RU2174022C1 - Method for treating diskogenic radiculitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves remotely exposing 1-5 fields of 4-8 cm diameter to pulsating high intensity laser radiation of 580-600 nm wavelength with impulse succession frequency being equal to 1-3 Hz, radiation impulse power density of 10 W/sm² - 200 kW/sm² during 40 s - 20 min. The method is individually adjustable by restructuring the parameters in the cited ranges. Total treatment course is 4-7 sessions long with treatment course repetition 2-3 weeks later. EFFECT: enhanced effectiveness of treatment. 1 tbl

Description

 The invention relates to medicine, in particular physiotherapy.

 Known methods for the treatment of intervertebral hernias of the disc by surgical intervention with the production of laminectomy and removal of a hernia of the disc, intradiscal administration of sclerosing drugs, underwater traction and manual therapy. [1,2].

 Surgical intervention leads to a long postoperative rehabilitation period (up to three years or more), is not always effective and often leads to disability. So, after 4 months after the operation, only 46% of patients started to work.

 The closest is a method of treating radiculitis using low-energy helium-neon, helium-cadmium and semiconductor lasers [3]. However, this method due to the low penetration ability of the radiation of these lasers in the tissue is long and ineffective. For this category of patients, treatment in a hospital, clinic or specialized hospital - sanatorium often takes several months, even using an alternation of various methods of physiotherapy. This leads to long periods of labor loss and the transfer of patients to disability.

 The technical essence of the invention is to increase efficiency and reduce treatment time.

This goal is achieved by the fact that in the method of treating discogenic radiculitis by exposure to a physical factor, according to the invention, the exposure is carried out by high-intensity rare-pulse laser radiation from 1-5 impact fields with a diameter of 4-8 cm remotely (transcutaneously) in the visible spectral range, with a pulse repetition rate of 1- 3Hz, radiation pulse power density of 10 W / cm ² - 200 kW / cm ² dose of 0.2 - 25 J / cm ² for 40 - 20 min and individualization process by rearranging the above parameters in said di pazonah during the course of treatment of 4 to 7 sessions and repetition rates after 2 - 3 weeks.

The method is as follows. After a comprehensive examination, establishing the range, indications for conservative treatment and the appointment of laser therapy, a controlled cutaneous planning of the radiation fields is performed. Treatment begins with exposure to the main focus with the center of the irradiation field on the herniated disc. If necessary, extended or additional radiation fields are used with the inclusion of paravertebral or distant radicular lesion zones. The use of a flexible fiber with a fixing device allows the patient to be released into the procedure in a position convenient for him, optimizing the conditions and technology of irradiation. This ensures the natural relaxation of soft tissues in the affected area. Irradiation of the planned fields is carried out in a pulsed mode with a pulse repetition rate of 1 - 3 Hz, in the visible spectral range with a radiation pulse power density of 10 W / cm ² to 200 kW / cm ² and a dose of 0.2 - 25 J / cm ² from 40 s to 20 min.

 The minimum parameters are used in the acute form of the lesion, the maximum in chronic. Treatment is carried out daily. The general course of treatment is from 4 to 7 sessions. If necessary, repeat the course after 2 to 3 weeks.

The effectiveness of the method was studied in 135 patients with discogenic radiculitis aged 26 to 64 years (44.3 ± 5.6 years), of which 92% were men. In 85% of cases, the radicular symptom complex is the result of hernia compression of the intervertebral discs of the roots of the lumbosacral region (L _4-5 C ₁ ). In 63% of patients, the starting moment of the development of the lesion was trauma against the background of pronounced degenerative changes in the spine. In 46% of patients, an acute form of the disease was noted, where the leading complaint was a sick syndrome, movement restriction, curvature of the spine, impaired sensitivity, parasthesia. All patients were diagnosed after a thorough clinical, instrumental and laboratory examination. The posterolateral hernias of the intervertebral discs of the lumbosacral region were more often diagnosed. Taking into account the testimony of patients, he planned surgical treatment, which for one reason or another (most often the patient’s refusal) was not carried out. After the abolition of all types of traditional physiotherapy (except massage and exercise therapy), patients were sent for therapy with high-intensity pulsed laser radiation (VIILI). The evidence of the possibility of achieving a positive result is the performance indicators of laser therapy VIILI (table), confirmed by clinical, radiological and computed tomography studies. Clinical observations were carried out by the authors in the Main Military Clinical Hospital. N.N. Burdenko since 1984 and the Bashkir Republican Oncology Center since 1992.

