RU2201266C2 - Method for treating painful and compression syndromes of lumbar osteochondrosis - Google Patents

Abstract

FIELD: medicine, neurology. SUBSTANCE: one should epidurally apply two electrodes (active and indifferent ones) with microirrigator onto affected radicle's coupling. Indifferent electrode should be placed opposite to active one. Electric current should be supplied through these electrodes. Medicinal preparations come through microirrigator. The present method enables to increase efficiency in treating painful and compression syndromes of lumbar osteochondrosis. EFFECT: improved results of therapy.

Description

 The invention relates to medicine, namely to neurology and neurosurgery, and is intended for the complex surgical treatment of pain and compression syndromes caused by degenerative-dystrophic diseases of the spine.

 There is a method of treating compression lesions of nerve trunks (patent RU 2004265 C1 5 A 61 N l / 36 publ. 15.12.93 BI 45/46), in which, after eliminating compression of the affected root, the first pair of electrodes is epidurally mounted on it. To simulate the natural flow of pulses along the efferent and afferent paths, one of the electrodes is placed on the ventral (motor), and the other on the dorsal (sensitive) portion of the root. In order to actively influence the segmental apparatus of the spinal cord, a second pair of electrodes is placed on a healthy root adjacent to the affected one.

 However, the impact on the lesion with only one electric current is insufficient for chronic recurrent pain syndromes, prolonged compression of the spinal roots and gross inflammatory or atrophic changes in them, as well as to prevent the development of scar-adhesions at the site of surgery.

 Closest to the claimed method is a method of treating osteochondrosis of the spine with radiculo-ischemic syndrome (patent RD 2062124 Cl A 61 N 1/20 publ. 06/20/96. BI 17), which consists in installing directly to the affected root of the active electrode with microirrigator and placing the indifferent electrode on skin of the distal part of the same lower limb. At the same time, medications are brought through the microirrigator to the radicular-spinal zone and exposed to the same zone with direct electric current.

 The main disadvantage of this method is the presence of a weak electric field in the lesion due to the large distance between the active and indifferent electrodes, because the indifferent electrode is placed on the skin of the lower limb. As a result, this leads to a low concentration of medications and insufficient electrical and drug stimulation of the radicular-spinal zone.

 The objective of the invention is to increase the effectiveness of electrical stimulation and drug exposure and reduce treatment time.

 The essence of the claimed invention lies in the fact that in a method of treating pain and compression syndromes of lumbar osteochondrosis, comprising installing an active electrode with a microirrigator epidurally on the root sleeve, applying drugs to the root and applying an electric current to it, the indifferent electrode is mounted on the affected root of the oppositely active electrode. This allows you to create a local electric field and the optimal concentration of the drug substance in the affected root zone. At the same time, due to the local directivity of the electric field to the affected root, the dose of the drug is reduced and at the same time the drug and electrostimulation effect are increased.

 The method is as follows. After removing the compressing substrate during the operation, two electrodes (active and indifferent) are installed on the spine, which are bundles of a thin silver or nichrome wire insulated with fluoroplastic with a total diameter of 300-400 microns, and a microirrigator, the free ends of which are displayed on the skin and attached to it interrupted sutures. An indifferent electrode is mounted on the spine opposite to the active one. In the postoperative period, drugs (vascular - trental, actovegin, etc., anesthetics - novocaine, lidocaine, etc., steroid hormones - kenalog, diprospan, etc.) are brought through the microirrigator to the radicular-spinal zone. At the same time, an electric current with a low voltage of 0.5-3 V and a current of 10-50 μA is supplied through the electrodes to the affected area. The polarity of the indifferent electrode is opposite to the polarity of the drug being administered. Exposure to electric current is carried out for 30-40 minutes. three times a day for 2-3 weeks, after which the electrodes and microirrigator are removed.

 The medical and social effectiveness of the proposed method lies in the fact that it can be used to treat both pain and compression syndromes with degenerative-dystrophic lesions of the lumbar spine. Local drug and electrical stimulation of the radicular-spinal zone provides restoration of lost functions, allows to achieve a long-lasting analgesic effect in the postoperative period, and significantly reduces the development of the scar-adhesion process.

 The method was applied in 4 patients with degenerative-dystrophic lesions of the spine with compression radicular syndrome (compression of the roots of herniated discs was revealed in 3 patients, compression was caused by lateral spinal stenosis in 1 patient). The observation results are from 3 to 5 months. All patients showed positive dynamics: reduction of pain, restoration of lost functions of interested neural structures, early recovery of disability (compared with patients who received conventional treatment).

 Example. Patient S., 34 years old, was admitted to SarnIIITO with complaints of lower back pain radiating to the posterolateral surface of the left leg, weakness in the left foot, periodic difficulty urinating, impaired posture.

 Operated 6 years ago for discogenic compression of the S1-root on the left: a partial laminectomy of the L5 vertebra was performed, the paramedian hernia of the L5-S1 disk on the left was removed. For 1.5 years I felt satisfactory, did the usual work. After lifting the severity, back pain again appeared with irradiation along the posterolateral surface of the left leg, muscle weakness of the extensors of the left foot, and periodic difficulty in urinating.

 Clinical and radiological diagnosis: osteochondrosis of the lumbar spine. Condition after partial laminectomy of the L5 vertebra with removal of a hernia of the L5-S1 disc on the left. Hernia of the L4-L5 disk on the left with compression of the L5 root and syndrome of paralyzing sciatica of the radicular-medullary type. Paresis of the left foot. Partial dysfunction of the pelvic organs.

 Operated on the 5th day after receipt. Under intubation anesthesia with posterior access, the old postoperative scar was excised and the approach to the arches of L4, L5 and S1 vertebrae was performed. Next, a yellow ligament between the L4-L5 vertebrae on the left is excised. When examining the 5th (L5) lumbar spinal root: it is cyanotic in color, swollen and stretched on a massive fragment (6x9 mm in size) of a prolapsed hernia L4-L5 of the intervertebral disc. The posterior longitudinal ligament is dissected and the fallen part of the disc is removed. The root was decompressed up to its exit from the intervertebral foramen. Two electrodes and a microirrigator are installed on the spine from the dorsal and ventral sides in such a way that the indifferent electrode is opposite to the active one, they are brought out to the skin and fixed to it with interrupted sutures. The postoperative wound is sutured tightly. On the next day, as in the next 3 weeks, Kenalog solutions were administered daily in the microirrigator at a rate of 1 mg / kg body weight to stop inflammation and prevent scar adhesions and a 2% lidocaine solution in the first 3 days for adequate analgesia with simultaneous exposure to electric current 3 times a day for 30-40 minutes (current parameters 20 μA, 0.83 V). On the 22nd day, the electrodes and microirrigator were removed, the sutures were removed, the wound healed by first intention.

 In the future, massage of the lower extremities, cutaneous electrical stimulation of the peroneal muscle group on the left is prescribed. After 4 weeks, the patient was activated and was discharged in a soft cloth corset for outpatient treatment by a neurologist at the place of residence. When viewed after 3 months, the patient does not complain, the strength of the muscles of the left foot is satisfactory, no dysfunctions of the pelvic organs were found.

 Complications with this method of treatment were not observed.

Claims (1)

 A method for the treatment of pain and compression syndromes of lumbar osteochondrosis, including installing an active electrode with a microirrigator epidurally on the root sleeve, bringing drugs to the root and applying an electric current to it, characterized in that the indifferent electrode is mounted on the affected root with the opposite active electrode.