RU2391106C1 - Method of treating verterbroneurological and spinal pathology - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology and orthopedics, and can be used in treatment of patients with vertebroneurological and spinal pathology. For this purpose course of successive alternating perineural radicular paravertebral blockades with medicinal mixtures is carried out. On the first day blockades are performed with mixture of 1.0 ml of 0.05% solution of cyanocobalamin (vitamin B12) and 40.0 ml of 0.5% solution of Novocain. The following day blockades are performed with mixture of 1.0 ml 2.5% solution of dimephosphon and 40.0 ml 0.5% solution of Novocain. Treatment course constitutes from 10 to 14 days.

EFFECT: method allows to increase treatment efficiency considerably due to activation of metabolic processes and microcirculation in pathologic focus and around it as a result of Novocain and cyanocobalamin action, which in turn prepares spinal marrow and its roots to further dimephosphon impact.

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Description

The invention relates to medicine, namely to neurosurgery, traumatology, neurology and orthopedics, and is used to treat variously expressed, with varying severity, neurological disorders and pain caused by osteochondrosis of the intervertebral discs, degenerative-dystrophic diseases of the spine, scoliotic disease, primary and metastatic tumors of the spinal cord and spine, inflammatory diseases of the spine (hematogenous osteomyelitis and tuberculous spondylitis), fractures perelomovyvihami vertebrae and other traumatic etiology (osteoporosis, hemangiomas, etc.) as in the postoperative management of patients and in the scheme of conservative treatment of these diseases.

There is a method of regional therapeutic blockade, which consists in reducing afferent impulse from the focus or efferent impulse to the focus, which restores the minute volume of blood, changes the conditions of nervous trophism, improving the humoral regulation of metabolic processes and microcirculation in the pathological focus (1). But the effect of the use of regional blockades for any spinal pathology is far from a full beneficial effect on the contents of the spinal column. Under these conditions, it is advisable to use blockades in combination with other drugs that affect the process of apoptosis of neurons, which leads to a progressive loss of the number of active cells and apoptosis of glia, which prevents the survival and germination of the remaining fibers, which is expressed in the absence of full regeneration in the spinal cord (2).

A known method for the implementation of novocaine blockade with hydrocortisone (3), the use of which apoptosis at a distance from the focus is suppressed, but stimulated in the affected area. We add that often local and prolonged use of glucocorticosteroids leads to a slowdown in the healing process, especially in the case of the use of regional blockade.

Closest to its technical solution to the proposed method is the "Method for the prevention of complications arising from the treatment of the spine using metal structures" (4), which are based on studies consisting in obtaining the therapeutic effect of the use of dimephosphone. This drug facilitates the restoration of neurons in the contusion zone (5) and, being a blocker of the open ion channel of muscle type n-cholinergic receptors, affects postsynaptic processes in the neuromuscular junction (6).

Pathological processes that occur in the surrounding tissues and in the focus caused by the underlying disease make it difficult to absorb the administered drug, which means that it reduces its effect. To ensure greater effectiveness of the considered regional blockade, it is necessary to combine the drug dimephosphon with other drugs.

The invention is expressed by a combination of essential features sufficient to achieve the desired technical result, which consists in enhancing the neuroprotective effect of drugs used in the treatment of vertebral neurological and spinal pathology.

This essence lies in the fact that the method of treating vertebral neurological and spinal pathology involves conducting a course of successively alternating perineural-radicular paravertebral blockades, while on the first day the treatment is carried out with a mixture of 1.0 ml of a 0.05% solution of cyanocobalamin (vitamin B12) and 40 , 0 ml of a 0.5% solution of novocaine, and the next day with a mixture of 1.0 ml of a 2.5% solution of dimephosphone and 40.0 ml of a 0.5% solution of novocaine, the course of treatment is from 10 to 14 days.

Cyanocobalamin has a high biological activity. Being a growth factor necessary for normal blood formation, it participates in the synthesis of choline, methionine, creatine, nucleic acids, in the synthesis of labile methyl groups, activates the metabolism of carbohydrates and lipids, and has a beneficial effect on the function of the nervous system (7).

Without dimephosphone, the number of motoneurons excited after maximum testing (high-frequency tetanization) is significantly increased. Dimephosphon leads to a decrease in the pool of responsive motor neurons and the subthreshold rim of neurons. The use of dimephosphone facilitates the restoration of neurons. In the area of damage and around it, a focus of pathologically enhanced excitation can form. An indirect confirmation of this is a decrease in the thresholds of responses of these neurons to transcranial magnetic stimulation. Edema and inflammation that develops at the site of damage have an exciting effect on neighboring motor neurons. The use of dimephosphone contributes to the development of protective (protective) inhibition in neighboring areas of the spinal cord. In diseases of the spine, spinal vessels lose the ability to promptly and adequately respond to stimuli of a chemical and physical nature. As a result, the states of inverted reactivity, areactivity or hyporeactivity of the vessels develop, violating the chemical and physical homeostasis of the spinal cord - a necessary condition for its normal functioning. In the implementation of the normalizing effect on the state of spinal functions, a significant role belongs to the ability of dimephosphone to improve the activity of the system of regulation of spinal circulation. It favors the repair and restoration of the function of damaged neurons of the spinal cord, acting on the vascular bed and neuronal activity of the spinal cord (8).

