Consilium MedicumConsilium MedicumConsilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum9525010.26442/20751753.2019.9.190588ArticlesСтатьиReview ArticleBACK PAIN ASSOCIATED WITH DEGENERATIVE SPINE DISEASEБОЛЬ В СПИНЕ ПРИ ДЕГЕНЕРАТИВНЫХ ИЗМЕНЕНИЯХ ПОЗВОНОЧНИКАMaksimovaMarina Yu.МАКСИМОВАМАРИНА ЮРЬЕВНА

д-р мед. наук, проф., рук. 2-го неврологического отд-ния ФГБНУ НЦН

ncnmaximova@mail.ruGerasimovaElizaveta V.ГЕРАСИМОВАЕЛИЗАВЕТА ВАДИМОВНА

аспирант нейрохирургического отд-ния ФГБНУ НЦН

KotlyarYana A.КОТЛЯРЯНА АЛЕКСАНДРОВНА

аспирант 2-го неврологического отд-ния ФГБНУ НЦН

Research Center of NeurologyФГБНУ «Научный центр неврологии»15092019219VOL 21, NO9 (2019)ТОМ 21, №9 (2019)859028122021Copyright ©; 2019, Consilium MedicumCopyright ©; 2019, ООО "Консилиум Медикум"2019Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://consilium.orscience.ru/2075-1753/article/view/95250

Back pain associated with degenerative spine disease is one of the most common reason for seeking medical attention. Pain syndrome in degenerative spine disease may originate from various damaged structures, such as intervertebral disc, joints, ligaments or muscles. Compression of nerve roots or spinal cord commonly can be pathogenetic sources of pain. A large number of scientific studies are focused on researching pathophysiological sources of compression pain syndrome. However, impaired blood flow to the spinal cord can cause pain by itself. Therefore, it is important to administer vascular therapy improving microcirculation and blood flow to control dironical pain. In this article summarizes possible pathophysiological mechanisms of pain in degenerative spine disease.

Боль в спине при дегенеративных изменениях позвоночника - одна из наиболее частых причин обращения пациентов за медицинской помощью. Источником болевого синдрома могут быть изменения межпозвонковых дисков, суставов, связочного аппарата, мышц. Часто патогенетической основой боли является компрессия спинномозговых корешков, спинного мозга. Большое количество научных работ посвящено изучению патофизиологических основ возникновения болевого синдрома на фоне их механического сдавления. Однако нарушение кровоснабжения спинного мозга может быть самостоятельной причиной возникновения боли. Поэтому нельзя отрицать необходимость назначения сосудистой терапии, улучшающей микроциркуляцию и кровообращение, при хроническом болевом синдроме. В статье рассмотрены возможные патофизиологические механизмы, лежащие в основе болевого синдрома при дегенеративных изменениях позвоночника.

