X-ray diagnosis of osteochondrosis

In recent years, the role of X-ray examination in spinal osteochondrosis has increased significantly. It is undertaken primarily to determine the possibilities of the secondary impact of changes in the spinal segment on the spinal cord, roots and vessels, as well as to exclude primary bone changes and lesions of various etiologies (developmental anomalies, tumors, etc.) At the same time, quite often when analyzing radiological data, certain difficulties arise in their correct interpretation, in a specific correlation of the nature and level of radiological findings and clinical manifestations. The basis of this are mainly two reasons. First, changes in the bone-ligament apparatus of the PDS of the spine, resulting from degeneration of the intervertebral disc, often become available to X-ray control after the onset of clinical signs. Secondly, degenerative-dystrophic changes of the spine clearly defined on radiographs are not always accompanied by relevant clinical pathology or occur with minimal clinical manifestations. In this regard, the X-ray signs of osteochondrosis, which are responsible for certain neurological or vascular disorders, are of crucial importance.

In the analysis of radiographs in the first place should take into account the place of the greatest manifestations of osteochondrosis in the PDS. For example, if the radiological signs of osteochondrosis are determined only by the anterior or anterolateral surfaces of the vertebral bodies, the effects on the nerve structures are not expected. In contrast, if there are changes in the posterior and posterior lateral parts of the spine, clinical symptoms may occur.

In the thoracic spine, due to the presence of physiological kyphosis and the associated distribution of power stresses, the formation of osteophytes usually occurs in the anterolateral spine, and does not give pain.

The pronounced lordosis in the cervical and lumbar spine with a predominant load on the posterior intervertebral discs leads to more frequent protrusions of the latter in the posterior and posterior-lateral directions with the subsequent formation of the posterior and posterolateral hernia and osteophytes, which often cause one or another clinical symptoms.

It should be noted that on radiographs of the cervical spine, the base of the skull and the first two thoracic vertebrae must be seen. In the area of C ₇ -Th, clinical importance is often the identification of cervical ribs and hypertrophied transverse processes of the vertebral bodies.

On radiographs of the lumbar spine, the region of the sacrum, the ileosacral joints, and the wings of the iliac bones should be captured.

The course and direction of radiological examination of the patient depend on the clinical picture. It is only necessary to emphasize the importance of performing, in some cases, radiographs in the position of the patient standing and sitting, which makes it possible to conduct a study under physiological stress.

On the lateral radiograph, the following symptoms are detected.

Narrowing of the intervertebral gap between the vertebrae, indicating a decrease in the height of the intervertebral disk as a result of disintegration, resorption or extrusion of its degenerated mass to the outside.

ATTENTION! The pronounced narrowing of the intervertebral fissure is already a late symptom of osteochondrosis.

The clinical significance of reducing the height of the intervertebral fissure, even without the presence of posterolateral hernias or osteophytes, may be due to the displacement of the articular articular processes of the PDS in such a way that the processes of the underlying vertebra are pressed into the intervertebral foramen, which are narrowed in both craniocaudal and oblique sizes. It is also possible a slight displacement of the adjacent vertebral bodies relative to each other. Often this is accompanied by the development of degenerative-dystrophic changes in small joints - spondyloarthrosis and reactive changes in the yellow ligament with a secondary effect on the spinal cord.

