RU2278708C1 - Method for treating the cases of intervertebral disk hernia and lumbosacral vertebral column segment hernia by applying complex stage-by-stage approach - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying frame traction and ultrasonic treatment. The treatment is carried out continuously in four stages. Medical exercises and positional repair of diskogenic disorders are applied at the first stage. Classic medical segmental massage techniques are applied at the second stage in paravertebral way using sparing method. Ultraphonophoresis with chondroprotectors is paravertebrally applied to lumbosacral vertebral column segment. Radicular syndrome being the case, ultraphonophoresis with hydrocortisone and B₁₂ vitamin is additionally applied to injured radix with intensity of 0.4-0.6 W/cm² in pulsating mode. The treatment is finished with frame traction 2-3 times a week in a 7-12 procedures long course. Rigid corset is applied after traction procedure for 2 h.

EFFECT: enhanced effectiveness of treatment.

2 cl

Description

The invention relates to medicine, namely to physiotherapy and neurology, and can be used to treat patients with protrusion and (or) herniated intervertebral discs with irritative-radicular or compression-radicular syndrome.

Vertebrogenic pathology, namely, hernias of the intervertebral discs are the most common cause of reduced (loss) of working capacity in young and middle-aged people.

Treatment is traditionally carried out with medications (non-steroidal anti-inflammatory drugs, analgesics, vitamins gr. B, etc.), physical correction methods (diadynamic therapy, amplipulse therapy, ultrasound therapy, etc.) aimed at stopping the pain syndrome (V. Veselovsky, Ivanichev G.A., Popelyansky A.Ya. et al. Principles of complex treatment of patients with osteochondrosis of the spine: Textbook. - L., 1985, 61 p., Balneology and physiotherapy (manual), edited by V. M. Bogolyubov, M .: Medicine, 1985, V.2, p.221-224, Strelkova NI Physical methods of treatment in neurology.M .: Medicine, 1991, p.165-176, etc.). All of the above methods, unfortunately, do not eliminate the causes of the disease, often cause side effects from the gastrointestinal tract and hepatobiliary system. Often with the ineffectiveness of the above treatment methods resort to manual therapy. However, in some patients, manual therapy methods can cause complications associated both with insufficiently qualified actions of the doctor, and with individual anatomical and physiological characteristics, which lead to the development of spinal circulation disorders, spinal cord injury, compression fractures of the vertebrae, etc.

Abroad (the Anglo-American school) is actively used for the treatment of herniated discs by the method of hardware traction (Parson W, Cummings J. Mechanical Traction in Lumbar Disc Syndrome. - Can.Med.Assoc. - J. 77: 7-11, 1957, Larsson V. Et al .: Auto-Traction for Treatment of Lumbago Sciatica. - Acta Orthop. Scand. 51: 791-798, 1980, Onel D., Tuzlaci M., Sari H. et al. Computed Tomographic investigation of the effect of traction on lumbar disc herniations. - Spine, 1989, v. 14, N1, p. 82-90). Unfortunately, despite the etiopathogenetic validity, this technique is not widespread in Russia due to the occurrence of a reflex myotonic reaction in response to traction and some increase in pain after the treatment procedure.

The prototype is a method for the complex treatment of hernias of the intervertebral discs of the lumbar and lumbosacral spine, including apparatus traction and ultrasound therapy [Saunders H. Unilateral Lumbar Traction. Phys. Ther. 61: 221-225, Feb 1981]. However, this method is not effective enough, causes pain in the patient, and also requires a long course of treatment.

The technical result is an increase in the effectiveness of treatment due to the rapid relief of pain and prolonged remission, time reduction and painlessness of the treatment procedure.

