PAIN SYNDROMES FORMATION IN DEGENERATIVE SPINE DISEASE

Abstract

Abstract. Etiological factors of degenerative spine disease and pathogenesis have been considered as a multifactor state. Biochemical and gross pathological changes have been outlined as well. Damage of pulpose disc core is the primary pathological process in degenerative spine disease. Therefore, pathogenetic factors have been defined: reflective, compressive, degenerative, as well as risk factors for development of degenerative and dystrophic changes. Inherent weakness of the connective tissue due to impaired collagen synthesis is significant in development of spine osteochondrosis, which leads to changes in collagen fibers of the fibrous ring, cracks and ruptures in it. Under the influence of various factors (hereditary, mechanical, hormonal, vascular, etc.), depolymerization of acid mucopolysaccharides, proteins, hyaluronic acid of the intervertebral disk pulpal nucleus takes place that leads to dehydration of the disk and reduction of its depreciation. The pathological process in spine osteochondrosis begins with the intervertebral disc, from where it spreads to other structures of the spine. In the pathogenesis of vertebrogenic radiculopathy, biologically active products of depolymerization of the pulp nucleus proteoglycans, as well as autoimmune inflammatory response caused by the pulpous nucleus fragments, which fell into the perineural and epidural space, are crucial. Thus, the established mechanisms and sources of pain in cases of spine osteochondrosis are: irritation of pain receptors, compression of nerve roots and nerve endings, oedema of nerve endings and disc, chemical inflammatory factor. The main factors that cause the pathological process are: autoimmune processes, inflammation, adhesion processes, compression and ischemia. They are closely interrelated and make an ‘endless circle’ in the resistance of pain syndrome in cases of spine osteochondrosis; therewith oedema of nerve endings or root is the main pathogenetic factor. That is why the epidurally administered corticosteroids have a positive result by blocking the receptors of the affected vertebral segments as well as by the action in the region of disco-radicular conflict that leads to reduction or elimination of inflammatory response, which is crucial in pain syndrome development.