RU2719672C1 - Method of treating patients with chronic lumbosacral radiculopathy with affected by degenerative spinal injury - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to balneology, neurophysiology, medical rehabilitation, aims at treating the patients with chronic compression lumbosacral radiculopathy due to degenerative spinal injury and can be used in medical and preventive and sanatorium establishments. Method consists in that a patient is exposed to variable diadynamic current with different intensity from 100 to 350 mA (mA), supplied for 15 minutes from three pairs of transversely arranged electrodes, in a hydrogalvanic bath filled with fresh water at temperature of 36−37 °C, the course is prescribed 10 daily procedures with a break for the weekend.

EFFECT: as a result of treatment, patients are observed to reduce pain syndrome, regress of sensitive disorders in the involved limb, spasmolytic effect in the form of reduced tonic tension of muscles of the lumbosacral region, local tenderness of trigger points, and anti-oedema action.

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Description

The invention relates to medicine, in particular to balneology, neurophysiology, medical rehabilitation, is intended for the treatment of patients with chronic compression lumbosacral radiculopathy due to degenerative lesions of the spine and can be used in medical and preventive institutions.

Back pain caused by degenerative damage to the spine has become so important that, according to various sources, it has become a kind of global pandemic. The widespread and lack of an unambiguous therapy strategy has brought the problem of nonspecific back pain out of the category of medical, giving it social, economic and psychological aspects. Radiculopathy is a frequent complication of degenerative lesions of the lumbosacral spine, while people of working age suffer mainly. According to statistics, the incidence during life is 3-5%. Compression radiculopathy develops as a result of compression of the nerve root by a displaced intervertebral disc, a hypertrophic yellow ligament formed by an osteophyte. In addition, the dura mater, epidural fatty tissue, blood vessels, perineural connective tissue are involved in the pathological process. The most significant for both the patient and the doctor in the clinical picture of compression radiculopathy is pain. It is on his relief that the main areas of therapy are directed.

A known method of treatment of compression lumbosacral radiculopathy based on the use of non-steroidal anti-inflammatory drugs (NSAIDs). The mechanism of their action is to inhibit the synthesis of prostaglandins due to inhibition of the key enzyme - cyclooxygenase (COX), which leads to a slowdown in the production of prostaglandin E2, thromboxane A2, as well as a decrease in the level of leukotrienes, kinins, histamine, serotonin and other inflammatory mediators. Thus, the inflammatory response is suppressed and pain impulses are suppressed at all levels of afferent transmission from peripheral nociceptors to the sensitive centers of the brain (Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. 2006). A significant drawback of NSAID therapy is the risk of serious side effects from the cardiovascular system and the gastrointestinal tract, which are sometimes unacceptable to the patient, and therefore further pharmacotherapy should be limited or canceled.

There is also a method of treating patients with compression lumbosacral radiculopathy, having the nature of a neuropathic pain syndrome, the appointment of anticonvulsants (anticonvulsants). The mechanism of their action is associated with the ability to block the activity of voltage-dependent calcium channels, which are important in the occurrence of neuropathic pain, as well as the impact on highly specific centers of the central nervous system (Danilov A.B. Pharmacotherapy of pain in case of radiculopathy. 2007). The disadvantage of prescribing this group of drugs is their ability to inhibit the central nervous system and often developing side effects: increased blood pressure, nausea, drowsiness, dizziness, headache, and others.

There is also a method of treating compression lumbosacral radiculopathy by the use of non-drug technologies. These include methods of manual therapy, including techniques for mobilization and relaxation of muscles, which leads to a decrease in analgesic scoliosis and an increase in range of motion in the spine. Manual therapy has been shown to be more effective than placebo and traction therapy in patients with compression radiculopathy of the lumbosacral roots in studies (Smirnov A.A., Profyev A.L., Belyakov K.M. Possibilities for optimizing the pathogenetic therapy of vertebrogenic radiculopathies. 2009). However, a significant drawback of manual therapy is the risk of worsening the condition of patients with compression radiculopathy, especially if there are relative indications for surgical treatment, due to the lack of clear dosing standards for the applied technique and often its excessive aggressiveness.

Closest to the technical nature of the proposed method is a method of treating discogenic compression radiculopathy using currents of various intensities - electrotherapy. Electrotherapy is now understood as a group of physiotherapeutic methods based on the effect of electric current on the human body. In this case, a constant (galvanic) or alternating current of various frequencies, intensities and pulse shapes can be used, for example, sinusoidally modulated therapy, diadynamic therapy, interference therapy. Currents of various frequencies and pulse shapes are used to achieve analgesic, decongestant antispasmodic action. The general principle of electrotherapy is a local effect, that is, electrodes with different sizes are applied, applied to the area of segmental innervation and / or the affected limb, while the area of therapeutic effect is limited due to the technical features of the current supply through the skin electrodes (Povazhnaya E.S., Zubenko I.V., Tereshchenko I.V. Comprehensive rehabilitation of patients with lumbosacral radiculopathy at the inpatient stage of treatment. 2016).

The disadvantages of using the electrotherapy method are contraindications associated with the presence of purulent-inflammatory diseases, oncological process, cardiovascular pathology in the stage of decompensation (arrhythmia, circulatory failure), violation of the integrity of the skin, and limited exposure due to the possibility of exclusively local application of the technique.

The technical result of the proposed method for the treatment of discogenic compression radiculopathy is to reduce the intensity of the pain syndrome, improve peripheral innervation and microcirculation, regress sensitive disorders, antispasmodic, anti-inflammatory and decongestant effects on the body.

