Possibilities of Arginine-Containing Therapy in the Treatment of Neurological Manifestations of Osteochondrosis of the Lumbar Part of the Spine

Abstract

Purpose of the study – to estimate the pathogenetic expediency of L-arginine use inpatients with neurological manifestations of osteochondrosis of the spine lumbar parton the basis of estimation of the clinical picture, cerebral Doppler data and analysis ofthe blood plasma levels of some indices of endothelial dysfunction, such as fibronectin,soluble fms-similar tyrosine kinase 1 (sFlt - 1) and tumor necrotic factor (TNF-α),using Glutargine as an example. Material and methods. 104 male patients with neurological manifestations ofosteochondrosis of the lumbar spine at the age of 25-45 years (mean age 34.05 ± 5.7)without obesity, somatic and vascular pathology and 25 practically healthy persons,who did not differ in age from groups of the patients under study, have been examined.Among the examined patients, there were 50 patients with radiculopathies against abackground of herniated intervertebral discs, verified by means of neuroimaging, and54 patients with reflex manifestations of osteochondrosis of the lumbar part of the spine.The study of the clinical picture of osteochondrosis neurological manifestations of thelumbar spine was carried out by the method of standard neurological examinationusing a visual- analogue pain scale.The state of the autonomic nervous system was assessed using standard tests forautonomic reactivity and autonomic provision of activity, as well as using theQuestionnaire to identify signs of vegetative changes and the Study Scheme to identifysigns of autonomic disorders (O.M. Wein, 1993).The study of cerebral circulation was carried out by the method of extra-intracranialDoppler ultrasonography according to the standard techniques on the Sonomed-350apparatus using the Overshut test for cerebrovascular reactivity.Concentration of fibronectin in the blood plasma, tumor necrosis factor alpha andsoluble fms- similar tyrosine kinase was investigated by enzyme immunoassay accordingto the manufacturer's procedure under laboratory conditions.The paired Student's test and Fisher's angular Phi-transformation are used.Results. Statistically significant decrease of the pain syndrome has been revealedaccording to the VAS scale in the group of patients, who took Glutargin in the complextreatment. Significant changes in autonomic homeostasis have not been revealed whenusing Glutargin. The index of endothelium-dependent vasodilation in the group ofpatients, who took glutargin after treatment, approached the values of the control group(0.3 ± 0.06 at the values in the control group - 0.3 ± 0.096).Analysis of the data of fibronectin investigation, soluble fms-similar tyrosine kinase-1(sFlt - 1) and tumor necrotic factor (TNF-α) in the groups of patients with radicularmanifestations of osteochondrosis of the spine lumbar part before and after treatmenttestifies to that there were positive changes in the studied parameters in both groupsof patients, both with the use of standard treatment, and with the use of Glutargin,however, only in the group of patients, who took Glutargin in addition to the standardtreatment, a decrease in the content of fibronectin and tumor necrotic factor in bloodplasma acquired statistical significance. The increase in the indices of soluble fmslike tyrosine kinase-1 (sFlt - 1) in both groups of patients was insignificant and notstatistically veritable.Conclusions. Glutargin use in the complex treatment of patients with radicularneurological manifestations of lumbar osteochondrosis has a positive effect on theclinical course, reliably reducing the intensity of the pain syndrome and leads to animprovement in the endothelial functional state.