nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2025-2-87-92nnp-2490Research ArticleCLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯDiscogenic lumbar pain due to fibrous ring ruptureДискогенная поясничная боль вследствие трещины фиброзного кольцаhttps://orcid.org/0000-0003-4950-144XИсайкинА. И.IsaykinA. I.

Кафедра нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского 

119021, Москва, ул. Россолимо, 11, стр. 1

Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine 

11, Rossolimo St., Build. 1, Moscow 119021

alexisa68@mail.ruhttps://orcid.org/0000-0002-7384-6715АхмеджановаЛ. Т.AkhmedzhanovaL. T.

Кафедра нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского 

119021, Москва, ул. Россолимо, 11, стр. 1;117513, Москва, ул. Островитянова, 1

Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine 

11, Rossolimo St., Build. 1, Moscow 119021;1, Ostrovityanovа St., Moscow 117513

https://orcid.org/0000-0002-0834-4030ВахнинаН. В.VakhninaN. V.

Кафедра нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского 

119021, Москва, ул. Россолимо, 11, стр. 1

Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine 

11, Rossolimo St., Build. 1, Moscow 119021

https://orcid.org/0009-0001-6636-7142ИсайкинИ. А.IsaykinI. A.

Кафедра нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского 

119021, Москва, ул. Россолимо, 11, стр. 1

Department of Nervous Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine 

11, Rossolimo St., Build. 1, Moscow 119021

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)Russian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет); ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University); N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian Federation2025210420251728792Copyright © Isaykin A.I., Akhmedzhanova L.T., Vakhnina N.V., Isaykin I.A., 20252025Исайкин А.И., Ахмеджанова Л.Т., Вахнина Н.В., Исайкин И.А.Isaykin A.I., Akhmedzhanova L.T., Vakhnina N.V., Isaykin I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/2490

In most cases, pain in the lumbar spine is caused by damage to the intervertebral discs (IVD), facet joints and/or sacroiliac joints and in these cases is regarded as non-specific lumbar pain (NLP). The pathogenetic basis of axial discogenic pain (DP) is inflammation and ingrowth of nerve fibers into the structure of IVD. DP is confirmed by the positive effect of epidural administration of local anesthetics and glucocorticoids. One of the little-known DP variants is the rupture of a fibrous ring (RFR), which is detected by magnetic resonance imaging in the T2 weighted mode as a zone with high signal intensity in the posterior segments of a fibrous ring. The recommended first-line treatment for NLP is patient's education, tips for maintaining activity, physiotherapy exercises and manual therapy. For the drug therapy nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxers are used. We describe two clinical observations of patients with NLP with RFR. Educational program, Aertal as NSAID and Mydocalm Long as muscle relaxer were effective in terms of therapy. The issues of optimization of treatment of patients with NLP are discussed.

Поясничная боль (ПБ) чаще всего вызвана поражением межпозвоночных дисков (МПД), фасеточных суставов и/или крестцовоподвздошного сочленения и расценивается в таких случаях как неспецифическая ПБ (НПБ). Патогенетической основой аксиальной дискогенной боли (ДБ) являются воспалительная реакция и прорастание нервных волокон в структуры МПД. ДБ подтверждает положительный эффект от эпидурального введения местных анестетиков и глюкокортикоидов. Одним из малоизвестных вариантов ДБ является трещина фиброзного кольца (ТФК), которая определяется при магнитно-резонансной томографии в Т2-взвешенном режиме в виде зоны высокоинтенсивного сигнала в задних отделах фиброзного кольца. В качестве лечения первой линии НПБ рекомендуются информирование пациента, советы по сохранению активности, лечебная физкультура и мануальная терапия. Методом выбора медикаментозной терапии являются нестероидные противовоспалительные препараты (НПВП), миорелаксанты. Представлено наблюдение двух пациентов с НПБ, у которых выявлена ТФК, а в качестве терапии были эффективны образовательная программа, использование Аэртала в качестве НПВП и Мидокалма Лонг как миорелаксанта. Обсуждаются вопросы оптимизации ведения пациентов с НПБ.

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The authors declare that there are no conflicts of interest present.