degenerative spine diseaseback painpathophysiological mechanisms of painspinal cord ischemiaдегенеративные изменения позвоночникаболь в спинепатофизиологические механизмы болиишемия спинного мозгаGBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 16; 390 (10100): 1211-59. DOI: 10.1016/S0140-6736(17)32154-2. PMID: 28919117Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet 2012; 4; 379 (9814): 482-91. DOI: 10.1016/S0140-6736(11)60610-7. PMID: 21982256Manchikanti L, Singh V, Falco FJ et al. Epidemiology of low back pain in adults. Neuromodulation 2014; 17 (Suppl. 2): 3-10. DOI: 10.1111/ner.12018. PMID: 25395111Braun J, Baraliakos X, Regel A, Kiltz U. Assessment of spinal pain. Best Pract Res Clin Rheumatol 2014; 28 (6): 875-87. DOI: 10.1016/j.berh.2015.04.031. PMID: 26096091Allegri M, Montella S, Salici F et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Res 2016; 5: (F1000 Faculty Rev): 1530. DOI: 10.12688/f1000research.8105.2. PMID: 27408698Minkalis AL, Vining RD. What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis. J Can Chiropr Assoc 2015; 59 (3): 300-10. PMID: 26500365Lorenzo A, Schildt P, Lorenzo M et al. Acute low back pain management in primary care: a simulated patient approach. Fam Pract 2015; 32 (4): 436-41. DOI: 10.1093/fampra/cmv030. PMID:26060210Gilchrist RV, Slipman CW, Bhagia SM. Anatomy of the intervertebral foramen. Pain Physician 2002; 5 (4): 372-8. PMID: 16886015Lin JH, Chiang YH, Chen CC. Lumbar radiculopathy and its neurobiological basis. World J Anest-hesiol 2014; 3 (2):162-73. DOI: 10.5313/wja.v3.i2.162Kobayashi S, Mwaka ES, Baba H. Microvascular system of the lumbar dorsal root ganglia in rats. Part II: neurogenic control of intraganglionic blood flow. J Neurosurg Spine 2010; 12 (2): 203-9. DOI: 10.3171/2009.8.SPINE08895. PMID: 20121357Sapunar D, Kostic S, Banozic A, Puljak L. Dorsal root ganglion - a potential new therapeutic target for neuropathic pain. J Pain Res 2012; 5: 31-8. DOI: 10.2147/JPR.S26603. PMID: 22375099Kobayashi S, Mwaka ES, Baba H et al. Microvascular system of the lumbar dorsal root ganglia in rats. Part I: a 3D analysis with scanning electron microscopy of vascular corrosion casts. J Neurosurg Spine 2010; 12 (2): 197-202. DOI: 10.3171/2009.6.SPINE08894. PMID: 20121356Guo W, Zhao P, Zhou W et al. Correlation studies between MRI and the symptom scores of patients with LDH before and after manipulative therapy. Zhongguo Gu Shang 2010; 23 (1): 17-9. PMID:20191957Yabuki S, Kikuchi S, Olmarker K, Myers RR. Acute effects of nucleus pulposus on blood flow and endoneurial fluid pressure in rat dorsal root ganglia. Spine (Phila Pa 1976) 1998; 23: 2517-23. PMID: 9854750Sun Z, Zhang M, Zhao XH. Immune cascades in human intervertebral disc: the pros and cons. Int J Clin Exp Pathol 2013; 6 (6): 1009-14. PMID: 23696917Molinos M, Almeida CR, Caldeira J. Inflammation in intervertebral disc degeneration and regeneration. J R Soc Interface 2015; 6; 12 (104): 20141191. DOI: 10.1098/rsif.2014.1191. PMID: 25673296Krames ES. The role of the dorsal root ganglion in the development of neuropathic pain. Pain Med 2014; 15 (10): 1669-85. DOI: 10.1111/pme.12413. PMID: 24641192Zhang JM, Jianxiong An. Cytokines, Inflammation and Pain. Int Anesthesiol Clin 2007; 45 (2): 2737. DOI: 10.1097/AIA.0b013e318034194e. PMID: 17426506Rydevik BL, Myers