 According to the clinical course, the patients we observed were of moderate severity. Most patients (82%) were treated inpatiently, the rest - on an outpatient basis. The average number of days of treatment with VIILI therapy was 9 days. In the control group (46 patients) with treatment without laser therapy, treatment averaged 36 days. A significant reduction in the duration of treatment is associated with the peculiarities of the pathological effect of the laser therapy of VIILI. After 2-3 procedures with the help of X-ray and CT examinations, the beginning of reduction of the herniated disc was noted. In 78% of cases, the onset of pain reduction occurred after 1 - 2 procedures.

 As can be seen from the table, in 15% of patients, on average, after 6 procedures it was possible to achieve practical recovery, in 59% - significant improvement and treatment was discontinued due to patients' resistance to the treatment method. In 17% of patients, after a significant decrease in pain, a short-term (1-2 days) wave-like increase in pain was noted, but the latter did not reach their initial severity, therefore, they could not be interpreted as an exacerbation as a response to the treatment method. Depending on the degree of effectiveness of laser therapy, the range of motion in the spine increased, the patient's motion function was restored, curvature of the spine, pain, and parasthesia decreased or disappeared. The general condition of the patient improved (sleep, appetite, mood, bowel function).

 To illustrate the above material, examples of clinical observation of patients with the final parameters of the method of laser therapy VIILI are given.

 Example 1

Patient M., 42 years old, was admitted for treatment on February 22, 1990 (patient history N 2806). Diagnosed with a lateral herniation of the intervertebral disc L ₄ -L ₅ with radicular syndrome L ₅ on the right. He complained of sharp pain in the lumbar region with radiation on the outer surface of the right thigh and lower leg, limitation of movement in the lower back, inability to move independently. Pain for 12 years. The onset of the disease is associated with hypothermia after physical work, annual exacerbations of the disease are noted. He was treated on an outpatient basis, three times in a hospital. The last exacerbation appeared a month ago, was hospitalized. The position in bed is forced, on the left side, the legs are bent. Moderate right-sided scoliosis and muscle tension are noted. Palpation of the spinous processes of L ₄ - L ₅ painful. Reduced sensitivity along the outer edge of the right lower limb. Symptom Laseg from the corner to the right - 12 ^o , left - 50 ^o . On radiographs of the spine - lumbar lordosis, the angles of bodies L ₄ - L ₅ are smoothed. When pneumomyelography revealed a hernial protrusion of the intervertebral disc L ₄ - L ₅ on the right. Conducted conservative treatment (medication, underwater stretching, massage, physiotherapy) did not produce an effect. The patient began a course of therapy VIILI. The treatment was carried out from one direct lumbosacral field with a diameter of 4 cm, centered on each projection of the lateral herniation of the intervertebral disc on the right with the inclusion of the right paravertebral zone of this level with laser radiation with a wavelength of 580 - 600 nm, a pulse repetition rate of 1 Hz and a pulse power density of radiation of 10 W / cm ² at a dose of 0.2 J / cm ² , 40 pulses per session. The course of treatment was 4 sessions. Immediately after the first laser therapy session, there was a decrease in pain within 25-50% of the initial, after the second - a noticeable improvement. The mobility of the spine increased (the patient walks freely around the department), the sensitivity on the right leg has improved. Procedures 3, 4 were fixing in nature. Discharged with significant improvement. Aimed at outpatient rehabilitation of exercise therapy. Follow-up examination in a month: the patient after a short course of exercise therapy started the main work. Examination after six months - the clinical effect is persistent.

