| Popis: |
At the present time for sanatorium treatment of dorsopathies no morpho-pathogenetic principles are based on severity of degenerative spine changes. The choice of treatment modalities is provided according only to clinical signs and the fact of degenerative spine disease presence, in spite of limitations and contradictions to some resort procedures because of their mechanisms and peculiarities of therapeutic effects. Materials and methods. Comparison of complex imaging examination and sanatorium resort intensity regimen medical appointments of 952 patients with dorsopathies was provided depending on morphological pattern and severity of degenerative spine changes. Case histories, sanatorium medical outpatient cards and the results of radiologic imaging (computed tomography, magnetic resonance imaging, spondylography and osteodensitom-etry) were analyzed. Results. Three groups of sanatorium resort therapeutic action intensity (maximal, 376 patients; limited, 493 patients; and minimal, 83 patients) for patients with dorsopathies were established. The most significant morphological criteria of patient distribution into appropriate groups were established, such as bone mineral density state, the presence and severity of spinal osteoarthrosis and spondylolisthesis, vertebral-motor segment stability or instability, vertebral body hemangiomas. The size of intervertebral disc extrusions and grade of disc height decreasing played a secondary role. The value of spondylography, computed tomography, magnetic resonance imaging and dual-energy radioabsorptiometry in determination of these criteria is presented, as far as in imaging algorithm of examination of patients with dorsopathies on the pre-sanatorium stage, with calculation of computed tomography and magnetic resonance imaging sensitivity, specificity and accuracy. Discussion. Forming morpho-pathogenetic approach to sanatorium resort treatment of dorsopathy demands essential application of modern radiologic imaging modalities. The presence, type and severity of degenerative spine morphological changes must be as fundamental as clinical and neurological pattern, affecting sanatorium resort intensity regimen selection and treatment modalities and schemes. In basic cases most advisable radiologic imaging pre-sanatorium examination modality should be computed tomography, but others are also necessary to use when concretely indicated. |
