An analysis of the effectiveness of laser vaporization in 67 patients (23 men, 44 women) with the syndrome of the “adjacent level” of the lumbarspine, who had previously undergone decompressive-stabilizing operations, is presented. The mean age of the patients was 48.3 years (from37 to 54 years).The most common cause of pain syndrome recurrence was protrusion of the intervertebral discs (60 people, 90 %). A positive result of laservaporization in the early postoperative period was achieved in 62 patients (92.5 %). Analysis of the results of treatment in 32 patients in the interimperiod revealed excellent results in 5 (15.5 %) patients, good results – in 12 (37.5 %) patients, and satisfactory results – in 15 (47 %) patients.

The aim of this study was to research the clinical and radiological efficacy of corpectomy and anterior stabilization with titanium mesh cages in patients with myelopathic syndrome associated with cervical spine degenerative diseases.Material and methods. A retrospective observational cohort study was performed. The study included medical records of patients with cervical myelopathy associated with degenerative diseases of the cervical spine who underwent corpectomy and anterior stabilization with titanium mesh cages. Clinical and instrumental parameters were assessed.Results. The study included 28 medical records of respondents who underwent corpectomy and anterior stabilization with titanium mesh implants. The average age of patients was 61.9 ± 11.3 years, males prevailed (60.7 %). By the 3rd month of postoperative follow-up, the severity of myelopathy significantly decreased (p˂0.001). After 12 months, the severity of cervical myelopathic syndrome also significantly decreased (p = 0.009). The neurological status of 18 (64.2 %) respondents improved in the first 3 months after corpectomy and anterior stabilization with titanium mesh implants and 6 months after the surgery, the status improved in the remaining 8 (30.7 %) patients (p˂0.001). Preoperative values of the Cobb sagittal angle allowed us to conclude the following. In 13 (46.4 %) patients, the normolordotic axis of the cervical spine was noted, in 12 (42.8 %) – the hypolordotic axis, and in 3 (10.8 %) respondents, the Cobb angle values corresponded to the kyphotic axis of the cervical spine.Conclusion. The technique of corpectomy and anterior fixation with mesh titanium implants in patients with myelopathic syndrome against the background of degenerative diseases of the cervical spine makes it possible to improve the clinical status of the latter already 3 months after the operation was performed while maintaining normal biomechanical parameters of the cervical spine and complete decompression of the neural structures and supply their vessels.

A clinical example shows a rare case of surgical treatment of facet syndrome, which is formed against the background of instability of the spinal motion segment of the spine at the LIV-LV level using the method of laser vaporization and denervation of the facet joints.The aim of the work is to consider the clinical and diagnostic indicators of facet syndrome and to assess the role of imaging research methods in the diagnosis of this syndrome. At the outpatient stage, with long-term persistent pain syndrome in the lumbar spine, non-stop conservative methods of treatment, the patient underwent survey radiography and MRI examination of this area in order to exclude a specific process (oncopathology, pathological fracture against the background of osteoporosis, spondylitis, etc.) Chronic pain syndrome with its ineffective conservative treatment leads to maladjustment of the psychoemotional and professional-labor state of the patient. Determining the source of pain impulses in the lumbar spine can be difficult, since pain can cause degenerative and pathological changes in various anatomical structures of the spine (intervertebral disc, facet joints, ligaments, muscles, etc.), which can form a clinical picture of pain syndrome with its various manifestations and symptoms, which do not always clearly determine the level and structure of the affected spine. In this connection, for the timely and correct determination of the diagnosis of all patients with chronic pain syndrome in the lumbar spine, it is necessary to be sent to specialized neurosurgical institutions, in which patients undergo a set of necessary medical and diagnostic procedures to determine the further management tactics and treatment algorithm for this category of patients.

