RU2380126C1 - Method of treating spinal osteochondrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, neurology. The method involves as follows. The points are exposed to the low intensity laser light generated with a light guide inserted through a needle. The exposure is performed at wave length 630 nm through the needle inserted at the angle 40 - 45° at the depth 30 - 35 mm. One of the points is a median located between spinous processes of vertebras adjoining the involved intervertebral disk. Three points are paravertebral and distanced 1.5 cm from each other and from spinous processes, while being aligned with a projection of intervertebral foramens. The exposure takes 5 minutes for each point. The therapy represents a course.

EFFECT: method activates reparative processes in tissues, reduces painful sensitivity due to reduced pulse activity of nervous fibres, while segmental-metameric bonds enable to create reflex phenomena of viscera.

3 cl, 2 ex, 4 dwg

Description

The invention relates to medicine, and is intended for the treatment of osteochondrosis of the spine using laser therapy interstitial method.

A known method of surgical treatment of radicular syndrome in osteochondrosis of the lumbar spine (RF patent No. 2054956, A61N 5/06). The method includes access to the pulpous nucleus of the intervertebral disc through a 4.0 mm channel created by laser radiation with a power of 50 W and a frequency of 50 Hz, and subsequent evaporation of the pulp nucleus substance within 2-3 minutes by deflecting the fiber-emitter from the original axis by 5 7 ° in different directions, forming a cavity with a volume of 2.0-2.5 cm ³ in the core. When using this method, a complete decompression of the intervertebral disc and spine is achieved, morbidity is reduced, the time of bed rest and disability is reduced, external fixation of the spine is not required.

The known method of A.I.Kozel for the treatment of osteochondrosis of the spine by puncture of the intervertebral disc with a hollow needle and dosed effects on the pulp nucleus (RF patent No. 2012388, A61N 5/06). According to this method, a point heat source is introduced into the needle cavity, the end of which is immersed in the disk, and a laser beam is directed to the other end. The radiation energy is dosed by changing the radiation power. Carry out a thermal effect, creating, depending on the stage of the disease, the necessary temperature for heating the pulpous nucleus, for its destruction and removal of decay products through the needle cavity, in which 20 W laser radiation with a duration of 20-35 sec is used, during which tissue is heated, followed by destruction of receptor nerve endings. The method aims to reduce the treatment time.

There is also a method of treating osteochondrosis of the lumbar spine, in which the evaporation of the pulp nucleus is carried out using a laser with a wavelength of 960-980 nm and a power of 2.5-5 W (RF patent No. 2212916, A61N 5/067, prototype).

The methods described above are based on the use of puncture laser disk decompression. A common disadvantage of these methods is their limited use, due to the fact that during the process (warming up), dehydration of the disk occurs. Therefore, the main criterion for the ability to perform these procedures is the degree of hydration of the disk. With significant dehydration of the intervertebral discs, evaporation of the pulpous nucleus material is significantly difficult, therefore, such procedures cannot be shown. In addition, contraindications to the use of these methods are also the presence of a violation of the integrity of the posterior longitudinal ligament, sequestration of a disc herniation, adhesions, severe spondylosis and spondylarthrosis, patients over 50 years of age, etc. However, as a rule, patients seeking medical help with spinal problems have at least one, and often several, of these symptoms.

The objective of the invention is to expand the arsenal of methods for non-surgical treatment of osteochondrosis of the spine.

The technical result of the invention is the development of a method of using low-intensity laser radiation (LLLT) in the treatment of neurological manifestations of spinal osteochondrosis, effective in the late complicated stages of the disease, with a significant reduction in the number of contraindications to treatment.

The problem is solved due to the fact that in the method of treatment of osteochondrosis of the spine, including exposure to low-intensity laser radiation by means of an LED inserted through a needle, according to the invention, the effect is carried out at a wavelength of 630 nm through a needle inserted at an angle of 40-45 ° to a depth of 30-35 mm, while sequentially acting on points, one of which is the midline located between the spinous processes of the vertebrae adjacent to the affected intervertebral disc, and three are paravertebral located on the p a distance of 1.5 cm from the spinous processes and between each other and the corresponding projection of the intervertebral foramen, the effect is carried out for 5 minutes at each point, treatment is carried out with a course.

Preferably, an intramuscular injection needle of 0.8 × 40 mm is used.

As a rule, the course of treatment includes 8-10 sessions every other day.

