Osteochondrosis Research Articles

BIOCHEMICAL AND BIOMECHANICAL SUBSTANTIATION OF REPARATIVE REGENERATION OF INTERVERTEBRAL DISCS IN PATIENTS WITH DEGENERATIVE DISC DISEASES

Degenerative disc diseases occupy the second place in the overall structure of morbidity with temporary disability. In 40% of patients with spinal osteochondrosis, diseases of the locomotor apparatus and connective tissue cause primary disability. Disc degeneration is a pathological process that is the main cause of low back pain and is observed in the vast majority of people at some point in their lives. The influence of mechanical stress leads to degenerative changes in the tissues of the nucleus pulposus of the intervertebral disc. Limited transport and low cellular saturation of the discs hinder recovery, make the intervertebral disc particularly vulnerable to injury, and contribute to the appearance of morphological tissue damage associated with the processes of biological aging. The pathological process involves all structural elements of the intervertebral disc. The earliest manifestations of disc degeneration usually occur in the nucleus pulposus, where a reduced content of proteoglycans disrupts mechanical function, which leads to progressive morphological degeneration of the entire intervertebral segment. Existing treatment methods (both surgical and conservative) are not able to adjust the number of cells in the nucleus pulposus and are unable to stop the pathological process in the intervertebral disc. Prevention of degeneration or repair of the intervertebral disc is a potential treatment for lumbar pain syndromes. Cell therapy has become a subject of great interest, as new research reports significant regenerative potential for many cellular sources, including the regeneration of the nucleus pulposus region of the intervertebral disc. The use and implementation of modern cell therapy in practical neurosurgery allows us to approach the problem of intervertebral disc degeneration at a new qualitative level with the use of multipotent cells, biochemical peptides in the reparative processes of the nucleus pulposus, as a possibility of treatment and prevention of vertebrogenic pain syndromes in the future. Keywords intervertebral disc, nucleus pulposus, cell therapy, transplantation, degenerative changes, reparation

Multidomain approach in chronic non-specific back pain patient's treatment

The concept of chronic nonspecific back pain (CNBP) as a pathology of the spine (osteochondrosis, spondylosis, intervertebral disc herniation, facet syndrome) is extremely outdated and has not justified itself, first of all, from the therapeutic view point. Numerous studies, including meta-analyzes and systematic reviews, have convincingly shown the ineffectiveness of the methods of CNBP treatment, aimed only at solving the problems of the spine itself and / or surrounding tissues. A substantial amount of special imaging studies have proven the dissociation between morphological vertebral changes and the clinical picture of pain. CNBP is the overall result of the interaction of numerous factors in the spine tissues (changes in the discs, joints, ligaments, fascia, muscles) and factors beyond the spine. The latter include, first of all, psychological and social factors, cognitive functions, the quality of night sleep, the level of physical activity, concomitant diseases (comorbidity). In each patient, the interaction of these factors determines the development of specific pathophysiological mechanisms of pain and, as a result, an individual clinical picture of pain (phenotype). Understanding these processes will allow for the reconsideration of the approach of searching for an anatomical pain source as the main pathogenetic factor; recognizing the multifocal generation of chronic pain as the result of a complex interaction of biological, psychological and social factors; the development of new principles and therapy algorithms. The authors propose to introduce into practice a multidomain screening approach for evaluating patients with CNBP, which would take into account the phenotype of pain, factors affecting its perception, and allow personalized treatment for each patient based on the biopsychosocial approach.

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 10-20system. 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.

Proteome Alterations in Equine Osteochondrotic Chondrocytes.

Osteochondrosis is a failure of the endochondral ossification that affects developing joints in humans and several animal species. It is a localized idiopathic joint disorder characterized by focal chondronecrosis and growing cartilage retention, which can lead to the formation of fissures, subchondral bone cysts, or intra-articular fragments. Osteochondrosis is a complex multifactorial disease associated with extracellular matrix alterations and failure in chondrocyte differentiation, mainly due to genetic, biochemical, and nutritional factors, as well as traumas. This study describes the main proteomic alterations occurring in chondrocytes isolated from osteochondrotic cartilage fragments. A comparative analysis performed on equine osteochondrotic and healthy chondrocytes showed 26 protein species as differentially represented. In particular, quantitative changes in the extracellular matrix, cytoskeletal and chaperone proteins, and in cell adhesion and signaling molecules were observed in osteochondrotic cells, compared to healthy controls. Functional group analysis annotated most of these proteins in “growth plate and cartilage development”, while others were included in “glycolysis and gluconeogenesis”, “positive regulation of protein import”, “cell–cell adhesion mediator activity”, and “mitochondrion nucleoid”. These results may help to clarify some chondrocyte functional alterations that may play a significant role in determining the onset and progression of equine osteochondrosis and, being related, of human juvenile osteochondrosis.