RR, Powell HC. Pressure increase in the dorsal root ganglion following mechanical compression. Closed compartment syndrome in nerve roots. Spine (Phila Pa 1976) 1989; 14 (6): 574-6. PMID: 2749371Lawson SN. Morphological and biochemical cell types of sensoryneurons. In: Scott AS, ed. Sensory Neurons, Diversity, Development and Plasticity. NY: Oxford University Press, 1992; p. 27-59.Kobayashi S, Mwaka ES, Meir A et al. Vasomotion of Intraradicular Microvessels in Rat. Spine 2009; 34 (10): 990-7. DOI: 10.1097/BRS.0b013e3181a100bfKobayashi S, Takeno K, Miyazaki T et al. Effects of Arterial Ischemia and Venous Congestion on the Lumbar Nerve Root in Dogs. J Orthop Res 2008; 26 (11): 1533-40. DOI: 10.1002/jor.20696 PMID:18536056Dubovy P. Wallerian degeneration and peripheral nerve conditions for both axonal regeneration and neuropathic pain induction. Ann Anat 2011; 193 (4): 267-75. DOI: 10.1016/j.aanat.2011.02.011. PMID: 21458249Olmarker K. Spinal nerve root compression. Acta Orthopaedica Scand 1991; 62: 1-27. DOI: 10.3109/17453679109153920Beggs S, Salter MW. Stereological and somatotopic analysis of the spinal microglial response to peripheral nerve injury. Brain Behav Immun 2007; 21: 624-33. DOI: 10.1016/j.bbi.2006.10.017. PMID:17267172Otoshi K, Kikuchi S, Konno S, Sekiguchi M. The reactions of glial cells and endoneurial macrophages in the dorsal root ganglion and their contribution to pain-related behavior after application of nucleus pulposus onto the nerve root in rats. Spine (Phila Pa 1976) 2010; 35: 264-71. DOI: 10.1097/BRS.0b013e3181 c67f1 e. PMID: 20042951Gilchrist RV, Slipman CW, Isaac Z et al. Vascular Supply to the Lumbar Spine: An Intimate Look at the Lumbosacral Nerve Roots. Pain Physician 2002; 5 (3): 288-93. PMID: 16902656Watanabe R, Parke WW. Vascular and neural pathology of lumbosacral spinal nerve roots in spinal stenosis. J Neurosurg 1986; 64: 64-70. DOI: https://doi.org/10.3171/jns.1986.64.1.0064Hoyland JA, Freemont AJ, Jayson MI. Intervertebral foramen venous obstruction. A cause of peri-radicular fibrosis? Spine (Phila Pa 1976) 1989; 14 (6): 558-68. PMID: 2749370Коновалов А.Н., Гринь А.А., Древаль О.Н. и др. Клинические рекомендации по диагностике и лечению дегенеративного стеноза позвоночного канала на пояснично-крестцовом уровне. Обсуждены и утверждены на пленуме Правления Ассоциации нейрохирургов России, Казань. 2015. М., 2015. [Konovalov A.N., Grin' A.A., Dreval' O.N. et al. Clinical recommendations for the diagnosis and treatment of degenerative stenosis of the spinal canal at the lumbosacral level. Discussed and approved at the Plenum of the Board of the Association of neurosurgeons of Russia, Kazan 2015. Moscow, 2015. (in Russian).]Takahashi K, Kagechika K, Takino T et al. Changes in epidural pressure during walking in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 1995; 15; 20 (24): 2746-9. PMID: 8747254Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World J Orthop 2014; 18; 5 (2): 134-45. DOI: 10.5312/wjo.v5.i2.134. PMID: 24829876Sluka KA, Winter OC, Wemmie JA. Acid-sensing ion channels: A new target for pain and CNS diseases. Curr Opin Drug Discov Devel 2009; 12 (5): 693-704. PMID: 19736627Wu WL, Cheng CF, Sun WH et al. Targeting ASIC3 for pain, anxiety, and insulin resistance. Pharmacol Ther 2012; 134 (2): 127-38. DOI: 10.1016/j.pharmthera.2011.12.009. PMID: 