paws daily for 2 weeks starting 14 days after the FCA injection. Rats with arthritis were examined hind paw edema, hyperalgesia, and motor deficits; their body weight and hematological parameters were recorded. The rats were euthanized on day 28, followed by histological examination of the ankle joint (HE stain). Rats with arthritis exhibited hind paw inflammation and hyperalgesia, motor deficits, changes of hematological parameters, reduced weight gain and spleen hypertrophy. Histological examination of the ankle joint revealed degenerative-dystrophic lesions of the cartilaginous tissue, proliferative inflammation of the synovium, edema and lymphocytic/macrophage infiltration of periarticular tissues. Hemantane gel reduced hind paw edema, pain, motor deficits and histological signs of inflammation; its effect was comparable to diclofenac gel. Hemantane gel alleviates FCA-induced arthritis in rats, and its effect is comparable to diclofenac gel.

MODERN APPROACH TO THE DIAGNOSIS AND TREATMENT OF SPONDYLOLISTHESIS

Pain syndrome and a variety of neurological syndromes resulting from degenerative-dystrophic changes of the lumbar spine lead to significant violations of labor and social adaptation. According to many researchers, pain in the lumbar spine radiating to the leg observed in 1/3 of patients with degenerative-dystrophic lesions of the lumbar spine, which in 40% of cases is due to the presence of herniated protrusions of the intervertebral discs and spondylolisthesis. The frequency of spondylolisthesis in the lumbar spine occurs to 50 out of 100,000 population. Spondylolisthesis is more common among middle-aged men.

Possibilities of neuroimaging of degenerative-dystrophic lesions of the cervical spine in humans and domestic animals

Possibilities of neuroimaging of degenerative-dystrophic lesions of the cervical spine in humans and domestic animals

Clinical Features of the Course of Musculoskeletal Infection after Local Administration of Glucocorticoids

Summary. In the treatment of patients with inflammatory and degenerative-dystrophic lesions of the joints, soft tissues and ligaments, local administration of drugs is often used in practice, usually (mainly) glucocorticoids.
 Objective: to determine the place and role of local administration of glucocorticoids in the occurrence and development of musculoskeletal infection.
 Materials and Methods. The peculiarities of the occurrence and development of infectious complications, their clinical manifestations, laboratory and anamnestic data after local administration of glucocorticoids in 56 patients aged 24 to 78 years were analyzed.
 Results. 44 patients had moderate and severe subcompensated comorbidities. Betamethasone was the most commonly used for injections (32 patients, 57.2%). Glucocorticoids were administered intra-articularly to 43 (76.8%) patients: knee joint (37.5%), shoulder (25.0%), ankle (7.1%), hip (3.6%), elbow and 1st metatarsophalangeal (1 case each). In other cases (bursitis, enthesitis, etc.), glucocorticoids were administered paraarticularly. It was a single injection only in 32%; the rest of patients were injected 2 – 20 times. In 96% of cases, monocultures were microbiologically isolated (S.aureus in 52%). At the time of hospitalization, the acute stage of the infectious process was detected in 22 (39.3%) patients, subacute in 16 (28.6%), and chronic active fistula phase in 18 (32.1%). All cases of clinically similar manifestations are systematized into groups of symptom complexes – clinical variants: 1) abscess and/or phlegmon of paraarticular soft tissues, necrotizing fasciitis; 2) septic bursitis; 3) septic arthritis (synovitis); 4) septic destructive arthritis; 5) osteomyelitis.
 Conclusions. We found no clinical differences depending on the drugs used. The most important reasons for the development of infectious complications are ignoring the principles of dosing, multiplicity and time intervals of administration, unreasonable repeated use, and the presence of serious subcompensated comorbidities, which should be considered as a relative contraindication and as a risk factor.