Pain in the spine is one of the most common pathological conditions and holds the second place in terms of disability throughout the world. Pain syndrome has a great influence on the functional capabilities of the spine and the professional activity of a person, and that carries a serious social and economic problem. The main causes of pain in the spine are: pathology of the intervertebral discs and the zygapophysial joints; dynamic instability of the spinal motor segment; spondylosis; stenosis of the spinal canal and dural sac with compression of the neurovascular structures; spondylolisthesis; osteoporotic compression fractures of the vertebrae; infectious diseases of the spine, etc. In connection with the aforementioned, of particular interest to clinicians is the pathology of the zygapophysial joints (spondylarthrosis), its diagnosis, and targeted ethiopathogenetic treatment using puncture surgical technology in the treatment of facet syndrome. This paper presents the results and features of puncture surgical technology in the treatment of facet syndrome in degenerative-dystrophic lesions of the zygapophysial joints of the lumbar spine. The analysis is based on 55 sources of literature of domestic and foreign authors. The article presents data on the anatomical and topographic features of the zygapophysial joints, their biomechanics, innervation and their function. The ethiopathogenetic features of pain during degeneration of facet joints are considered. The effectiveness of the use of methods of using radio and laser denervation of the zygapophysial joints in the treatment of facet syndrome is analyzed. The materials of the article describe the methods of using chemodeception, cryodestruction, and intra-articular administration of hyaluronic acid preparations.

Every year, the number of operations on the lumbar spine with the use of various spinal fusion techniques increases, which leads to an increase in the number of cases in the long-term period of surgical treatment, the formation of pathology of the adjacent segment (ASP), which is part of the structure of the failed back surgery syndrome (FBSS). It is known that the pathology of the adjacent segment is a general term and covers two concepts: the degeneration of the adjacent segment (ASDeg) and the disease of the adjacent segment (ASDis). ASDeg is represented by radiographic changes occurring in the adjacent spinal motion segments during spinal surgery with spinal fusion, and ASDis refers to the clinical symptoms that develop during radiographic changes in these segments. With the pathology of an adjacent segment, clinically significant degenerative changes in it are not always formed. If these X-ray changes are formed and correlate with clinical and neurological manifestations, then surgical treatment is indicated. This pathology can be treated with repeated surgical intervention, which this article demonstrate with the clinical example of surgical treatment of the adjacent segment of the spine during fusion.

One of the main causes of pain in the cervical spine, which causes the development of neurological deficit, is the stenosing process of the spinal canal with compression of the neurovascular structures. To determine the tactics of treatment, to predict the consequences of the disease, timely diagnosis of the functional state of neural structures is of great importance.Materials and methods. An informative method for diagnosing stenosing processes of the cervical spine, along with radiography and MRI, is electroneuromyography (ENMG). The analysis was based on 35 patients with a stenosing process of the spinal canal at the cervical level (17 men, 18 women), the average age of patients was 47.7 ± 9.9 years.Results. In the study of changes in the functional state of the axillary, radial, ulnar and median nerves, with stenosing processes, a unidirectional deviation of the entire ENMG complex of indicators of the limb with pain syndrome and contralateral limb was noted. A decrease in the amplitude of the maximum M-responses is recorded due to damage to the peripheral motor neuron and axon degeneration. Selective damage to the slow-conducting anterior motoneurons does not cause a decrease in the speed of impulse conduction due to demyelination. Bilateral changes in late electroneuromyographic phenomena (F-wave) are possibly caused by a general reaction of the peripheral and central nervous systems.Conclusion. In patients with a stenosing process of the cervical spine with severe clinical manifestations, ENMG values can be used both to determine indications for surgical treatment and to assess the dynamics of changes in the postoperative period.

