This disease is a pathology that includes a group of diseases of the spinal column. At the same time, the disease persistently “gets younger”, so more and more people aged 20-30 years complain about problems with the spine. This is due to sedentary work, improper organization of the workspace, and insufficient physical activity.
Violation of the statics of the spine brings with it painful symptoms that require timely treatment. Otherwise, the person faces disability and surgical treatment. In this article we will look at what static diseases of the spine are, what they are like and how to deal with them.
Violation of the static function of the spine: features and characteristics of the pathology
Cervical spine
This organ consists of vertebrae as well as intervertebral discs. The latter are cartilage, which in the center has a core (a jelly-like formation responsible for the mobility of the spinal column). The so-called intervertebral discs provide a close connection with the vertebrae, performing a static function. With various pathologies and injuries, thinning and deformation of the cartilage structure occurs. First, its edges are affected, and then the degenerative process affects the core of the structure. Because of this, the vertebrae become excessively mobile, which leads to compression of nearby structures: nerves, blood vessels, soft tissues.
Thus, a violation of statics is a pathological condition characterized by a violation of the relationships between the vertebrae. Disorders of the static function of the spine include several diseases that are of different nature, but have similar symptoms and consequences for the patient. They are extremely insidious, since in the initial period of development of the pathology the patient does not feel any symptoms and, accordingly, considers himself completely healthy. At this time, the intervertebral disc becomes thinner, the vertebrae become more mobile. The patient consults a doctor when structural changes have already occurred that are extremely difficult to reverse.
Wearing a corset and giving a massage
What to do if your neck hurts? For people with this condition, it is best to use special corsets that will help avoid possible displacement of the vertebrae and maintain the correct position of the spine when walking. A good effect can also be achieved by using course massage and physical therapy, which helps strengthen muscles and strengthen ligaments. The patient must properly organize his workplace and choose a good orthopedic mattress for sleeping.
Problems with the position of the vertebrae are a serious pathology that requires professional treatment. Only timely assistance from the attending physician and proper treatment will help prevent surgery and avoid deterioration of the condition and severe pain.
Causes of pathology
Currently, medicine knows of many diseases that can cause a violation of the statics of the spine. Typically, such patients have:
- Congenital pathologies of the spine. In case of inappropriate behavior during pregnancy (alcohol, drugs) or infectious diseases of the mother, abnormal structures of the spine may develop, leading to static disorders.
- Degenerative diseases. With this problem, the intervertebral disc suffers due to incorrect blood supply. Improper nutrition and inhibition of local metabolism lead to rapid aging and destruction of cartilage.
- Operations. In case of serious fractures of the spine, doctors fix bone fragments using special materials. If surgical treatment is performed poorly and the material is not firmly fixed, trauma to the intervertebral discs can naturally occur.
- Osteochondrosis. This degenerative disease of cartilage tissue leads to its depletion. Over time, the vertebrae “sag,” which inevitably leads to crushing of the cartilage, compression of nerve fibers and blood vessels.
- Traumatic lesions of the spinal column. Cartilage can suffer as a result of bruise, fracture, or birth injury.
Nonsteroidal drugs and surgery
At an early stage of the disease, non-steroidal anti-inflammatory drugs are used to eliminate pain symptoms. If they do not bring the desired effect, then they try a novocaine blockade or corticosteroid injections. In addition, it is very important to use additional treatment methods. To eliminate muscle spasms, careful massage of the affected area provides a good effect; special gymnastic exercises are well suited to strengthen ligaments.
Physiotherapeutic treatment is common. They help eliminate severe pain, inflammation in soft tissues, suppress muscle spasms and restore metabolic processes. Good results can be achieved using thermal procedures, laser, magnetic therapy and current pulse. To avoid possible pinching of the nerves and restore staticity of the vertebrae, spinal traction is performed.