The specified technical result is achieved through the use of common hydro-galvanic baths, while the action is carried out by an alternating diadynamic current with various intensities from 100 to 350 milliamps (mA), supplied for 15 minutes from three pairs of transverse electrodes in a specially designed hydro-galvanic bath filled with fresh water an indifferent temperature of 36-37 ° C, 10 daily procedures are prescribed for the course with a break for the weekend.

An essential feature of common hydroplating baths is the simultaneous effect of two therapeutic factors: fresh warm water and alternating electric current. The simultaneous effect of two factors determines their synergistic effect, and also contributes to better tolerance of electric current by the patient and the possibility of increasing the contact area of the skin, while the current is dosed gradually from 100 to 350 mA, depending on the individual sensitivity of the patient.

Description of the method Patients with discogenic compression lumbosacral radiculopathy are prescribed balneotherapy procedures. All patients were prescribed a course of 10 procedures of common hydro-galvanic baths according to the transverse method, that is, with the supply of electric current from transverse electrode plates, which was carried out daily with a break for the weekend, the duration of the procedure was 15 minutes. During the procedure, the patient in a supine position is in a specially designed bathtub having three pairs of transverse electrodes located at the level of the hips, legs and feet of the electrode plates on the inner surface of the side walls, filled with fresh water with an indifferent temperature of 36-37 ° C. The impact is carried out by an alternating diadynamic current of 100-350 mA, the intensity is dosed individually until a tingling sensation or comfortable vibration, the polarity of the current changes in each procedure. The treatment is carried out against the background of basic drug therapy without the appointment of additional pharmacotherapeutic agents.

Examples of the proposed method of treatment

Example 1

Patient M., 58 years old, was under observation with a diagnosis of dorsopathy of the lumbosacral spine, spondylosis, spondylarthrosis. Discogenic compression radiculopathy L5 root on the right. Neurological status showed a violation of superficial and deep segmental sensitivity in the form of hypesthesia in the innervation zone L5 of the root on the right, positive Laseg symptom on the right at 50 degrees, local musculo-tonic syndrome in the form of tonic painful tension of the paravertebral muscles of the lumbosacral spine at the level of L4 -S1 segments, more pronounced on the right. In the structure of complaints, pain was noted in the lumbar region on the right with irradiation along the lateral surface of the right lower extremity, which was aching with sharp lumbago, sensations of tingling, itching, numbness in the region of the first toe of the right foot. According to magnetic resonance imaging (MRI), degenerative changes in the lumbosacral spine, spondylosis, spondylarthrosis, spinal stenosis at the L4-L5 level on the right with signs of moderate neural compression were detected. The patient previously received a course of conservative treatment, against which the intensity of pain in the lumbar region decreased. The patient was assigned a course of 10 procedures of common hydroplating baths according to the transverse method daily with a break for the weekend. The fresh water temperature was 37 ° C, the intensity of the supplied diadynamic current ranged from 130 to 170 mA. The duration of the procedure was 15 minutes. The patient did not notice any side effects during the course of treatment, the tolerability of the procedures was good. After a course of common hydroplating baths, the intensity of the pain syndrome decreased from 5 points on a visual analogue scale (VAS) to 2 points, while the patient noted the disappearance of unpleasant sensations of itching and tingling in the affected limb. At the control neurological examination, a regression of sensitive disorders in the foot was noted.

Example 2

Patient K., 39 years old, was operated on in the neurosurgical department for sequestered herniated disc L5-S1 on the left. In the postoperative period, there was a regression of pain in the lumbosacral region and the left lower extremity, however, sensitive disorders persisted in the form of segmental type hypesthesia in the innervation zone S1 of the root on the left. 6 months after the surgical treatment, the patient was assigned a course of 10 procedures of common hydroplating baths according to the transverse method daily with a break for the weekend. The fresh water temperature was 36.5 ° С, the intensity of the supplied diadynamic current ranged from 180 to 240 mA. The duration of the procedure was 15 minutes. The patient did not notice any side effects during the course of treatment, the tolerability of the procedures was good. After a course of common hydroplating baths, the patient noted an improvement in sensitivity in the left lower limb, during the neurological examination after the end of the course of treatment, positive dynamics were recorded in the form of an objective improvement in sensitivity in the left lower limb.

The proposed method of treatment was applied in 31 patients (20 women and 11 men, the average age was 25-65 years). The treatment allowed to achieve a stable clinical effect in 91% of patients. 25 of the treated patients had sensitive disorders, 19 of them showed a regression of symptoms after the end of the course of treatment. The results were recorded during a clinical and neurological examination, and the reduction in pain was confirmed by a VAS assessment from 5 (3.25-5) to 3 (1-5) points (p <0.01).

As a result of treatment with the proposed method, all patients noted a decrease in pain, unpleasant sensations in the lower limb in the form of tingling, lumbago, itching, numbness, while the effect of the course of the procedures was stable when evaluated in the delayed period (after 3 months). In most patients, a regression of sensitive disorders in the affected limb was noted. Also, positive dynamics was recorded in the form of relief of the local vertebrogenic syndrome in the form of muscle tension of the lumbosacral region, local pain of trigger points. All patients noted a good tolerability of the procedures, side effects or adverse events were not recorded in any case. In this regard, it should be noted the high adherence of patients to treatment with the non-drug method of common hydroplating baths.

Claims (1)

A method of treating patients with chronic lumbosacral radiculopathy against a background of degenerative spinal injury by applying alternating diadynamic current, characterized in that the patient is simultaneously affected by two therapeutic factors: fresh water and alternating diadynamic current, while the exposure is carried out by alternating diadynamic current with different intensities 100 to 350 milliamps (mA), supplied over 15 minutes from three pairs of transversely spaced electrodes, to a hydro galvanic second bath filled with fresh water temperature of 36-37 ° C, at the rate prescribed 10 daily treatments with a break for the weekend.