Ефективність застосування плазми, збагаченої тромбоцитами, у лікуванні хворих на остеохондроз хребта

Ефективність застосування плазми, збагаченої тромбоцитами, у лікуванні хворих на остеохондроз хребта

CONNECTIVE TISSUE DYSPLASIA IN CHILDREN. THE EXPERIENCE OF AN ORTHOPEDIST IN AN OUT-PATIENT UNIT

Pediatric orthopedists in out-patient pediatric units - unlike traumatologists- orthopedists for adult population - face a great number of various congenital malformations in the muscular-skeletal system of children, and, in the end, malformations of the connective tissue. Unfortunately, diagnosis “dysplasia of the connective tissue”, one of the most widespread diagnosis in the pediatric practice, is frequently a result of “hyper diagnostics” at the primary stage of pediatric control. A decisive role in putting this diagnosis, undoubtedly, belongs to pediatric orthopedists. Dysplasia of the connective tissue occupies a leading place in the pathology of locomotor apparatus in children who are brought to trauma units with injuries for consultations and medical aid. So, the basic purpose of this work was to develop an algorithm for monitoring patients with connective tissue dysplasia and to define ways for increasing the efficiency of prophylactic measures, treatment and rehabilitation of children with the discussed pathology. 30 children with congenital dysplastic impairments in the connective tissue, who were consulted and treated in 2011 - 2018, were included into the trial. All of them (100%) had fractures of upper and lower extremities in anamnesis ( tibia, metatarsal bones, lower third of the radius, transcondylar fractures of the humerus). There were no fractures in the skull, pelvis, fingers. No displacement of bone fragments. The cranial vault was disproportionately large, had a spherical shape. In anamnesis, delayed fontanel closure. During the dynamic observation, main clinical symptoms of the disease were: distorted limbs due to fractures ( 3 and more in each patient), muscle hypotension, vicious posture (scoliotic, kyphotic, kyphoscoliotic, flat back), blue sclera, carious teeth. Findings of laboratory, radiological and densitometric examinations were the final chain in the clinical diagnosis. Modern highly professional medical and rehabilitation measures can lead to good results in children with the connective tissue dysplasia and significantly improve their quality of life. To know the basic clinical manifestations of the disease and ways of its treatment is a need not only for orthopedists in pediatric clinics, but, first of all, for pediatricians who carry out the primary patronage of newborns. Early detection of connective tissue pathologies allows to avoid the most serious complications of the disease, such as idiopathic scoliosis, early juvenile osteochondrosis, and Shoerman-Mau disease.

Bone mineral density and the level of active metabolites of vitamin d in postmenopausal women with spinal osteochondrosis

In the elderly and senile age, osteoporosis and spinal osteochondrosis are found with high frequency, which determines the study of their common development mechanisms.Objective: to study the level of 25(OH)D and 1.25(OH)2D3 and indicators of bone metabolism in the blood serum of postmenopausal women with spinal osteochondrosis and low bone mineral density (BMD).Methods: a retrospective analysis was performed using bone densitometer (Explorer QDR W, Hologic) data; BMD of the lumbar spine and proximal femur was assessed in 123 postmenopausal women with clinically and radiologically confirmed spinal osteochondrosis. The active serum metabolites of vitamin D (1.25(OH)2D3, 25(OH)D) were studied in the blood serum of patients by enzyme-linked immunosorbent assay; total and ionized calcium, phosphorus, magnesium, acid and alkaline phosphatase activity were determined.Results: in postmenopausal women with spinal osteochondrosis and decreased BMD, the average values of 25(OH)D were recorded at the level of insufficiency, and 1.25(OH)2D3 was at deficiency level. Among them osteoporosis was diagnosed in 67.5 %. A reduced level of magnesium was detected in 52.8 % (65) of the women examined, a reduced level of ionized calcium was detected in 60.9 % (75). Moreover, in patients with a deficiency of 25(OH)D, the serum magnesium level was on average lower than normal and by 1.2 times (p < 0.05) lower compared to the group with 25(OH) D deficiency. The level of total calcium was lower than the reference values in 26.8 % (33) patients, phosphorus was lower in 4.1 % (5).Conclusions: low BMD is associated with deficiency and insufficiency of 25(OH)D and 1.25(OH)2D3 in 100 % of postmenopausal women with spinal osteochondrosis. A decrease of the level of 25(OH)D is accompanied by a low level of serum magnesium, which should be considered when prescribing compensatory therapy of vitamin D.