22233754.North RA. P2X3 receptors and peripheral pain mechanisms. J Physiol 2004; 15; 554 (Part 2): 3018. DOI: 10.1113/jphysiol.2003.048587. PMID: 12832496Harvey VL, Dickenson AH. Mechanisms of pain in nonmalignant disease. Curr Opin Support Palliat Care 2008; 2 (2): 133-9. DOI: 10.1097/SPC.0b013e328300eb24. PMID: 18685411.Chien SQ, Li C, Li H et al. Sympathetic Fiber Sprouting in Chronically Compressed Dorsal Root Ganglia Without Peripheral Axotomy. J Neuropathic Pain Symptom Palliation 2005; 1 (1): 19-23. DOI: 10.1300/J426v01n01_05. PMID: 17387381Janig W, Levine JD, Michaelis M. Interactions of sympathetic and primary afferent neurons following nerve injury and tissue trauma. Prog Brain Res 1996; 113: 161-84 PMID: 9009734.Kummer W, Gibbins IL, Stefan P, Kapoor V. Catecholamines and catecholamine-synthesizing enzymes in guinea-pig sensory ganglia. Cell Tissue Res 1990; 261 (3): 595-606. PMID: 1978803Kobayashi S, Takeno K, Yayama T et al. Pathomechanisms of sciatica in lumbar disc herniation: effect of periradicular adhesive tissue on electrophysiological values by an intraoperative straight leg raising test. Spine (Phila Pa 1976) 2010; 15; 35 (22): 2004-14. DOI: 10.1097/BRS.0b013e3181d4164d. PMID: 20959779Falconer MA, McGeorge M, Begg AC. Observations on the cause and mechanism of symptomproduction in sciatica and low-back pain. J Neurol Neurosurg Psychiatry 1948; 11: 13-26. PMID: 18907039Nouri A, Tetreault L, Singh A et al. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine (Phila Pa 1976) 2015; 15; 40 (12): E675-93. DOI: 10.1097/BRS.0000000000000913. PMID: 25839387Oyinkan MB, Capone PM. Myelopathy. Handb Clin Neurol 2016; 136: 1015-26. DOI: 10.1016/B978-0-444-53486-6.00052-1. PMID: 7430455.Хить М.А., Гуща А.О., Щекутьев Г.А., Никитин С.С. Шейная спондилогенная миелопатия: диагностика, лечение, прогноз. Вопр. нейрохирургии им. Н.Н. Бурденко 2012; 76 (3): 75-80. [Khit' M.A., Gushcha A.O., Shchekut'ev G.A., Nikitin S.S. Sheinaia spondilogennaia mielopatiia: diag-nostika, lechenie, prognoz. Vopr. neirokhirurgii im. N.N. Burdenko 2012; 76 (3): 75-8 (in Russian).]Al-Mefty O, Harkey HL, Marawi I et al. Experimental chronic compressive cervical myelopathy. J Neurosurg 1993; 79 (4): 550-61. DOI: 10.3171/jns.1993.79.4.0550 PMID: 8410225Carvalho DZ, Hughes JD, Liebo GB et al. Venous Congestive Myelopathy due to Chronic Inferior Vena Cava Thrombosis Treated with Endovascular Stenting: Case Report and Review of the Literature. J Vasc Interv Neurol 2015; 8 (1): 49-53. PMID: 25825633Rodriguez FJ, Crum BA, Krauss WE et al. Venous congestive myelopathy: a mimic of neoplasia. Mod Pathol 2005; 18 (5): 710-8. DOI:10.1038/modpathol.3800350. PMID: 1557807Okada S, Chang C, Chang G, Yue JJ. Venous hypertensive myelopathy associated with cervical spondylosis. Spine J 2016; 16 (11): e751-e754. DOI: 10.1016/j.spinee.2016.06.003. PMID: 27293119.Krishnan C, Malik JM, Kerr DA. Venous hypertensive myelopathy as a potential mimic of transverse myelitis. Spinal Cord 2004; 42 (4): 261-4. DOI: 10.1038/sj.sc.3101517. PMID: 15060524.Matsubara T, Akutsu H, Watanabe S. Histologically proven venous congestive myelopathy without concurrent vascular malformation: Case reports and review of the literature. Surg Neurol Int 2012; 3: 87. DOI: 10.4103/2152-7806.99922. PMID: 23050201.McKinley WO, Tewksbury