Vertebral syndrome

Vertebral syndrome is a symptom complex of pathological conditions caused by diseases of the spinal column. It can be formed by various pathological conditions, but the common feature is the presence of pain of the lumbago or radiculalgia type, changes in mobility, configuration of the spine, posture and gait, there may be changes caused by damage to the spinal cord, spinal nerves and their roots.

The configuration is determined by three main curvatures. Of these, kyphosis and lordosis can be functional and pathological.

Kyphosis is a curvature of the spine in the sagittal plane with a posterior convexity. Kyphosis can be congenital in the presence of a congenital wedge-shaped vertebra or hemivertebra.

But more often kyphosis is formed with osteochondropathy, spondylitis and spondyloarthrosis, after operations, especially extended laminectomies, trauma, after a specific infection, with senile involution and degeneration of the vertebrae.

Clinically, vertebral syndrome is characterized by a characteristic arcuate or angular curvature of the spine with a posterior convexity. Localization depends on the characteristics of the underlying process, mainly in the thoracic region (upper, middle, lower sections). The entire spine may be affected, for example, with Bechterew's disease, an arcuate deformation is formed from the neck to the coccyx. The degree of severity varies: from a "point" hump, determined by the protrusion of one spinous process, to a "giant" hump with an acute angle of curvature of the spine. In its severe form, vertebral syndrome is combined with chest deformation and a decrease in the height of the torso. It is often combined with scoliosis (kyphoscoliosis).

A distinction is made between non-fixed, mobile kyphosis, i.e. correctable, which develops with osteochondropathy, rickets, spondylitis, some diseases of the spinal cord; and fixed kyphosis, mainly with degenerative processes, Bechterew's disease, etc. According to the rate of development, a distinction is made between rapidly progressing, slowly progressing and non-progressing kyphosis.

Lordosis is a curvature of the spine with a forward convexity. Lordosis is almost never seen as an independent vertebral syndrome, but compensatory lordosis often occurs due to an increase or decrease in physiological lordosis. This occurs because the spine, pelvis and lower limbs are a single support system, any violation in one of these links leads to changes in this entire system to ensure the vertical axis of the body. In adolescents, lordosis is mobile, but by the age of 20-25 it becomes fixed, causing the development of painful pathological conditions (osteochondrosis, spondyloarthrosis and arthritis), causing lumbago. Instrumental examination: radiography in two projections and X-ray cinematography in a standing position, maximum flexion and extension.

Scoliosis is a curvature of the spine in the frontal plane. Vertebral syndrome is a manifestation of many diseases of the back. According to pathogenesis, there are: discogenic, arising from disk dysplasia and its displacement; gravitational, formed with contracture of the back muscles, changes in the position of the pelvis and hip joints; myopathic, developing with failure of the muscles of the trunk, for example, with poliomyelitis, myasthenia, etc.

By the level of curvature, there are upper thoracic, mid-thoracic, thoracolumbar, lumbar, and combined, when there is curvature in two sections. By the shape of the curvature, there are C-shaped and S-shaped scoliosis. By the magnitude of the curvature, there are four degrees: I - from 5 to 10 degrees; II - 11-30 degrees; III - 31-60 degrees; IV - 61-90 degrees.

The vertebral syndrome itself is visible to the eye, the degree is specified by scoliosometry with a plumb line fixed on the spinous process of the 7th cervical vertebra. Instrumental examination is radiological, scoliosometry is also performed on radiographs. Early detection of scoliosis and referral of the patient to a vertebrologist are important.

Lumbodynia is a vertebral syndrome in the lumbar region that occurs with sudden or careless movements in it. The patient's movements become cautious, since a shooting pain occurs at any moment, especially when standing up - the position of "Lazarus rising from the grave" - with support, listening to the sensations. Lumbodynia is the main symptom of lumbar pathology, most often caused by osteochondrosis, spondylosis, spondylitis and spondyloarthrosis, often combined with radiculitis and sciatica.

Spina bifida is a spinal malformation characterized by non-fusion of the vertebral bodies or arches and incomplete closure of the spinal canal. Vertebral syndrome is most often observed in the form of a hidden cleft (without herniation, protrusion of the brain), or there may be a spinal hernia, which is detected with the birth of the child. It can be localized in any section, but in most cases it is located in the lumbar region.

Hidden clefts are often asymptomatic. The skin over the cleft area may not be changed, but hypertrichosis with excessive hair growth on unchanged or pigmented skin is more often observed.

Vertebral syndrome can be observed in the form of radiculitis, paresthesia of the lower extremities, nocturnal enuresis, imperative urge to urinate, sexual disorders, decreased perineal and cremasteric reflexes. This vertebral syndrome is combined with foot deformities in the form of clubfoot and flatfoot.

The diagnosis is confirmed by X-ray.

Schmorl's hernias are hernia-like protrusions of the nucleus pulposus of the intervertebral disc.

Rupture of the hyaline cartilage plate with subsequent protrusion can occur with curvatures, vertebral fractures, bruises, ruptures of the intervertebral fibrous rings, as well as with degenerative diseases.

This vertebral syndrome can develop even in adolescence, but is more common after 25-30 years.

The protrusion can occur in the spongy substance of the vertebral bodies, but more often they bulge into the spinal canal, with the development of myelopathy and radiculitis. Schmorl's nodes are localized mainly in the lower cervical and lower lumbar regions, very rarely, but can be in the thoracic region. There are no specific symptoms of the disease, except that the pain is more pronounced than with osteochondrosis, accompanied by shooting pains in the arm or leg, more widespread, when checking the motor function of the spine, circular movements in it are usually not impaired, but with severe discosis, flexion and extension movements can cause jamming. The diagnosis is based on X-ray examination or magnetic resonance imaging.