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Naturally, the source of irritation can be not only tissues of the
vertebral column.
The
prevalence of reflexive muscle-tonic and neuro-dystrophic disturbances in
the greater pectoralis muscle can be often a cause of pseudo-cardiac
syndrome of the front side of the thorax; the prevalence of muscle-tonic
reaction in the minor side of the thorax - is a cause of the compression
of the brachial plexus and axial artery, i.e. so-called "Saturday"
paralysis or "police" paralysis of the muscles of the hand.
Dorsalgia.
Dorsalgia as well as pectalgia very often occurs as a
consequence of dystrophic changes in the thorax part of the vertebral
column.
However, due to the fixed state of this part, usually not
osteochondrosis and joints have a clinical meaning, but heads and
prominences of the rib, that is their arthroso- periarthrosis.
Palpation always allows to define lesioned level. The
secondary neuropathy of the intercostal nerve - that is a rare find.
Lumbalgia.
Lumbalgia - acuta (lumbago), subacuta, chronica. The
mechanism of the origin is considered above in the case of "cervicalgia".
Since kyphosation provides decompressive increase of
sagittal diameter of the vertebral canal, during lumbalgia such a pose is
formed. Not rarely there appears scoliosis.
It is formed by local muscles of vertebral segment - m. m.
intertrasversarii, rotatores.
The tension of paravertebral muccles, especially m. m.
multifidus is clearly defined by sight and by palpation.
When standing they are relaxed (the lardotic pose is
achieved by the gravitation and not by the activity of the muscles).
When bending forward a little they are tensed. During the
lumbar osteochondrosis these muscles are already tensed in the state of
relaxation and do not relax when beading forward for a long time or when
standing on one leg ("sign of ipsilateral strain") or other movement of
the leg.
If reflexive miofixation of lesioned vertebral segment is
sufficient a movement in the hip joint (sign of Lassegue) a disc is not
traumatized and pain in the lumbar does not appear.
As it was mentioned above, all vertebrogene syndromes are
divided according to the topical principle schematically into vertebral,
ventrales (cervico-, dorso-, and himbalgia; here is possible to classify
and coccygodynia) and extravertebrales.
Thus, for example, extravertebral syndromes m. scalenes are
not only extravertebrales, but vertebrates as well, since these muscles
are joined by one of the tags to the vertebral columns.
That can be applied to the syndrome of the pear-shaped
muscle as well.
Among pelviomembrale syndromes there are the following most
often met syndromes:
Syndromes of pelviale bottom.
It is constituted of muscles (levator ani, coccygeus,
gemelli, piriformis) and chords (first of all, sacrotuberale,
sacrospinale).
Reflexive strain of these muscles and reflexive dystrophic
disturbances of connective tissue structures of chords and muscles - that
is a source of pain and deformations in this field.
In its turn, the shortening of m. piriformis and dystrophy
of bottom chords causes compression neuropathy of n. pudendus.
So called, coccygodynia is more often caused not by a trauma
of the osteale, but by muscular-tonic and neurodystrophic disturbances.
Summation of impulses from pathologic organs exhibited by
pains and tenderness. Spina ischiadica is painful in 100%.
There are marked neuravasculare disturbances in the region
of perineum and by signs of abaissement from the part of n. pudendus.
Piriformis syndrome.
That is a reflexive syndrome of this muscle.
Clinical exhibitions are pains and tenderness in the region
of buttock, restriction of movements in articulatio coxal.
Secondary compression exhibitions are caused by an influence
of the shortened muscle on an. ischiadicus, pudendus et and on glutea
inferion.
Subpiriforme syndrome claudication
intermittenc.
We have chosen this variant, as being different from
endarteriitis, or myelo-caudogenic claudicatio intermittens.
It is provoked by an irritation of vasomotors under thicenet
and platenet m. piriformis.
The spasm occurs not in the greater vessels of the leg, but,
as it has been confirmed by the result of investigations, in smaller
vessels.
Blood filling of vessels of legs is lessened
paroxysmatically. After a short break pains disappear.
Obturator syndrome.
Obturator syndrome is connected with reflexive vertebrogenic
and dystrophy of m. obturator internus.
Buttock and perineum pains increase during phenomena
of statis in the pelvis in the state of relaxation and disappear during
walking.