For more serious forms of the disease, the specialist prescribes surgery. It is important if the conservative method of treatment does not bring the desired effect and does not help eliminate pain. This is especially dangerous if the patient has pinched nerves and has intervertebral hernias. The operation is also indicated in the presence of vertebral dislocation.
Cervical region
The cervical region consists of 7 vertebrae.
It is the latter that connect the skull to the thoracic region. During the day we turn and tilt our necks hundreds of times. This is the most mobile part of the spinal column, which makes it most vulnerable to static disorders. This part of the spine usually suffers due to prolonged forced postures, for example, tilting the head forward. Please note that when you work at the computer, text on your phone, or read a book, your neck is slightly tilted. At this moment, “weak muscle groups” work. With prolonged static load, of course, they get tired, which entails their relaxation and stretching. To hold our head, our body uses muscle groups that are not working and pulls it in different directions. Because of this, there is a slight displacement of the vertebrae in the horizontal plane. Such changes inevitably lead to compression of the vessels supplying the intervertebral disc, as well as the development of degenerative processes in it.
Currently, spinal instability (M 53.2) is one of the most common spinal problems with which patients seek help in outpatient medical institutions.
Instability of the cervical spine (CS) is the appearance of additional degrees of freedom during flexion or extension, when the muscular-ligamentous apparatus of the cervical-collar zone is not able to provide movement of the seven cervical vertebrae as a whole [9]. The history of studying the phenomenon of instability began in the 30-40s of the 20th century, when researchers began to pay great attention to the issues of osteochondrosis and especially to the violation of the fixation ability of the dystrophically changed spine. The term “instability” was first introduced by A. Ferguson in 1934, but over the years, many authors have defined the essence of this concept differently [20]. The first opinions on the causes of spinal instability were expressed by foreign authors. For example, R. Hirsch in 1948 associated the occurrence of such a pathology with partial or complete rupture of the fibers of the posterior sections of the fibrous ring of the intervertebral disc [27]. A. Farfan considered instability of the intervertebral segments as a result of damage to at least one of the following supporting components: the disc, one or both facet joints.
The second wave of studying this phenomenon, associated with the names of domestic researchers, arose in the 70s of the last century. So, according to L.Ya. Tsivyan, “segmental instability is one of the earliest functional features of disc degeneration, characterized by the appearance of unusual movements forward and backward, and manifested radiographically by displacement of the overlying vertebra anteriorly during flexion and posteriorly during extension” [22].
G.S. Yumashev defined instability as excessive sliding of the vertebrae in the sagittal plane by more than 2 mm relative to each other, accompanied by pain due to the tension of the abundantly innervated joint capsules [26]. The history of the issue of spinal instability is also associated with such names as A.I. Osna, N.I. Khvisyuk, G.V. Pavelescu, I.Yu. Popelyansky et al. [20]. But the subject of interest, as a rule, was the lumbar spine. Only later did researchers pay attention to the instability of the SHOP and its consequences.
Along with studying the pathology of the statokinetic function of the cervical spine, doctors also paid attention to the features of hemodynamics in the vertebral arteries (VA) located in the bone canal of the transverse processes of the cervical vertebrae. And the first to assess the significance of the pathological mobility of the cervical vertebrae, raising the issue of intrapartum damage to the cervical spine, the clinical features of the pathology, and the age range of the most pronounced manifestation of vascular disorders, was A.Yu. Ratner [10, 14].
It is currently known that acute and chronic dislocations of the upper cervical vertebrae lead to acute and chronic trauma to the VA with corresponding disturbances of blood and lymph circulation in the vertebrobasilar system (VBS). Disruption of the statics of the cervical intervertebral segments is accompanied by damage to the caudal parts of the brain stem, the myelobulbar junction and the four upper segments of the spinal cord, which is manifested by autonomic disorders, dysfunction of the circulatory and respiratory systems [8]. Back in the 60s of the last century N.V. Vereshchagin noted that damage to the distal parts of the VA leads to insufficient blood supply to the cerebellum, diencephalic region and brain stem, and its occipital lobes [1]. Many authors assumed that even in the development of Wellenberg-Zakharchenko syndrome, a significant role could be played not only by the pathology of the intracranial part of the VA, but also by the pathology of its extracranial part against the background of degenerative-dystrophic changes in the cervical spine [4]. Symptoms such as transient alternating paralysis, visual and vestibular disorders have been associated with dynamic circulatory disorders in the PA system [11, 25].