• In severe cases of osteochondrosis, sclerosis of subchondral bone tissue occurs, detected on radiographs in the form of marginal sclerosis of the vertebral bodies. This radiological symptom of osteochondrosis has no independent clinical significance and can only be an indication of the presence of a degenerative-dystrophic process.
• Cartilaginous hernias of vertebral bodies (Schmorl's hernia) have no clinical significance either. They often develop in the process of aging in the thoracic and lumbar spine and are rarely observed in the cervical region.
• Identifying posterior or posterior lateral osteophytes is often of clinical importance, often causing compression of the spinal cord or roots, especially at the cervical level, where due to the relative narrowness of the spinal canal and intervertebral holes, conditions are such that even a small osteophyte or dorsal disc bulging can affect the spinal cord. Brain or roots. It is clearly established that in the cervical spine the cause of compression is often not herniation of the intervertebral disk, namely, the posterior and posterior-lateral osteophytes. At the lumbar level, horsetail tail roots are more often compressed due to posterior protrusion or disc prolapse. It is known that the spinal canal is wider here than in the cervical spine, and under the influence of large loads, the degenerated intervertebral disk apparently has a greater ability to prolapse posteriorly.
• Anterior osteophytes are also detected, and the reaction of the anterior longitudinal ligament in the form of its calcification is also visible.

On face radiographs:

1. thoracic and lumbar spine can be determined and osteophytes on the lateral surfaces of the vertebral bodies, often multiple. The clinical significance of the former is minimal and only indicates the presence of a degenerative process at this level. The ratio of lateral osteophytes to the anterior parts of the vertebral body dramatically reduces their clinical significance (N.S. Kosinskaya);
2. of the cervical spine, the phenomena of uncovertebral arthrosis, which is one of the earliest signs of osteochondrosis, are often detected, often determined in the initial stages, when only a functional X-ray examination confirms the presence of changes in the intervertebral discs. This is due to the increased load on them in the area of the joints of Lyushka. Radiologically defined manifestations of uncovertebral arthrosis often also affect the vertebral artery and the vertebral nerve.

• Determining the displacement of the vertebral bodies, which can have an impact on the spinal cord and roots, even in the absence of posterolateral osteophytes or hernias, is of particular clinical importance. It should also be remembered that vertebral displacements in the lumbar region can occur in the absence of osteochondrosis with abnormal development of the vertebrae, changes in statics, etc. Moreover, spinal osteochondrosis can often develop a second time.
• Smoothness of lordosis in the cervical and lumbar spine in middle and old age, especially straightening it at the level of individual segments, is an early symptom of osteochondrosis.
• Angular kyphosis of the cervical or lumbar spine in the physiological position of the patient is always an indication of the presence of pathology of the intervertebral disc.
• Arthrosis of the small joints of the spine (spondylarthrosis) is most often found on the same level as the degenerative-dystrophic changes in the intervertebral discs. At the same time, the coincidence of the degree of lesion of intervertebral joints and discs is not observed (I.L. Tager); sometimes with severe osteochondrosis, the phenomena of spondyloarthrosis are small, often absent,
  and vice versa.

Spondyloarthrosis is characterized by changes in the form of newly formed osteophytes, narrowing of the joint space, an increase in its length, the presence of sclerosis of the subchondral bone. Neoarthrosis is often formed with the base of the arches, Pommer's nodules in the form of small defects in the endplate with clear contours and sclerotic reaction around.

The clinical significance of spondyloarthrosis is that it almost always causes reactive changes in the yellow ligament, narrowing of the spinal canal with effects on the spinal cord. Changes in the articular processes of the vertebrae also determine a decrease in the anteroposterior size of the intervertebral foramina, with an effect on the nerve roots; they can be directly affected by osteophytes formed during spondyloarthrosis. The influence of the latter on the vertebral arteries is also possible.

• The intervertebral foramen in osteochondrosis can be narrowed due to the convergence of the vertebral bodies, posterolateral osteophytes, osteophytes in uncovertebral arthrosis in the cervical and spondyloarthrosis. In the lumbar spine, the intervertebral foramen often narrows the posterior lateral hernia of the disk. The narrowing of the intervertebral foramen in the cervical spine directly of the herniated disc is a rare phenomenon, since the ligament of the uncovertebral joints impedes its progress.