Deep palpation discovers tenderness of muscles and of locus
of its attaching.
We appeal to the trochanter mayor a little later after
tendon of m. piriformis.
Night bicepsodynia (bicepsodynia
nocturna).
Night pains in ischio-crural muscles in the state of stasis
in the smaller pelvis and dystrophy of lig. sacrotuberale.
Its continuation in the zone of tuber ischii is the tendon
of bicepitis femori.
Pains and tenderness of this muscle is different too, it
increases when it is stretching and in the state of relaxation at night in
the state of stasis in the smaller pelvis.
Hamstring syndrome.
Pain and tenderness in the loci of attaching to
the ischiocrurale muscles to crurum and in the loci of attaching to the
tendons of m. gastrocnemius in the hamstring zone.
Characteristic zone of "reflections" of sclerotomic pain
during the lesion of ileosacrale chords.
Often the syndrome occurs myoadaption lesion of hamstring
structures along with overstretching of ischiocrurale muscles when lifting
the back sections of the pelvis during lumbar hyperlordosis.
Pathologic impulsation from lumbale part of the column
increase reflexively strain and dystrophy of stretched muscles.
Stenosolia.
We
call stenosolia pressing (compressing, squeezing) pains in the region of
m. soleus - analogously to the stenocardia.
This
the only red muscle of a man, when the patient's disease is lumbar
osteochondrosis, displays itself very characteristic.
They
are compressive crampiformice pains however with a very unpleasant
emotional "burning" shade and a stony platening of the muscle.
Paroxysm is easily provoked by the stimulating of Lassegue, at that
the pain is sensed in the region of gluteus media and in the lumbar.
Combinations and consequences of development of neurological
syndromes varies from case to case.
All
enumerated here and many others include neuravasculare and other
vegetative components.
Isolated or prevalent neuravasculare syndromes are met quite
rarely, as for instance, syndromes of vertebral or Subpiriforme
claudicatio intermittens.
Usually neuravasculare components of every syndrome shows itself as
a vasospastic or vasodilatatore variant, generalisate, regional or local.
We have
enumerated here just a small part of clinical symptoms of vertebrogenic
pathology.
It can be
met quite often, since that is one of the most widespread disease of an
adult.
What is
the reason of clinical variety and spread of osteochondrosis and
other vertebral diseases?
Osteochondrosis is caused by
the dystrophy of statically-dynamically overloaded low-lumbar and low-neck
pulpose components.
Up to the
period of puberty ripen the third inner layer of annulus fibrosis, the
base of the pulpose complex.
This
complex is organised intricately and is similar to a joint. There are
cavities of different shapes and consequently different directions of
compression and distraction of a disc. There can be traced pileformic
"pumps".
The
pulpose complex of an adult is different from that of a new-born child or
of a quadripedal animal.
Simple
homogeneous formation - pulpose nucleus.
That is a
firm amortizing (paddy) formation having a configuration of a bridge,
which is not subjected to osteochondrosis. The function of an adult's
pulpose complex differs entirely from that of a new-born child, it is
antivibrating.
Orthogradic posture of a homo
sapiens promotes an opportunity of adaptation to the environment. Up to
the period of puberty the last remnants of the chord (i.e., nucleus a
pulpose of a new-born child disappear) and, as it has been already
mentioned above, pulpose complexes are formed.
We
consider a man not belonging to the class of Chordata.
It is an
essentially new organism. The new stage of the development both of the
cerebrum and the pulpose complex defines a new stage of human thinking and
walking. This stage defines a new phase and new difficulty of brain
diseases and the pulpose complex.
One should
distinguish between vertebroneurology and vertebrology.
It is not
only maintenance of unity of a mechanical construction, including unity of
a disc, and absence of hernia. MRL-pictures confirmed once again that
recovery from the complication of a disease is not only disappearance of
hernia.
Hernia
remains, and the disease, i.e. irritative and coordinate neurological
disturbances have suffered some back development. Activity of central and
peripheral nervous system provides new movement stereotypes, adaptation in
view of the remained disc hernia. The complication of the disease is a
disturbance of an adapting function of the nervous system, that is a
disturbance of that facility of probability of prognosis, providing the
defence of the muscle corset.