In the first decades of the 21st century, the problem of SHOP instability has not lost its relevance. The issue of vascular disorders in the VBS that occurs in patients of working age has again become acute. Not taking into account whiplash and birth injuries to the neck, the prevalence of instability of the spinal cord in the population at the present stage is quite high. Its occurrence in people of working age is associated with the characteristics of modern work activity. Physical inactivity, stereotypical postures when working at a computer or driving a car, poor organization of the workplace, lack of technical breaks - all this leads to abnormal loads on the cervical-collar area. Chronic mechanical impact on the spine with hyperextension puts the greatest load on the CI-CII joint, and with hyperflexion - on the CIV-CV segment. With static loads accompanied by stretching or hyperextension of the spinal cord, hemorrhages into the adventitia of the VA are possible with the development of persistent vasospasm (AS) [1, 11] and the clinical picture of bulbomyeloischemia. Loads with hyperflexion usually lead to damage to the disc ligament apparatus, and subsequently signs of intervertebral instability, compression of the radiculomedullary artery and regional myeloradiculoischemia appear [10]. As a rule, the first clinical harbingers of already developing instability of the spine are headaches. According to A.Yu. Ratner, these headaches are more often localized on one side, they can change their side from attack to attack, their intensity depends on the movement of the head, its prolonged tense-forced position, and intensifies when walking [9]. An example of a clear extravasal influence is MRI and angiography-confirmed attacks of sudden falls due to switching off muscle tone when turning the head sharply - the so-called transient spinal attacks (dropp attaks). In these cases, clinical and instrumental comparison clearly indicates short-term vertebrogenic compression of the vertebral artery with the development of ischemia. In our observations, in some patients with instability of the spine, MRI revealed multiple small foci of vascular origin in the medulla. These patients complained of episodes of loss of consciousness during sudden turns or throwing back the head. Thus, the position or even the degree of duration of stereotypical poses is of key importance. In particular, research by T.A. Khorevoy [21] confirm the important role of head position during sleep in patients with vertebrobasilar insufficiency (VBI), emphasizing the difficulty of venous circulation according to ultrasound data in fast sleeping patients as one of the leading factors. Such headaches often occur at night and persist or worsen in the morning. Often, these cephalgic attacks intensify or provoke autonomic dysfunction of the body in the form of lability of blood pressure (BP), palpitations, hyperhidrosis, chills or, on the contrary, sensations of heat, nausea and vomiting. Before the onset of headache attacks, one of the clinical manifestations of instability of the cervical spine may be “fogginess” of consciousness that occurs when turning the head. Often, patients themselves noted the appearance of asthenia, adynamia, and disturbances in the rhythm of sleep and wakefulness. All this, both domestic and foreign authors, was regarded as dysfunction of the reticular formation of the brainstem, caused by circulatory deficiency in the VLS [4, 11, 15]. If in the 60-70s. In the 20th century, it was possible to assume the vascular genesis of the above-mentioned disorders in patients with cervical spine pathology, based on clinical and radiological research methods, but in the era of ultrasound technology it became possible to clarify their pathogenesis using duplex scanning of the brachiocephalic vessels (BCV) and registration of blood flow velocity indicators in Doppler mode [6]. Further improvement of ultrasound diagnostic methods made it possible to evaluate not only arterial inflow, but also venous outflow, the disruption of which is no less important for the formation of circulatory failure in the VVS [24].
Material and methods
We examined 256 patients who had an outpatient appointment with a neurologist. Of these, 197 (76.9%) were women and 59 (23.1%) were men. The average age of the subjects was 36.8±11.6 years.
