Background: Postoperative epidural fibrosis (EF) after lumbar discectomy is the most common and at the same time controversial issue. Purpose: The etiology and pathogenesis creates a lot of discussion and selection of methods of treatment and prevention continues. Methods: LIV laminectomy with dura mater (DM) exposition was done in 24 rats, and then, 0.3 ml of elements of suspension of autologous intervertebral disk was implicated on DM. As autologous intervertebral disk, we used the intervertebral disk from amputated tail. In all the animals, incisions were closed with 3/0 Vicryl. EF was examined. Fibroblast cell density was calculated in each field at ×40 magnification: Grade 1 - fewer than 100 fibroblasts in each field; Grade 2 - 100-150 fibroblasts in each field; Grade 3 - more than 150 fibroblasts in each field. Results: Based on histological results, we confirmed our model of experiment. On the 30th day of evaluation, there were significant histological evidences of postoperative epidural adhesions in experimental animals, which included the obliteration of epidural space, the presence of adhesions in the dura and nerve roots, the restructuring of the yellow ligament, bone sclerosis, excessive appearance of fibrous tissue around the autologous intervertebral disk tissue that applied on the DM. Conclusion: In our work, we describe a new experimental model, where the elements of autologous intervertebral disk play the role of inflammation trigger, which cause postoperative scar and EF.
and subdural spaces in the formation of connective tissue. This fact must be taken into account when preventing the development and formation of epidural fibrosis, because during surgery, damage to the dura mater is detected from cell-molecular to tissue levels, which are not always visualized during surgery using microsurgical technologies and equipment.
Objective. To analyze clinical manifestations of cervicobrachial syndrome and identify their relationship with sagittal imbalance using data of MRI and radiological examination.Material and Methods. Clinical manifestations of cervicobrachial syndrome associated with degenerative changes in the spine were studied in 22 patients. Clinical examination, radiography of the cervical spine, electroneuromyography of the upper extremities, and MRI study were performed. The intensity of the pain syndrome was assessed by VAS, and the quality of life – by the NDI questionnaire. The sagittal balance of the cervical spine was evaluated according to the following characteristics: angle of T1 slope, atlantoaxial (C1–C2) angle, degree of shift of the center of gravity of C2–C7, and Cobb angle.Results. The pain intensity in cervicobrachial syndrome correlates with sagittal balance changes in the C2–C7 Cobb angle (r = 0.656; p < 0.05), the angle of T1 vertebra slope (r = 0.520; p < 0.05), and in the degree of shift of the center of gravity of C2–C7 (r = 0.756; p < 0.02). Differences between MRI and radiological results of the sagittal balance measurement are not significant (p < 0.04).Conclusion. The study of the sagittal balance can be included in the algorithm for diagnosing osteochondrosis of the cervical spine. The MRI, along with spondylography, can be used to assess the state of sagittal balance. Understanding the identified relationships can help in determining the program of etiopathogenetic treatment of patients with cervicobrachial syndrome with obligatory including the sagittal balance correction in the program.
РезюмеВ статье проведён анализ данных 58 литературных источников по лечению шейно-плечевого синдрома у пациентов с остеохондрозом шейного отдела позвоночника. В работе отмечены анатомо-топографические особенности шейного отдела позвоночника, которые являются предрасполагающими факторами развития изучаемой патологии, а именно: малый размер тел позвонков и их повышенная подвижность. Выявлена высокая частота встречаемости дегенеративно-дистрофических заболеваний шейного отдела позвоночника у лиц старше 60 лет (50 %) и в возрасте 60 лет и старше (75 %) с преобладанием развития патологического процесса на уровне позвоночно-двигательного сегмента C V -C VI . По данным литературы, отношение к проблеме лечения данной патологии неоднозначно. Основными точками приложения консервативного лечения являются: устранение болевого синдрома, мышечного спазма, увеличение объёма движений в шейном отделе позвоночника. В изучаемой литературе имеются сведения об эффективности комплексного подхода этиопатогенетически обоснованного консервативного лечения данной патологии с учётом индивидуальных особенностей каждого пациента. Несмотря на то, что в последние годы достигнуты значимые успехи в консервативном лечении пациентов с патологией шейного отдела позвоночника, остаются нерешёнными и требуют дальнейшего анализа многие задачи, в связи с чем проблема совершенствования диагностики и лечения остаётся актуальной, социально значимой и своевременной.
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