RU2763678C1 - Method for surgical treatment of chronic pain in bertolotti's syndrome - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to traumatology, orthopedics and neurosurgery, and can be used in Bertolotti’s syndrome, accompanied by chronic pain syndrome. It is used for persistent relief of chronic pain. Wiltse’s dorsal access to the posterior column of the spine is performed. Access is carried out in accordance with preoperative planning from the incision along the paraspinal line on the right or left, depending on the anatomical variant of Bertolotti’s syndrome and the location of the pain syndrome. With a scalpel, the skin, subcutaneous fat and aponeurosis are cut, the muscle mass is bred in the longitudinal direction with access to the transverse process of the L5 vertebra. A wound expander is installed in the projection of the hypertrophied transverse process of the L5 vertebra. A set of surgical instruments is used to resect the hypertrophied transverse process of the L5 vertebra to the base with mandatory control and resection of the ilio-lumbar ligament.EFFECT: method provides stable relief of chronic pain in Bertolotti’s syndrome due to surgical correction of the anatomical substrate causing chronic pain syndrome.1 cl, 2 dwg, 1 ex

Description

Technical field

SUBSTANCE: invention relates to medicine, traumatology and orthopedics, neurosurgery, namely to spinal surgery, and is used in the treatment of patients with congenital malformation of the lumbar spine, with Bertolotti's syndrome accompanied by chronic pain syndrome.

State of the art

Known various methods of relief of chronic vertebrogenic pain syndrome by paravertebral and epidural blockades with anesthetic solutions.

There are also known methods of magnetotherapeutic effects in discogenic neurological manifestations (see, for example, RU No. 2326705, IPC Α61N 2/04, publ. 20.06.2008).

A known method for the treatment of herniated lumbar intervertebral discs, including the implementation of a drug analgesic blockade, while in combination with the blockade, electrical stimulation of the injection site of the anesthetic is carried out with a pulsed electric current with a frequency of 50 Hz, a current of 10-15 mA, an electric pulse duration of 0.2 ms, the duration of the procedure 8-10 minutes daily. The course of treatment is 10-12 procedures (RU No. 2368401, published on September 27, 2009).

Known methods of combined reflexology and drug exposure (pharmacopuncture) for pain syndromes, dorsopathies with lesions of the cervicothoracic and / or lumbar spine (RU 2616128, C1, 12.04.2017, Shilenkov G.L. and others).

The disadvantage of these methods is the low efficiency of treatment due to the long-term regression of the pain syndrome. Known methods of blockade give a short-term effect in Bertolotti's syndrome, since they do not eliminate the anatomical substrate of pain.

A known method for the treatment of middle-aged patients with chronic pain in dorsopathy of vertebrogenic and non-vertebrogenic genesis (RU 2740268). For the treatment of chronic dorsopathies of vertebrogenic and non-vertebrogenic genesis, a complex of drug and physical effects is carried out, where botulinum therapy is used as a drug effect.

This method does not allow to eliminate the cause of pain in Bertolotti's syndrome, since it does not eliminate the anatomical substrate that causes chronic pain, which returns after a certain period of time, after drug relief.

Another way to relieve pain is the method of radiofrequency destruction (RFD). A known method for the treatment of compression fractures of the spine (RU 2724857). Dereception is carried out by local thermal destruction of the dorsal branch of the spinal nerve by exposure to radiofrequency pulses from a high-frequency pulse generator. In this case, the electrode is introduced under X-ray control of an image intensifier into the localization points of the dorsal branch of the spinal nerve of the intervertebral joints in combination with dereception of the intervertebral discs by exposure to radiofrequency pulses from a high-frequency pulse generator. At the same time, motor and sensory tests are carried out.

The method of pain treatment by RFD is based on the effect of electrical stimulation by ultrahigh frequency currents of the nerve pathways, leading to their destruction. It is used to disable the transmission of pain signals along the nerve pathways to the brain. RFD is performed without incisions and requires minimal hospital stay.

But, as in other methods, with Bertolotti's syndrome, pain returns after a certain period of time, since the anatomical substrate that causes pain is not eliminated (PULSED RADIOFREQUENCY TREATMENT FOR BERTOLOTTI'S SYNDROME RESENTING WITH LOW BACK PAIN: REPORT OF FOUR CASES Ryo Kanematsu MD , Junya Hanakita MD, PhD, Toshiyuki, Takahashi MD, PhD, Yosuke Tomita MD, PhD and Manabu Minami MD, PhD Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan, E-mail: ryo.knmt@gmail.com. Interventional Management of Chronic Low Back Pain Associated with Bertolotti's Syndrome: Report of Case Series/ Rui Zhang* and Jianguo Cheng / Annals of Clinical Case Reports - Anesthesiology/ 2017 | Volume 2 | Article 1348).

The mechanical cause of pain in Bertolotti's syndrome is a hypertrophied transverse process of the L5 vertebra, which leads to compression of the structures in contact with it. In addition, the iliopsoas ligament is attached to the L5 vertebra, connecting the 5th lumbar vertebra to the iliac crest, it is located in the transverse direction from the vertebra to the pelvis. The ligament additionally fixes the roots of the spinal cord, and if the iliac-lumbar ligament is not resected during the removal of the process, it fixes the roots of the spinal cord and also causes pain.