Актуальность. В настоящее время совершенно не изучена экспрессия генов ацетилтрансфераз в структурах, участвующих в формировании патологического очага при развитии дегенеративно-дистрофических процессов в позвоночно-двигательном сегменте. Ведущая роль гипертрофии и оссификации жёлтой связки (Ligamentum flavum) в развитии и прогрессировании стенозирующих процессов позвоночного канала и дурального мешка, а также участие ацетилтрансфераз в метаболизме соединительной ткани определило цель исследования: выявить генетические особенности реакций ацетилирования у больных со стенозами позвоночного канала и дурального мешка на поясничном отделе позвоночника в зависимости от выраженности процессов оссификации Ligamentum flavum. Методы. В исследование включен 31 пациент (15 мужчин, 16 женщин, средний возраст 45,7 ± 2,0 лет) со стенозирующими процессами позвоночного канала и дурального мешка на поясничном уровне. У всех пациентов во время оперативного вмешательства были забраны образцы Ligamentum flavum, в которых затем общепринятыми методами патоморфологии определяли признаки наличия или отсутствия гипертрофии и / или оссификации, а также методом количественной ПЦР (кПЦР) определяли экспрессию генов NAT1 и NAT2. Результаты. В биоптатах Ligamentum flavum обнаружена экспрессия генов NAT1 и NAT2, что свидетельствует о ранее неизвестной роли процессов ацетилирования в метаболизме соединительной ткани. Варианты «медленного» ацетилирования достоверно чаще встречались у пациентов с выявленной оссификацией Ligamentum flavum. Обнаружены различные паттерны экспрессии генов NAT1 и NAT2, что свидетельствует о полиморфности клинических вариантов патологии. Часть выявленных вариантов экспрессии изоферментов ацетилтрансфераз характеризуют склонность к развитию оссификации Ligamentum flavum. Женщины чаще страдают от оссификации Ligamentum flavum по сравнению с мужчинами (χ2 = 39,1, р < 0,01), при этом, повторные оперативные вмешательства, как и избыточная масса тела, не увеличивали риск её оссификации. Активность экспрессии гена NAT2 можно отнести к информативным маркёрам, свидетельствующим о повышенном риске развития процессов эктопической оссификации Ligamentum flavum. Заключение. Выявленные особенности реакций ацетилирования у больных со стенозами позвоночного канала и дурального мешка могут помочь клиницистам прогнозировать развитие гипертрофии и оссификации жёлтой связки при оперативном вмешательстве на позвоночнике, а полученные новые фундаментальные знания лягут в основу разработки способов профилактики развития эпидурального фиброза на дооперационном этапе. Background. Expression of acetyltransferase genes in structures participating in formation of a pathological focus in development of degenerative spine conditions is presently unstudied. Hypertrophy and ossification of Ligamentum flavum play a leading role in the development and progression of stenosing processes in the spinal canal and dural sac whereas acetyltransferases are involved in metabolism of connective tissue. The aim of this study was to identify genetic characteristics of acetylation reactions in patients with stenosis of the lumbar spinal canal and dural sac depending on severity of ossification of Ligamentum flavum. Methods. This study included 31 patients (15 men and 16 women aged 45.7 ± 2.0 years) with stenosing processes of the spinal canal and dural sac at the lumbar level. Samples of Ligamentum flavum were taken from all patients at the time of surgical intervention. Signs of hypertrophy and/or ossification were detected in these samples with standard pathomorphological methods. Real time PCR was used to determine the expression of NAT1 and NAT2 genes. Results. Expression of NAT1 and NAT2 genes was found in biopsy samples of Ligamentum flavum. This indicated a previously unknown role of acetylation processes in connective tissue metabolism. Variants of «slow» acetylation were significantly more common in patients with documented ossification of Ligamentum flavum. Different patterns of NAT1 and NAT2 gene expression were identified, which suggested polymorphism of clinical variants of the disease. Some of the identified variants of acetyltransferase isoenzyme expression characterize a tendency towards development of Ligamentum flavum ossification. Women were more likely to have ossification of Ligamentum flavum than men (χ2 = 39.1, p < 0.01). Repeated surgery and overweight did not increase the risk for ossification of Ligamentum flavum. The activity of NAT2 gene expression can be classified as an informative marker for increased risk of ectopic ossification of Ligamentum flavum. Conclusion. The identified patterns of acetylation reactions in patients with spinal canal and dural sac stenosis may help clinicians to predict the development of hypertrophy and ossification of Ligamentum flavum during spine surgery and to find ways for prevention of epidural fibrosis at the preoperative stage.