The proposed method is as follows: conduct a comprehensive phased treatment, which includes:

1) First, therapeutic gymnastics is carried out, with individual positional correction of discogenic disorders (L. Boneva, Manual of kinesitherapy. Medicine and physical education, Sofia, 1978, S. 248-256, Physical Therapeutic Physics: Ref. / Ed. By V.A. Epifanova, M., 1987, S. 43-52 and others). Physical therapy is used to strengthen the muscles of the back, abdominals and limbs, eliminate myofascial block, and impaired posture. To exclude axial load on the spine, initial exercises are used while lying (on the back, on the side, on the stomach). Isometric exercises are used to strengthen muscles without increasing mobility. In patients with compression-radicular syndromes, legs are bent in the hip and knee joints, followed by straightening. Torso torso exercises are contraindicated. Raises of straight legs in the supine and sitting position, sharp rotational movements are unacceptable;

2) the classic therapeutic segmental massage, which is performed paravertebrally according to the gentle method in order to reduce the severity of myotonic disorders (Belaya N.A., Guide to therapeutic massage, M., 1983, p. 58-69, Kunichev L.A. Therapeutic massage, 1985, S. 22-31). The tactile pressure (ischemic kneading) of painful muscle nodules and areas of hypertonus is carried out. Initially, the zone of the nodule is allotted with rough movements, then with the fingertips they approach the epicenter of the nodule, increasing the kneading efforts. The direct effect on the vertebral segments is through the use of "saws". Spread 1 and 2 fingers of both hands are placed on the sides of the spinous processes so that a skin roll is formed between the fingers. It is displaced by sawing movements of both hands in opposite directions. In this way, the surface is massaged from segment to segment from bottom to top. The main indicators for massage are myotonic, neurodystrophic disorders;

3) drug phonophoresis with chondroprotectors paravertebrally to the lumbosacral spine and, in the presence of radicular syndrome, additional phonophoresis with hydrocortisone and vit. B ₁₂ on the projection of the affected root with an intensity of 0.4-0.6 W / cm ² in a pulsed mode to enhance trophic-reparative processes in the intervertebral discs and increase its elasticity, increase the speed of impulses along the affected nerve root (trunk) and accelerate processes myelination (Balneology and physiotherapy (manual), edited by V.M. Bogolyubov, M .: Medicine, 1985, T.1, p. 504-519. Technique and methods of physiotherapeutic procedures (reference) / Edited by V.M. Bogolyubova. - M.: Medicine, 1983, S.236-241);

4) hardware traction on the traction table "Triton-M" with individual selection of the load level and mode of the procedure, followed by rigid corsetting within 2 hours after the procedure (Hickling J / Spinal Traction Technique. Physiotherapy 58.1972, Saunders H Spinal Traction; A Continuing Education Learning Package for Physical Therapeutists. Independent. Study Division of Continuing Education, University of Kansas, 1979; Saunders H. Unilateral Lumbar Traction. Phys. Ther. 61: 221-225, Feb 1981). Traction is carried out on the horizontal surface of the Triton-M traction table. The procedure begins with the attachment of the chest bodice and lumbar corset. Traction is carried out with individual selection of the load, taking into account the own weight, starting from 1/4 of the body weight, gradually increasing by 4-5 procedure to 1 / 3-1 / 2 of the patient’s own weight in the step-by-step load amplification mode. The procedure is carried out for 20-40 minutes, after which the patient is in a horizontal position for 20 minutes using orthopedic appliances. After the end of the treatment session, corseting is performed for 2 hours.

This complex of therapeutic measures is carried out on the same day in stages, without interruptions, 2-3 times a week, for a course of 7-12 procedures.

The authors in the scientific, medical and patent literature did not find information about the popularity of the proposed phased complex treatment of hernias of the intervertebral discs of the lumbar and lumbosacral spine. Thus, the present invention meets the patentability criterion of "world novelty."

As a result of clinical trials, the authors first established that the above sequence of distinguishing features of the method allows to achieve effective cure with a long period of remission, rapid relief of pain, leveling pain during hardware traction. Thus, the present invention meets the criterion of "inventive step".

The proposed method is illustrated by the following examples.