MA, Godbout CJ. Comparison of medical complications following nont-raumatic and traumatic spinal cord injury. J Spinal Cord Med 2002; 25: 88-93. PMID: 12137222.New PW, Rawicki HB, Bailey MJ. Nontraumatic spinal cord injury: demographic characteristics and complications. Arch Phys Med Rehab 2002; 83: 996-1001. PMID: 12098161.Hao JH, Xu XJ, Yu YX et al. Hypersensitivity of dorsal horn wide dynamic range neurons to cutaneous mechanical stimuli after transient spinal cord ischemia in the rat. Neurosci Lett 1991; 8: 128 (1): 105-8. PMID: 1922936.D'Mello R, Dickenson AH. Spinal cord mechanisms of pain. Br J Anaesth 2008; 101 (1): 8-16. DOI: 10.1093/bja/aen088. PMID: 18417503.Hao JH, Xu XJ, Yu YX et al. Baclofen reverses the hypersensitivity of dorsal horn wide dynamic range neurons to mechanical stimulation after transient spinal cord ischemia; implications for a tonic GABAergic inhibitory control of myelinated fiber input. J Neurophysiol 1992; 68 (2): 392-6. DOI: 10.1152/jn.1992.68.2.392. PMID: 1527566.Du S, Sun Y, Zhao B. Interleukin-6 Serum Levels Are Elevated in Individuals with Degenerative Cervical Myelopathy and Are Correlated with Symptom Severity. Med Sci Monit 2018; 24: 740513. DOI: 10.12659/MSM.912868. PMID: 30327453.Karadimas SK, Moon ES, Yu WR. A novel experimental model of cervical spondylotic myelopathy (CSM) to facilitate translational research. Neurobiol Dis 2013; 54: 43-58. DOI: 10.1016/j.nbd.2013.02.013. PMID: 23466695.Ifergan I, Kebir H., Bernard M et al. The blood-brain barrier induces differentiation of migrating monocytes into Th17-polarizing dendritic cells. Brain 2008; 131 (Part 3): 785-99. DOI: 10.1093/bra-in/awm295. PMID: 18156156.Donnelly DJ, Popovich PG. Inflammation and its role in neuroprotection, axonal regeneration and functional recovery after spinal cord injury. Exp Neurol 2008; 209 (2): 378-88. DOI: 10.1016/j.exp-neurol.2007.06.009. PMID: 17662717.Beattie MS, Manley GT. Tight squeeze, slow burn: inflammation and the aetiology of cervical myelopathy. Brain 2011; 134 (Part 5): 1259-61. DOI: 10.1093/brain/awr088. PMID: 21596766.Kawasaki Y, Zhang L, Cheng JK, Ji RR. Cytokine Mechanisms of Central Sensitization: Distinct and Overlapping Role of Interleukin-1b, Interleukin-6, and Tumor Necrosis Factor-a in Regulating Synaptic and Neuronal Activity in the Superficial Spinal Cord. J Neurosci 2008; 28 (20): 5189-94. DOI: 10.1523/JNEUROSCI.3338-07.2008. PMID: 18480275.Kempster PA, Rollinson RD. The Lhermitte phenomenon: variant forms and their significance. J Clin Neurosci 2008; 15 (4): 379-81. DOI: 10.1016/j.jocn.2007.05.002. PMID: 18280165.Khare S, Seth D. Lhermitte's Sign: The Current Status. Ann Indian Acad Neurol 2015; 18 (2): 1546. DOI: 10.4103/0972-2327.150622. PMID: 26019410.Baldwin RN, Chadwick D. Lhermitte's "sign" due to thoracic cord compression. J Neurol Neurosurg Psychiatry 1986; 49 (7): 840-1. PMID: 3746318.Гуща А.О., Герасимова Е.В., Полторако Е.Н. Болевой синдром при дегенеративно-дистрофических изменениях позвоночника. Анналы клин. и экспериментальной неврологии. 2018; 12 (4): 67-75. DOI: 10/25692/ACEN.2018.4 [Gushcha A.O., Gerasimova E.V., Poltorako E.N. Bolevoi sindrom pri degenerativno-distrofiches-kikh izmeneniiakh pozvonochnika. Annaly klin. i eksperimental'noi nevrologii. 2018; 12 (4): 67-75. DOI: 10/25692/ACEN.2018.4 (in Russian).]