In the thesis the study of the basic pathological processes that determine the development and course of acute compression lumbosacral radiculopathies (ALSR) caused by degenerative-dystrophic changes of the spine is carried out.
The materials of the complex clinical-neuroorthopedic, neuroimaging, neurophysiological and laboratory-diagnostic examination of 100 patients with ALSR caused by degenerative-dystrophic changes of the spine were taken as the basis of this work.
Examination of patients included clinical analysis, study of the structural characteristics of VMS in the lumbosacral spine according to neuroimaging, assessment of neural conduction according to electroneuromyography and neurometry.
Examination of patients was performed in three stages according to the inflammation in the area of disco - radicular conflict on a time scale: 3-7 days, 10-20 days, a month later.
The presence of urogenital infections was accompanied by more pronounced clinical manifestations, structural changes in VMS, as well as an unfavorable course.
The comparison of clinical manifestations of radicular syndrome and the results of assessment of structural and functional changes in VMS according to CT examination revealed a dissociation between the localization of hernial protrusion and the affected root, which was determined by the direction of hernial protrusion and anatomical and topographic features of root arrangements. Evaluation of neural conduction in the area of the compressed root in the dynamics of ASLR development according to ENMG and neurometry allowed to establish the regularity of involvement in the pathological process of various morphological structures of the damaged root. Based on the assessment of the rate of excitation propagation and indicators of the total action potential of motor units according to ENMG, there was no correlation (p <0.001) between clinical manifestations of the affected root and the presence of sensorimotor deficiency in stages I and II of the study. and root damage was limited to demyelination, regardless of the nature of the lesions in VMS. According to the stimulation EMG, it was found that only in stage III were signs of axonal-demyelinating process in the affected radicular nerve, while significant changes in the M-response at all stages of the study were not detected. According to the needle EMG, it was found that at stage III changes in muscle fibers indicated the beginning of the reinnervation process in the muscle concerned.
Quantitative sensory testing (neurometry), in contrast to ENMG, allowed to objectively assess the condition of the sensitive fibers of the affected roots from the first days of disco-radicular conflict.
Conservative treatment of ASLR depending on the stage of inflammation in the area of disco-radicular conflict has been improved. In the stage of alternative exudative inflammation, analgesics and nonsteroidal anti-inflammatory drugs, anticonvulsants, antidepressants, paravertebral blockade with local anesthetics and glucocorticosteroids are recommended. In case of urogenital infections (UGI) - specific antibiotic therapy. In the stage of productive inflammation - neurotrophic drugs, massage, physiotherapy, developed method of vibrotraction postisometric muscle relaxation with biomechanical stimulation of the muscles of the paravertebral corset. In the proliferation stage, the duration of neurotrophic therapy was determined according to the ENMG study.
Scientific novelty. For the first time, the nature, severity and direction of pathological changes that determined the peculiarities of the formation of ASLR were revealed.
For the first time the regularities of formation are revealed and the dynamics of the disease course is specified taking into account the pathomorphological changes caused by the development of inflammation in the zone of disco-radicular conflict.
For the first time, a causal relationship between latent and persistent urogenital infection in the development and course has been established.
For the first time the regularity of involvement in the pathological process of both sensory and motor fibers of the compressed root in the dynamics of ASLR development at different manifestations of degenerative-dystrophic changes in the lumbosacral spine has been established.
The practical significance. An algorithm for the diagnosis of acute lumbosacral radiculopathy due to degenerative-dystrophic changes of the spine, which included evaluation of clinical and neurological and neuroorthopedic examination, biochemical blood tests (ELISA to IgG, study of monoclonal antibodies to the diagnosis of urogenital infection) ,ENMG, neurometry. More significant informativeness of methods of needle EMG (from 14 days) and neurometry (from the first days of a disease) is established.
The algorithm of conservative treatment of ASLR is improved.
The main prognostic criteria that have a negative impact on the course of the disease have been developed.