Effects of additional organic micro-minerals and methionine on carcass composition, gait score, bone characteristics, and osteochondrosis in replacement gilts of different growth rate

Osteochondrosis (OC) is a multifactorial defective endochondral ossification that causes lameness and early culling in gilts and sows. Previous research suggested that nutrition and growth rate could influence OC development and progression. As part of a broader study [n = 360 gilts; 28.8 ± 8.8 kg body weight (BW)] designed to evaluate the effect of 4 dietary treatments: 1) basal diet (CON); 2) CON plus organic micro-minerals (MIN, copper, manganese and zinc at 10, 20 and 50 mg/kg, respectively); 3) additional methionine (MET, at 102% methionine:lysine); and, 4) the organic micro-minerals plus the additional methionine (MM), on lameness and performance, a sub-sample of 40 heavy replacement gilts (10 gilts/treatment, 171.5 ± 8.1 kg of BW) was used. Within treatment, gilts were classified for final average daily gain (ADG) as low (LG, 838 ± 36.3 g/day; n = 20) or high (HG, 922 ± 31.1 g/day; n = 20). Dietary treatment and growth classification were the fixed effects to evaluate gait, OC, tibia bending measures, metacarpal mineralization; and using computerized tomography, the carcass composition, bone size, and whole bone density (WBD). The WBD was expressed as volume of Hounsfield values (HU), where higher values indicate increased density. A porcine reproductive and respiratory syndrome virus outbreak occurred during this trial. It differentially affected MM gilt performance and consequently may have influenced the results for this treatment. Gilts fed MIN diet had 0.75 cm larger tibia than CON (P < 0.05), and 10% increase of WBD > 140 HU compared to CON and MET (P < 0.05). The volume of high dense bones (> 1000 HU) was also increased in MIN and MET compared with CON (P < 0.05). Tibia bending moment and breakage strength were greater (P < 0.05) in MIN than in CON, with MET and MM intermediate. Metacarpal ash, Ca, and P content, but not proportions, were higher in gilts fed MIN than CON (P < 0.05). Total score of OC lesions was lower in MM gilts compared to CON (P < 0.05). The OC total score increased with ADG from 35.8 to 109.8 kg BW (R2 = 0.10; P < 0.10). However, between 109.8 and 171.5 kg BW OC score increased with decreased ADG (R2 = 0.14; P < 0.05). In conclusion, supplementing growing gilts with MIN enhanced bone strength and bone density, MET increased the proportion of highly dense bone (>1000 HU), and MM dietary treatment reduced OC lesion score compared with CON.

Migraine and other headaches in transient ischemic attacks

Headache is a common symptom in acute cerebrovascular diseases; however, no studies have evaluated the prevalence of specific headache types in patients with transient ischemic attacks (ТIАs).Objective: to analyze all headaches within the last year and the last week before and during ТIАs.Patients and methods. TIA patients included in the study (female 55% (n=120); mean age, 56.1 years) according to the existing definition of TIAs had a transient neurological dysfunction episode caused by focal brain damage or retinal ischemia for up to 24 hours without forming a new acute heart attack on diffusion-weighted MRI (n=112) or CT (n=8). All the patients were examined by one neurologist within one day after their admission. Patients (female 64% (n=192); mean age, 58.7 years) who had been admitted with a diagnosis of lumbago, lumbar spine osteochondrosis, or gastrointestinal ulcer were examined as a control group. A clinical semistructured face-to-face interview with the patients of both groups was carried out to analyze headache.Results and discussion. The prevalence of migraine without aura during one year before TIA was substantially higher in patients with TIA than in control ones: 20.8 and 7.8%, respectively (p=0.002). Twenty-two (18.3%) patients had sentinel or warning headache within the last week before a TIA that manifested as an increase in and greater frequency of previous headache, as lack of effect of painkillers, and as the emergence of a new type of headaches, which were previously absent. During TIAs, 16 (13.3%) patients developed a new type of headache. Twelve of these 16 patients had migraine-like headache; three patients had headache resembling tension headache; one patient had a thunderclap headache. None of the control patients was found to have a new type of headache. TIAs were significantly more common in the vertebrobasilar basin than in the carotid artery one in patients with headache during the last week before and during TIA.Conclusion. The one year prevalence of migraine was significantly higher in ТIА patients than in control patients, and so was the prevalence of headache within the last week before and during TIA. Migraine-like headache prevailed among the new types of headaches in the development of TIA. A previous headache with a change in characteristics and a new type of headache can be predictors for TIA.