Courses of conservative treatment with drugs can reduce the intensity of pain or completely eliminate the pain syndrome for a certain time, however, with Bertolotti's syndrome, they still have the same main drawback - pain recurrence after an indefinite period of time.

Thus, the problem of the known methods of pain relief in Bertolotti's syndrome is the inevitable recurrence of the pain syndrome. Known methods are applicable at the outpatient stage of treatment, for the rapid relief of pain, however, they have one common drawback - they do not eliminate the cause of chronic pain.

The essence of the technical solution

The technical result consists in persistent relief of chronic pain in Bertolotti's syndrome.

The technical result is achieved by the fact that in the method of surgical treatment of chronic pain in Bertolotti's syndrome, a dorsal Wiltz approach to the posterior column of the spine is performed, the access is carried out in accordance with preoperative planning from an incision along the paraspinal line on the right or left, depending on the anatomical variant of Bertolotti's syndrome and location pain syndrome, the skin, subcutaneous fat and aponeurosis are cut with a scalpel, the muscle mass is bred in the longitudinal direction with access to the transverse process of the L5 vertebra, a retractor is installed in the projection of the hypertrophied transverse process of the L5 vertebra, a set of surgical instruments is used to resect the hypertrophied transverse process of the L5 vertebra to the base with obligatory control and resection of the iliac-lumbar ligament.

Unlike the known methods of pain relief, the treatment of chronic pain in Bertolotti syndrome is carried out by surgical correction of the anatomical substrate that causes chronic pain syndrome, which avoids the recurrence of pain syndrome.

The method is illustrated by illustrations, which show:

Figure 1 - a variant of the Bertolotti syndrome and transverse pelvic impingement on the right, causing chronic pain. X-ray and 3D CT before surgery. The arrow indicates the transverse process.

Fig.2 - CT image of the lumbosacral spine after surgery. The arrow indicates the resected transverse process.

The method is carried out as follows.

This method is applicable in patients with anomalies of the lumbosacral spine (Bertolotti syndrome).

Unlike the known methods of pain relief, the treatment of chronic pain in Bertolotti syndrome is carried out by surgical correction of the anatomical substrate that causes chronic pain syndrome, which avoids the recurrence of pain syndrome.

In the method of surgical treatment of chronic pain in Bertolotti's syndrome, a set of surgical instruments performs resection of the transverse processes of the L5 vertebra to the base and resection of the iliac-lumbar ligaments. To do this, a dorsal Wiltz approach to the posterior column of the spine is performed, the access is carried out in accordance with preoperative planning from the incision along the paraspinal line on the right or left, depending on the anatomical variant of the Bertolotti syndrome and the location of the pain syndrome. The length of the access is about 2.5-3 cm. The skin, subcutaneous fat (SFA) and aponeurosis are cut with a scalpel. Next, using tube retractors, the muscle mass is bluntly bred in the longitudinal direction with access to the transverse process of the L5 vertebra. A minimally invasive retractor is installed in the projection of the hypertrophied transverse process of the L5 vertebra. A set of surgical instruments perform resection of the transverse process to the base with mandatory control and resection of the iliopsoas ligament. The volume of resection is important because while maintaining the iliac-lumbar ligament, there is a risk of recurrence of the pain syndrome. The technical result provided by the above set of features is the relief of chronic vertebrogenic pain syndrome against the background of an anomaly in the development of the lumbosacral spine.

A clinical example is shown in FIG. 1 and FIG. 2.

Figure 1 shows radiographs and 3D CT of the patient before treatment with the present method. There is a variant of Bertolotti's syndrome and transverse pelvic impingement on the right, causing chronic pain. The arrow indicates the hypertrophied transverse process of L5. Figure 2 shows a CT image of the lumbosacral spine of the patient after surgery according to the claimed method. The arrow indicates the area of the resected transverse process L5.

For the treatment of chronic pain, a dorsal Wiltz approach to the posterior column of the spine was performed, the access was carried out in accordance with preoperative planning from a 3 cm long incision along the paraspinal line on the right, the skin, subcutaneous fat and aponeurosis were cut with a scalpel, the muscle mass was bred in the longitudinal direction with an exit on the transverse process of the L5 vertebra, a retractor was installed in the projection of the hypertrophied transverse process of the L5 vertebra, a set of surgical instruments was used to resect the hypertrophied transverse process of the L5 vertebra to the base with mandatory control and resection of the iliopsoas ligament.

The application of the method in this patient made it possible to stop the pain syndrome by eliminating the anatomical substrate that is the cause of pain.

Claims (2)

1. A method for the surgical treatment of chronic pain in Bertolotti's syndrome, characterized by the fact that a dorsal Wiltz approach to the posterior column of the spine is performed, the access is carried out in accordance with preoperative planning from an incision along the paraspinal line on the right or left, depending on the anatomical variant of Bertolotti's syndrome and location pain syndrome, the skin, subcutaneous fat and aponeurosis are cut with a scalpel, the muscle mass is bred in the longitudinal direction with access to the transverse process of the L5 vertebra, a retractor is installed in the projection of the hypertrophied transverse process of the L5 vertebra, a set of surgical instruments is used to resect the hypertrophied transverse process of the L5 vertebra to the base with obligatory control and resection of the iliac-lumbar ligament. 2. A method for the surgical treatment of chronic pain in Bertolotti syndrome according to claim 1, characterized in that the length of the incision is 3 cm.

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