The leading complaint was persistent headaches, accompanied by symptoms of vertebrobasilar insufficiency (VBI) (dizziness, tinnitus, hearing loss, incoordination, staggering, etc.) and signs of autonomic dysfunction (nausea, retching, palpitations, instability of arterial blood). pressure, increased sweating, etc.). Often, when questioning patients, attention was drawn to information about morning swelling of the face or eyelids, not associated with taking fluids at night, morning weakness and reduced ability to work. According to the patients, performance increased in the afternoon and was accompanied by a decrease or complete disappearance of the pastiness of the face and eyelids.
The clinical examination included an assessment of the neurological status of the patients (stating the symptoms of the VBN syndrome complex: the presence and nature of nystagmus, accuracy of coordination tests, maintaining balance in the Romberg test, we also assessed the patient’s gait) and the condition of the fundus of the eye (features of the course of arteries and veins, changes in the optic nerve head ).
The main method for diagnosing cervical spine instability was survey spondylography, supplemented by functional tests. In our work, the study was carried out using a digital X-ray machine Axiom Iconos R 200 (Germany). The method did not require special training or additional recommendations. The radiation exposure when performing an X-ray of the spine with functional tests corresponded to 0.384 mSv and did not exceed the permissible radiation exposure for medical research per year (1 mSv) in addition to natural radiation (2 mSv/year).
The method of functional x-ray examination (FRI) is given particular importance in identifying unstable vertebral displacement [13, 17-19, 28]. The technique consists of taking lateral radiographs in the position of maximum flexion and extension. This diagnostic method makes it possible to identify instability of the spine in the form of anterior, posterior or combined listhesis, determine the amplitude of vertebral displacement and establish the position (flexion and/or extension) in which additional degrees of freedom of movement of the vertebrae appear. To assess unstable vertebral displacement I.L. Tager and I.S. Mazo (1979) introduced an additional criterion - the instability index (P), which is the sum or difference in the extent of vertebral displacement, measured in millimeters and obtained when performing FRI in two mutually opposite directions [16]:
Р=L1+L2,
where L1 is the greatest extent of vertebral displacement, L2 is the smallest extent of vertebral displacement.
According to a number of authors, a displacement of the vertebrae by 2 mm in the anteroposterior direction when performing FRI cannot be considered as a reliable sign of instability of the intervertebral segments [13], which one may disagree with when studying the issue of instability of the spinal spine, due to the fact that the above The studies are based on the summation of clinical material on instability of the lumbar spine. Nevertheless, some researchers believe that in relation to the cervical spine, “staircase displacements” of up to 2-3 mm should not be regarded as pathological. In emergency orthopedics, for example, instability of the lower part of the spine is understood as a displacement of the vertebrae relative to each other by more than 3-5 mm with the appearance of anterior or posterior spinal syndrome, and instability of the upper part of the spine (C1-C2) is a displacement of ≥7 mm, which indicates a rupture of the transverse ligaments [2].
In the literature available to us, we were unable to find specific reports on instability of the spinal cord of a non-traumatic nature as a cause of vascular disorders in the VBS and the characteristics of blood flow in the VA. At the same time, a lot of data have been published on dysfunction of blood flow in the VBL against the background of degenerative-dystrophic changes in the cervical spine.
To assess the effect of displacement of the cervical vertebrae on blood flow in the VBS at the extracranial level, we recorded changes in the systolic linear velocity of blood flow (LSVsyst.) in the V2 and V3 segments of the VA using the Angiodin device from BIOSS (Russia) at rest and after performing functional tests with rotation heads. The study of the structure of the BCS was performed using duplex scanning (DS) on an Antaros “Siemens” apparatus, Germany. The study was carried out in the supine position with the chin raised. During the diagnosis, hemodynamically significant obstacles at the extracranial level were identified (hemodynamically significant atherosclerosis of the blood vessels of the central nervous system and/or macroangiopathy), the nature of the course of the VA in the bone canal formed by the openings of the transverse processes of the cervical vertebrae.