Carpal tunnel syndrome: issues of diagnosis and treatment

Objective: to analyze the typical medical practice management of patients with carpal tunnel syndrome (CTS), to evaluate the efficiency of surgical treatment, and to identify factors influencing the successful outcomes of surgical treatment.Patients and methods. The investigation enrolled 85 patients (14 men and 71 women; mean age, 62±10.8 years). Previous diagnosis and treatment of patients were assessed in other healthcare facilities. All patients underwent median nerve decompression. The efficiency of surgical treatment was assessed according to the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analogue scale for pain before and 1, 3, 6, and 12 months after surgery.Results and discussion. Informative diagnostic tests are rarely performed in patients with CTS, but cervical spine neurovisualization is often unreasonably prescribed. Erroneous diagnoses (predominantly those of cervical spine osteochondrosis (46%), and diabetic neuropathy (6%)) are made frequently (60%) in patients with CTS; the latter receive ineffective treatment for a long time. Surgical treatment in reducing pain and improving hand functionality is noted to be highly effective. The mean BCTQ score decreased from 2.81±0.68 to 1.62±0.55 and 1.24±0.41 at 1 and 12 months, respectively (p&lt;0.05), the mean functional state score dropped from 2.92±0.78 to 2.4±0.72 and 1.46±0.57, respectively (p&lt;0.05). Permanent numbness, subjective weakness, thenar muscle atrophy, Stage III CTS, and diabetes mellitus are predictors for less pronounced improvement in BCTQ scores after surgery (p&lt;0.05).Conclusion. Physicians are noted to be unaware of the manifestations of CTS and effective methods for its diagnosis and treatment. Decompression surgery is shown to be a highly effective procedure in patients with CTS following 1 and 12 months.

Disarticulation-Associated Femoral Head Separation in Clinically Normal Broilers: Histologic Documentation of Underlying and Predisposing Cartilage Abnormalities.

Routine and quantitative histologic studies on femoral head separation (FHS) associated with coxofemoral joint disarticulation at necropsy were conducted on 125 femoral heads collected from 21- to 50-day-old clinically normal broilers. The study compared groups demonstrating grossly detached femoral heads (DFHs) with those having attached femoral heads (AFHs). Marked microscopic lesions compatible with osteochondrosis (OCD) consistently occurred along the separation surface in the DFH population. The histologic changes consisted of cartilage degeneration and necrosis sometimes forming small clefts or microfractures. Hemorrhage and less frequent inflammatory cells were often present along the separation surfaces. Small foci of OCD in the femur occurred in the AFH group with lesser frequency and severity. The histologic changes were mainly found within the proximal proliferative zone of the physis near the epiphyseal junction. Histomorphometry disclosed significant quantitative reductions in chondrocyte density with increased pyknosis occurring adjacent to the separation site and to a lesser extent in deeper regions of the growth plate for the DFH compared with AFH. Measurements made along the separation surface of the percentage length occupied by osteochondrotic defects and actual separated cartilage disclosed significant differences between evaluation groups. However, determinations of vascular canal areas present within two or more regions of the growth plate revealed a slight and significant increased area for DFH compared with AFH. Severity scores for the occurrence of microthrombi within the growth plate showed no difference between the groups. The pathogenesis of FHS in broilers is related to defective cartilage production or degeneration resulting in increased fragility. This contrasts with the proposed pathogenesis of OCD in mammals, which involves ischemic necrosis due to underlying vascular defects. The results for the FHS-disarticulation model also differ from those reported for glucorticoid-induced femoral head necrosis in broilers. The FHS-associated lesions occurred without histologic evidence of bacterial chondritis or osteomyelitis.

