RU2775880C1 - Method for the treatment of pain syndrome in arthrosis of the facet joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurosurgery, and can be used for surgical treatment of pain. The method includes posterior puncture transcutaneous cervical access in the paraarticular region at a point 4-5 cm lateral to the corresponding spinous process under local anesthesia and temperature exposure in the area of ​​the affected joint. When making access, a puncture needle is inserted into the cavity of the facet joint through its posterior surface. Then, through the puncture needle, the electrode of the cold plasma apparatus is inserted into the cavity to the anterior surface of the facet joint under X-ray control. All surfaces of the joint are treated with plasma at a temperature of 30-40°C for 15-20 s.

EFFECT: method reduces the risk of damage to the spinal cord roots, surrounding soft tissues, blood vessels, nervous structures, shortening the operation time and postoperative recovery period by reducing the pressure inside the joint.

1 cl, 3 dwg, 3 ex

Description

The invention relates to medicine, namely to neurosurgery, and can be used for surgical treatment of pain.

The pathology of the facet (facet) joints of inflammatory, post-traumatic, degenerative-dystrophic origin affects patients, mainly the able-bodied adult population, and causes severe pain. Currently, the treatment of this pathology is solved by the use of conservative drugs or surgical techniques that eliminate pain and reflex syndromes.

The risk of open transcervical surgery for the pathology of the facet joints of the spine is as follows:

1. The need for an incision in the soft tissues of the neck.

2. Damage to the arteries and veins of the neck.

3. Manipulations on the cervical vertebrae and, consequently, their trauma.

4. Instability of the spinal segment.

A known method for the treatment of radicular pain syndrome for the treatment of osteochondrosis of the spine, which includes determining the level of the required foraminal opening, at the cervical level, the needle is inserted from the anterolateral access prevertebral towards the intervertebral foramen with the patient in the supine position and slide it off the transverse process in the ventral direction. Upon reaching a short-term increase in pain, drugs are administered (RF Patent 2250116 IPC A61M 25/01, publ. 2006).

The disadvantage of this method is the high probability of damage to the nerve root when the needle is inserted towards the intervertebral foramen or damage to the neurovascular bundle at the access stage.

The closest is a method for the treatment of pain in arthrosis of the facet joint, including posterior puncture transcutaneous cervical access in the paraarticular region at a point 4-5 cm lateral to the corresponding spinous process under local anesthesia, with a temperature effect of 80 ° C in the area of the affected joint is performed during 90 seconds. (Sharamko T.G. “Treatment of vertebrogenic pain syndrome by radiofrequency destruction of the facet nerves” Dissertation for the academician of the senior candidate of medical sciences, 2018, p. 64-67). In this case, the needle advances medially at an angle of 25-30° until it stops in the articular process. The final position of the needle is controlled by a fluoroscope. The electrode is then inserted into the cannula. On the radio frequency generator, the temperature is set to 80 ° and the exposure time is 90 seconds.

The disadvantage of this method is the traumatic heating of the paravertebral muscles and the periosteum of the transverse processes for a long time, with subsequent possible disruption of the blood supply in the zone of thermal exposure.

The objective of the invention is to eliminate these shortcomings, improve the efficiency of surgical treatment by reducing the time of surgery and reducing tissue trauma. Reducing the risk of damage to the roots of the spinal cord, surrounding soft tissues, blood vessels, nerve structures, shortening the time of the operation and the recovery postoperative period.

This task is achieved by the fact that in the treatment of pain in arthrosis of the facet joint, including posterior puncture transcutaneous cervical access in the paraarticular region at a point 4-5 cm lateral to the corresponding spinous process under local anesthesia, temperature exposure in the area of the affected joint is proposed when access is made insert the puncture needle into the cavity of the facet joint through its posterior surface. Then, through the puncture needle, insert the electrode of the cold plasma apparatus into the cavity to the anterior surface of the facet joint under X-ray control, treat the surfaces of the joint with plasma at a temperature of 30-40°C for 15-20 seconds.

The proposed operation allows to reduce intra-articular pressure, cause wrinkling of the capsule and dereception of the treated joint in a minimally invasive, easily accessible way. The patient immediately noted a positive trend. This operation shortens the early postoperative period.

In the course of the proposed operation, the time of the operation is reduced, the operating surgeon has direct contact with the patient, which allows assessing the patient's condition during the operation.

The essence of the method is illustrated by drawings.

In FIG. 1 - shows the direction of passing the needle (electrode) into the cavity of the facet joint; in fig. 2 - radiography of the cervical region before surgery (example 1); fig. 3 - radiography after surgery (example 1).

The method is carried out as follows.

Access is made at a point 4-5 cm lateral to the corresponding spinous process under local anesthesia. A puncture needle-cannula 2 is inserted on the neck in the paraarticular region. Then the needle advances medially at an angle of 25-30° until it stops in the articular process. Next, the needle is passed into the cavity of the facet joint 3 under x-ray control (EOP). Further, electrode 1 (of the Perc type of the System 2000 ArthroCare device) is inserted along the needle to the anterior surface of the joint capsule, the diameter of the electrode is 1.1 mm, on the working surface of which a cold plasma cloud is created with a temperature of 30-40 ° C during exposure for 15- 20 s.

The curved end of the electrode treats all surfaces of the joint under X-ray control.

