Журнал «Боль. Суставы. Позвоночник» Том 11, №2, 2021
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Изменения Modic в поясничном отделе позвоночника: гистология, факторы риска, клиническая картина и лечение
Авторы: Шаповалов В.С.(1), Быстрицкая М.А.(2), Дедух Н.В.(2), Балык А.И.(2)
(1) — Киевская городская клиническая больница скорой медицинской помощи, г. Киев, Украина
(2) — ГУ «Институт геронтологии имени Д.Ф. Чеботарева НАМН Украины», г. Киев, Украина
Рубрики: Ревматология, Травматология и ортопедия
Разделы: Справочник специалиста
Версия для печати
У статті наведені дані огляду літератури, присвяченого змінам замикаючої пластинки тіла хребця, описаним M.T. Modic (МСs), які з високою частотою визначаються в поперековому відділі хребта у пацієнтів із хронічним болем у спині. Етіологія МСs невідома, найбільш імовірними сьогодні вважають три причини: механічну, інфекційну та біохімічну, загальним механізмом для всіх є міграція прозапальних молекул із дегенеративно зміненого диска. Був виявлений і описаний тісний зв’язок між МСs і неспецифічним хронічним болем у спині. За дегенерації диску підвищене навантаження на замикальні пластинки може привести до мікротріщин у них, через які медіатори запалення надходять у кістковий мозок і провокують MCs. Протоколів лікування МСs із позиції доказової медицини не існує. Певні успіхи отримані при використанні антибіотикотерапії, ін’єкцій стероїдів і антирезорбентів, досліджується ефективність анти-TNF-α терапії. Наявні поодинокі дані літератури свідчать, що пацієнтам із МСs і хронічним болем у спині, нестабільністю, які не відповідають на консервативне лікування, може бути показано хірургічне лікування для зняття болю й покращення якості життя. Однак не всі з представлених методів хірургічного лікування пацієнтів із хронічним болем у спині ефективні в осіб зі змінами Modic. Розбіжності в результатах лікування пацієнтів, наведені в різних джерелах, свідчать про необхідність подальших досліджень задля розуміння патогенезу МСs і розроблення патогенетичних підходів до лікування цієї патології.
В статье представлены данные обзора литературы, посвященного изменениям замыкательной пластинки тела позвонка, описанным Modic (МСs), которые с высокой частотой определяются в поясничном отделе позвоночника у пациентов с хронической болью в спине. Этиология МСs неизвестна, наиболее вероятными сегодня считаются три причины: механическая, инфекционная и биохимическая, общим механизмом для всех является миграция провоспалительных молекул из дегенеративно измененного диска. Была выявлена и описана тесная связь между МСs и неспецифической хронической болью в спине. При дегенерации диска повышенное напряжение на замыкательные пластинки может привести к их микротрещинам, через которые медиаторы воспаления поступают в костный мозг и провоцируют MCs. Протоколов лечения МСs с позиции доказательной медицины не существует. Определенные успехи получены при использовании антибиотикотерапии, инъекций стероидов и антирезорбентов, исследуется эффективность анти-TNF-α терапии. Имеющиеся единичные данные литературы свидетельствуют, что пациентам с МСs и хронической болью в спине, нестабильностью, не отвечающим на консервативное лечение, может быть показано хирургическое лечение для купирования боли и повышения качества жизни. Однако не все из представленных методов хирургического лечения пациентов с хронической болью в спине эффективны у лиц с изменениями Modic. Расхождения в результатах лечения пациентов, представленные в различных источниках, свидетельствуют о необходимости дальнейших исследований для понимания патогенеза МСs и разработки патогенетических подходов к лечению этой патологии.
The article presents a literature review on the Modic changes (MCs) in the vertebral endplates, which are frequently detected in patients with chronic low back pain. The etiology of MCs is unknown; however, there are three causes which are considered the most probable today: mechanical, infectious and biochemical. They share a common mechanism of pro-inflammatory molecule migration from the degenerative disk. A close association has been identified and described between the MCs and a non-specific chronic low back pain. Disc degeneration exerts a further stress on the endplates and produces microcracks, through which the inflammatory mediators enter the bone marrow and provoke the MCs. At present, there are no evidence-based treatment protocols for the MCs. A certain progress has been made with antibiotic therapy, injections of steroids and antiresorbents; the effectiveness of anti-TNF-α therapy is being explored. The sporadic reference data on our disposal indicate that patients with MCs and chronic low back pain, along with instability, who do not respond to a conservative treatment, may be referred for the surgical treatment to relieve pain and improve quality of life. However, not all of the presented methods of surgical treatment with chronic back pain are effective in patients with the Modic changes. The divergence of patient treatment outcomes presented by various sources indicates the need for a further research to understand the MC pathogenesis and develop pathogenetic approaches to the treatment of this pathology.
біль у спині; зміни Modic; міжхребцевий диск; замикальна пластинка тіла хребця
боль в спине; изменения Modic; межпозвонковый диск; замыкательная пластинка тела позвонка
back pain; Modic changes; intervertebral disc; vertebral endplate
Интерпретация изменений Modic по данным МРТ
Гистологические нарушения
Факторы риска возникновения изменений Modic
Клинические проявления изменений Modic
Диагностика
Лечение
Выводы
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