Some Aspects of the Pathogenesis and Diagnosis of Osteochondrosis of the Cervical Spine (Literature Review)

The aim of this research was to study the most important problems in diagnosing a socially significant problem - osteochondrosis of the cervical spine. According to some authors, in the structure of disability and disability associated with pathology of the spine, diseases of the cervical spine occupy one of the leading positions.

The paper analyzes data from 41 sources of literature on the pathogenesis and diagnosis of osteochondrosis of the cervical spine. Due to the complexity and ambiguity of the approaches to the diagnosis of osteochondrosis of the cervical spine, this paper analyzes the most important research methods in the diagnosis of this pathology. Attention is focused on the main pathogenetic prerequisites for the occurrence of pain.

According to literature data, the main attention in the diagnosis of osteochondrosis of the cervical spine is given to the basic methods: clinical and neurological examination, where the severity of the disorders is determined using scales that include not only an assessment of the intensity of the pain syndrome, but also the determination of a number of neurological disorders. The authors propose the use of a DN4 questionnaire, LANSS scales, neurological impairment scales (N1S); radiation research methods, such as survey spondylography of the cervical spine in direct and lateral projections, functional spondylography of the cervical spine in the position of maximum flexion and extension, multispiral computed tomography, magnetic resonance imaging data, and neurophysiological studies. Radiation research methods can determine pathological changes in the bone tissue itself. Magnetic resonance imaging indices make it possible to assess the degree of pathological changes in the soft tissue anatomical structures of the spinal canal and intervertebral discs. According to the literature, much attention is paid to functional research methods, in particular, electroneuromyography, which allows to assess the level and degree of damage to nerve fiber, the dynamics of the pathological process. Attention is paid to the allocation of marker indicators. All methods are significant, evidence-based, objective and modern and do not exclude the possibility of using data from other research methods.

The analysis of the presented literature once again convinces clinicians of the ambiguity and heterogeneity of approaches to the issues of pathogenesis and diagnosis of the cervical spine, which requires further improvement of the proposed methods for clarifying and objectifying the pathological process. An important andjustified is a pathogeneti-cally grounded approach to their study.

1. Lutsik AA, Fomichev NG, Zaydman AM, Bondarenko GYu, Krutko AV, Okladnikov GI. Discussion and indisputable aspects of spinal osteochondrosis. Khirurgiya pozvonochnika. 2012; (2): 63-69. (In Russ.)

2. Shostak NA, Pravdyuk NG. Neck pain - a multidisciplinary problem: diagnosis, treatment approaches. Consilium medicum. 2012; (2): 75-78. (In Russ.)

3. Guess M, Hildingsson C, Nilsson M. et al. The prevalence of neck pain. Acta Orthop Scand. 2002; 73: 455-459. https://doi.org/10.1080/00016470216329

4. Fejer R, fyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006; 15: 834-848. https://DOI:10.1007/s00586-004-0864-4

5. Alexander EP. History, physical examination, and differential diagnosis of neck pain. Phys Med Rehabil Clin N Am. 2011; 22(3): 383-393. https://doi:10.1016/j.pmr.2011.02.00

6. Hoy DG, Protani M, De R, Buchbinger R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010; 24(6):783-792. https://doi:10.1016/j.berh.2011.01.019

7. Shestel EA. Epidemiological features of neck pain in the elderly. Rossiyskiyzhurnalboli. 2016; 2(50): 73-74. (In Russ.)

8. Orel AM. Age-related aspects of the epidemiology of degenerative-dystrophic diseases of the intervertebral discs according to the system analysis of spinal radiographs. Meditsinskaya vizualizatsiya. 2010; (5): 113-121. (In Russ.)

9. Yoon SN. Cervical radiculopathy. Phys Med Rehabil Clin N Am. 2011; 22(3): 439-446. https://doi:10.1016/j.pmr.2011.02.013

10. Popelyanskiy YaYu. Orthopedic Neurology (Vertebroneurol-ogy): A Guide for Physicians. 6th edition. Moscow: MEDpress-inform, 2017. (In Russ.)

11. Abelskaya IS, Mikhaylov AN. Actual aspects of the radiological diagnosis of osteochondrosis of the cervical spine at the stages of medical rehabilitation. Vestnik rentgenologii i radiologii. 2006; (6): 22-28. (In Russ.)

12. Podymova IG, Danilov AB. Facet syndrome. Russkiymed-itsinskiyzhurnal. 2014; Special issue: 47-50. (In Russ.)

13. Gellhorn AC. Cervical facet-mediated pain. Phys Med Rehabil Clin N Am. 2011; 22(3): 447-458. https://doi:10.1016/j.pmr.2011.02.006

14. Ohtori S, Takahashi K, Chiba T, Yamagata M, Sameda H, Moriya H. Sensory innervation of the cervical faset joints in rats. Spine. 2001; 26: 147-150.

15. Manchikanti L, Kaye AD, Boswell MV, Bakshi S, Ghari-bo CG, Grami V, Grider JS, Gupta S. et al. A systematic review and best evidence synthesis of effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Physician. 2015; (18): 535-540.

16. Turnikov VM. Degenerative-dystrophic lesions of the spine: diagnosis, clinic and treatment. Russkiy meditsinskiyzhurnal. 2008; 16(26): 1739-1744. (In Russ.)