Using the DS BCS, blood flow was assessed at the level of the V2 segment of the VA and the probable vertebrogenic effect on the VA was determined by the difference in velocity parameters between the transverse processes of the vertebrae.
In addition to identifying the characteristics of arterial blood flow in the system of carotid and vertebral arteries, we recorded venous blood flow in the vertebral venous plexuses to diagnose paravertebral venous disticulation (VD). The basin of the vertebral veins (plexuses) was examined with the patient lying on his back in the projection of the V2 and V3 segments of the VA. Considering the fact that the outflow of venous blood from the cranial cavity in a horizontal position is carried out through the jugular veins, increased venous blood flow in the vertebral plexuses indicates its difficulty. In our work, “zero” blood flow values were recorded in some patients, which, according to some authors, is quite common in the population and is one of the normal variants [5]. According to the literature, in DS, paravertebral venous discirculation manifests itself, as a rule, by expansion of the vertebral plexuses and acceleration of the linear velocity of blood flow to an average of 50.02±30.88 [5] and even up to 75-80 cm/s. [8] However, at the present stage, researchers have not been able to clearly establish standard blood flow indicators for the venous plexuses.
If indicated, in a number of cases patients underwent magnetic resonance imaging (MRI) of the brain and spine, including in vascular mode.
Patients underwent a detailed comprehensive examination of the cardiovascular (CVS), endocrine system, esophageal system, etc. If causes other than instability of the spinal cord were identified that could affect blood flow in the VBL, patients were excluded from the study.
results
When patients sought medical help in their neurological status, clinical signs of VBI were identified. The majority of those examined were diagnosed with horizontal small-scale unilateral or bilateral nystagmus, unsatisfactory performance of the finger-nose test in the form of missing on one or both sides, instability in the form of deviation of the body to the right and/or left not only in the complicated, but also in the simple Romberg test.
As a rule, nystagmus was stable and was noted in most patients both during the period of exacerbation and after relief of the pain syndrome. The degree of severity of other clinical manifestations (uncertainty when performing coordination tests, instability of body position in the Romberg test) varied depending on the timing of the examination: at the time of a painful attack, its subsidence, against the background of a subjective satisfactory state.
In a number of cases, when examining patients, attention was drawn to the puffiness of the face and the pastiness of the eyelids.
During an ophthalmological examination, all patients had signs of retinal angiopathy, expressed in vasospasm of arterioles and their tortuosity, as well as dilation, tortuosity, tension or atony of venules, which correlated with ultrasound data on paravertebral VD. Signs of congestive optic disc were not noted in any observation.
During the X-ray examination, displacement of the vertebrae only during flexion was detected in 75 patients (29.3%), only during extension - in 95 (37.1%). Signs of instability of the intervertebral segments both in the flexion and extension positions were diagnosed in 86 cases (33.6%).
In a comparative analysis of vertebral displacement, it was found that in the flexion position, unstable retrolisthesis and antelesthesis occurred in an equal number of cases, which corresponded to 79 (30.9%) and 81 (31.6%) observations. In the extension position, unstable retrolisthesis was significantly more common. They were identified in 177 people (69.1%), while unstable antelestheses occurred in only 5 patients (1.9%).
Both in the position of maximum flexion and in the position of maximum extension, the C2-C6 vertebrae were involved in the process of formation of pathological mobility of the intervertebral segments, while the C1 and C7 vertebrae remained stable.
