F.A. KHABIROV^1,2

¹Kazan State Medical Academy — Branch Campus of the FSBEI FPE RMACPE MOH Russia, 36 Butlerov Str., 420012 Kazan, Russian Federation

²Republic Clinical-diagnostic Center for Demyelinating Diseases, 13 Vatutin Str., Kazan, Russian Federation, 420021

 Khabirov F.A. — D. Sc. (medicine), Professor, Head of the Neurology Department, Head of the RCDCDS, tel. (843)278-97-28, e-mail: Farit.Нabirov@tatar.ru, ORCID ID: 0000-0002-2572-6970

 Objective ― to present the classification and justification of the clinical diagnosis necessary for doctors.

Material and methods. The article highlights the literature data and, to a greater extent, own data on the features of diagnosis of vertebrogenic pathology.

Results. The formulation of the diagnosis should include, firstly, the determination of the nature and location of the main lesion of the vertebral-motor segment (VMS), and secondly, specific vertebral and extravertebral syndromes. A single definition of degenerative-dystrophic process (DDP): osteochondrosis, spondylarthrosis, spondylosis ― is not a diagnosis. It becomes the initial part of the formulated diagnosis only when the topic expression is specified: along the spine vertical or (in case of a protrusion, hernia) along its diameter. As for the vertical injury localization, clinical syndromology is often determined not by the VMS, which spondylogram shows as apparent signs of DDP, but the adjacent one. In this damaged VMS, immobilization has not yet been completed: neither the stable contracture of its small muscles nor the fibrosis of the disc has yet been established. 

The diagnosis should reflect the causal factors of the disease (DDP, tumor processes, as well as inflammatory lesions and their residual effects) as the main etiological factor indicating the location, severity, and stage. Vertebrogenic syndromes should be presented depending on the degree of their severity and dysfunction. In particular, pain is defined as moderate, pronounced, and sharply pronounced. The disease course should be reflected too: the stage (exacerbation, remission), the stage of exacerbation (progression, stationary, regression).

In the first place in the diagnosis should be the main etiological factor, namely, the VMS lesion.  However, in order to improve the incidence accounting, the following sequence in the diagnosis formulation was proposed as an exception: in the first place ― neurological syndrome: radicular, spinal, reflex (muscular-tonic, neurodystrophic, neurovascular), and in the second place ― vertebral lesion.

It is also necessary to take into account the stages of exacerbation. Thus, traction treatment at the progression and inpatient stages promotes decompression of the spine, and at the stage of progression, when local myofixation is formed, the same procedure can contribute to its destruction.

Conclusion. The proposed classification and definition of clinical diagnosis in vertebrogenic pathology will be useful for doctors: neurologists, manual therapists, orthopedists, rheumatologists and rehabilitation specialists.

Key words: degenerative-dystrophic process, osteochondrosis, spondylosis, spondylarthrosis, vertebral-motor segment, compression-neural syndrome, myofascial trigger zones, radicular nerve.

(For citation: Khabirov F.A. Classification and clinical diagnosis of vertebrogenic pathology. Practical Medicine. 2018)

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