It is the improvement under the action of novocaine of the humoral regulation of metabolic processes and microcirculation in the pathological focus and around it, the activation of biological processes that occur in the surrounding tissues and the focus of the disease with the drug cyanocobalamin, prepare the function of the spinal cord and its roots for subsequent exposure to it with a 2.5% dimephosphone solution .

The method is as follows.

A needle with a stop, ten centimeters long, at a selected level, at a distance of three centimeters from the spinous process, is carried out perpendicularly to the stop in the transverse process or in the rib. After stopping in the bone, the limiter is installed at a distance of two centimeters from the skin. The needle is pulled back by a centimeter and deviates by (30-35) ° in relation to the sagittal plane, and moves deeper, until the stopper comes into contact with the skin. After performing a syringe test, 10.0 ml of a mixture is introduced, consisting of 1.0 ml of a 0.05% solution of cyanocobalamin (vitamin B12) and 40.0 ml of a 0.5% solution of novocaine (or the next day - a mixture of 1.0 ml 2.5% solution of dimephosphone and 40.0 ml of 0.5% solution of novocaine). After that, the needle is pulled to the level of the transverse process, and the remaining 30.0 ml of this solution is introduced here. The procedure is repeated on the other side of the spinous process. In this way, drugs are delivered to the sympathetic trunk and spinal nerves.

Clinical example:

Patient I. s. H.G., born in 1959, source Disease No. 5577, 10/14/08 he was admitted to the neurosurgical department of the SRC "WTO" with a diagnosis of chronic compression-tear fractures of the L ₂ and L ₃ vertebral bodies. Osteochondrosis, deforming spondylosis of the lumbar spine. Herniated discs L ₄ -L ₅ and L ₅ -S ₁ discs. Complicated by n / paraparesis and radicular syndrome.

On the first day of treatment, the patient received perineural-radicular paravertebral blockade with a mixture of 1.0 ml of a 0.05% solution of cyanocobalamin (vitamin B12) and 40.0 ml of a 0.5% solution of novocaine. The next day, the blockade was carried out with a mixture of 1.0 ml of a 2.5% solution of dimephosphone and 40.0 ml of a 0.5% solution of novocaine. Over the next 12 days, the blockades continued to alternate. The pain syndrome regressed by the end of the first week, the next week clearly observed positive dynamics in the resolution of n / paraparesis. When extracting complaints, the patient does not show, neurological status - with a positive trend.

Information sources

1. Ibatullin I.A. et al. Regional blockade in surgery. // Guide for doctors. - Kazan, 2003. - S.10-18, 156-157. - 335 p.

2. Ray S.K., Wilford G.G., Matzelle D.C., Hogan E.L., Banik N.L. // 1999. - Ann. N.Y. Acad. Sci. 890, 261-269.

3. Skaromets A.A., Skaromets A.P., Skaromets T.A. Nervous diseases. // M. - 2005 .-- S. 373. - 543 p.

4. Tumakaev R.F., Bochkarev D.V. RF patent No. 2322974. // Bull. discoveries and inventions. - 2008, No. 6. - S.393.

5. Eremeev A.M., Tumakaev R.F., Yafarova G.G., Ibragimov Y.Kh., Pleschinsky I.N. "The effect of dimephosphone on the restoration of the functions of the damaged spinal cord." Journal of the Russian Academy of Medical Sciences "Bulletin of Experimental Biology and Medicine", No. 2, volume 141. - 2006. - P.140-143.

6. Pryazhnikov EG The effect of dimephosphon and its homologs on synaptic transmission in the neuromuscular junction of the cold-blooded: Abstract. Cand. honey. sciences. - Kazan, 2005 .-- 16 p.

7. M.D. Mashkovsky. Medicines // M. - 1993. - P.19. - 685 s.

8. Tumakaev R.F., Yafarova G.G. "Experimental justification for the use of dimephosphone in spinal cord injury." Journal of Spinal Surgery, No. 1. - Novosibirsk, 2007 .-- P.69-74.

Claims (1)

A method for the treatment of vertebro-neurological and spinal pathology, including a course of sequentially alternating perineural-radicular paravertebral blocks, the treatment being carried out on the first day with a mixture of 1.0 ml of a 0.05% solution of cyanocobalamin (vitamin B12) and 40.0 ml of 0.5 % solution of novocaine, and the next day with a mixture of 1.0 ml of a 2.5% solution of dimephosphone and 40.0 ml of a 0.5% solution of novocaine, the course of treatment is from 10 to 14 days.