In the flexion position, displacement of the C4 vertebra was detected in 109 patients, which accounted for 42.6% of clinical observations. The amplitude of its displacement reached an average of 2.5±0.6 mm (1-4 mm). Pathological mobility of the C3 and C5 vertebrae occurred in 89 (34.8%) and 55 (21.5%) cases, respectively, and the extent of pathological sliding of the vertebrae during functional loads was 2.5±0.7 mm (1-5 mm) and 2.5±0.6 mm (1-3 mm). Less often, according to the FRI data, displacement of the C2 and C6 vertebrae was noted. Thus, pathological mobility of the C2 vertebra occurred in 41 (16%) cases and reached 2.3±0.6 mm (1-4 mm), and displacement of the C6 vertebra - in 16 (6.25%) and corresponded to 2. 75±0.45 mm (2-3 mm).
In the extension position, displacement of the C3 and C4 vertebrae was most often recorded. The presence of an additional degree of freedom of the C3 vertebra during extension of the spinal spine was established in 120 patients (46.9%), while the displacement reached 2.4±0.6 mm (1-4 mm). Instability of the C4 vertebra was diagnosed in 130 (50.8%), with a displacement of 2.4±0.7 mm (1-4 mm). Instability of the C2 vertebra was noted somewhat less frequently - in 54 patients (21.1%) with a deviation amplitude of 2.2±0.6 mm (1-5 mm), and instability of the C5 vertebra - in 81 (31.6%) with an amplitude 2.5±0.6 mm (1-4 mm). Displacement of the C6 vertebra in the position of maximum extension was found in only 11 people (4.3%) and remained 2.25±0.9 mm (1-3 mm) (Table 1)
.
As a rule, displacements of not one, but several vertebrae were more common. Thus, in the position of maximum flexion, instability of the 1st cervical vertebra was detected only in 49 patients (19.1%). Most often, excessive mobility of 2 or 3 vertebrae was observed. Thus, simultaneous displacement of 2 vertebrae was diagnosed in 54 people (21.1%), 3 - 39 (15.2%). Displacement of 4 vertebrae was quite rare - in 12 patients (4.7%). And only one patient (0.4%) had displacement of 5 vertebrae.
In the maximum extension position, displacement of 1, 2 and even 3 vertebrae was found in equal proportions, which corresponded to 55 (21.5%), 59 (23%) and 54 (21.1%) clinical observations. As with flexion, instability of the 4th and 5th cervical vertebrae during extension is diagnosed in a rare percentage of cases. Thus, simultaneous pathological displacement of 4 vertebrae was recorded according to FRI data in 14 patients (5.5%), and 5 vertebrae - in only one (0.4%) (Table 2)
.
When studying blood flow at the extracranial level in the carotid and vertebral-basilar systems, it was found that speed indicators in the carotid vascular system corresponded to the norm, while LSCsist. in both PAs on average was below standard indicators (Table 3)
.
Features of blood flow in the VBS in the pathology of the cervical spine affect not only the arterial, but also the venous component.
Thus, in terms of arterial blood flow in the VBS, a decrease in LSCsist indicators was revealed in the group of patients as a whole. in both PAs. In 89 patients (34.7%), a vertebrogenic effect on the extracranial part of the VA was noted when turning the head, and in 66 patients (25.8%) asymmetry of the LSCsist was registered. regardless of the diameter of the PA. However, not all patients had non-straightness of the V2 segment of the VA. In most of them, blood flow asymmetry was established with almost equal diameters of the right and left VAs and with their straight course in the canal of the transverse processes of the cervical vertebrae. In 5 (1.95%) observations an increase in LSCsist was recorded. over 50 cm/s according to the AS PA type, and in 17 (6.6%) - a decrease in LSCsist. below 30 cm/s.
Features of venous blood flow in 101 patients (39.45%) consisted of registration of paravertebral VD. The results obtained, as noted above, correlated with the data of an ophthalmological examination, which revealed changes in the fundus veins against the background of VD.
Despite the direction and degree of displacement of the cervical vertebrae, intact blood flow in the VA was recorded in 51 (19.9%) patients. In these subjects, no circulatory pathology was detected either in the arterial or venous segment of the VBS, even with a displacement of the vertebrae of up to 3 mm. In a number of observations, on the contrary, in patients with a displacement of 1-2 mm, there was a simultaneous decrease in the speed of blood flow in the VA, their asymmetry, a vertebrogenic effect on the VA when turning the head, as well as paravertebral VD.
