Method for treating the cases of radicular pain syndrome

FIELD: medicine.

SUBSTANCE: method involves determining required foramen level. Needle is introduced at lumbar, sacral and thoracic segment level in paravertebral way with posterolateral access method and with anterolateral access at the cervical segment level. Tuochi 16-20 needle is applied. The needle is introduced 7-12 cm far from vertebral column median in the direction of intervertebral foramen at an angle of 50-80° to table surface in prone patient position at lumbar, sacral and thoracic segment level. The needle is brought in sliding in lateral direction after it has rested against joint facet. The needle is introduced towards the intervertebral foramen in dorsal patient position. Then, the needle slides from the transverse process in ventral direction. Short-term pain increase being the case, drugs are introduced.

EFFECT: enhanced effectiveness of treatment.

 

The invention relates to medicine, namely to neurosurgery and neurology, and can be used to treat degenerative disc disease of the spine.

At different stages of osteochondrosis (I-IV) may occur vertebral radicular pain syndrome, which can manifest itself at different levels of the lesion (from cervical to sacral regions). The emergence of radicular pain syndrome associated with the presence of the compression factor (disc herniation), and absence of explicit rendered the vertebro-radicular conflict (terminally stenosis, protrusion of intervertebral disc, spondylarthrosis) and the formation of reflex radicular pain syndrome. In patients with severe and persistent radicular pain syndrome and failure of conservative therapy is generally accepted surgical tactics: the removal of herniated disc, decompression roots, various types of endoscopic operations other

A known method of surgical treatment of radicular syndrome with osteochondrosis of the lumbar spine (see RF patent №2054956, publ. 1996.01.17), including access to the pulpous nucleus of an intervertebral disc, its evaporation by laser and forming a cavity by the color of the light guide of the radiator, using a laser power of 50 W, 50 Hz,pre-exposure is performed by the radiation on the tissue of the annulus within 2 seconds and create a channel with a diameter of 4.0 mm, and evaporation of the nucleus pulposus is carried out for 2-3 min using the deflection of a light guide of the radiator from the original axis 5-7° in different directions and form a cavity with a volume of 2.0-2.5 cm3.

The downside of it is the trauma associated with the destruction of the nucleus pulposus laser, and the duration of the operation.

A prototype of the invention taken way to treat radicular pain syndrome, which is applied in degenerative lesions of the spinal cord (protrusion and herniated discs, postoperative changes in the spinal canal), described in the article by Gebhard Schmid and others “CT-assisted epidural perineurally injection of pain associated with disorders in the lumbar spine”. J. “cardiovascular and interventional radiology”, 1999, 22, pp. 493-498, namely, that the needle No. 23 G injected from the posterolateral paraspinal access to the affected level degenerative process segment. For controlling the position of the needle using a computer tomograph, which selects scans (5-7 scans at intervals of 3 mm) at the level of terminalnode holes where the ganglion nerve root is located at the level of the intervertebral disc, and non-ionic contrast substance is distributed along the nerve root in the epidural space. After that enter races is the thief of bupivacaine 0.125 per cent - 2.0 ml and triaminobenzene - 40 mg

Pain in the lumbar region and pseudoradicular pain syndromes applied introduction needle No. 25 G, which is mounted on the back surface of the many-faceted joint of the paramedian access, and after confirming the location of the needle outside the cavity of a joint introduce a 50% solution of the alcohol in a volume of 2 ml and bupivacaine.

The disadvantages of the method are the probability of injury of the nerve root due to the fact that the author uses a thin needle, which reduces the effectiveness of the treatment, furthermore, multiple scanning increases the radial load on the patient and the duration of the procedure.

The objective of the invention is to increase the effectiveness of treatment of radicular pain syndrome and a reduction in the duration of the procedure by increasing the area of effect of drugs on all reflex area, which is the source of pain generation, resulting in the psychological comfort and early activation of patients.

This is achieved by using neuroimaging examination to determine the level of required terminalnode holes and Tuohy needle No. 16-20 G thoracic, lumbar, sacral levels enter the posterolateral access paravertebral reached for 7-12 cm from the midline of the spine in the direction of the Oia to the intervertebral opening angle 50-80° to the surface of the table, in this case, when the needle rests in the many-faceted joint, it slips from it laterally, and at the cervical level, the needle is introduced from anterolateral access prevertebral towards the intervertebral foramen on the posterior edge of the sternocleidomastoid muscle or through it and sliding it with the transverse process in ventral direction.

The method is as follows (lumbar, sacral and thoracic levels).

