Инновационные методы дифференциальной диагностики цервикалгии: научный обзор

Целью данной обзорной статьи является систематизация и анализ современных инновационных методов дифференциальной диагностики цервикалгии. Цервикалгия, или боль в шее, является распространенной патологией, часто связанной с дегенеративно-дистрофическими изменениями в шейном отделе позвоночника. В последние годы появились новые методы диагностики, такие как ультразвуковая эластография, функциональная магнитно-резонансная томография (фМРТ), молекулярная диагностика, диффузионно-взвешенная МРТ, постуральный анализ, а также технологии виртуальной и дополненной реальности. Эти инновационные методы позволяют более точно и объективно оценить состояние шейного отдела позвоночника, выявить ранние признаки патологических изменений и провести дифференциальную диагностику болей в шее. Также рассматриваются такие передовые технологии, как МРТ спектроскопия и оптическая когерентная томография. Особое внимание уделяется использованию искусственного интеллекта и машинного обучения для анализа медицинских изображений. В данной статье обсуждаются преимущества и перспективы этих инновационных подходов, а также их влияние на улучшение качества медицинской помощи и повышение качества жизни пациентов. 

1. Safiri S., Kolahi A.-A., Hoy D., Buchbinder R., Mansournia M. A., Bettampadi D., … & Naghavi M. Global, regional, and national burden of neck pain in the general population, 1990–2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ. 2020;368. https://doi.org/10.1136/bmj.m791

2. David D., Giannini C., Chiarelli F., & Mohn A. Text Neck Syndrome in Children and Adolescents. Frontiers in Pediatrics. 2021;9: 635643. https://doi.org/10.3389/fped.2021.635643

3. Popescu A., & Lee H. Neck pain and lower back pain. Medical Clinics. 2020;104(2): 279-292. https://doi.org/10.1016/j.mcna.2019.10.007

4. Cohen S. P., & Hooten W. M. Advances in the diagnosis and management of neck pain. BMJ. 2017;358. https://doi.org/10.1136/bmj.j3221

5. Vikat A., Rimpelu00e4 A., Salminen J. J., & Rimpelu00e4 M. Neck or shoulder pain and low back pain in Finnish adolescents. Scandinavian Journal of Rheumatology. 2000;29(3): 166-172. https://doi.org/10.1080/030097400447912

6. Assessment of stresses in the cervical spine caused by posture and position of the head. PubMed. 2014, November 1. https://pubmed.ncbi.nlm.nih.gov/25393825/

7. Fares J., Fares M. Y., & Fares Y. Musculoskeletal neck pain in children and adolescents: risk factors and complications. Surgical Neurology International. 2017;8. https://doi.org/10.4103/sni.sni_168_17

8. Adamson G., Murphy S., Shevlin M., Buckle P., & Stubbs D. Profiling schoolchildren in pain and associated demographic and behavioural factors: A latent class approach. Pain. 2007;129(3): 295u2013303. https://doi.org/10.1016/j.pain.2006.10.015

9. Shan Z., Hong Y., Zeng Q., & Pi J. How schooling and lifestyle factors affect neck and shoulder pain? BMC Musculoskeletal Disorders. 2014;15(1): 1-9. https://doi.org/10.1186/1471-2474-15-245

10. Dieleman J. L., Cao J., Chapin A., Chen C., Li Z., Liu A., ... & Murray C. J. US health care spending by payer and health condition, 1996-2016. Jama. 2020;323(9): 863-884. https://doi.org/10.1001/jama.2020.0734

11. Lezin N., & Watkins-Castillo S. The impact of musculoskeletal disorders on Americans-opportunities for action, executive summary of the burden of musculoskeletal diseases in the United States: Prevalence, societal and economic cost. Bone and Joint Initiative. https://doi.org/10.1016/j.joca.2007.03.004

12. Price J., Rushton A., Tyros I., Tyros V., & Heneghan N. R. Effectiveness and optimal dosage of exercise training for chronic non-specific neck pain: A systematic review with a narrative synthesis. PloS One. 2020;15(6): e0234511. https://doi.org/10.1371/journal.pone.0234511