Conclusion
Instability of the spinal cord can serve as an extravasal cause of impaired blood flow in the VBL. It can be assumed that there are stages of development of the morphological process in the walls of the VA, manifested by pathophysiological changes in blood flow in the V2 and V3 segments of the VA and the progression of clinical symptoms, which may be due to an increase in the degree of displacement of the cervical vertebrae. At the initial stages of the formation of additional degrees of freedom of the cervical segments, AS of the extracranial part of the VA occurs due to irritation by the bone structures of the perivascular nerve fibers and is temporary. With the formation of a more significant displacement of the vertebrae during flexion and extension, rotation of the spine, in each individual clinical case, mechanical damage to the walls of the vessels themselves occurs and changes in blood flow become more stable, associated with more gross morphological changes in the vascular tissue of the VA (microhemorrhages were identified using the example of sectional material into the VA wall [3], decreased elasticity of the VA wall, periarterial scar process [12, 23]). Achieving a critical displacement can contribute to a temporary cessation of blood flow and the appearance of a corresponding clinical picture, expressed as a stable neurological deficit, even death.
Despite the significant impact of instability of the spinal cord on the blood flow of the spinal vein and the occurrence of neurological symptoms, not all patients can be diagnosed with dysfunction of the blood supply in the spinal vein. For the occurrence of stable changes in blood flow in the VA and the formation of the corresponding neurological deficit, the diameter of the opening of the transverse process of the cervical vertebra and the diameter of the corresponding VA passing through this opening are of greater importance. Both of these sizes are important both for the irritation of the paravasal nerve plexuses with the formation of AS VA, and for the mechanical impact on the VA itself during displacement of the vertebrae, which explains the instability of neurological symptoms at the initial stages of the formation of cervical spine instability and their acquisition of a stable character with progressive maximum permissible displacement.
The occurrence of instability of the spine can be associated with various reasons (trauma, forced posture of the head and neck, birth trauma), but, as a rule, they are all damaging to the ligamentous apparatus of the spine, which performs a support-limiting function. They can be a “whiplash” injury received in road accidents, an injury during various sports (skiing, speed skating, artistic or rhythmic gymnastics, weightlifting, etc.).
In the 80s of the last century, much attention was paid to birth injuries, during which the cervical spine was damaged [14]. It was noted that a birth injury to the brain immediately manifests itself as severe neurological symptoms, while when reserve blood supply pathways are turned on, cervical injury, even with a temporary cessation of blood flow in the VA, can manifest itself with a detailed clinical picture only when compensatory capabilities are disrupted. Often, behind the minimal local neurological signs of a birth injury suffered by the cervical spine, there may be, at first glance, a seemingly minor injury to the cervical vertebrae. One of the alarming manifestations of birth trauma to the cervical spine, especially in children of middle and high school age, is headaches that occur during mental stress during school and extracurricular activities, static loads on the cervical spine when the child is forced to sit at a desk, and motor stress during physical education lessons. On this occasion, E.I. Aukhadeyev developed strict criteria for selecting such children for physical education with strict medical supervision in order to avoid any complications (quote from A.Yu. Ratner) [14]. Underestimation of the severity of damage does not allow specific treatment to be provided to all pediatric patients, and lack of control over this pathology leads to the appearance of “spinal instability syndrome,” which may be sufficient to cause the occurrence of quite diverse and the most severe neurological syndromes in older patients [14].