17. Firsov AA, Kusaykin AYu, Nikonov AA. Vertebrogenic cervical radiculopathy: clinical aspects of diagnosis and treatment. Arkhiv vnutrenney meditsiny. 2012; 34-39. (In Russ.) https://doi.org/10.20514/2226-6704-2012-0-5-34-39

18. Scheer JK, Tang JA, Smith JS, Acosta FL, Protopsaltis TS, Blondel B, Bess S, Shaffrey CI, Deviren V, Lafage V, Schwab F, Ames CP. Internation Spine Study Group (2013): Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013; 19: 141-159. http://thejns.org/doi/abs/10.3171/2013.4

19. Skulovich SZ, Chekhonatskiy AA, Kolesov VN, Chekho-natskiy IA. Prediction of the course of osteochondrosis of the cervical spine. Saratovskiy nauchno-meditsinskiy zhurnal. 2012; 8(2): 527-533. (In Russ.)

20. Matkhalikov RA, Tedoradze RV. Cervicogenic headache. Zemskiy vrach. 2011; (4): 19-22. (In Russ.)

21. Kalbus AI. Cervical radiculopathies: diagnostic and treatment options. Mezhdunarodnyy nevrologicheskiy zhurnal. 2014; 7(69): 26-30. (In Russ.)

22. Bekhtereva EV, Shirokov VA, Potaturko AV, Obraztsova RG, Leyderman EL. Difficulties in diagnosing cervical myeloradiculopathy. Ural'skiy meditsinskiyzhurnal. 2014; 9(123): 13-17. (In Russ.)

23. Andaluz N, Zuccarello M, Kuntz C. Long-term follow-up of cervical radiographic sagittal spinal alignment after 1- and 2-level cervical corpectomy for the treatment of spondylosis of the subaxial cervical spine causing radiculomyelopathy or myelopathy: a retrospective study. Clinical article. J Neurosurg Spine. 2012; 16: 2-7. https://doi:10.3171/2011.9

24. Anekstein Y, Blecher R, Smorgic Y, Mirovsky Y. What is the best way to apply the Spurling test for cervical radiculopathy? Clin Orthop Relat Res. 2012; 470(9): 2566-2572. https://doi:10.1007/s11999-012-2492-3

25. Baron R, Binder A. А how neuropathic is sciatica? The mixed pain concept. Orthopade. 2004; 33: 568-575. https://doi:10.1007/s00132-004-0645-0

26. Gangavelli R, Sreekumaran N, Bhat AK, Solomon JM. Cer-vicobrachial pain - How often is it neurogenic? Journal of Clinical and Diagnostic Research. 2016; 10(3): 14-16. https://doi:10.7860/JCDR/2016/16456.7492

27. Rogozhin AA, Devlikamova FI. Electromyographic diagnosis of radiculopathy. Prakticheskaya meditsina. 2012; 2(57): 47-50. (In Russ.)

28. Albeck MJ, Taher G, Lauritzen M, Trojaborg W. Diagnostic value of electrodiagnostic tests in patients with sciatica. Acta Neurol Scand. 2000; 101: 249-254.

29. American Association of Electrodiagnostic Medicine. Practice parameter for needle electromyographic evaluation of patients with suspected cervical radiculopathy: summary statement. Muscle Nerve. 1999; 22: S209-S221.

30. Gekht BM, Kasatkina LF, Samoylov MI, Sanadze AG. Electromyography in the diagnosis of neuromuscular diseases. Taganrog, 1997. (In Russ.)

31. Ippolitova EG, Verkhozina TK, Koshkareva ZV, Sklyaren-ko OV. Marker indicators of electroneuromyography in the diagnosis of osteochondrosis. Sibirskiy meditsinskiy zhurnal (Irkutsk). 2018; (1): 13-17. (In Russ.)

32. Fisher MA. H-reflexes and F-waves. Fundamentals, normal and abnormal patterns. Neurologic Clinics. 2002; 20(2): 145-151.

33. Hurtevent JF. The place of electroneuromyography in the exploration ofradiculopathy. Rev Neurol (Paris). 2002; 158: 1232-1235.

34. Ivanichev GA. X-ray examination of the spine. Moscow: Meditsina, 2001. (In Russ.)

35. Osna AI. Pathogenetic basis ofthe clinical manifestations of osteochondrosis of the spine. Osteokhondroz pozvonochnika. 1973; 1: 7-15. (In Russ.)

36. Mikhaylov AN, Abel'skaya AS, Luk'yanenko TN. Comparative analysis of the significance of radiation diagnostic methods in characterizing the bone structures of vertebral segments in cervical osteochondrosis. Mezhdunarodnye obzory: klinicheskaya praktika izdorov'e. 2015; 44(16): 5-24. (In Russ.)

37. Chernorotov VA, Kradinov AI, Kradinova EA, Prokopenko OP, Barketova DA, Chernorotova EV, Mashikhina LA. Multispiral computed tomography in determining the prospects for the restoration of functions (rehabilitation potential) in patients with osteochondrosis of the cervical spine. Tavricheskiy mediko-biolog-icheskiy vestnik. 2016; 19(4): 106-112. (In Russ.)

38. Raniga SB, Menon V, Al Muzahmi KS, Butt S. MDCT of acute subaxial cervical spine trauma: a mechanism-based approach. Insights Imaging. 2014; (5): 321-338.

39. Scheer JK, Tang JA, Smith JS, Acosta FL, Protopsaltis TS, Blondel B, Bess S, Shaffrey CI, Deviren V, Lafage V, Schwab F, Ames CP. Internation Spine Study Group (2013): Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013; 19: 141-159. http://thejns.org/doi/abs/10.3171/2013.4

40. Anderberg L, Annertz M, Brandt L, Saveland H. Selective diagnostic cervical nerve root block - correlation with clinical symptoms and MRI-pathology. Acta Neurochir (Wien). 2004; 146: 559-565. https://dok10.1007/s00701-004-0241-4