13. Barbero M., Navarro-Santana M. J., Palacios-Ceu00f1a M., Ortega-Santiago R., Cescon C., Falla D., & Fernu00e1ndez-de-Las-Peu00f1as C. Clinical significance and diagnostic value of pain extent extracted from pain drawings: a scoping review. Diagnostics. 2020;10(8): 604. https://doi.org/10.3390/diagnostics10080604

14. Romero-Morales C., Bravo-Aguilar M., Abuin-Porras V., Almazan-Polo J., Calvo-Lobo C., Martinez-Jimenez E. M., ... & Navarro-Flores E. Current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Disease-a-Month. 2021;67(10): 101210. https://doi.org/10.1016/j.disamonth.2021.101210

15. Khanum F., Khan A. R., Khan A., Aafreen A., Khan A. A., Ahmad A., ... & Obaidat S. M. Predicting mechanical neck pain intensity in computer professionals using machine learning: identification and correlation of key features. Frontiers in Public Health. 2024;12: 1307592. https://doi.org/10.3389/fpubh.2023.1307592

16. Liew B. X. W., Kovacs F. M., Ru00fcgamer D., & Royuela A. Machine learning versus logistic regression for prognostic modelling in individuals with non-specific neck pain. European Spine Journal. 2022;31(8): 2082-2091. https://doi.org/10.1007/s00586-021-06936-8

17. Anan T., Kajiki S., Oka H., Fujii T., Kawamata K., Mori K., & Matsudaira K. Effects of an artificial intelligenceu2013assisted health program on workers with neck/shoulder pain/stiffness and low back pain: randomized controlled trial. JMIR mHealth and uHealth. 2021;9(9): e27535. https://doi.org/10.2196/27535

18. Park C., Mummaneni P. V., Gottfried O. N., Shaffrey C. I., Tang A. J., Bisson E. F., ... & Chan A. K. Which supervised machine learning algorithm can best predict achievement of minimum clinically important difference in neck pain after surgery in patients with cervical myelopathy? A QOD study. Neurosurgical Focus. 2023;54(6). https://doi.org/10.3171/2023.3.FOCUS2344

19. Jimu00e9nez-Grande D., Farokh Atashzar S., Martinez-Valdes E., Marco De Nunzio A., & Falla D. Kinematic biomarkers of chronic neck pain measured during gait: A data-driven classification approach. Journal of Biomechanics. 2021;118: 110190. https://doi.org/10.1016/j.jbiomech.2021.110190

20. Harvie D. S., Smith R. T., Moseley G. L., Meulders A., Michiels B., & Sterling M. Illusion-enhanced virtual reality exercise for neck pain: A replicated single case series. The Clinical Journal of Pain. 2019;36(1): 101-109. https://doi.org/10.1097/AJP.0000000000000777

21. Grassini S. Virtual reality assisted non-pharmacological treatments in chronic pain management: A systematic review and quantitative meta-analysis. International Journal of Environmental Research and Public Health. 2022;19(7): 4071. https://doi.org/10.3390/ijerph19074071

22. Dieterich A. V., Yavuz U. u015e., Petzke F., Nordez A., & Falla D. Neck Muscle Stiffness Measured with Shear Wave Elastography in Women with Chronic Nonspecific Neck Pain. Journal of Orthopaedic & Sports Physical Therapy. 2020;50(4): 179-188. https://doi.org/10.2519/jospt.2020.9212

23. Ertekin E. Neck Pain in Rounded Shoulder Posture: Clinico-Radiologic Correlation by Shear Wave Elastography. International Journal of Clinical Practice. 2022; e14240. https://doi.org/10.1111/ijcp.14240

24. Onda A., Onozato K., & Kimura M. Clinical features of neck and shoulder pain (Katakori) in Japanese hospital workers. Fukushima Journal of Medical Science. 2022;68(2): 79-87. https://doi.org/10.5387/fms.2022-1

25. Velu00e1zquez Saornil J., Su00e1nchez Milu00e1 Z., Campu00f3n Chekroun A., Barru00e1gu00e1n Casas J. M., Frutos Llanes R., & Rodru00edguez Sanz D. Effectiveness of Dry Needling and Ischaemic Trigger Point Compression of the Levator Scapulae in Patients with Chronic Neck Pain: A Short-Term Randomized Clinical Trial. Journal of Clinical Medicine. 2023;12(19): 6136. https://doi.org/10.3390/jcm12196136