 Example 2

Patient E., 53 years old. He was admitted to the hospital on January 7, 1991 (case history of patient N 127) with complaints of pain in the lumbar region with radiation to the right buttock, thigh and lower leg, with severe numbness of the outer surface of the right lower leg and foot. Sick for 10 years. The disease is associated with trauma. It was treated on an outpatient basis and folk remedies without much effect. The last exacerbation lasts 8 months, of which 3 months was on the sick leave. Objectively: the patient cannot straighten and walk, the position in bed is bent, on his left side. Right-sided scoliosis and kyphosis of the lumbar spine. The lumbar muscles are on the right. The knee and plantar reflexes on the right are somewhat reduced, while the Achilles are absent. When tapping on the spinous processes of L ₅ and C ₁ intensifies pain along the C ₁ root. Symptom Lasega on the right 35 ^o , left 50 ^o . On a CT scan of the spine - right-sided scoliosis, a sharp narrowing of the gap L ₅ - C ₁ with intervertebral disc herniation on the right. The final diagnosis: a hernia of the intervertebral disc L ₅ -C ₁ with radicular syndrome C ₁ on the right. The patient was offered surgical treatment, which he refused. For 45 days, he took complex treatment: painkillers and densitizing agents, ultrasound, ampuls, UV treatment, helium-neon laser irradiation (10 sessions), mud applications, underwater traction, massage, exercise therapy. No noticeable improvement was observed. After a week-long break, a course of laser therapy has begun.

The treatment was carried out from 5 direct fields: lumbosacral, right gluteal, femoral, ankle and ankle with a diameter of 8 cm remotely onto the projection of a pronounced area of pain along the posterior surface of the right lower limb. Pulse laser irradiation was used with a radiation wavelength of 580 - 600 nm, a pulse frequency of 3 Hz, a radiation power density of 200 kW / cm ² at a dose of 25 J / cm ² for 20 minutes. The course of treatment was 7 procedures. A noticeable decrease in pain was noted after 2 procedures (40%), after 4 procedures a significant improvement was noted. Almost pain does not bother. There is a staged sequence of pain reduction, starting with the lumbosacral, buttocks, thighs and lower legs. The patient straightened up, began to walk around the department and go to the procedures. After a 10-day rehabilitation course, exercise therapy with a practical recovery was discharged home. A year later, no complaints. There is a lack of muscles of the Achilles reflex on the right and hypesthesia along the outer edge of the foot. He works in the specialty. He is engaged in independently physiotherapy exercises.

List of references
1. Shustin BA Panyushkin A.I. Clinic and surgical treatment of discogenic lumbosacral sciatica. L .: Medicine, 1985

 2. Ermolenko V. F. Susin V.I. Treatment outcomes for discogenic lumbosacral radiculitis. Modern issues of diagnosis and treatment in a multidisciplinary hospital, part 1. Moscow: Voenizd., 1990, p. 274.

 3. Strelkov N.I. Diseases of the nervous system (radiculitis). Handbook of Physiotherapy, Ed. prof. Yasnogorsky V.G. M .: Medicine, 1992, p. 181-186.

Claims (1)

A method of treating discogenic radiculitis by exposure to a physical factor, characterized in that the exposure is carried out by high-intensity pulsed laser radiation from 1 to 5 fields with a diameter of 4 to 8 cm at a distance wavelength of 580 to 600 nm, with a pulse repetition rate of 1 to 3 Hz, radiation pulse power density 10 W / cm ² - 200 kW / cm ² , a dose of 0.2 - 25 J / cm ² for 40 s - 20 min and the individualization of the method due to the adjustment of the above parameters in the indicated ranges with a course of treatment from 4 to 7 sessions and repetition courses in 2-3 weeks.

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