The work presents a rare clinical case of adhesive arachnoiditis, which developed against the background of epidural fibrosis during repeated surgical interventions. The cicatricial adhesion in the epidural space is formed in 100% of cases after surgery and is a frequent cause of intraoperative complications during repeated surgical interventions (bleeding, damage to the spinal cord and the dura mater with subsequent outflow of cerebrospinal fluid) and, therefore, an unsatisfactory result of surgical treatment with the formation of constant pain of various intensity, pseudomeningocele, commissural arachnoiditis, etc. The cicatricial adhesion in the epidural space is the main reason for the development of failed back surgery syndrome (FBSS), which today is an important and unresolved problem in spinal surgery. The epidural, as well as the subdural and subarachnoid space of the operated spinal motor segment of the spinal canal can be involved in the cicatricial adhesion, as it is shown in our clinical example. In this regard, it is important to prevent the development of the cicatricial adhesion in the epidural space during primary spinal surgeries, since with the increase in life expectancy of the population and increase in surgical activity during spinal surgeries, the patient can be operated repeatedly. Consequently, the question arises of preventing the formation of the cicatricial adhesion in 100% of cases with each surgical intervention, since the formed cicatricial adhesion in the epidural space does not have effective methods of conservative and surgical treatment and worsens favorable and satisfactory forecasts of surgical treatment for repeated surgical interventions.

The work presents a rare clinical case of adhesive arachnoiditis, which developed against the background of epidural fibrosis during repeated surgical interventions. The cicatricial adhesion in the epidural space is formed in 100% of cases after surgery and is a frequent cause of intraoperative complications during repeated surgical interventions (bleeding, damage to the spinal cord and the dura mater with subsequent outflow of cerebrospinal fluid) and, therefore, an unsatisfactory result of surgical treatment with the formation of constant pain of various intensity, pseudomeningocele, commissural arachnoiditis, etc. The cicatricial adhesion in the epidural space is the main reason for the development of failed back surgery syndrome (FBSS), which today is an important and unresolved problem in spinal surgery. The epidural, as well as the subdural and subarachnoid space of the operated spinal motor segment of the spinal canal can be involved in the cicatricial adhesion, as it is shown in our clinical example. In this regard, it is important to prevent the development of the cicatricial adhesion in the epidural space during primary spinal surgeries, since with the increase in life expectancy of the population and increase in surgical activity during spinal surgeries, the patient can be operated repeatedly. Consequently, the question arises of preventing the formation of the cicatricial adhesion in 100% of cases with each surgical intervention, since the formed cicatricial adhesion in the epidural space does not have effective methods of conservative and surgical treatment and worsens favorable and satisfactory forecasts of surgical treatment for repeated surgical interventions.

The purpose of the study: assessment of the use of laser vaporization of the disc with hernial protrusion on the lumbar spine and its effectiveness in the treatment of pain.Material and methods. We analyzed the effectiveness laser vaporization in 230 patients with degenerative-dystrophic diseases of the lumbar spine (protrusions and hernias of the intervertebral discs) treated in the neurosurgical department of the Irkutsk Scientific Centre of Surgery and Traumatology for the period from 2011 to 2018. There were 122 men and 108 women. The average age of the patients was 41 years. The duration of the disease before surgical treatment is 11 ± 3 weeks. Clinical and neurological examination revealed lumbalgia in 102 patients (44.3 %), lumbar ischalgia in 98 (42.6 %) and radiculopathy in 30 patients (13.1 %). Median hernias of the intervertebral discs were revealed in 130 patients (56.4 %), lateral hernias - in 41 (17.8 %) and protrusions - 59 (23.8 %). The leading localization of the pathological process was the LIV-LV segment (138 patients, 60 %). Assessment of the effectiveness of surgical treatment was carried out using VAS and Macnab scales.Results. In 100 % of cases were laser vaporization was applied a decrease in the intensity of the pain syndrome was achieved in terms of up to 3 months. The analysis of the long-term results of this treatment in 124 patients from 3 months to 3 years by Macnab scale revealed excellent results in 25 (20.1 %) patients, good results - in 50 (40.3 %), satisfactory - in 42 (33.8 %), and unsatisfactory results - in 7 (5.6 %) cases.Conclusion. Thus, laser vaporization of hernias of the intervertebral disc is effective in the treatment of pain, which does not stop with conservative treatment for 4-6 weeks; with a hernia of up to 6 mm; with a median localization and with no signs of sequestration.