26. Kragel P. A., Han X., Kraynak T. E., Gianaros P. J., & Wager T. D. Functional MRI can be highly reliable, but it depends on what you measure: A commentary on Elliott et al.(2020). Psychological Science. 2021;32(4): 622-626. https://doi.org/10.1177/0956797620985835

27. Boutet A., Madhavan R., Elias G. J., Joel S. E., Gramer R., Ranjan M., ... & Lozano A. M. Predicting optimal deep brain stimulation parameters for Parkinsonu2019s disease using functional MRI and machine learning. Nature Communications. 2021;12(1): 3043. https://doi.org/10.1038/s41467-021-23298-1

28. Cortese S., Aoki Y. Y., Itahashi T., Castellanos F. X., & Eickhoff S. B. Systematic review and meta-analysis: resting-state functional magnetic resonance imaging studies of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2021;60(1): 61-75. https://doi.org/10.1016/j.jaac.2020.10.011

29. Yin Y., He S., Xu J., You W., Li Q., Long J., ... & Gong Q. The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies. The Journal of Headache and Pain. 2020;21(1): 1-20. https://doi.org/10.1186/s10194-020-01133-1

30. Ihara N., Wakaizumi K., Nishimura D., Kato J., Yamada T., Suzuki T., ... & Morisaki H. Aberrant resting-state functional connectivity of the dorsolateral prefrontal cortex to the anterior insula and its association with fear avoidance belief in chronic neck pain patients. PLOS ONE. 2019;14(8): e0221023. https://doi.org/10.1371/journal.pone.0221023

31. Wang X., Ni X., Ouyang X., Zhang Y., Xu T., Wang L., ... & Zhao L. Modulatory effects of acupuncture on raphe nucleus-related brain circuits in patients with chronic neck pain: A randomized neuroimaging trial. CNS Neuroscience & Therapeutics. 2024;30: e14335. https://doi.org/10.1111/cns.14335

32. Yang Q., Xu H., Zhang M., Wang Y., & Li D. Volumetric and functional connectivity alterations in patients with chronic cervical spondylotic pain. Neuroradiology. 2020;62(6): 741-748. https://doi.org/10.1007/s00234-020-02418-7

33. Adam G., Darcourt J., Roques M., Ferrier M., Gramada R., Meluchova Z., ... & Bonneville F. Standard diffusion-weighted imaging in the brain can detect cervical internal carotid artery dissections. American Journal of Neuroradiology. 2020;41(2): 318-322. https://doi.org/10.3174/ajnr.A6394

34. Zhang J. K., Jayasekera D., Javeed S., Greenberg J. K., Blum J., Dibble C. F., ... & Ray W. Z. Diffusion basis spectrum imaging predicts long-term clinical outcomes following surgery in cervical spondylotic myelopathy. The Spine Journal. 2023;23(4): 504-512. https://doi.org/10.1016/j.spinee.2022.11.003

35. Zhang J. K., Javeed S., Greenberg J. K., Dibble C. F., Song S.-K., & Ray W. Z. Diffusion basis spectrum imaging identifies clinically relevant disease phenotypes of cervical spondylotic myelopathy. Clinical Spine Surgery. 2022;36(3): 134-142. https://doi.org/10.1097/BSD.0000000000001383

36. Farrell S. F., Cowin G., Pedler A., Durbridge G., & Sterling M. Spinal cord injury is not a feature of chronic whiplash-associated disorder: A magnetic resonance spectroscopy study. European Spine Journal. 2020;30(3): 591-597. https://doi.org/10.1007/s00586-020-06652-3

37. Chen Y.-L., He Z.-G., Wang Q., Xiang H.-B., Fan L., & Xiong J. Specific patterns of spinal metabolite ratio underlying u03b1-me-5-ht-evoked pruritus compared with compound 48/80 based on proton nuclear magnetic resonance spectroscopy. Current Medical Science. 2020;40(4): 761-766. https://doi.org/10.1007/s11596-020-2238-y

38. Wang L., Yu J., Shu D., Huang B., Wang Y., & Zhang L. Primary endodermal hemangiopericytoma/solitary fibrous tumor of the cervical spine: a case report and literature review. BMC Surgery. 2021;21(1): 405. https://doi.org/10.1186/s12893-021-01366-y