Typical features in the X-ray picture of deforming spondylosis are as follows:

1. Systemic damage - osteophytes develop on several vertebrae (can also be detected on radiographs). Large osteophytes, developing only in one vertebra, testify against the purely degenerative and static-degenerative origin of the deformity and are more common in posttraumatic spondylosis.
2. Disorder and unevenness of defeat. When deforming spondylosis, osteophytes on different vertebrae have different sizes.
3. The defeat of both (caudal and cranial) halves of the vertebrae. Osteophytes are developing both toward the cranial and toward the caudal disc. This feature is often detected on radiographs only in both (direct and lateral) projections.
4. The soldering of the vertebrae in deforming spondylosis develops as a result of the fusion of osteophytes. This merging is unbalanced and not necessarily at the disk level. Often, two “beaks” growing towards each other form a kind of joint (osteophytes nonarthrosis), on which secondary osteophytes develop in turn.
5. Disks (intervertebral cracks) with “pure” forms of deforming spondylosis without combination with osteochondrosis are not narrowed. On the contrary, the projection intervertebral slits seem even somewhat widened and have a clearly pronounced appearance of biconvex lenses. This is explained by the fact that the vertebral bodies are enlarged in diameter and elongated in the area of X-ray "corners" due to bone growths.
6. The bodies of the vertebrae in deforming spondylosis are usually not porotic. The absence of osteoporosis is due in part to the fact that the spine is, as it were, enclosed in a “sheath” of ossification, and also because the function of the spine remains unchanged until the development of osteophytes.

The variants of the structure of the spine should first of all be attributed to quantitative deviations. However, the total number of vertebrae in humans varies only slightly, and mainly in the area of the sacrum and tailbone. The most susceptible to such variations are the so-called transitional divisions: cranial-cervical, cervico-thoracic, sternum-lumbar, and lumbosacral.

At the same time, such changes in shape occur (mainly the arches and their processes), which give the last cervical vertebra the shape of the thoracic (development of the cervical ribs). Similarly, the last thoracic vertebra can have only rudimentally developed ribs, not much different from the transverse processes of the 1st lumbar vertebra, or the 1st lumbar vertebra may have a rib rudiment. In the transitional lumbosacral region, a partial or complete transformation of the last vertebra by the type of the sacral or the 1st sacral by the type of the lumbar can be observed. The terms used for such options are dorsalization, sacralization and lumbarization.

Neck ribs It is known that almost 7% of all people have certain variants of the type of neck ribs, usually in the VII cervical vertebra, and more often bilateral, than unilateral. Observed, although quite rarely, the development of cervical ribs in several cervical vertebrae.

Lumbosacral. Of all the spine, the transitional lumbosacral is undoubtedly the most variable. Variations are observed here in relation to the number of vertebrae (instead of the normal number 5, 4 and 6 can be observed), the shape of the transverse processes, mainly in the lumbar vertebra, in the posterior section of the vertebral arches (openings and variants of the L ₅ and sacral vertebrae fusion ) and finally in relation to the articular processes of the lumbar vertebrae and the 1st sacral.

However, it should be emphasized that the analysis of anomalies and variants of the spine on radiographs should be complex. It is impossible, for example, to identify the cleft of the bow of the 1st sacral vertebra, not to pay any attention to the state of the bodies of the lumbar vertebrae, discs and processes of the arches, firstly, because the variants of the arches are often accompanied by variants of the processes; secondly, because along with the bow variant, changes such as osteochondrosis, arthrosis of the intervertebral joints, etc. Can be detected. Experience shows that identifying easily detectable, but insignificant variants leads to viewing other difficult to detect, but clinically more important acquired changes.

In severe, recurrent, resistant to conventional treatment, ishalgia, in which x-ray indicates sacralization, spina bifida, spondylolisthesis, osteophytes, or rheumatic type changes, one should not conclude that they are the cause of ischalgia. Intra-spongy disc hernias indicate the possibility of a general disease of the intervertebral discs.

Of all these combined symptoms, some are random, while others can only emphasize congenital anomalies, thereby indicating the place of least resistance of the lumbar spine segment.