Osteochondrosis in the Distal Femoral Physis of Pigs Starts With Vascular Failure.

Articular osteochondrosis (OC) arises due to vascular failure and ischemic chondronecrosis. The aim of the study was to describe the histological and computed tomographic (CT) characteristics of changes in the distal femoral physis of pigs, to determine if they represented OC lesions and if the pathogenesis was the same as for articular OC. The material included 19 male Landrace pigs bred for predisposition to OC. One or 2 pigs were euthanized and CT-scanned at 2-week intervals from 82 to 180 days of age. Material from 10 pigs was available for histological validation. The CT scans revealed 31 lesions confirmed in 3 planes and 1 additional macroscopically visible lesion confirmed in 2 CT planes. Twelve of the lesions were histologically validated. All lesions were compatible with OC. Cartilage canal and eosinophilic streak morphological changes corresponded to failure of end arteries coursing from the epiphysis, toward the metaphysis. The location of lesions was compatible with failure at the point of vessel incorporation into bone. Vascular failure was associated with retention of viable hypertrophic chondrocytes and delayed ossification but not cartilage necrosis. Lesion width ranged from 1.1% to 45.6% of the physis. Several lesions were expected to resolve due to small size and evidence of CT-identifiable, reparative ossification. Angular limb deformity was not detected in any pig. The pathogenesis of physeal OC started with vascular failure that was morphologically identical to articular OC. The heritable predisposition may therefore be the same. The association between lesions and limb deformity should be studied further in older pigs in future.

Maturation of the medial femoral condyle epiphyseal growth plate and osteochondral junction

Purpose: The osteochondral junction region has an important role in osteoarthritis and many early pathophysiological features (e.g. chondrocyte hypertrophy) of the disease recapitulate development events. Femorotibial osteoarthritis arises most commonly in the medial compartment in humans and horses. Furthermore, juvenile osteochondrosis (JOCD) also develops in this region, and if not treated successfully, the persisting incongruency can lead to secondary osteoarthritis. The maturation of the epiphyseal growth cartilage and the osteochondral junction of the medial femoral condyle (MFC) of the distal femur is poorly described in the literature. Horses are also increasingly recognized to be appropriate large animal models for cartilage repair investigations and information on maturation of the osteochondral junction is lacking. Our goal was to describe the normal development of the equine MFC osteochondral junction from birth to 2 years old. Methods: Distal femurs were collected from Thoroughbred horses (n=61, 0-2 years old), presented for post-mortem examination for reasons unrelated to this study. Radiographs and tomodensitometry were performed to screen for healthy specimens without focal osteochondral junction lesions. Micro-tomodensitometry (μ-CT), histology and immunohistochemistry were performed on the selected MFCs (n=29). μ-CT: A region of interest (ROI) was selected for study in a weight bearing area of the MFC that also incorporated developmental disease (JOCD and equine cysts/osteochondrosis) prone sites. Cartilage thickness (Cth) and trabecular bone volume were measured. 3D images were also constructed and the osteochondral junction morphology was assessed. Histology: MFC epiphyseal growth plate structure was studied on hematoxylin phloxine and saffron (HPS) stained sections. Collagen structure (picrosirius red) and proteoglycan content (Safranin O fast green) were also evaluated. Chondrocyte lacunae diameters were measured in predefined regions below the articular surface and near the osteochondral junction as an indicator of chondrocyte hypertrophy. Collagen X (Col X) immunohistochemical staining was also employed as a marker of endochondral ossification. Results: μ-CT: The Cthranged from 3.8mm in the youngest specimens to 1.2mm at 2 years of age. The Cthdecreased from birth to 7 months and remained constant thereafter (regression into 2 segments, p<0.0001). From birth to 6 months of age, the ossification front was porous on 3D images (fig 1.a) and later had a smooth appearance (fig 1. d). The trabecular bone volume did not change with age and was significantly higher at the periphery of the condyle, near the cartilage, compared to the center (p<0.0001). Histology: The structure of the epiphyseal growth cartilage differed from that reported for the physis as there was no columnar organization of the chondrocytes. The safranin O fast green and picrosirius stains showed a stratification of the extracellular matrix content that varied with age. The osteochondral unit was immature up to 6 months of age: Cartilage canals containing blood vessels crossed the ossification front (fig 1.b) and the chondrocytes were undergoing hypertrophy near the cartilage-bone junction. The chondrocyte lacunar volume increased 14-fold beside the osteochondral junction in the youngest specimens (fig 1.c). Expression of Col X was evident in the extracellular matrix surrounding hypertrophic chondrocytes in site matched specimens in the juvenile specimens alone. At six months of age, the absence of chondrocyte hypertrophy and Col X immunostaining indicated the conclusion of endochondral ossification. This coincided with the smallest Cth, similar to mature articular cartilage and the appearance of a narrow band of compact bone indicating formation of a subchondral cortical bone plate (fig 1.e). Conclusions: The equine MFC osteochondral junction is structurally immature and undergoes endochondral ossification up to 6 months of age. At this time, the histological structure of a subchondral cortical bone plate emerges. Cartilage canals and hypertrophic chondrocytes are no longer present and the cartilage thickness is stable and consistent with a mature articular cartilage. Although we have explored the structural and matrix maturation events, additional studies are now required to assess the biomechanical maturation of the region. New information is provided on MFC osteochondral junction development that may help towards the understanding of the remodeling events occurring in osteoarthritic joints.