CLINICAL-MORPHOMETRIC RATIO OF DEGENERATIVE-DYSTROPHIC PROCESSES OF THE CERVICAL SPINE IN HUMANS AND ANIMALS IN SPINAL CHANNEL STENOSIS

Relevance. Spinal stenosis is a common manifestation of degenerative-dystrophic lesions of the cervical spine (CS). In most cases it occurs with the development of neurological complications in the form of secondary spondylogenic myelopathy, radicular dysfunction, pain. Isolated studies indicate that this type of damage occurs in some animals.
 Objective: a comparative analysis of clinical, radiological and morphometric data on degenerative-dystrophic lesions in human and domestic animals on the background of degenerative changes in bone structures that provoke stenosis of the spinal canal with the development of spondylogenic myelopathy.
 Material and methods. The retrospective analysis included 65 patients (25 men, 40 women) with neurological symptoms who underwent computed tomography during 2018-2021. Prospectively, a study was performed with the participation of 75 domestic animals with similar symptoms (19 dogs of large breeds weighing more 20 kg, 42 dogs of small and medium breeds weighing less 20 kg, and 14 cats.
 Results. There was a close correlation of symptoms in humans and large dogs in the presence and degree of narrowing of the canal: in cases of stenosis of the ventricles in humans (75.3%), large breeds of dogs (78.9%), patients had similar neurological symptoms. The maximum decrease in the sagittal diameter of the spinal canal was found more at the level of the C6 vertebral body in both humans and animals, weighing more than 20 kg. The mass share of stenotic changes was mainly registered in men (84.0% vs. 70.0% in women). In addition, according to the Pavlov-Torg morphometric index, the width of the spinal canal in men was smaller than in women. Stenosis of the spinal canal was mainly registered in large breeds of dogs (78.9%), which almost completely coincided with the morphometry in humans (75.4%).
 Conclusions. The data of our research indicate the possibility of using large breeds of dogs in predicting the course of degenerative-dystrophic changes in humans, because physiological and pathophysiological processes in dogs are on average 7 times faster than in humans. The severity of the process, the clinic and morphometric data of CS animals depend on the species, breed, weight, age, and common factors in the development of degenerative-dystrophic changes in humans and some groups of animals may be aging in general and the spine in particular.

Епідуральна інфільтрація глюкокортикоїдів та місцевих анестетиків при лікуванні неспецифічного болю в спині

Актуальність. Неспецифічний біль у спині — найчастіша скарга після невеликих травм і гострих респіраторних захворювань та провідна причина обмеження фізичної активності пацієнтів молодше 45 років. Це захворювання продовжує залишатися соціально значущою медичною проблемою внаслідок як тривалої непрацездатності цієї групи пацієнтів, так і високої вартості лікування. Мета: оцінити ефективність епідуральної інфільтрації місцевими анестетиками і глюкокортикостероїдами при неспецифічному болі в спині, пов’язаному з дегенеративно-дистрофічним ураженням різних відділів хребта, та визначити її вплив на покращання якості життя таких хворих. Матеріали та методи. Проаналізовані результати лікування 71 пацієнта віком від 36 до 74 років, які перебували в Центрі лікування болю та неврологічному відділенні КЗОЗ «Харківська обласна клінічна лікарня — Центр екстреної медичної допомоги та медицини катастроф» із 2016 по 2017 рік із приводу хронічного неспецифічного болю в спині. Пацієнти були розподілені на 2 групи: основну — 38 осіб, яким як монотерапію епідурально вводили розчин глюкокортикостероїду та місцевого анестетика, та контрольну — 33 пацієнти, яким проводили стандартне консервативне лікування. Результати. У результаті проведеної терапії пацієнти відчували зменшення болю в спині, покращання загального самопочуття та якості життя. Однак через 6 тижнів після лікування рівень болю в групі пацієнтів, які отримувала епідуральні ін’єкції, був нижчим у 1,7 раза порівняно зі стандартною терапією. Покращання життєдіяльності та загального функціонування в два рази порівняно з результатами до лікування спостерігалось в основній групі через 3 тижні після початку терапії, у той час як пацієнти контрольної групи не досягли такого результату навіть через 6 місяців після лікування. Висновки. Проведене дослідження показало доцільність використання епідуральних ін’єкцій розчину глюкокортикоїду та місцевого анестетика в пацієнтів із хронічним неспецифічним болем у спині в моделюванні больового синдрому.