A number of authors (Laskasas, Pizon, Yungans) turned their attention to the angle drawn up by the vertebra L4, and accordingly the L5 with the sacral bone.

Sacro-vertebral angle does not exceed 118 °. The Yungans angle, determined by the median axis of the vertebral bodies L5-S1, is 143 ° open, and the vertebral sacral disc is 20 ° open.

Cranial-neck border. In the transitional cranial-cervical region, there are several types of anomalies and variants, among them: a) the assimilation of Atlanta, and b) the "manifestation" of Atlanta.

During assimilation, the I cervical vertebra merges with the occipital bone in the region of both or one lateral mass. Atlanta arc soldering may also occur with partially free lateral masses. Along with assimilation, peaking in the posterior arc of the atlanta and very rarely in the anterior (VADyachenko) are quite common. The opposite state - “manifestation of the atlas”, i.e. The appearance of unusual protrusions along the edges of the occipital foramen, resembling a rudimentary atlas. This option has no practical significance.

Anomalies and variants of the articular processes of the spine are reduced mainly to the following points.

• The alternative position of the articular facet with respect to the sagittal plane of the body is what Putti called the “tropism anomaly” of the articular facets. For example, normally the articular facets of the lumbar vertebrae stand in a plane close to the sagittal one; in the case of the “Tropism anomaly” we find that the facets are on one or both sides in a more frontal plane. Inverse relationships are observed in the joints between L5 and S1, where the facets are normally located in the frontal plane.

Under the "tropism" understand the morphological version of the lumbar spine, in which the plane of the intervertebral articulation on the right is asymmetric with respect to the plane of the intervertebral articulation on the left /

The phenomena of tropism are most often observed in the lumbosacral spine. Imperfectly constructed intervertebral joints with additional trauma or static overload of the spine can serve as a place for the development of deforming arthrosis and cause pain in the lumbar spine.

• Rotate the long axis of the facet in relation to the longitudinal axis of the body.
• Anomaly of the size of the articular process or only the articular facet.
• Sphenoid joint.
• Transverse slit, dividing the process on the base and apex (additional core of ossification).
• Lack of articular processes.
• Spontaneous.
• Hypoplastic joints of the transitional vertebra with the sacrum. It should also be noted that all the described isolated anomalies and variants of the articular processes of cx relate mainly to the lumbar spine.

Sacrococcygeal transitional boundary

The sacrum usually consists of 5 vertebrae that enclose four pairs of sacral holes. At the lower end of the sacrum there are peculiar bays, which, with appropriate fit of the 1st coccygeal vertebra, form a fifth pair of holes; thus, the sacrum includes another vertebra.

For the most part I and II, the coccygeal vertebrae are connected by a joint, and the I coccygeal and the last sacral can be connected osteally. On radiographs, it is often possible to identify a bone union between the last sacral and 1 coccygeal vertebra.

X-ray studies have allowed to distinguish the following morphological forms of the coccyx (IL Tager): a) perfect; b) unilaterally assimilated; c) bilaterally assimilated. 

Clinical Classification of Lumbar Vertebrae Offsets

Offset type	Stability of the spinal segment	Compression neurological syndrome	Medical tactic
BUT	Stable offset	Missing or Moderate	Conservative treatment
AT	Stable offset	Expressed	Decompression of the spinal canal
WITH	Unstable offset	Missing or Moderate	Stabilization
D	Unstable offset	Expressed	Decompression and stabilization

The perfect shape of the coccyx is characterized primarily by the presence of a detached 1st coccygeal vertebra with horns and transverse processes and isolated, decreasing in size of the remaining vertebrae. In this case, the last vertebrae can be deformed and merged with each other.

Unilateral assimilation - when the 1st coccyx vertebra on one side only takes on the shape of the sacral vertebra, it is soldered to the sacrum with only one side to form the fifth sacral opening on the side of soldering. There is a varying degree of fusion: either complete bone marrowing with complete bone closure of the sacral orifice and the design of the lateral parts of the coccygeal vertebra according to the lower edge of the sacrum, or the lateral parts of the coccygeal vertebra lie adjacent to the lateral part of the sacrum, but are separated by a few millimeters gap, a linear gap or even after the gap.