Оценка эффективности низкочастотной магнитотерапии от аппарата АЛМАГ+ в комплексном лечении дорсопатий (остеохондроз позвоночника, грыжи дисков позвоночника)

Оценка эффективности низкочастотной магнитотерапии от аппарата АЛМАГ+ в комплексном лечении дорсопатий (остеохондроз позвоночника, грыжи дисков позвоночника)

Sling Suspension Versus Gym Balls in the Treatment of Juvenile Spinal Osteochondrosis

Sling Suspension Versus Gym Balls in the Treatment of Juvenile Spinal Osteochondrosis

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.

Застосування адаптивної фізичної культури у відновленні компенсаторних функцій хребта при остеохондрозі у осіб другого зрілого віку

The restoration of the compensatory functions of the spine in osteochondrosis in the elderly is a pressing issue in both medicine and physical rehabilitation. Almost half of the persons of the second period of mature age suffer from osteochondrosis of the spine, which leads to pain, muscle contractions, a decrease in the amplitude of movement, and the like. That is why the need for the application of special methods of physical rehabilitation to restore vital functions. Based on the analysis and synthesis of scientific medical literature and physical education and sports, an experimental technique has been developed to actively restore the spinal compensatory functions in osteochondrosis of the spine in the elderly. The method is based on the use of methods of adaptive physical culture as a set of measures, including exercise therapy and therapeutic massage. Spinal osteochondrosis is a degenerative process, in which there may be subluxations in the vertebral joints or slipping of the vertebrae is observed, as a result of which the spinal cord and its roots are injured. Use in the elderly, patients with osteochondrosis of the spine, experimental methods of active recovery of the compensatory functions of the spine gave a positive dynamic of functional changes. The experimental methodology is based on the application of adaptive physical culture methods as a set of measures that include exercise therapy and therapeutic massage. An experimental procedure for the active restoration of compensatory functions of the spine with osteochondrosis has been developed, which is based on: exercises for relaxation of the muscles of the upper extremities, shoulder girdle; unloading of the affected division of the spine; relaxation exercises; exercises for small and medium muscle groups; corrective exercises; breathing exercises static and dynamic. It is proved that taking special exercises, dispensing them, depending on the nature and clinical course of the disease, can purposefully affect and mainly change certain functions of the body by restoring damaged systems, adapting the patient to the physical load of domestic and industrial nature. Evaluation of the effectiveness of the method of active restoration of compensatory functions of the spine in osteochondrosis included the definition of appropriate criteria, which include: mobility of the intervertebral joints; the dynamics of pain syndrome; research of psychoemotional manifestations. The results of experimental studies have shown positive dynamics in the experimental group of the elderly, patients with spinal osteochondrosis, in connection with adaptation to physical activity and increase their motor activity. The testing of mental functions showed a positive effect of the experimental complex of exercises on the emotional state of patients.

