FEATURES OF THE CLINICAL PICTURE OF NEUROLOGICAL MANIFESTATIONS OF LUMBAR SPINE OSTEOCHONDROSIS IN MALES UNDER 45 YEARS OF AGE

Objective – to study the clinical picture of neurological manifestations of lumbar spine osteochondrosis in modern young patients, taking into account their psychological status and autonomic nervous system to improve diagnostics and optimize treatment. Materials and methods. 95 male patients with neurological manifestations of spinal osteochondrosis aged 19 to 45 years (mean age – 34.05±5.7) were examined. Among the examined patients, there were 45 patients with radiculopathies and 50 patients with reflex manifestations of lumbar spine osteochondrosis. The examination of patients included clinical somatic and neurological examination with a detailed study of the autonomic nervous system state and levels of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). The control group consisted of 25 practically healthy individuals of corresponding age and sex. Statistical processing of the obtained results was performed with the determination of the Student’s t-test. Differences between groups were considered statistically significant at p<0.05. Results. It has been found that the average duration of the disease in all patients under examination was 6.3 ± 0.4 years, while the duration of the disease with L5 radiculopathy was approximately twice as long as with S1 radiculopathy. Analysis of the neurological status in hernias of the intervertebral discs of the lumbar spine has revealed that the decrease or complete loss of the Achilles reflex is more characteristic of the LV-SI disc hernia than the LIV-LV disc hernia. The absence of the knee reflex is not characteristic of intervertebral disc hernias, both LIV-LV and LV-SI. Therefore, changes in reflexes in discogenic radiculopathies have relative significance and allow only to suggest the level of damage. Analysis of anxiety and depression indicators according to the HADS scale showed that the average level of anxiety in the control group was 8.33 ±1.24 points, and the level of depression was 0.8 ±1.06 points. In the group of patients with discogenic radiculopathies, the average level of anxiety was 9.78 ±1.58 points, and the level of depression was 4.1± 2.13 points. In the group of patients with reflex lumbar pain, the average level of anxiety was 8.01 ±1.16 points, and the level of depression was 1.53± 1.5 points. The obtained indicators did not statistically uncertainly differ from the indicators of the control group. No statistically significant differences were found in the indicators of anxiety and depression between the group of patients with discogenic lumbar radiculopathies and reflex lumbar pain. Conclusions. A certain discrepancy was found between the classical ideas about the clinical picture of root damage and the modern clinical picture of radicular manifestations of degenerative- dystrophic changes in the spine. A significant level of neurotization of patients with the occurrence of anxiety and autonomic dysfunction was revealed, which should be taken into account when working with this group of patients, as such disorders can contribute to the chronicity of the back pain, and this will have not only medical but also economic consequences.