Laser therapy is one of the fastest growing branches of medicine and is widely used in the treatment of dystrophic and traumatic injuries of the musculoskeletal system. For therapeutic purposes, low-intensity laser radiation (LLLT) with a wavelength of 0.632 μm and 0.830-0.888 μm (the red and infrared optical regions of the spectrum of electromagnetic waves) is used mainly, which is produced by helium-neon and carbon dioxide lasers. The main mechanisms of laser therapy are: increased cellular respiration, stimulation of biologically active substances, including endorphins, accelerated recovery processes in damaged tissues, increased local blood circulation, decreased sensitivity of pain receptors.

Laser radiation has a fixed wavelength (monochromaticity), the same phase of photon emission (coherence), low beam divergence (high directivity) and a fixed orientation of the electromagnetic field vectors in space (polarization).

The activation of photobiological processes during selective absorption of laser radiation causes vasodilation of the microvasculature, normalizes local blood flow and leads to dehydration of the inflammatory focus. The reparative processes in the tissues are activated. The laser also causes the destruction of the shell of microorganisms on the irradiated surface. A decrease in the impulse activity of nerve fibers leads to a decrease in pain sensitivity.

Along with local reactions, reflex reactions of internal organs are formed by segmental-metameric bonds.

Therapeutic effects: anti-inflammatory, reparative, hypoalgesic, immunostimulating, bactericidal.

Figure 1 illustrates the implementation of the method; figure 2 shows the propagation of laser radiation in the impact area, where 1 is the spinous process, 2 is the distribution of laser radiation, 3 is the intervertebral foramen; figure 3, as an example of a specific implementation of the method, shows a tomogram of the lumbar spine of the patient before treatment, figure 4 is the same after treatment.

The method is as follows.

The patient is placed on a couch lying on his stomach. Palpation determines the affected vertebral motor segment (PDS). The midpoint between the spinous processes of neighboring vertebrae with the affected intervertebral disc is determined, into which a 0.8 × 40 mm needle including a quartz optical fiber for intramuscular injection is inserted to a depth of 30-35 mm (Fig. 1, Fig. 2). The second end of the specified fiber is optically connected to a source of low-intensity laser radiation, for example, a Mulat laser apparatus that generates low-intensity laser radiation with a wavelength of 630 nm, which corresponds to the maximum absorption of laser radiation by blood. In addition to the interspinous point, three paravertebral points are determined that are at a distance of 1.5 cm from the spinous processes and at the same distance between them. At these points, in turn, at an angle, mainly at 45 ° (40-45 °), a needle with a quartz light guide is inserted in the same way, as shown in Fig. 1. It has been established that it is under such conditions that the best penetration of laser radiation into the zone of disco-radicular conflict is possible. The laser emitter operates at each point for 5 minutes. Then the device turns off, an aseptic dressing is applied to the skin. In total, the patient receives 8-10 sessions, every other day. Patients are observed throughout the year with conducting control, tomographic studies after 6 and 12 months.

As shown above, the low-intensity laser irradiation according to this method, in contrast to the known methods, is applied to nearby tissues to the spine, while the pulp nucleus is not directly affected and the disc is not punctured. There is no trauma to the disk, there is no dehydration of the disk, the structures of the spinal canal are not injured.

In this case, the necessary and sufficient exposure to laser radiation occurs, which ensures the removal of the inflammatory process in the area of the affected disk and the corresponding nerve root.

Results. During 2007, the method according to the invention, as described above, was treated 460 patients, men (260 people) and women (200 people) aged 18 to 65 years. The method was carried out using the apparatus of laser therapy "Mulatto".

It was found that by the 4th or 5th procedure, 60% of patients noted a significant reduction in pain, normalization of sleep, an increase in range of motion in the affected spine. At the same time, 40% of patients noted an improvement in their condition later in the course of the first month after treatment (possibly due to slower processes of activation of metabolic processes in the tissues surrounding the affected PDS). 2 months after treatment, 45-50% of treated patients regressed compression-radicular symptoms. Further dynamic monitoring of treated patients showed that in 30% of patients, pain and other neurological deficits returned 4-6 months after treatment. He underwent repeated treatment, which brought relief and lasting positive effect in 20-25% of these patients, and in 5-10% of patients received less or very weak results.

Despite the absence of a direct effect on the intervertebral disc during control tomographic studies of the spine (after 6 months), in addition to the achieved positive clinical effect in 40% of the treated patients, there was a decrease in the size of hernial protrusion and regression of disco-radicular conflict.

The following are specific examples of the implementation of the method according to the invention.