With bilateral assimilation, the 1st coccygeal vertebra completely enters the sacrum, forming the fifth pair of sacral openings. The tailbone consists of one or two vertebrae in the form of oval fragments. In these cases, different degrees of assimilation are also noted: along with complete bone merging, there are forms of the coccyx with not quite welded side parts of the 1st coccygeal vertebra with the sacrum, separated by a narrow slit or even its trace.

[1], [2], [3], [4]

Vertebral displacement

Clinically, radiologically and experimentally, spondylolisthesis was studied by GI Turner (1926). It is known that a vertebral displacement cannot occur without disturbing its fixation in the intervertebral disk. In essence, each case of displacement should be considered as “discolouration” of the disc, and spondylolisthesis - as “intervertebral disc disease”. There are three degrees of spondylolisthesis:

• 1st degree - the displaced vertebra slid anteriorly moderately, partially exposing the surface of the 1st sacral vertebra;
• Grade 2 - significant exposure of the upper surface of the sacrum, V vertebra strongly inclined anteriorly;
• 3rd degree - the entire upper facet of the sacrum is exposed;
• 4th degree - the vertebra is shifted to the small pelvis.

Since the first studies on spondylolisthesis appeared, there have been numerous attempts to systematize it. The most widespread classification Meyerding (1932), which distinguished 4 degrees of displacement of the vertebrae on the basis of spondylography. The displacement to the j-part of the vertebra corresponded to the I degree, from j to S - II degrees, from S to s - III degrees and from s and further - IV degrees. Junge and Kuhl (1956) proposed to add a V degree to Meierding’s classification - complete displacement of the vertebra relative to the underlying one. Newman, Wiltse, Macnab (1976) proposed a classification based on the etiopathogenetic factor (dysplastic spondylolysis degenerative traumatic pathological spondylolisthesis).

The proposed V.V. Dotsenko et al. (2002) The clinical classification of spondylolysis can serve as an adjunct to existing radiologic and etiopathogenetic.

Stable offset:

• lumbodynia is absent or not constant;
• patient activity is slightly reduced or normal;
• no need to take analgesics;
• the patient does not need external immobilization;
• there are no radiological signs of instability.

Unstable offset:

• lumbodynia constant;
• patient activity is reduced;
• severe drug dependence;
• the need for external immobilization;
• radiological signs of instability.

Compression neurological syndrome (moderate):

• intermittent radicular syndrome susceptible to conservative treatment;
• there are no signs of "loss" of the root function;
• patient activity is normal or slightly reduced.

Compression neurological syndrome (pronounced):

• persistent radiculopathy at the level of a displaced vertebra, not amenable to conservative treatment;
• increase in the syndrome of "loss" of the function of the roots or roots;
• patient activity is reduced.

Spondylolysis is a gap in the vertebral arch between the articular processes, and not the place where the arch connects with the vertebral body, as some authors mistakenly interpret it (there is normally a cartilaginous layer between the vertebral bodies and up to 8 years old). Spondylolysis gaps are located, as VADyachenko's observations show, right now under the articular facet of the superior articular process and most often have a transverse oblique direction - from the inside and from above, outwards and downwards. In other cases, the gap transversely crosses the arch, under the base of the superior articular process and its facet. The surface of the cracks have an almond, triangular shape; they are smooth, without spikes, the surfaces of the gaps are usually symmetrical, two-sided.

Spondylolysis in most cases is found only in one vertebra, rarely in two and is detected in radiological practice in patients after the age of 20-30 years.

Spondylolisthesis in combination with spondylolysis occurs in men 5-6 times more often than in women and is usually detected after the age of 30 years.

