RU2452954C2 - Method of estimating functional status of spinal cord - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: patients are examined for the amount of protein in a spinal liquid, and if observing this parameter conforming with norms, microscopic V-dehydration of a dried drop of the spinal liquid is required for the purpose of investigation. The dried drop of irregular salt crystals with lay-ups and splits in the centre enables to diagnose spinal cord dysfunction.

EFFECT: using the method provides pre-clinical estimation of spinal cord dysfunction if observing a latent, slowly progressive pathology that shall enable well-timed treatment and prevention.

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Description

The invention relates to medicine, namely to laboratory research, and can be used to determine the functional state of the spinal cord in the early stages of the disease, for example, with discogenic radiculitis, herniated discs, the consequences of injuries, and also with hidden, slowly progressing disorders associated with with the costs of the profession, age characteristics, bad habits, etc.

In laboratory studies, for example, with discogenic radiculitis, as some authors believe, an increase in the amount of protein in cerebrospinal fluid is important (Friedman A.P. Fundamentals of liquorology. "Medicine", Leningrad branch, 1971). It was found that hernias of the intervertebral discs lead to compression of the dural sac, as a result of which a complete or partial block of the caudal part of the subarachnoid space develops. This leads to a violation of cerebrospinal fluid circulation, to stagnation in the radicular vessels, especially in the veins, and, consequently, to an increase in the protein concentration in the cerebrospinal fluid. Naturally, such a hyperproteinosis should be a characteristic phenomenon for diagnosing a functional disorder of the spinal cord in various pathologies, including herniated discs. However, according to some researchers, obtained on a large number of patients, in 36% of cases in the cerebrospinal fluid, the total amount of protein remains within the normal range. Thus, the study of cerebrospinal fluid does not always give the clinician support points for assessing the functional state of the spinal cord.

A known method of magnetic resonance imaging of hernias of the spinal cord (Pat. RF No. 2141254, class A61B 8/00, op. 20,11,99,) This method of differential diagnosis of hernias of the spinal cord involves conducting magnetic resonance imaging of the spine of the patient, lying on your back and stomach. When the spinal cord is shifted anteriorly, involvement of only its membranes in the hernial sac is determined, meningocele is diagnosed, and in the absence of changes in the tomographic picture, which remains the same as when the patient is lying on his back, the involvement of the membranes and roots of the spinal cord in the hernial sac and diagnosed with meningoradiculocele.

This method allows to obtain an objective differential assessment of the functional state of the spinal cord. However, such an assessment can only be given at a late stage, that is, to differentiate a far-reaching pathological process.

The closest is a method for assessing the functional state of the spinal cord, including microscopic examination of a dried drop of cerebrospinal fluid (Pat. RF No. 2132067, class G01N 33/483, publ. 06/20/1999). In this method, a patient with a spinal injury under local anesthesia by lumbar puncture of the spinal cord receive cerebrospinal fluid. Two drops of cerebrospinal fluid are applied to a glass slide, one of which is added a drop of a 0.9% NaCl solution. The droplets are dried under a coverslip, then studied in polarized light using a photometer, the transmission coefficients in optical units are determined, and the state of disturbance processes is evaluated depending on their magnitude.

This method is limited to patients with spinal injuries and allows you to identify rapidly progressive dysfunction of the spinal cord in the acute period of spinal injury. With the development of rapidly progressive dysfunction of the spinal cord, the protein concentration in the cerebrospinal fluid will increase, and cytosis will increase. In addition, the method is time-consuming, it is necessary to purchase special equipment (polarizing photometer), which significantly reduces the possibility of its widespread use in laboratory practice.

The objective of the invention is to eliminate these drawbacks and expand the capabilities of the method by reliably assessing spinal cord function in the early stages both in the presence of discogenic radiculitis, herniated discs, trauma, and in case of latent, slowly progressing disorders associated with the costs of the profession, age-related characteristics, harmful habits, etc.

In addition, the proposed method is distinguished by its technical simplicity, the absence of the use of any special devices and chemical reagents, and therefore can be widely used in laboratories of medical institutions of any capacity.

To solve this problem, in a method for assessing the functional state of the spinal cord, including clinical studies and microscopic examination of a dried drop of cerebrospinal fluid, it is proposed in clinical studies to determine the amount of protein in the cerebrospinal fluid, and if this parameter is normal, the study of a drop of cerebrospinal fluid by wedge-shaped dehydration, moreover, in the detection in the central zone of the dried drop of crystals of salts of irregular shape with layers and leniyami diagnose disorders of the spinal cord.

