Pathogenesis of reflex syndromes
The formation of pain and tonic disorders is triggered by pathological impulses from the receptors of the affected spinal segment. The main receptor zone is the posterior longitudinal ligament, which is rich in nerve endings. The deformed annulus fibrosus, articular-ligamentous apparatus, and periosteum are also subject to irritation.
Impulses via Luschka's sinuvertebral nerve (recurrent meningeal branch) enter the spinal cord through the intervertebral foramen. From there, excitation is transmitted to the anterior and lateral horns, leading to reflex tension of skeletal muscles, as well as visceral and vasomotor reactions. Prolonged pathological impulsation causes neuroosteofibrosis — dystrophic changes in tendons and ligaments at their attachment sites.
Classification of vertebrogenic syndromes
In clinical practice, several main categories of disorders developing against the background of degenerative changes are distinguished:
- Reflex vertebrogenic syndromes: divided into musculoskeletal, neurovascular, and neurodystrophic.
- Compression syndromes: caused by mechanical compression of the spinal canal contents by a disc herniation, osteophytes, or a displaced vertebra (include radiculopathy, myelopathy, and radiculomyeloischemia).
- Myoadaptive syndromes: secondary changes in the muscles of the spine and limbs arising due to spinal column deformity.
- Discogenic pathobiomechanical syndromes: manifest as functional blocks, regional postural imbalance, and non-optimal movement patterns.
Peripheral manifestations and angiopathies
Pathological changes affect not only the spine but also the limbs, forming local and generalized disorders:
- Symphyseal and abdominal syndromes: pubalgia, abdominalgia syndrome, "symphysis-sternal syndrome".
- Limb syndromes: vertebrogenic lumbopelvic syndrome, "gluteal-tract syndrome", adductor syndrome, cramps (painful muscle spasms).
- Reflex myosclerotomic syndromes: trochanteritis, knee epicondylitis, ankle periarthrosis, and secondary nerve entrapment syndromes of the lower extremity.
- Angiopathic syndromes: vascular dystonia of the legs with a predominance of vasospasm or vasodilation, subpiriformis intermittent claudication syndrome, and restless legs syndrome.
Reflex chain: Luschka's ligament $\rightarrow$ Spinal cord $\rightarrow$ Muscle (LSM). Pathological impulse from the posterior longitudinal ligament via Luschka's nerve goes to the spinal cord and closes on the muscles.
Class and exam questions
What role does the sinuvertebral nerve play in the development of musculoskeletal syndromes?
The sinuvertebral nerve (Luschka's nerve) serves as the pathway for pathological impulsation. It branches off from the spinal ganglion, returns to the spinal canal, and transmits signals from irritated ligaments and the disc to the spinal cord, triggering reflex muscle tension.
How do compression syndromes differ from reflex syndromes?
Reflex syndromes occur due to a stream of impulses from the receptors of the affected segment and lead to muscle tension and dystrophy. Compression syndromes are caused by mechanical compression of nerve roots, the spinal cord, or blood vessels by a herniation or osteophytes.
What is neuroosteofibrosis?
These are dystrophic changes in the fibrous tissues of ligaments and tendons (especially at their attachment sites) that develop as a result of prolonged pathological impulsation in reflex syndromes.
What else to study on this topic
- Pathogenesis of intravertebral disc herniations and features of osteophyte formation
- Clinical differentiation of radiculopathy, myelopathy, and radiculomyeloischemia
- Symphyseal, abdominal, and adductor syndromes of the lower extremities
- Reflex myosclerotomic and secondary nerve entrapment syndromes of the leg
- Variants of reflex angiopathic syndromes and vascular dystonias of the lower extremities
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