Example 1. Patient A., born in 1970. I contacted the reception on 07/18/07. Complaints of pain in the lumbar region of a chronic nature with irradiation along the posterolateral surface of the left thigh and lower leg, numbness along the lateral surface of the left thigh and the dorsum of the left foot. Pain and numbness intensified when walking, as well as at night in the supine position and when changing posture. When conducting a magnetic resonance imaging of the lumbar spine (POP), a posterior diffuse herniation with left-side lateralization of the herniated disc L4-L5 (md), approximately 10 mm, was revealed. According to an objective examination: revealed hypesthesia in the L5 and S1 zones of the roots on the thigh, lower leg and foot on the left, a decrease in the left knee reflex and the absence of a left Achilles reflex. Hypotension of the posterior muscle group of the left thigh and lower leg. No other pathologies have been identified.

Clinical diagnosis: Lumbosacral osteochondrosis. Condition after L4-L5 microdiscectomy of the left ventriculus, removal of disc herniation from 04.24.06. Hereditary hernia L4-L5 Mpd with left-side lateralization of about 10 mm. Left-sided discogenic radiculopathy L5, S1. Left-sided lumbar ischalgia syndrome. Chronically relapsing course, stage of exacerbation, resistant severe pain syndrome.

From July 18, 2007, the patient was admitted for treatment. 8 procedures were carried out every other day according to the method according to the invention. By the sixth procedure, the patient's well-being improved: the intensity of pain and numbness significantly decreased. Movement restrictions while walking disappeared. Upon repeated examination after 2 months, the patient complained of slight pain in the left gluteal region, occasionally there was an irradiation of pain in the left thigh and lower leg, numbness and pain in the lumbar region were not observed.

With a repeated, six months later, MRI scan of POP, positive dynamics were noted: a decrease in the size of the hernia to 7 mm. A repeated course of identical treatment was carried out, with pronounced positive dynamics. The disappearance of sensory disorders was noted. The left Achilles reflex recovered and leveled off. According to the MRI scan of the EPP, a decrease in the size of the hernia to 4 mm and a lack of compression of the roots in the intervertebral openings are noted in the next six months.

Example 2. Patient B., born in 1961. He turned to the reception on 08.19. 04. Complaints of severe pain in the lumbar region, with irradiation on the back of the thigh and lower leg, curvature of the body due to pain, numbness in the right lower leg. An MRI scan of POP dated 07/30/04 determined a right-sided paramedian hernia of the L5-S1 disc, 11 mm in size.

Clinical diagnosis: Lumbosacral osteochondrosis. Right-sided paramedian hernia L5-S1 with an efficiency of about 11 mm, discogenic right-sided compression syndrome L5, with the right-sided lumbar ischalgia, the first exacerbation, severe pain.

Since August 19, 2004, a course of treatment according to the method according to the invention, 8 procedures every other day. At the end of treatment, the pain syndrome is completely stopped, the statodynamic disturbances have passed. A course of drug treatment was prescribed for fixation - a vasoactive drug and a chondroprotector for 1.5 months. At repeated examinations after 2 and 6 months, the state of health remained stably good, with an objective examination, no obvious negative dynamics were noted. On January 25, 2005, a second course of treatment was carried out according to the above method. According to the MRI study dated 06/01/05, no data on hernia L5-S1 were recorded, the protrusion of L5-S1 was determined with a right lateralization of up to 4 mm.

In general, the results of the application of the method according to the invention in the treatment of neurological manifestations of intervertebral osteochondrosis confirm the effectiveness of this method of treatment: the method provides a regression of subjective and objective symptoms and has a biostimulating effect on the regeneration of cartilage tissue.

Claims (3)

1. A method for the treatment of osteochondrosis of the spine, including exposure to low-intensity laser radiation through a fiber inserted through a needle, characterized in that the exposure is carried out with a wavelength of 630 nm through a needle inserted at an angle of 40-45 ° to a depth of 30-35 mm, while affect points, one of which is the median, located between the spinous processes of the vertebrae adjacent to the affected intervertebral disc, and three are paravertebral, located at a distance of 1.5 cm from the spinous processes and between minutes and the corresponding projections of the intervertebral foramen, exposure was carried out for 5 min at each point, the treatment is carried out rate. 2. The method according to claim 1, characterized in that use a needle for intramuscular injection of size 0.8 × 40 mm 3. The method according to claim 1, characterized in that the course of treatment includes 8-10 sessions every other day

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