Причины и симптомы остеохондроза

Причины и симптомы остеохондроза

An outpatient with hand numbness: old prejudices, new strategies of differential diagnosis and treatment

To search for 'diagnostic masks' of tunnel syndrome (TS) of the upper limbs and evaluate the efficacy of the antiacetylcholinesterase agent ipidakrine in the treatment of TS in a polyclinic. An analysis of outpatient cards showed that 597 people had complaints of numbness in their hands (23.9% of all neurological pathology). After exclusion of patients with vascular, demyelinating pathology, somatoform disorders, 92 people, who previously had the diagnosis of osteochondrosis, were first-time diagnosed with TS of upper limbs with mild to moderate severity. Kruskal-Wallis' nonparametric analysis of variance revealed homogeneity of clinical and instrumental manifestations in all patients. Patients were divided into 2 comparable groups: the control group (n=42), which received traditional therapy and the main group (n=50), which additionally received ipidacrine. The follow-up clinical-neurophysiological examination was carried out 4 weeks after treatment. A significant improvement was revealed during the use of ipidacrine in addition to the traditional therapy, despite the short period of drug administration. Positive dynamics was also observed in the group receiving traditional therapy, but no significant differences were recorded between baseline and after treatment. The key 'diagnostic masks' of TS are various syndromes caused by spinal osteochondrosis. The high efficacy of ipidacrine in the complex treatment of patients with mild to moderate TS is confirmed.

Оцінка структурних змін хребтових сеґментів у хворих на поперековий остеохондроз з порушеннями рухового стереотипу з використанням методів променевої діаґностики

Aim.&nbsp;To investigate the lumbar segments roentgenanatomic changes in patients with vertebral osteochondrosis with a disturbance of&nbsp;the&nbsp;motor stereotype. Material and Methods.The material&nbsp;of the study were&nbsp;protocols of clinical and radiological examination of 80 patients of 22-44 years&nbsp;of agewith lumbar osteochondrosis with a disturbance of the male motor stereotype . X-ray characteristics and signs of degeneration of elements of lumbar segments were evaluated. Statistical&nbsp;methods used were ones&nbsp;of descriptive statistics,&nbsp;and&nbsp;t-criterion by Student method with significance level&nbsp;of&nbsp;p&lt;0,05. Results and Discussion.&nbsp;In the&nbsp;course of&nbsp;lumbar spondylograms analysis, a significant predominance of structural asymmetry of the elements of the lumbar segments was&nbsp;established: asymmetry of articular processes (in LIII - LIV - 77.5%, LIV - LV - 85.0%, LV - SI - 70.0%, disconverting of articular facets - 72.5%, 81.3%, 57.5% respectively, the asymmetry of the transverse processes is 51.3%, 46.4%, and 76.3%, respectively. Anomalies of the tropism,&nbsp;and&nbsp;rotation of the spinous processes were observed in more than half of the patients. All patients showed signs of degeneration of all elements of the investigated lumbar segments. On the magnetic resonance imaging scans, changes in end-plates&nbsp;of the&nbsp;vertebral bodies&nbsp;of Modic 1 and Modic 2 types were dominant, which amounted to 63.8% for the LIII - LIV segment, 82.6% for LIV - LV and 87.5% for LV - SI. There were signs of degeneration of intervertebral discs of varying degrees in all&nbsp;the&nbsp;studied lumbar segments. Conclusions.&nbsp;The roentgenanatomic characteristics of lumbar segments in patients with spinal osteochondrosis with motor stereotype disturbance are characterized by a significant predominance of the structural asymmetry of the LIII, LIV, and LV vertebrae: the asymmetrical value of articular (77.5%, 85.0%, 70.0%,&nbsp;respectively) and&nbsp;transverse (51, 3%, 46.4%, 76.3%,&nbsp;respectively) of the processes, discontinuity of the articular facies (72.5%, 81.3%, 57.5% respectively), anomalies of tropism (47.5%, 55.0%, 52.5%,&nbsp;respectively), rotation of spinous processes (67.5%, 63.8%, 33.8%,&nbsp;respectively). Dysplastic and degenerative deformations of the lumbar segments visualized in radiography and magnetic resonance imaging in patients with vertebral osteochondrosis with the motor stereotype disturbance can potentiate the development of vertebral pain syndromes.