Example 1. Patient P., 38 years old, complained of pain in the lumbosacral spine, radiating along the posterolateral surface of the left leg, difficulty walking. Sick for about 5 years, exacerbations 2-3 times a year, was repeatedly treated in a hospital. The last exacerbation lasted about 4 months, the therapy was ineffective. The patient was sent for surgical treatment to the neurosurgery department, but categorically refused the operation. On examination, a sharp restriction of movement in the lumbosacral spine, the absence of lumbar lordosis with protective scoliosis in the lumbar spine to the right was revealed. Sharp positive symptoms of tension on the left at an angle of 30 °, pain along the nerve trunks, inhibition of the knee and Achilles reflexes on the left. Hypotrophy and hypotension of the lower leg muscles. Violation of superficial sensitivity by the type of pain hyposthesia in the area of innervation of the roots L4-L5 on the left. Computer tomograms of the lumbosacral spine revealed a protrusion of L2-L3 discs of 3 mm in size, L3-L4 of 2-3 mm in size, L4-L5 of 4 mm in size, a median herniation of the intervertebral disc of 12 mm in size at the L5-S1 level with left-side lateralization and squeezing the spine on the left.

Conducted 9 sessions of complex phased therapy with a break of 1-2 days. A decrease in the intensity of the pain syndrome and an increase in the volume of active movements was noted after 4 sessions, a complete relief of the pain syndrome occurred after the 7th session of complex physiotherapy. By the end of the course of treatment, the patient recovered the volume of active movements, and the symptoms of "loss" of the spine on the left regressed. After the course of treatment, a second computed tomography of the lumbosacral spine was performed. As a result, a decrease in the size of a hernia of the intervertebral discs from 12 to 4 mm was observed. A protrusion of the intervertebral discs during the re-examination was not detected.

Example 2. Patient 3., 29 years old, profession - gymnast, for 8 years, constant back pain after a “whiplash” injury. Deterioration was noted for about 1 year, the conventional therapy carried out did not have a positive effect. An examination revealed a sharp restriction of movement in the lumbar spine with severe myotonic disturbances, smoothness of lumbar lordosis, pain on palpation of paravertebral points in the lumbar spine. X-ray revealed osteochondrosis of the lumbar spine with a shift of the vertebral bodies L2 anteriorly by 2 mm relative to L3 with rotation of the vertebral body L2. According to computed tomography, a median hernia of the intervertebral disc of 9 mm size was found at the level of L2-L3 with protrusion into the lumen of the spinal canal and compression of the dural membrane by 2-3 mm. Conducted 10 sessions of complex phased physiotherapy. A decrease in the intensity of pain and an increase in the volume of active movements was noted after 3 procedures. By the end of the course of treatment, the pain syndrome was almost stopped, the volume of active movements was completely restored, the symptom complex of myotonic disorders regressed. When repeated computed tomography of the lumbosacral spine was performed after 4 months, a decrease in the size of a hernia of the intervertebral disc was revealed to 3 mm.

The proposed method treated 53 patients with osteochondrosis of the lumbosacral spine, complicated by a hernia of intervertebral discs with sizes from 5 to 12 mm. The advantage of this method is its high efficiency (up to 100%), due to pathogenetically substantiated therapies, painlessness and comfort of the technique, and the absence of a side effect on the digestive organs. It can be used both on an outpatient basis and in a hospital setting. Thus, the present invention meets the criterion of "industrial applicability".

As a result of using the proposed method, it becomes possible to conservatively treat patients with herniated intervertebral discs with irritative-radicular or compression-radicular syndromes both as monotherapy and in combination with medications.

Claims (2)

1. A method for the complex treatment of hernias of the intervertebral discs of the lumbar and lumbosacral spine, including hardware traction and exposure to ultrasound, characterized in that the treatment is carried out sequentially without interruption in four stages, while the first stage is performed therapeutic exercises with positional correction of discogenic disorders, at the second stage, a classical therapeutic segmental massage is performed paravertebrally according to the gentle method, at the third stage, phonophoresis with chondroprotectors paravert Ebrally, on the lumbosacral spine, in the presence of radicular syndrome, an additional phonophoresis with hydrocortisone and vitamin B _{12 is} performed on the projection of the affected root with an intensity of 0.4-0.6 W / cm ² in a pulsed mode, the treatment is completed with hardware traction, and the treatment spend 2-3 times a week, a course of 7-12 procedures. 2. The method according to claim 1, characterized in that after the traction procedure, tight corsetting is performed for 2 hours