To establish an objective picture of the beginning of the pathological process became possible with the advent of a new diagnostic technology - the morphology of dehydrated biological fluid (Shabalin V.N., Shatokhina S.N. Morphology of human biological fluids. Chrysostom, M., 2001, 303 pp.). The theoretical basis of the new approach to obtaining integral information is the provision on the systemic organization of biological fluids based on self-organization. A practical way to extract this information is based on our method of wedge-shaped dehydration. The essence of the method is to transfer a drop of biological fluid (blood serum, urine, cerebrospinal, intraarticular fluid, etc.) into the solid phase. A “dry” drop of biological fluid takes the form of a structured film and is called a facies. In essence, the facies is a “thin section of non-cellular tissue” and has a morphological picture characteristic of each type of fluid, which carries in itself the features caused by one or another process in the body.

Figure 1 shows the morphological picture of a dried drop of cerebrospinal fluid under ordinary microscopy, in the central part of which crystals of salts of regular rectangular shape were found (example 1).

Figure 2 shows the morphological picture of a dried drop of cerebrospinal fluid under ordinary microscopy, in the central part of which crystals of salts of irregular shape in the form of splitting, layering of layers were found (example 2).

Figure 3 shows the morphological picture of a dried drop of cerebrospinal fluid (figure 2), but in polarized light, in which inclusions of protein-lipid formations are visible, which give birefringence in polarized light.

Figure 4 shows the morphological picture of a dried drop of cerebrospinal fluid (figure 1), but in polarized light. A thin layer of structures with weak anisotropic luminescence is visible in the crystal line.

The method is as follows.

In patients with discogenic radiculitis, a hernia of the intervertebral discs, the result of injuries, as well as age-related changes in the spine, in which the physicochemical and cytological examination of the cerebrospinal fluid established normal parameters (protein concentration 0.14-0.45 g / l), cerebrospinal fluid was examined. in its native form (that is, without diluting or adding any reagents). Liquor in the amount of 0.02 ml was applied to the surface of the plastic and dried under standard conditions. After 4-10 hours, the dried sample was microscopically in ordinary light and the shape of the salt crystals in the central zone of the sample was evaluated. In the presence of salt crystals of regular rectangular shape, the physiological state of the function of the spinal cord was evaluated (Fig. 1), and in the presence of crystals of salt of irregular shape in the form of splitting, layering, the functional state of the spinal cord was assessed (Fig. 2).

To explain the phenomenon of the formation of salt crystals of irregular shape in the central zone of a dried cerebrospinal fluid sample in patients with impaired functional state of the spinal cord (discogenic sciatica, disc herniation, consequences of injuries, etc.), we studied the morphological picture of the central zone of the sample in polarized light and compared it with the picture cerebrospinal fluid of those patients in whom the physiological state of the functions of the spinal cord was noted. Figure 3 shows that with impaired function of the spinal cord, a salt crystal (sodium chloride) includes protein-lipid formations in its structure, which, in polarized light, produce birefringence. This fact indicates that cerebrospinal fluid in these patients is in a bound state with the mineral component (sodium chloride salt).

Why, then, the protein in these cases was not detected by the usual method?

During a routine clinical trial, cerebrospinal fluid is centrifuged (before determining the protein concentration in it, the supernatant of the cerebrospinal fluid is examined using a photoelectrocolorimeter), salt crystals with bound protein are precipitated, hyperproteinosis is leveled and an erroneous conclusion is drawn about the normal protein content in the cerebrospinal fluid under study. The clinician also makes an erroneous conclusion about the preserved function of the spinal cord.

Clinical examples.

Example 1. Patient P., 23 years old. The consequences of a brain injury.

Study of cerebrospinal fluid: protein 0.18 g / l, the cellular composition is normal. The study of the proposed method showed that the salt crystals in the central zone of the dried sample of native cerebrospinal fluid have a regular rectangular shape (figure 1). Conclusion: the physiological state of spinal cord function.

Further clinical examination revealed the absence of any pathological changes in the function of the spinal cord.

Example 2. Patient F., 22 years old. Examination due to increased intracranial pressure. Study of cerebrospinal fluid: protein 0.16 g / l, the cellular composition is normal. The study of the proposed method showed that the salt crystals in the central zone of the dried sample of native cerebrospinal fluid have an irregular shape (the shape of a butterfly, bow), they are marked by layering, splitting (figure 2). Conclusion: dysfunction of the spinal cord.

Further clinical examination (radiography of the cervicothoracic spine) revealed the presence of an intervertebral hernia in the thoracic spine.

Using a simple, widely available method will allow to assess dysfunction of the spinal cord at the preclinical stage of the disease, in the presence of a hidden, slowly progressing pathology, which will allow timely treatment and prevention.

Claims (1)

A method for assessing the functional state of the spinal cord, including clinical research and microscopic examination of a dried drop of cerebrospinal fluid, characterized in that during clinical trials in patients, the amount of protein in the cerebrospinal fluid is determined, and if this parameter is normal, a microscopic examination of the droplet spinal cerebral fluid by the method of wedge-shaped dehydration, moreover, if irregular salt crystals are detected in the central zone of a dried drop of crystals of salt with layering and splitting diagnose spinal cord dysfunction.

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