With pronounced degrees of bias, a diagnosis of grade I spondylolisthesis is made on the basis of a clinical examination: the body is shortened in the lumbar region, the ribs are close to the iliac crests, and the spinous process of the V lumbar vertebra is palpated above which the deep cavity is determined. At the same time, the sacrum maintains a vertical position. The transverse folds of the skin (especially in women) hang on the abdomen and in the lumbar region. The tension of the long muscles is determined. In the presence of an enlarged lumbar lordosis, the body is somewhat deflected backwards. According to V.D. Chaklin, the most severe forms of spondylolisthesis are also accompanied by scoliosis.

In severe cases of spondylolisthesis, a clinical examination can often determine the shortening of the waist with the presence of transverse folds in the lumbar region above the crests of the iliac bones. This shortening is formed not so much due to the displacement of the vertebra, as due to the straightening of the pelvis, approaching the crests of the iliac bones to the lower ribs.

Often, spondylolisthesis reveals a decrease in spinal mobility in the lower lumbar region, which is explained both by loss of the movable spinal segment due to a lesion of the intervertebral disc and contracture of the muscles of the lumbar region.

On the neurological side, patient complaints are reduced to pain in the lumbar region, manifested in the form of lumbar radiculitis (lumbago) or lumbar ischalgia. Pain sometimes occurs suddenly after an overload or sudden movements.

Pseudospondylolisthesis is observed in the vast majority of cases in elderly obese women and much less frequently in men (10: 1). The displacement of the vertebra is moderate. As a rule, the IV lumbar vertebra is displaced by V. At clinical examination, sharp hyperlordosis and muscle tension in the lower back are striking.

ATTENTION! On the basis of clinical data alone, without X-ray examination, the diagnosis of this type of spondylolisthesis is almost impossible, as, however, it is impossible with mild degrees of spondylolisthesis.

Currently distinguished:

• fixed (functional) spondylolisthesis, i.e. Such an anterior vertebra displacement, which is “fixed” by the presence of a spondylolysis gap in combination with osteochondrosis or, in the absence of spondylolysis, by lengthening of the articular part of the arch in combination with osteochondrosis;
• fixed or non-fixed spondylolisthesis, representing spinal osteochondrosis in combination with local deforming arthrosis of the articular pair corresponding to this disc;
• functional displacement due to the presence of osteochondrosis, but without noticeable radiological deformation of the bow and its joints.

Displacement of the posterior vertebrae is known by various names - retrospondilolisthesis, retroposition. The cause of posterior vertebral displacement, most experts believe degenerative lesion of the disc. Traumatic and inflammatory etiology of displacement is not excluded.

In the mechanism of rear displacements Brocher, the main role is assigned to a significant backstage on the side of the yellow ligaments and the powerful extensor of the back, which are antagonists of the anterior longitudinal ligament.

At clinical examination, there are no objective signs that would reveal the posterior displacement of the vertebrae. Only X-ray examination makes it possible to finally establish the diagnosis. The photographs in the rear projection do not reveal the details of such displacements; lateral photographs are absolutely essential for this, where at the displacement level, a lateral violation of the line through the dorsal contours of the vertebrae is determined.

In contrast to the “pseudo-correspondence lysthesis,” arthrosis in the joints of the handles during posterior displacement is not detected. Displacement of the posterior vertebrae is a severe form of pathological displacement and gives the highest percentage of disability.

The posterior displacements are located more often in the zone II-III of the lumbar vertebrae. Functional radiography provides invaluable assistance, making it possible to objectively document not only the presence of posterior displacement, but also the degree of “looseness” in the corresponding spinal PD.

Consequently, as with anterior displacements, posterior displacements can occur at any level of the lumbar spine, but the relationship between the static of the spine and the level of posterior displacements is opposite to those of “pseudospondilolisthesis”. Thus, with hyperlordosis, the lower vertebrae are displaced forward, and the posterior lumbar vertebrae; with hypolordosis, the ratios are inverse. This allows us to conclude that the level of displacement of the vertebrae and the direction of displacement (forward or backward) depend entirely on the characteristics of the statics of the thoracolumbar spine.