Наш опыт применения пульсовой радиочастотной абляции ганглиев задних спинальных корешков (PRF DRG) в лечении поясничных радикулопатий

Актуальность. Дегенеративные поражения поясничного отдела позвоночника и связанные с ними клинико-неврологические проявления — одна из наиболее важных проблем современной ортопедии. Консервативное лечение данной патологии эффективно у 60 % пациентов. В остальных случаях боль становится хронической, что приводит к инвалидизации. Эти факты стимулировали разработку малоинвазивных процедур, обладающих достаточной эффективностью при низком риске потенциальных осложнений. Наибольшую распространенность из них получило интервенционное радиочастотное лечение. Цель исследования: изучить динамику болевого синдрома и социальной адаптации у пациентов, страдающих хроническими поясничными радикулопатиями, при использовании в их лечении пульсовой радиочастотной абляции ганглиев задних спинальных корешков (pulsed radiofrequency of dorsal root ganglion — PRF DRG). Материалы и методы. В ретроспективное исследование включены 42 пациента в возрасте от 27 до 78 лет (49,7 ± 14,8 года), пролеченных в 2016–2018 годах в клинике «Нейромед» г. Киева и Институте травматологии и ортопедии НАМН Украины. В обследование были включены пациенты, страдающие реактивными пояснично-крестцовыми радикулопатиями вследствие дегенеративно-дистрофического поражения позвоночника. Болевой синдром оценивался по 10-балльной визуально-аналоговой шкале (ВАШ) перед манипуляцией, непосредственно после нее и через 6 месяцев после ее проведения. Социальную адаптацию в повседневной жизни объективизировали при помощи Oswestry Low Back Pain Disability Questionnaire (ODI). Результаты. Осложнений не зарегистрировано. Абсолютно все пациенты отмечали снижение болевого синдрома. Большинство пациентов до манипуляции характеризовали свою боль как очень сильную (ВАШ — 7,14 ± 0,68), а после процедуры такое же количество больных уже говорили о своей боли как о средней (ВАШ — 4,02 ± 0,81). Подобная же тенденция сохранялась и через полгода после лечения (ВАШ — 1,85 ± 0,78). До манипуляции индекс нарушения жизнедеятельности из-за болевого синдрома составлял 71,42 ± 6,83 балла. А спустя полгода после проведения процедуры индекс ODI уже составлял 18,57 ± 7,83 балла. Выводы. Радиочастотное пульсовое воздействие на ганглии заднего спинального корешка (PRF DRG) является безопасным и эффективным методом лечения хронических поясничных радикулопатий.

Ефективність застосування пілатесу як засобу фізичної терапії у жінок з дегенеративно-дистрофічними ураженнями поперекового відділу хребта

Degenerative-dystrophic lesions of the lumbar spine are characterized by a systemic multifactorial course and significantly affect the quality of life. Spinal pain due to degenerative-dystrophic diseases very often affects middle-aged people, in particular women, leading to temporary or permanent disability. Degenerative-dystrophic diseases of the spine are accompanied by neurological manifestations, pain syndromes, prone to a protracted course and have repeated relapses. The purpose of the study was to determine the features of physical therapy to improve the functional state of the spine in middle-aged women with degenerative-dystrophic lesions of the lumbar spine. Materials and methods. The following research methods were used in the study: theoretical analysis of scientific and methodological literature, empirical (determination of the functional state of the muscles of the trunk), pedagogical experiment, methods of mathematical statistics. The study involved 28 women. The main group and the comparison group of 14 people each were formed by the method of random sampling, the average age of the subjects was 40.44 ± 1.25 and 41.60 ± 1.14 years old, respectively. The main group was studied according to the developed program of physical therapy with the use of Pilates, the comparison group – according to the program of therapeutic gymnastics (general developmental orientation) of the communal non-profit enterprise "Zaporizhzhya Regional Clinical Hospital". The study of the functional state of the muscles of the trunk was assessed according to the following tests: the time of holding the lateral support; keeping the support lying on the forearms; static body retention; holding the torso at an angle of 60˚; flexion and extension of the spine. Results and discussion. According to the results of the final rehabilitation examination, it was found that in the comparison group it was not possible to record a possible improvement in the functional state of the muscles of the trunk and the amplitude of the spine. At the same time in the main group such changes occurred in all the studied parameters. In particular, the index of lateral support retention in the main group significantly increased by 8.00 s (p <0.05), retention of the support lying on the forearms – by 10.00 s (p <0.05), static trunk retention - by 9.5 s (p <0.05), holding the trunk at an angle of 60˚ - by 10.00 s (p <0.05), flexion of the spine – by 3.00 cm (p <0.05), extension of the spine – by 5.00 cm (p <0.05). Conclusion. The results of the study indicate that Pilates is an effective means of improving the functional state of the muscles of the trunk and the amplitude of the spine, which was confirmed by significantly better indicators of functional tests in the main group compared with the women in the comparison group