МИТОГЕН-АКТИВИРУЕМЫЕ ПРОТЕИНКИНАЗЫ И ИХ ЗНАЧИМОСТЬ В РЕПАРАТИВНОМ ПРОЦЕССЕ ПРИ ЛАМИНЭКТОМИИ: ФУНДАМЕНТАЛЬНЫЕ АСПЕКТЫЖивотенко А

The paper presents the results of surgical treatment of 12 patients with stenosing processes of the vertebral canal at the craniovertebral transition due to chronic, unstable type 2 injuries of the C odontoid process (classification of fractures of odontoid process proposed in 1974 by Anderson and D’Alonzo). Patient examination included clinical-neurologic examination, review spondylograms of the cervical spine in 2 projections, MSCT, MRI. All patients were admitted to the clinic with external fixators (cervical support collar or Philadelphia collar). In the preoperative period, all patients were divided into 2 groups according to indications and contraindications for the application of the HALO-device. The first group consisted of 7 people, with cervical spine still fixed with the cervical support collar or Philadelphia collar, and the second group consisted of 5 patients with CII fracture fixed and corrected in the preoperative period by the HALO-device. All patients underwent surgical intervention – posterior approach decompression of the spinal canal and dural sack in the craniovertebral passage by CI laminectomy, partial resection of the posterior margin of the occipital aperture followed by the implementation of atlanto-axial occipitospondylodesis (a clamp with shape-memory effect for posterior occipitospondylodesis, OOO “MITS SPF”, Novokuznetsk, Russia). A comparative analysis of the results of surgical treatment of posttraumatic stenoses of the vertebral canal with and without the use of the HALO-traction device was performed. The results was better in the second group, which makes it possible to consider the second variant of surgical treatment more pathogenetically justified. Thus, HALO-traction restors anatomo-topographic relationships in the craniovertebral zone creating hard external fixation, helping to avoid intraoperative complications.

The article presents the review of domestic and foreign literature on the use of neurophysiological diagnostic methods – electroneuromyography (ENMG) and electromyography (EMG) in degenerative-dystrophic diseases of the spine. The ENMG method is of great importance for theoretical neurology, obtaining new data on the structural and functional organization of the central and peripheral nervous system in the process of individual development. Electromyography as a diagnostic method studies the electrical activity of the peripheral apparatus of the nervous system. With these methods we directly evaluate both voluntary bioelectric activity of muscles at rest and during their activation (EMG), and caused by stimulation (ENMG). Most authors believe that modifications of stimulation electromyography are objective diagnostic methods that allow to assess the functional state of the peripheral nervous system. Interesting is the fact that changes in EMG and ENMG parameters for osteochondrosis of the spine are recorded even in the absence of external manifestations of the disease. At the same time, for patients with myofascial syndrome in lumbar osteochondrosis, a bilateral decrease in the direct and reflex excitability of motoneurons is characteristic, a slowing down of the pulse along the arc of the H-reflex on the side of the pain and a two-sided local acceleration of the pulse on the distal part of the efferent part of the H-reflex arc from the popliteal pits to soleus muscle. Noteworthy is the fact that the pathological process in the nervous tissue according to ENMG in patients with osteochondrosis of the spine with unilateral radicular syndromes is bilateral. The work of our clinic has shown that diagnostic electroneuromyography can be considered as a medical procedure – electropuncture, according to its results, tactics of both surgical and conservative treatment can be determined. Data of EMG and EMG, carried out after the end of any of the listed types of treatment, serve as an objective control of their effectiveness.