Russian
vertebroneurologists have proved that clinically a real osteochondrosis is
an inherited predisposition to disturbances of the first coordinations,
providing a defending muscle corset.
There
would be difficult without taking into consideration the new ideology of
the disease to decrease the number of cases of osteochondrosis on our
planet.
This
ideology of Russian Neurism has allowed to present a original description
of vertebral diseases of the nervous system and to define new ways of
their medical treatment and their main prophylaxis.
In spite
of the poor financial maintenance and material base the ideology provides
the working out of methodical principles of the investigation of
vertebroneurological patients.
It is a separate branch of medicine - vertebroneurology or
orthopedic neurology (see our manuals):
-
Y. Y. Popelyanskiy "Vertebrogenic
diseases of the nervous system",
v.v. l, 2 , 3, 1974-1986;
Orthopedic neurology, v. 1-2, Kazan, 1997 (in
Russian).
See also our articles:
-
Y. Popelyanskiy and M.Podolskaya
"Über zerebrale Faktoren spondylogener Erkrankungen. Die Role der
Proprioception und der Wahrscheinlichkeits prognozierung."
- "Manuelle Medizin" -1990, v.28, p. 48-50;
-
Y. Y. Popelyanskiy (in Russian) "About
vertebroneurological and biological aspects of osteochondrosis"
- "The Neurological Bulletin (Vestnik)", 1999, № 1-4,
p. 5-9.
and
303 other articles and Monographies list that of labors, which have a
relation to Orthopedic Neurology, there are in the two-volume Manual of
author (1997, v. 2, p. p. 346-470, in Russian), get ready for translation
in English.
Let us illustrate uniqueness of medical investigation of
vertebroneurologic patients by two examples.
Example 1.
For a long time Lasegue's symptom has been considered the
most important symptom of "radiculitis".
It has been thought that, while bending a straight leg into
articulatio coxe, nervous trunks are stretching and the great one is
informing about it reporting about approaching pain.
Russian researchers have presented
doubtless evidence of incapacity of such an explanation.
Having refused the obligation of
inflammation or compression of nervous trunks we concentrate our attention
on irritated receptors of peripheral tissues, first of all muscles.
Receptors inform the brain of a patient
about vertebrogene reflexive tonic and dystrophic changing of tissues.
Bending of the straight leg is
stretching of ishiocrural and gluteale muscles.
If the reflexively contracted muscle
resists this stretching it becomes a painful indicator of spreading of a
painful zone.
Directing on a ishiocrural, popliteal
or gluteale zone of pain it displays a zone, where palpation will discover
tenderness.
If the patient informs about appearing
that moment pain in the lumbar, it means that deformed part of the
vertebral column contains a source of pain.
That means, that in the hypermobile
segment of the column deformation of cinematic chain "leg - vertebral
column" pain receptors are subjected by traumatism of hernia or other
pathological structure.
If
the defending muscle corset get a good nervous signaling, it protects the
painful vertebral segment and at that moment the pain is absent.
Example 2.
The muscles of extremities are shortened while points of
attaching are drawing together, whereas the back long muscles of the
vertebral column are tensed, on the contrary, at the moment of their
lengthening - when the body is bending forward for (not more that for
15-20 0 ).
When the patient is standing, in the state of rest these
muscles are soft and the balance of the body is kept due to gravitation
and muscles are not active.
If there is a painful vertebral segment pathological impulse
causes sharp reflexive tension in the muscle.
That can be observed even in the state of quiet standing and
doesn't disappear, when the body is bending more that for 20 0
, and in the state of standing only on one leg (the norm is that on
the ipsilateral side paravertebral muscles are relaxing that moment).
Thus, in disposal of a vertebroneurologist there are methods
of defining of quantitative and qualitative marks of reflexive reactions
of the pathology of the vertebral column.
These marks allow to define not only the tonic and the
character of the process but its dynamic development as well.
We hasn't touched here upon the problem of cure, which can
be solved taking into consideration pathogenesis of mentioned here
syndromology studied with the use of the developed scheme of
investigation.
In conclusion there should be
noted that owing to the well-known reasons the experience of Russian
vertebroneurologists has not been yet claimed neither in Western Europe
nor in the USA. | 