Application of pilates means in physical therapy of middle age women with degenerative-dystrophic lesions of the lumbar department

Degenerative-dystrophic diseases in middle-aged women are a common pathology of the spine, which is caused by a sedentary lifestyle, insufficient attention to the problem of spinal health and signs of the disease at an early stage of its development. Purpose: to determine the features of improving the vital functions of middle-aged women with degenerative-dystrophic lesions of the lumbar spine by Pilates. Research methods: theoretical analysis of scientific and methodological literature, empirical (questionnaires by Ostwestry, Rolland-Morris, visual-analog scale), pedagogical experiment, methods of mathematical statistics. The women of the main group were engaged in the developed program of physical therapy, which provides a reasonable choice of tools and methods, taking into account age, pain and functional status of the spine. For each patient of the main group, the means and methods of physical rehabilitation were selected individually, which would most effectively help to solve the problem and achieve the set goal. Classes were held individually 4 times a week for 40-50 minutes. Results: experimental verification of the effectiveness of the developed program of physical therapy showed that at the end of the study women of the main group had better indicators according to the questionnaire Osvestri by 9.86 points (p<0.05), Roland-Morris - by 2.41 points (p<0.05), the indicator of VAS - by 1 point (p<0.05) compared with women in the comparison group, respectively, which confirmed the effectiveness of the proposed program of physical therapy with the means of Pilates.

Rational Pharmacotherapy in Case of Exacerbation of the Primary Low Back Pain

Low back pain (LBP) is one of the most common causes of orthopedic disability in people under 45 years of age. Primary LBP accounts for more than 90 % of all cases. The main objectives of treatment are to slow the progression of the degenerative process, reduce the intensity of inflammation and pain, increase functional activity and quality of life of patients. The solution of the set tasks is impossible without effective complex influence on numerous links of pathogenesis of degenerative-dystrophic and inflammatory process and ensuring safety at treatment.
 The objective: to evaluate the clinical effectiveness of complex conservative treatment of primary LBP with the use of the drug Alsokam (meloxicam) in patients with uncomplicated forms of degenerative-dystrophic lesions of the spine in the period of exacerbation.
 Materials and methods. A non-randomized, prospective comparative clinical study in two parallel groups involved 30 patients with exacerbation of LBP on the background of uncomplicated forms of degenerative-dystrophic lesions of the spine (osteochondrosis, spondyloarthritis). The mean age of patients was 40±7,2 years. There were 12 (40 %) female patients and 18 (60 %) male patients. The main group consisted of 15 patients who were prescribed the drug Alsokam (meloxicam) at a dose of 15 mg 1 time per day intramuscularly for 7 days. The control group consisted of 15 patients who received diclofenac sodium at a traditional daily dose of 75 mg intramuscularly once daily for 7 days during the same treatment period. In both groups, tolperisone 150 mg 3 times a day and B vitamins were also used for 10 15 days. Outcome evaluation parameters included: Visual analog pain scale (VAS), Huskisson; assessment of the patient’s functional status on the Roland-Morris scale (RDQ-24); accounting for side effects and adverse events in the observation groups.
 Results. In both groups, a significant decrease in the intensity of the pain syndrome was observed in the assessment of pain by VAS, but no statistically significant difference was observed between the observation groups (p=0,312). The analysis of the results of the evaluation of RDQ-24 also showed an increase in functional capacity in both groups, but without a significant difference between the groups of clinical observation (p=0,302). Analysis of the number of undesirable side effects in the observation groups showed a significantly lower frequency in patients of the main group with a high statistical probability (p<0,01).
 Conclusions. The results of a clinical study showed the effectiveness of meloxicam (Alsokam) in the complex conservative treatment of patients with primary LBP in the period of exacerbation, which correlates with the effect of diclofenac sodium in the average daily dose. The nature and frequency of adverse reactions in the main and comparator groups showed that meloxicam in Alsocam has a significantly higher safety profile compared to diclofenac sodium, and its use in complex treatment regimens for patients with primary LBP syndrome reduces the risk of NSAIDs gastropathies.