Plasma treatment of the articular surface and joint capsule leads to a significant decrease in pressure inside the joint and wrinkling of the capsule due to the physical dissociation of tissue molecules. In this case, dereception of the capsule of the treated joint occurs. The pain disappears or its severity decreases significantly.

After completion of exposure inside the joint, all surgical instruments are carefully removed, and a sterile plaster is applied to the miniature wound.

After the operation, it was not recommended to use a rigid neck brace.

In the postoperative period, if indicated, you can start outpatient rehabilitation treatment (drug therapy, physiotherapy, massage).

This operation belongs to the minimally invasive, high-tech methods of treatment.

Example 1

Patient S., aged 40, was admitted with a diagnosis of Osteochondrosis of the cervical spine. Arthrosis of the facet joints C2-3, C3-4 on both sides.

She was sick for more than 8 months, the patient was prescribed external immobilization with a rigid neck brace, antibiotic therapy, immunomodulatory therapy, exercise therapy, physiotherapy, repeated courses of conservative treatment were carried out, without a significant effect.

The patient had pain in the paravertebral points of the affected joints. Computed tomography (CT) showed signs of arthrosis of the facet joints and destruction.

The condition is relatively satisfactory, in consciousness. Palpation of the cervical region is painful.

On the presented x-ray (Fig. 3) of the cervical spine, a picture of arthrosis of the facet joints is revealed - marginal growths of the articular surfaces of the joint.

The operation was carried out according to the proposed method.

Access was made under local anesthesia, at a point 4 cm lateral to C2-C3 of the spinous processes.

The curved end of the electrode from the anterior surface of the facet joint under X-ray control was used to treat the surfaces of C2-C3, C3-C4 facet joints with plasma at a temperature of 30°C for 20 seconds.

Immediately after the operation, the pain disappeared, there was a significant clinical improvement. Discharged in a satisfactory condition.

When re-examined after 2, 6, 12 months, a positive trend persists.

Example 2

Patient M., aged 46, was admitted with a diagnosis of Osteochondrosis of the cervical spine. Arthrosis of the facet joints C3-4 on both sides.

She was ill for more than 2 years, the patient was prescribed conservative therapy, exercise therapy, physiotherapy, magnetic therapy, without effect.

The patient had pain in the paravertebral points of the affected joints. Computed tomography (CT) showed signs of arthrosis of the facet joints and destruction.

The condition is relatively satisfactory, in consciousness. Palpation of the cervical region is sharply painful.

On the radiography of the cervical spine, a picture of arthrosis of the facet joints is revealed - the growth of the articular surfaces of the joint, an increase in the articular capsule.

The operation was carried out according to the proposed method.

The facet joints were dereceived with cold plasma according to the method described above. Access was carried out under local anesthesia, on the neck in the paraarticular region at the projection point of the affected facet joint, a puncture needle-cannula is inserted medially at an angle of 28° until it stops to the facet joint under X-ray control (EOP), the needle-cannula is advanced into the affected facet joint. Further, an electrode is inserted along the needle into the joint cavity, on the working surface of which a cloud of cold plasma with a temperature of 40 ° C is created during exposure for 15 s.

Immediately after the operation, the pain disappeared, there was a significant clinical improvement. Discharged in a satisfactory condition.

When re-examined after 2, 6, 12 months, a positive trend persists.

Example 3

Patient T., aged 53, was admitted with a diagnosis of Osteochondrosis of the cervical spine. Arthrosis of the facet joints C4-5, C5-6, on both sides.

I was ill for about 2 years, conservative therapy was carried out, without effect.

The patient had pain in the paravertebral points of the affected joints. Computed tomography (CT) and radiography showed signs of arthrosis of the facet joints.

The condition is relatively satisfactory, in consciousness. Palpation of the spinous processes and paravertebral points is painful.

On the x-ray of the cervical spine, a picture of arthrosis of the facet joints is revealed - marginal growths of the articular surfaces of the joint.

The operation was carried out according to the proposed method.

The surfaces of the joint were treated with plasma at a temperature of 37°C for 20 s.

Immediately after the operation, the pain disappeared, there was a significant clinical improvement. Discharged in a satisfactory condition.

When re-examined after 2, 6, 12 months, a positive trend persists.

According to the proposed method in the neurosurgical department of MONIKI, operations were performed on 16 patients with arthrosis of the facet joints.

In 100% of cases in the postoperative period, patients showed positive dynamics. According to the visual analog scale (VAS), pain regressed immediately after surgery in all patients. The pain in the cervical region disappeared, the frequency of headaches decreased, dizziness disappeared. In the long-term period, the patient's quality of life index according to the Karnofsky scale was estimated at 100 points.

The proposed method for the treatment of arthrosis of the facet joints of the cervical region significantly improves the quality of life of patients, reduces the time of the rehabilitation period, helps to reduce the period of disability, reduces the number of postoperative bed-days, which is of economic and social importance.

Claims (1)

A method for the treatment of pain in case of arthrosis of the facet joint, including posterior puncture transcutaneous cervical access in the paraarticular region at a point 4-5 cm lateral to the corresponding spinous process under local anesthesia, temperature exposure in the area of the affected joint, characterized in that the puncture needle is inserted during the access into the cavity of the facet joint through its posterior surface, then through the puncture needle, the electrode of the cold plasma apparatus is inserted into the cavity to the anterior surface of the facet joint under X-ray control, all surfaces of the joint are treated with plasma at a temperature of 30-40°C for 15-20 s.

Images