Skidanov A. Development mechanisms and diagnostics of the lateral recess stenosis with the patients suffering from degenerative diseases of lumbar spine

Object: Degenerative diseases of lumbar spine. The purpose: to perfect the diagnostics of lumbar spine lateral arthritic stenosis basing on the study of special features of the structure of lumbar spine vertebral canal, vertebrae articular processes and mechanisms of the development of this disease with the patients suffering from degenerative diseases of lumbar spine. Methods: clinical, roentgenologic, computertomographic, magnetic resonance tomographic, mathematical modeling using finite element method and statistical ones. The character of the effects of spinal canal trefoil form and arthritic narrowing of root canal on clinical course of lumbar spine degenerative diseases has been determined. The diagnostic value of particular clinical symptoms and syndromes in the proc-ess of diagnostics of arthritic degenerative stenosis of root canal depending on the level of stricture formation has been detected. For the first time the special features of lumbar spine canal structure, predisposing to the development of lateral arthritic degenerative stenosis, have been revealed and the innate character of these peculiarities has been proved. We’ve developed a method of detection of vertebrae articular processes space orientation and have built a mathematical model of lumbar spine with the help of finite element method. Anatomical peculiarities of facet joint which cause unfavorable tensions of articular processes leading to the development of lateral arthritic degenerative stenosis have been detected. Mechanisms of root canal stricture formation under spondylarthrosis influence have been studied. Quantitative and qualitative diagnostics criteria according to clinical data and data of roentgenometry and computer tomography have been revealed. The diagnostic value and information value of X-ray contrasting signs has been detected. The mentioned studies helped to understand some features of aetiology and pathogenesis of lateral arthritic degenerative stenosis of lumbar spine and its effect in the clinical course ofother degenerative diseases of lumbar spine. New information on pathogenesis of the disease allowed us to present the connection of structure functional changes of vertebral segment with clinical symptomatology more exhaustively. It gave us an opportunity to update diagnostics and to approach the treatment of lumbar spine degenerative diseases, their manifestations and effects from new positions. The developed algorithm of diagnostics of lumbar spine lateral arthritic stenosis by means of the study of clinical manifestations, development mechanisms, quantitative and qualitative computer tomography and magnetic resonance tomography signs allowed us to reduce the number of unsuccessful surgical interventions with lumbar spine degenerative diseases; helped with zone determining and planning the necessary size of surgical decompression. The results of clinical researches have been introduced into the work of SE “Sytenko institute of spine and joint pathology AMS Ukraine” departments; they have also been includedin the teaching materials of traumatology and orthopedics subdepartment of Kharkov Medical Academy Postgraduated Education and adopted by clinical practice of traumatological centre in Kharkov Regional Clinical Hospital of Traumatology, and traumatology and orthopedics subdepartment of Kharkov Municipal Multisectoral Hospital №18. Traumatology and orthopedy.