ASPECTS OF THE USE OF PROPENSITY SCORE MATCHING METHODS IN NEUROSURGERY

ABSTRACT Objective Observational studies and register data provide researchers with ample opportunities to obtain answers to questions that randomized controlled trials cannot answer for organizational or ethical reasons. One of the most common tools for solving this problem is the use of propensity score matching (PSM) methods. The purposes of our study were to compare various models and algorithms for selecting PSM parameters, using retrospective clinical data, and to compare the results obtained using the PSM method with those of prospective studies. Methods The results of two studies (randomized prospective and retrospective) conducted at the Novosibirsk Research Institute of Traumatology and Orthopedics were used for comparative analysis. The trials aimed to study the effectiveness and safety of surgical treatment of degenerative dystrophic lesions in the lumbar spine. We compared the results using the recommended PSM parameters (caliper=0.2 and 0.6) the propensity score is the probability of assignment to one treatment conditional on a subject’s measured baseline covariates. Propensity-score matching is increasingly being used to estimate the effects of exposures using observational data. In the most common implementation of propensity-score matching, pairs of treated and untreated subjects are formed whose propensity scores differ by at most a pre-specified amount (the caliper widthand the caliper values often used in real-life studies (0.05, 0.1, 0.25, 0.5, and 0.8) with the those obtained in a similar prospective study. Results After eliminating systematic selection bias, the results of the retrospective and randomized prospective studies were qualitatively comparable. Conclusion The results of this study provide recommendations for the use of PSM: when evaluating efficacy scores in neurosurgical studies (with a sample size < 150 patients), we recommend matching on the logit of the propensity score using calipers of width equal to 0.6 of the standard deviation of the logit of the propensity score. Level of evidence V; Type of study is expert opinion.

Puncture Surgical Technologies in the Treatment of Facet Syndrome for Spondylarthrosis in the Lumbar Spine (Literature Review)

Pain in the spine is one of the most common pathological conditions and holds the second place in terms of disability throughout the world. Pain syndrome has a great influence on the functional capabilities of the spine and the professional activity of a person, and that carries a serious social and economic problem. The main causes of pain in the spine are: pathology of the intervertebral discs and the zygapophysial joints; dynamic instability of the spinal motor segment; spondylosis; stenosis of the spinal canal and dural sac with compression of the neurovascular structures; spondylolisthesis; osteoporotic compression fractures of the vertebrae; infectious diseases of the spine, etc. In connection with the aforementioned, of particular interest to clinicians is the pathology of the zygapophysial joints (spondylarthrosis), its diagnosis, and targeted ethiopathogenetic treatment using puncture surgical technology in the treatment of facet syndrome. This paper presents the results and features of puncture surgical technology in the treatment of facet syndrome in degenerative-dystrophic lesions of the zygapophysial joints of the lumbar spine. The analysis is based on 55 sources of literature of domestic and foreign authors. The article presents data on the anatomical and topographic features of the zygapophysial joints, their biomechanics, innervation and their function. The ethiopathogenetic features of pain during degeneration of facet joints are considered. The effectiveness of the use of methods of using radio and laser denervation of the zygapophysial joints in the treatment of facet syndrome is analyzed. The materials of the article describe the methods of using chemodeception, cryodestruction, and intra-articular administration of hyaluronic acid preparations.