The article analyzes the data of 58 sources of literature on the treatment of cervicobrachial syndrome in patients with cervical osteochondrosis. The anatomical and topographic features of the cervical spine, which are predisposing factors for the development of the studied pathology, namely, the small size of the vertebral bodies and their increased mobility are noted in the work. A high incidence of degenerative-dystrophic diseases of the cervical spine was found in persons over 60years old (50 %) and aged 60years and older (75 %) with a predominance of the development of the pathological process at the level of the CV-CVI vertebral motor segment. According to the literature, the attitude to the problem of treating this pathology is contradictory. The main points of application of conservative treatment are the elimination of pain and muscle spasm, an increase in the volume of movements in the cervical spine. Despite the fact that significant progress has been achieved in recentyears in conservative treatment of patients with pathology of the cervical spine, many tasks remain unresolved and require further analysis, and therefore the problem of improving diagnosis and treatment remains relevant, socially significant and timely.

Degenerative stenosis of cervical level of spinal canal occurs in 4,9 - 9 % among the adult population and are caused by the progressing cervical osteochondrosis. Cervical osteochondrosis dominates in the structure of morbidity of the adult population and is defined by the high frequency of disablement and incapacitation. Over the past few decades the capacities of the diagnostics of spinal canal stenosis significantly increased. Modern methods of neuroimaging help to differentiate the changes in spinal canal structures and to determine the degree of compression of vascular and neural spinal canal structures, to assess epidural and liquor space of spinal cord. Further studying of the degree of spinal canal stenosis with assessment of the reserve spaces state, studying remote results of the treatment and determination of the correlation of neurological disorders with stenosis allows us to predict the course of degenerative processes and to choose optimal algorithms for conservative and surgical treatment tactics.

To evaluate the effectiveness of the developed method of acupuncture in the complex of conservative treatment of pain in patients with osteochondrosis of the cervical spine in the neurosurgical Department of Irkutsk Scientific Centre of Surgery and Traumatology, 58 patients were under observation, 38 of whom were treated with acupuncture. The results of treatment were evaluated by the applying VAS testing and conducting stimulation electroneuromyography. The patients had 9–10 sessions of corporal and auricular acupuncture. Acupuncture was carried out according to 1st or 2nd variants of inhibitory action. When selecting points, the locally segmental principle was used, and the effect was carried out on symmetric points of general action (P7, GI4, GI 11 , E36 , RP6, VB34), on local pain ah shi points, in “near” and “far” points from the pain zone; on standard points of meridians of calming action: sympathetic, sedative and analgesic (points-cracks). Specific pain points were used: in pain in the area of the shoulder girdle – R5, E37, R4: in the rear surface of the chest and region of the scapula – T26, V43, V11; in neuralgia – V60, TR5, VB41. Corporal reflexology “enhance” auricular, we used impact on АТ 55, АТ 13, АТ 22, АТ 51, АТ 34. In cases of severe pain and musculotonic syndromes, treatment was initiated with effects on auricular points: АР 37 point of the cervical spine and АР 55 point Shen Men. When comparing the results of VAS testing before and after the treatment, in all patients we noted a decrease in the intensity of pain, and 16 of patients went into the category of “mild cases”. The positive dynamics is confirmed by the data of electroneuromyographic studies: an increase in the amplitude of the M-response and a decrease in latency, a change in the characteristics of the F-wave. The obtained data indicate the high efficiency of acupuncture in the treatment of pain and muscle-tonic syndromes in patients with spinal osteochondrosis.