The study of radiographs shows that posterior vertebrae are displaced in the transitional zone of kypolordosis: it is here that the rear sections of the discs are the point of greatest vertical load, in which, due to prolonged compression, degenerative changes occur (osteochondrosis). But since in the transitional zone, the discs and the vertebrae are arranged in such a way that their ventral divisions are higher than the dorsal, then naturally, the vertebrae slide at this level can occur only posteriorly. This applies to both cases of hyperlordosis and cases of hypolordosis.

From the point of view of the sliding mechanism, it should also be noted that the articular processes, due to their location at a certain posterior angle, cannot resist the posterior displacement of the vertebra, which is also enhanced by the constant thrust experienced by the vertebra from the yellow ligaments during extensor movements.

When assessing the presence of rear bias, the possibility of so-called false retroposition should be taken into account. In such cases, we are talking about increasing the anteroposterior size of the vertebra relative to the underlying one. Such an increase can be observed in turn as a true (for example, after consolidation of a compression fracture, with Paget's disease, hemangioma, etc.) or a false one, due to marginal posterior osteophytes.

ATTENTION! False retropositions can cause a pronounced neurological syndrome, since they are always accompanied by degenerative changes in the disc.

Clinical and radiological observations allow to distinguish two more groups of vertebral displacements: ladder and combined displacements.

With ladder spondylolisthesis, two (possibly more) vertebrae are simultaneously displaced in one direction — forward or backward.

Combined displacements are characterized by simultaneous displacement of two vertebrae in opposite directions.

The diagnosis of osteochondrosis is made on the basis of the presence of several radiological signs listed above. In the clinic for a comprehensive assessment of the detected radiological changes, it is advisable to use the following criteria.

Criteria reflecting impaired depreciation function of the disc: narrowing of the intervertebral fissure, sealing of the vertebral body plates, presence of anterior or posterior growths (osteophytes), obliquity of the vertebral bodies in the region of the anterior marginal border, calcification of the fibrous ring, development of arthrosis and neoarthrosis. For the cervical spine, a very pathognomonic sign of osteochondrosis is the change of the hooked processes, their deformity, the formation of uncovertebral arthrosis.

Criteria reflecting a violation of the motor function of the vertebral segment, which are most clearly identified and refined with functional tests: pathological mobility or immobility ("block") of one or more segments. Signs of fixation on radiographs are straightening of physiological curvatures or local angular kyphosis, lordosis, scoliosis, displacement of the spinous processes, and in far-gone cases - convergence of the transverse processes of the vertebral bodies, local “block” (a symptom of the “strut”), as well as sections of the triangular disc Forms facing the tip of the intervertebral gap. Often there are signs of immobility in combination with signs of hypermobility in the PDS (pseudospondylolisthesis, subluxation according to Kovacs, etc.).

To assess the stages and severity of osteochondrosis, Zecker’s classification can be recommended:

• 1st stage - minor changes of lordosis in one or several segments;
• Stage 2 - moderate changes: straightening of lordosis, slight thickening of the disc, moderately pronounced anterior and posterior exostoses, or deformity of the hooked processes in the cervical spine;
• Stage 3 - pronounced changes, i.e. The same, but with a significant narrowing of the intervertebral foramen;
• Stage 4 - significantly pronounced osteochondrosis with narrowing of the intervertebral foramen and the spinal canal, massive exostoses, directed posteriorly - towards the spinal canal.

ATTENTION! Not always clinical symptoms may be due to radiographically detected bone changes in the PDS of the spine.

In clinical practice, radiologists, neurologists, orthopedic traumatologists, rheumatologists and other specialists working with this category of patients, there are often inconsistencies of x-ray symptoms of spinal lesions with the severity of clinical manifestations.