The use of chondroitin sulfate (Mucosat) for the treatment of chronic back pain and osteoarthritis

The representation of pain syndromes of various localization is very extensive: in the knee and hip joints, this figure reaches 57,8% of the general population, in the shoulder joint 48–84%, and pain in the lower back is experienced by up to 85%. The prevalence of osteoarthritis (OA) increases with age. OA occupies a leading position among all rheumatological diseases, accounting for more than 60–70 % of their total number, and is the leading cause of chronic pain syndrome in the older age group. Clinical symptoms of OA are observed in 30–50% of the population in people over 65 years. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs for the treatment of pain syndromes. NSAIDs are characterized by a good analgesic effect, but are often the cause of the development of adverse events (NSAIDS). Alternative for the treatment of degenerative-dystrophic lesions of the joints is chondroprotectors (CP). CPS belong to the group of drugs of delayed action of symptomatic therapy (SYSADOA). Among CP, chondroitin sulfate (CS) is considered to be the most acceptable means that can affect metabolic processes in cartilage, synovial and bone tissue, suppressing the synthesis of proinflammatory mediators. The main effects that CS has on the joint in OA are: anti-inflammatory, analgesic, and protective. CS improves the phosphorus-calcium metabolism in cartilage, inhibits enzymes that violate the structure and function of articular cartilage, inhibits the degeneration of cartilage; stimulates the synthesis of glycosaminoglycans (GAG), normalizes the metabolism of hyaline tissue, promotes the regeneration of cartilage surfaces and the articular bag. The main effects that show CS on the joint in OA: anti-inflammatory, analgesic, protective. Slowing bone resorption, reduces the loss of Ca2+ and accelerates the processes of bone repair, inhibits the progression of OA. It has analgesic effect, reduces joint pain, pain at rest and when walking, the severity of inflammation, reduces the need for non-steroidal anti-inflammatory drugs (NSAIDs). One of the representatives of medicinal products based on CS is Mucosate (ampoules 1 and 2 ml) containing 100mg of CS in 1ml. A number of studies have demonstrated the effectiveness of therapy with Mucosat in the treatment of patients with low back pain (LBP) using the 2 ml intramuscularly every other day, a course of 25 injections, as well as in the treatment of OA using the 1 ml intramuscularly every other day, starting with the 4th injection – 2 ml every other day, also a course of 25 injections. Recent developments – a new oral form of Mucosate (capsule) containing harpagophytum and the NEM® complex can serve as a supplement to the injectable course of therapy.

The frequency of degenerative-dystrophic lesions of the joints of the spine in young and middle-aged patients with dorsopathy

Introduction. Degenerative-dystrophic lesion of the spinal joints or spondylarthrosis is one of the most common diseases of the spine. The signs of non-infl ammatory changes in the joints can be detected even in children. The reason for this is the repetitive biomechanical microtrauma. The goal of research — to study the frequency of degenerative-dystrophic lesions of the spinal joints at all the levels in young and middle-aged patients suffering from dorsopathy.Materials and methods. Radiography of all the regions of the spine was performed with the description of system models of 507 patients: 211 men and 296 women, suffering from dorsopathy. The method of integral study of the spine roentgenograms was used. Systemic models of patients with determined diagnosis of ankylosing spondylitis (Bekhterev disease) were excluded from the general population. The reason for this was a signifi cant morphological change in the joints and in the spinal column as a whole, due to chronic infl ammation, which is the main manifestation of this disease. Statistical processing was carried out using Microsoft Offi ce Excel 2007.Results. It was established that with age the frequency of appearance of radiological signs of spondylarthrosis increases. Signs of arthrosis of the zygapophyseal joints appear in the fi rst turn and are the most frequent ones. Arthrosis of the zygapophyseal joints is diagnosed in 70–90 % of patients. Spondylarthrosis of the semilunar joints is diagnosed in almost 80 % of patients. Most often arthrosis of the semilunar joints was observed in the vertebrae CV and CVI. Athrosis of costovertebral joints was registered in 32,7 % of patients. In most cases the joints TVII–TX were affected by this disease. Arthrosis of the sacroiliac joints was diagnosed in an average of 63,8 % of patients, equally often on the left and on the right sides. The interspinal neoarthrosis (Baastrup symptom) was diagnosed at the level of LIII–LV(VI) in 22,6 % of patients and at the level of CI–CII in 2 % of patients.Conclusion. Radiological manifestations of spondylarthrosis are markers of static and dynamic biomechanical overload of the spinal joints.