Osteoporosis and osteochondrosis have common clinical manifestations: poor posture, reduced flexibility and mobility of the spine, joint pain, fatigue, weakness; both diseases appear most often in old age. Having a lot in common in symptoms, osteoporosis and osteochondrosis differ in etiology, treatment and prognosis.The development of osteoporosis is based on impaired bone remodeling, but it has been established that this process is also important in the pathogenesis of osteochondrosis. The results of previous studies indicate that there is a relationship between the functional state of the neuromotor apparatus and the violation of the structure of bone tissue in the spinal canal stenosis of the lumbar spine. There is data on the study of the nerve conduction and bone mineral density in patients with osteochondrosis of the cervical spine in a small sample.To study the functional state of peripheral nerves and the presence of disorders of bone tissue structure in 2018, 25 patients of the neurosurgical department of Irkutsk Scientific Centre of Surgery and Traumatology were observed with the diagnosis "Dorsopathy, Osteochondrosis of the cervical spine" (М50.1) and 25 volunteers of the control group, representative of the main sex and age. As a result of the examination, all patients of the main group showed sufficiently deep afferent-efferent dysfunctions of the segment apparatus of the cervical spine, while in the control group changes in ENMG indicators showing initial changes in the function of the neuromotor apparatus were observed in 20 % of the examined. The change in bone density was observed in most of the main group examined (72 %), in the control group the decrease in bone density was less frequent (54 %, of which 29 % registered osteopenia). The results of the examination indicate the existence of a relationship between osteochondrosis and osteoporosis - the more symptoms of sensory-motor dysfunction of the root increase in osteochondrosis of the cervical spine, the more often the change in bone density - osteoporosis or osteopenia - is diagnosed.

Objective. To analyze clinical manifestations of cervicobrachial syndrome and identify their relationship with sagittal imbalance using data of MRI and radiological examination. Material and Methods. Clinical manifestations of cervicobrachial syndrome associated with degenerative changes in the spine were studied in 22 patients. Clinical examination, radiography of the cervical spine, electroneuromyography of the upper extremities, and MRI study were performed. The intensity of the pain syndrome was assessed by VAS, and the quality of life – by the NDI questionnaire. The sagittal balance of the cervical spine was evaluated according to the following characteristics: angle of T1 slope, atlantoaxial (C1–C2) angle, degree of shift of the center of gravity of C2–C7, and Cobb angle. Results. The pain intensity in cervicobrachial syndrome correlates with sagittal balance changes in the C2–C7 Cobb angle (r = 0.656; p < 0.05), the angle of T1 vertebra slope (r = 0.520; p < 0.05), and in the degree of shift of the center of gravity of C2–C7 (r = 0.756; p < 0.02). Differences between MRI and radiological results of the sagittal balance measurement are not significant (p < 0.04). Conclusion. The study of the sagittal balance can be included in the algorithm for diagnosing osteochondrosis of the cervical spine. The MRI, along with spondylography, can be used to assess the state of sagittal balance. Understanding the identified relationships can help in determining the program of etiopathogenetic treatment of patients with cervicobrachial syndrome with obligatory including the sagittal balance correction in the program.

This paper presents the analysis of diagnostic policy of 72 patients with cervical osteochondrosis and cervicobrachial syndrome. All patients were examined according to a single program, which included a specially designed questionnaire containing address data, diagnosis, history of life and illness, patient complaints, with a mandatory examination by a neurologist for the presence of compression of neural structures of the cervical spine with a detailed description of the local status and clinical and neurological syndromes. Patients underwent general spondylography of the cervical spine in the anteroposterior and lateral projections. For the diagnosis of segmental instability, functional spondylography was performed in the position of maximum flexion and extension and functional spondylography with burdening, which is based on mathematical modeling of the distribution of the vector force load system in the cervical spine under conditions of inclination of the head at an angle of 45° (flexion) and 15° (extension) with the weight on the head weighing up to 500 grams (putting a special device on the head). A mathematical formula for calculating the index of instability of the vertebral motor segment in the cervical spine is proposed. Sagittal balance of the cervical spine was studied with the correlative dependence of its indicators with the intensity of the pain syndrome according to standard spondylography and magnetic resonance imaging. Identified marker indicator of electroneuromyographic studies of the upper extremities - F-wave. Based on the obtained fundamental knowledge, an algorithm for diagnosing osteochondrosis of the cervical spine and cervicobrachial syndrome has been developed and scientifically substantiated.