39. Kollmer J., & Bendszus M. Magnetic resonance neurography: improved diagnosis of peripheral neuropathies. Neurotherapeutics. 2021;18(4): 2368-2383. https://doi.org/10.1007/s13311-021-01084-3

40. Takahara T., Hendrikse J., Yamashita T., Mali W. P., Kwee T. C., Imai Y., & Luijten P. R. Diffusion-weighted MR neurography of the brachial plexus: feasibility study. Radiology. 2008;249(2): 653-660. https://doi.org/10.1148/radiol.2492080264

41. Tadenuma H., Abe K., Yoneyama M., Goto Y., Takeyama M., Tanaka I., & Sakai S. Improved visualization of diffusion-prepared MR neurography (SHINKEI) in the lumbosacral plexus combining high-intensity reduction (HIRE) technique. Magnetic Resonance Imaging. 2020;69: 22u201327. https://doi.org/10.1016/j.mri.2020.02.006

42. Eguchi Y., Enomoto K., Sato T., Watanabe A., Sakai T., Norimoto M., Yoneyama M., Aoki Y., Suzuki M., Yamanaka H., Tamai H., Kobayashi T., Orita S., Suzuki M., Inage K., Shiga Y., Hirosawa N., Inoue M., Koda M., . . . Ohtori S. Simultaneous MR neurography and apparent T2 mapping of cervical nerve roots before microendoscopic surgery to treat patient with radiculopathy due to cervical disc herniation: Preliminary results. Journal of Clinical Neuroscience. 2020;74: 213u2013219. https://doi.org/10.1016/j.jocn.2019.08.099

43. Sato T., Eguchi Y., Norimoto M., Inoue M., Enomoto K., Watanabe A., ... & Ohtori S. Diagnosis of lumbar radiculopathy using simultaneous MR neurography and apparent T2 mapping. Journal of Clinical Neuroscience. 2020;78: 339-346. https://doi.org/10.1016/j.jocn.2020.07.036

44. Meng W., Chan B. W., Harris C., Freidin M. B., Hebert H. L., Adams M. J., ... & Smith B. H. A genome-wide association study finds genetic variants associated with neck or shoulder pain in UK Biobank. Human Molecular Genetics. 2020;29(8): 1396-1404. https://doi.org/10.1093/hmg/ddaa041

45. Elliott J. M., Rueckeis C. A., Pan Y., Parrish T. B., Walton D. M., & Linnstaedt S. D. microRNA let-7i-5p mediates the relationship between muscle fat infiltration and neck pain disability following motor vehicle collision: A preliminary study. Scientific Reports. 2021;11(1): 3140. https://doi.org/10.1038/s41598-021-82411-1

46. Giroud M., Karbiener M., Pisani D. F., Ghandour R. A., Beranger G. E., Niemi T., ... & Amri E. Z. Let-7i-5p represses brite adipocyte function in mice and humans. Scientific Reports. 2016;6(1): 28613. https://doi.org/10.1038/srep28613

47. Goldstein E. D., Gopal N., Badi M. K., Hodge D. O., De Havenon A., Glover P., ... & Meschia J. F. CGRP, migraine, and brain MRI in CADASIL: A pilot study. The Neurologist. 2023;28(4): 231-236. https://doi.org/10.1097/NRL.0000000000000398

48. Gao Y., Chen Z., Chen S., Wang S., & Lin J. Risk factors for neck pain in college students: a systematic review and meta-analysis. BMC Public Health. 2023;23(1): 1502. https://doi.org/10.1186/s12889-023-11570-0

49. Khan Z. K., Ahmed S. I., Baig A. A. M., & Farooqui W. A. Effect of post-isometric relaxation versus myofascial release therapy on pain, functional disability, rom and qol in the management of non-specific neck pain: a randomized controlled trial. BMC Musculoskeletal Disorders. 2022;23(1): 567. https://doi.org/10.1186/s12891-022-05683-8

50. Mahmoud N. F., Hassan K. A., Abdelmajeed S. F., Moustafa I. M., & Silva A. G. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Current Reviews in Musculoskeletal Medicine. 2019;12(4): 562u2013577. https://doi.org/10.1007/s12178-01