It is known that compensatory mechanisms of cerebral blood flow can persist for quite a long time and do not manifest themselves in childhood, and their breakdown is possible in adulthood, when not only physical, but also psycho-emotional stress increases. And then patients of the older age group seek medical help due to increased frequency or new, but persistently progressive headaches, accompanied by signs of VBI. Currently, the cause of this pain syndrome may be the load on the cervical-collar area imposed on patients due to the nature of their work activity. Computerization of workplaces, abnormal static loads with a long stay in a forced position with neck tension, lack of dynamic unloading - all this can lead to aggravation of instability of the spine or lead to its formation in initially healthy individuals. Microtraumatization by chronic loads of the initially healthy ligamentous apparatus of the spinal cord or aggravation of an existing problem creates the risk of vertebral dislocation in response to a fall, injury, sharp turn of the head or torso. In some cases, even a prolonged position of forced flexion or extension in the workplace or at home, an uncomfortable posture of the head and neck during sleep can lead to dislocation of the vertebrae with the appearance of neurological symptoms from persistent headaches to intermittent cerebrovascular accidents caused not only by arterial dysfunction, but also venous blood flow [24].
Therefore, the relevance of this issue, which has somewhat receded into the background over the past 30 years, has again become obvious. It is possible that the occurrence of instability of the cervical spine observed in patients of working age is associated with modern working and living conditions, although it is possible that such conditions only expose a chronic problem originating in childhood: it is important to take into account the birth history (post-term, rapid labor, stimulation of labor, obstetric aid, manual influences (traction)).
conclusions
1. Displacement of a vertebra in the spine by more than 3 mm is not always the cause of changes in blood flow in the VBS; at the same time, displacement of the cervical vertebrae of less than 3 mm is often accompanied by peculiarities of blood flow in the VBS and neurological symptoms.
2. At the beginning of the formation of instability of the spinal cord, complaints and neurological symptoms indicating VBI are transient; When a certain degree of vertebral displacement is reached, neurological symptoms become permanent.
3. In the majority of clinical observations, the formation of instability of the spinal cord leads to disruption of blood flow in the VBL; in a number of observations, in patients with instability in the SC, it is not possible to detect any deviations in blood flow in the VBL.
4. Instability with displacement of the cervical vertebrae up to 2 mm, as a rule, is not accompanied by hemodynamically significant disorders, but requires dynamic monitoring, as it tends to increase displacement and the occurrence of severe vascular disorders in the VVS.
Thoracic region
Violation of the statics of the thoracic spine is usually caused by osteochondrosis, osteophytes or trauma (as a result of a compression fracture). The mechanism of development of the pathology is identical to the processes in the cervical spine and the main symptoms will also be similar.
Pain syndrome that occurs after a long period of rest (sleep, working at the computer). They have a shooting character, often radiating to the shoulder blade, arms, chest, and abdomen. The main difference from the cervical spine is that the pain does not go away with further physical activity, but intensifies.
Lumbar
Lumbar spine
In terms of the frequency of occurrence of static disorders of the spine, problems with the lower back take second place after the neck. Here the pathology arises not only due to age-related degenerative processes. When lifting heavy loads, the main compression load falls on this part of the spinal column. Regular and excessive physical activity of this type leads to trauma to the ligamentous apparatus of the spine. It collapses, and the vertebrae move in relation to the main axis.
If the statics in the lumbar spine are disturbed, the pain syndrome will differ significantly. The pain will be of a shooting nature, localized in the lumbar region. It can spread to the lower limbs and groin area.
This symptom significantly limits the patient’s physical activity. Such people cannot fully straighten up, bend over, or get out of bed on their own.
Possible complications
Problems with the statics of the vertebrae can appear during long-term degenerative-dystrophic processes. It is important to remember that regularly changing the location of the vertebrae can lead to dangerous and irreversible consequences. Violation of statics leads to accelerated degeneration of joints. If the patient has not yet had osteochondrosis, then with regular mobility it will certainly appear sooner or later. At the same time, osteophytes often form on the diseased vertebrae. These are bone growths.
In addition, a vertebra that regularly changes its location often becomes the site where an intervertebral hernia forms. Under increased loads or a sudden change in body position, problems with the statics of the vertebrae can lead to their subluxation or dislocation. This process is especially dangerous for the neck, as it can cause death.