Prescription of chondroitin sulfate in back pains

One of the promising areas of pharmacotherapy in degenerative-dystrophic lesions of the joints, such as osteoarthritis (OA), is the use of chondroprotectors (CP). CPs belong to the group of Symptomatic Slow Acting Drugs for OsteoArthritis (SYSADOA). Among CPs, chondroitin sulfate (CS) is considered to be the most acceptable means capable of influencing metabolic processes in cartilage, synovial and bone tissue, suppressing the synthesis of proinflammatory mediators. CS improves phosphorus-calcium metabolism in cartilage tissue, inhibits enzymes that violate the structure and function of articular cartilage, inhibits the degeneration of cartilage tissue; stimulates the synthesis of glycosaminoglycans (GAG), normalizes the metabolism of hyaline tissue, promotes regeneration of cartilage surfaces and articular bags.The main effects that show CS on the joint in OA: anti-inflammatory, analgesic, protective. Slowing bone resorption, reduces the loss of Ca2+ and accelerates the processes of bone repair, inhibits the progression of OA. It has analgesic effect, reduces joint pain, pain at rest and when walking, the severity of inflammation, reduces the need for non-steroidal anti-inflammatory drugs (NSAIDs). The appointment of correctors of bone and cartilage metabolism is indicated at any stage of the degenerative process in the joints. One of the medicinal product (MP) based on CS is Chondroitin-ACOS (capsules, 25mg), whose effectiveness in the treatment of patients with OA has been demonstrated in a number of studies. Dosage Chondroitin-ACOS: 0,75 g 3 times a day for 3 weeks, then 0,5 g 2 times a day for 9 weeks. The therapeutic effect develops after 8-12 weeks of taking the drug. Within one month after discontinuation of Chondroitin-ACOS, its aftereffect persisted. Chondroitin-ACOS can be recommended for patients with severe pain syndrome, radiologically confirmed OA I-III stages of different localization.

Тест генерации тромбина в оценке адаптационных возможностей системы гемокоагуляции у пациентов с дегенеративно-дистрофическими заболеваниями суставов

