ДЕГЕНЕРАТИВНО-ДИСТРОФИЧЕСКИЕ ИЗМЕНЕНИЯ КАК ВЕДУЩАЯ ПРИЧИНА ВТОРИЧНОГО СТЕНОЗА ШЕЙНОГО ОТДЕЛА ПОЗВОНОЧНОГО КАНАЛА

Abstract

Secondary stenosis of the cervical spinal canal is one of the most significant clinical and morphological manifestations of degenerative-dystrophic diseases of the spine. The leading pathogenetic factors in its development include osteochondrosis of the intervertebral discs, spondyloarthrosis, uncovertebral arthrosis, disc protrusions, and disc herniations, which collectively lead to a reduction in the reserve space of the spinal canal, intervertebral foramina, and lateral recesses. The degenerative process develops as a multistage cascade involving dehydration of the nucleus pulposus, reduction in disc height, fibrous-fissural changes of the annulus fibrosus, compensatory osteophytic reaction, hypertrophy of the facet and uncovertebral joints, as well as secondary segmental instability. The clinical significance of these changes is determined not only by the morphological severity of stenosis, but also by the degree of compression of the spinal cord, nerve roots, neurovascular structures, disturbances of cerebrospinal fluid dynamics, and the development of compressive-ischemic myelopathy. The article presents an analysis of the main degenerative-dystrophic factors of secondary stenosis of the cervical spinal canal and proposes original tables for pathomorphological stratification and clinical-radiological correlation.