At disk herniation there is a range of factors promoting lumbar osteochondrosis clinical signs´ manifestation and, especially, circulatory disturbances in spinal cord and spinal roots. Their timely diagnostics and release, no doubt, create favourable conditions for the given vertebral column pathology treatment improvement.
With this objective in view we have carried out a detailed retrospective analysis of 1848 lumbar osteochondrosis patients´ integrated survey and treatment data.
Among the patients the occurrences of radiculoischemia were detected in 302 persons (16,3%), myeloischemia - in 111 patients (6,0%). Among the myeloischemic syndrome patients in 83 (74,8%) cases it was combined with occurrences of radiculoischemia. Hence, the radiculoischemic syndrome or radiculomyelopathy occurred in 330 surveys (17,9%).
Thereat, it was detected that against the background of intervertebral disks´ changes there are factors promoting the manifestation of clinical signs of circulatory disturbances in spinal cord and roots.
A narrow spinal canal detected in 24 patients (7,3%) is referred to these factors. The vertebral foramen stricture was found out in 79 cases (23,9%). The vertebral foramen stricture was either congenital or acquired. The acquired stricture was conditioned by changed bone structures, hernial outpouching of the intervertebral disk, the cicatrical-adhesive process in this region and various combinations of these factors. From 330 radiculoischemic syndrome patients the instability in spinal motional segments was found out in 117 (35,4%) persons, that allows considering this pathological situation as one of the factors promoting circulatory disturbances both in the radiculae and spinal cord. One of the causes of circulatory disturbances in the spinal roots and spinal cord is the cicatrical-adhesive process development both in the pre-surgical period and especially after a surgical aggression. Among the radiculomyeloischemic syndrome patients the cicatrical-adhesive process in the region of radiculae at the disk hernation level was found out in 46 persons (13,9%). And, finally, in 13 persons (3,9%) the development of radiculomyeloischemic phenomena was conditioned by the appearance of a liquor block as a result of a well-marked compression of the intervertebral disk by the hernia and the presence of cicatrical-adhesive changes at this level.
The analysis of remote results of the operative therapy of diskogenic lumbar radiculomyeloischemias in 267 patients allowed establishing that after an essential or complete regression of ischemic disturbances in the long-term post-surgical period the circulation disturbance relapse in the spinal cord and radiculae took place in 25 persons (9,4%).
Clinically it was manifested by the pain syndrome nascence or spurt against the background of a favourable or relatively favourable post-surgical period for the period of not less than a year. Then acutely (within several hours) or subacutely (within several days) a well-marked clinical picture in the form of a radiculoischemic or radiculomyeloischemic syndrome developed.
The data analysis of the integral survey of 25 patients with a diskogenic post-surgical relapsing radiculomyeloischemic syndrome allowed establishing that the operated intervertebral disk hernia relapse occurred in 14 persons (56,0%), the cicatrical-adhesive process availability in the region of surgical aggression - in 6 patients and the combination of diskal hernia relapse and epiduritis - in 5 cases (20,0%).
However, the ischemic disturbances in long terms after surgical interference were registered in the patients earlier operated on the lumbar osteochondrosis without radiculomyeloischemic phenomena in the pre-operative period. From 330 patients with the presence of radiculomyeloischemic disturbances a similar situation was observed in 12 persons (3,6%).
In such cases the progression of degenerative processes in the intervertebral disks adjacent to the operated one takes place. This very fact aids the development of the radiculae´ and the attending vessels´ compression in the presence of functionally meaningful vessels at this level.
Clinically it is manifested by the radiculalgia nascence or spurt in remote terms of the favourable post-operative period. In all the 12 persons a well-marked clinical picture of radiculoischemia or radiculomyeloischemia developed acutely (within several hours) or subacutely (within several days) for the period of not less than 3 years after the operation.
We define a similar manifestation of the disease in the patients earlier operated on the lumbar osteochondrosis not complicated with ischemic disturbances as a syndrome of diskogenic post-operative remote ischemia of the spinal cord and radiculae.
The cause of the nascence of circulatory disturbances in the spinal cord and roots of the spinal nerve can be not only the development of hernial outpouching of the intervertebral disk at another level, but also progressing pathological changes in the region of surgical aggression in the form of a cicatrical-adhesive process and instability in the lumbar spine. A similar manifestation of the disease occurred in 3 patients from 12 earlier operated on the lumbar spine osteochondrosis not complicated with ischemic disturbances.
The findings testify that:
- At disk herniation there is a range of factors promoting the manifestation clinical signs of circulatory disturbances in the spinal cord and spinal roots. The narrow spinal canal, vertebral foramen stricture, cicatrical-adhesive process, instability in spinal motional segments and liquor block are referred to them.
- In 9,4% of the cases in remote terms after the operation a relapse of the radiculomyeloischemic syndrome occurs due to the earlier operated intervertebral disk hernia relapse, the cicatrical-adhesive process development in the region of surgical aggressionor combination of the diskal hernia relapse and epiduritis.
- In 3,6% of the patients earlier operated on the lumbar osteochondrosis without radiculomyeloischemia phenomena the ischemic disturbances conditioned by both intervertebral disk hernia at the level neighboring to the operated one and epiduritis and instability of the spine in the region of surgical intervention develop in remote terms after the operation.
The work was submitted to international scientific conference «Present-day problems of experimental and clinical medicine», Thailand - Cambodia, February 18-28, 2009. Came to the editorial office on 16.01.2009.