Введение. Поиски методов оценки функционального состояния системы гемокоагуляции у пациентов, которые ожидают выполнения эндопротезирования крупных суставов нижних конечностей, обоснованы высокой частотой встречаемости у них тромбоэмболических осложнений. Цель исследования: изучение теста генерации тромбина (ТГТ) с позиции оценки адаптационных возможностей системы гемокоагуляции у больных с дегенеративнодистрофическими заболеваниями крупных суставов нижних конечностей. Материалы и методы. Обследован 141 больной с дегенеративнодистрофическими поражениями тазобедренных и коленных суставов (35 мужчин, 106 женщин), средний возраст 62,6 9,9 лет. Контрольную группу составили 30 условно здоровых доноров, средний возраст 49,7 6,5 лет. Исследовали коагуляционные свой ства крови рутинными методами и регистрировали кривую процесса тромбинообразования в ТГТ, анализируя параметры: tlag латентное время тромбинообразования, ttpeak время достижения максимума тромбина, peak максимальное количество тромбина, VI индекс скорости тромбинообразования, AUC площадь под кривой. Больные были разделены на 2 группы в зависимости от характера изменения временных параметров ТГТ в ответ на инициацию тромбиногенеза активаторами с концентрацией тканевого фактора 2 пмоль/мл (активатор RB) и 5 пмоль/мл (активатор RClow). Результаты. В 1й группе значения параметров tlag и ttpeak в ответ на действие активатора RClow были меньше, чем на действие активатора RB, реакцию системы гемокоагуляции расценивали как адекватную. Во 2й группе значения tlag и ttpeak при использовании активатора RClow превышали величины аналогичных параметров при инициации тромбообразования активатором RB, а корреляционный анализ отразил ослабление связей между параметрами ТГТ, что свидетельствовало об адаптационной перестройке системы на фоне высокого тромбогенного потенциала и повышенном риске развития гемокоагуляционных осложнений у больных 2й группы. Заключение. ТГТ с использованием активаторов RB и RClow ерспективный инструмент выявления больных с высоким риском развития послеоперационных гемокоагуляционных осложнений. Introduction. The search of methods for assessing of hemocoagulation functional state in patients that are waiting endoprosthesis replacement of large joints of lower extremities is justified by the high incidence of thromboembolic complications. Aim: to study thrombin generation assay (TGA) for assessment of hemocoagulation adaptive potential in patients with degenerativedystrophic diseases of the large joints of lower extremities. Materials and methods. We examined 141 patients with degenerativedystrophic lesions of hip and knee joints (35 men, 106 women), average age was 62.6 9.9 years. Control group consisted of 30 relatively healthy donors, average age was 49.7 6.5 years. We investigated blood coagulation properties by routine methods and recorded the curve of thrombin formation by TGA. We analyzed next parameters: tlag is the latent time of thrombin formation, ttpeak is the time to reach the maximum of thrombin, peak is the maximum amount of thrombin, VI is the index of thrombin formation speed, AUC is the area under the curve. Patients were divided into 2 groups according TGA parameters in response to thrombinogenesis initiation by activators with different tissue factor concentrations 2 pmol/ml (RB activator) and 5 pmol/ml (RClow activator). Results. In the 1st group, tlag and ttpeak values in TGA with RClow activator were less than with RB activator, the hemocoagulation response was regarded as adequate. In the 2nd group, tlag and ttpeak values with RClow activator were higher than with RB activator and correlation analysis revealed the weakening of the relationships between TGA parameters. This indicated about system adaptation at a time of high thrombogenic potential and about increased risk of developing hemocoagulation complications in patients of the 2nd group. Conclusion. TGA with RB and RClow activators is a promising tool for identifying patients with a high risk of postoperative hemocoagulation complications.

Pulsed radiofrequency ablation of the posterior spinal root ganglia (PRF DRG) for the treatment of chronic lumbar radicular pain

Radicular lumbar pain constitutes a significant proportion of the total number of pain syndromes. Conservative treatment of this pathology is effective in 60 % of patients. In other cases, the pain may become chronic, leading to disability. These facts have been a stimulus for the development of minimally-invasive procedures which are sufficiently effective and have a low risk of potential complications. The most common of these is interventional radiofrequency treatment.The purpose of this study is to investigate the dynamics of pain and social adaptation in patients suffering from chronic lumbar radicular pain, who have been treated with pulsed radiofrequency ablation of the posterior spinal root ganglia (pulsed radiofrequency of dorsal root ganglion, PRF DRG).Materials and methods. A retrospective study included 42 patients aged from 27 to 78 years (49.7 ± 14.8) who were treated in 2016–2017 at the Neuromed Clinic in Kyiv and the Institute of Traumatology and Orthopedics of NAMS of Ukraine. The study included patients suffering from reactive lumbosacral radicular pain due to degenerative-dystrophic lesions of the spine. Pain syndrome was assessed on a visual analogue scale (VAS) before manipulation, immediately after it, and six months afterwards. Social adaptation in everyday life was objectified using the Oswestry Low Back Pain Disability Questionnaire.Results. No complications were registered. Absolutely all patients confirmed a decrease in pain. Before the manipulation, most of the patients described their pain as “very strong” (VAS 7.14 ± 0.68), whilst after the procedure the majority answered that their pain decreased to “average” (VAS 4.02 ± 0.81). A similar trend persisted for six months after treatment (VAS 1.85 ± 0.78). Before manipulation, the index of impairment due to pain (ODI) was 71.42 ± 6.83. Six months after the procedure, the ODI index was 18.57 ± 7.83.Conclusion. Pulsed radiofrequency of the dorsal spinal ganglia (PRF DRG) is a safe and effective procedure for the treatment of chronic lumbar radicular pain.