The patient is placed on the table of the CT scanner in position on the abdomen. Under the pelvic bone and the belly enclose a small cushion to increase the distance between the transverse processes and the arches of the vertebrae, thereby providing greater accessibility to terminalname hole. Place manipulation is processed three times with 70% alcohol solution and obkladyvaetsja sterile wipes. Conduct infiltration of the skin and subcutaneous tissue 2% solution of lidocaine, create on the spot vcol "lemon peel". Then do a scan on the computer tomograph and taking into account the neurological status, data magnetic resonance imaging to determine the level of required terminalnode holes (L1-S3). Using light label scanner, some distance from the middle line 7-12 cm angle 50-80° to the surface of the table at this level of the posterolateral access paravertebral is Ino injected Tuohy needle No. 18 G. When the needle rests in the many-faceted joint, it is necessary to slide it laterally.

In the cervical spine needle is injected from the anterolateral access to a place out of the back of the spinal canal, sliding off the transverse process in ventral direction. When reaching the needle nerve root pain increases. Then injected contrast agent and, thus, confirm the trajectory distribution further input medicines, namely along the nerve root and ganglion, many-faceted joint, posterior longitudinal ligament and into the epidural space. Next, enter a local anesthetic and a glucocorticosteroid.

So, get two or three shots of a scanogram and one or two axial snapshot, which is 2 times less than that of the author of the prototype. In addition, the introduction of a needle made from a single point.

Clinical examples.

Patient P., aged 35, was admitted to the neurosurgery Department with complaints of pain in the lumbar region, radiating on the lateral surface of the femur and tibia on the left, worse when walking. Complaints arose after physical exertion and worry within 3 months. Conservative symptomatic therapy with moderate short-term effect. MRI is determined Terminalia protrusion of L5-S1intervertebral disk to the left to 5 the m In neurological status without motor and sensory fallout.

After positioning the patient on the table computed tomography with Abed in the stomach roller and processing the injection site alcohol 70% solution do the scan. Choose the scan at the level of L5-terminalnode holes. In light label CT scan at a distance of 10 cm from the midline at an angle of 70° after the injection of the skin and subcutaneous tissue 2% solution of lidocaine, and paravertebral muscles, in a volume of 10 ml, Tuohy needle No. 18 G injected from the posterolateral access paravertebral. After the needle rests in the many-faceted joint, slip in the lateral direction, thus achieving terminalnode holes. After a short gain pain patient injected with a contrast agent. Next, perform a scan on the scanner this level and get the path of propagation of the contrast along the nerve root and ganglion, many-faceted joint, posterior longitudinal ligament and into the epidural space. Then enter solution of bupivacaine 0.125 per cent to 2.0 ml and diprospan - 40 mg

On the table, the patient noted a significant decrease in pain in the left leg. In neurological status radicular pain syndrome regressed within 30 minutes.

Patient M., 40 HP, was admitted to the neurosurgery Department with W lalami pain in the cervical spine, irradiating on the outer surface of the left upper extremity to the first to third fingers. Amid the ongoing medical and physiotherapy pain has decreased slightly. MRI is determined posterolateral hernia C5-C6intervertebral disk to the left to 4 mm In the neurological status of the motor and sensory deposition no.

After positioning the patient on the table of the CT scanner on the back under the neck area spurious roller. The injection of treated 70% alcohol. Made the scan of the cervical spine. The selected scan at the level of terminalnode C5- holes. In light label CT scan at a distance of 6 cm from the midline on the posterior edge of the sternocleidomastoid muscle or through it at an angle of 60° to the plane of the table, after the injection of the skin, subcutaneous tissue and prevertebral muscles 2% lidocaine solution volume of 10 ml, the Tuohy needle No. 18 G introduced to the level terminalnode holes, namely to the transverse process of C5- vertebra. After amplification of the pain syndrome introduced contrast agent volume to 2 ml Next conducted a scan of this level and the trajectory of the distribution of contrast agent along the nerve root and ganglion. Many-faceted joint posterior longitudinal ligament and into the epidural space. Then within 3 to the minutes introduces the solution of bupivacaine 0.125 per cent - 2.0 ml and diprospan - 40 mg

On the table, the patient noted a significant decrease in pain in the left hand. In neurological status radicular pain syndrome regressed within 10 minutes, motor and sensory deposition no.

Patient S., 38 HP, was admitted to the neurosurgery Department with complaints of pain in the thoracic spine, irreversibly on a lateral surface of the chest to the right to the level of the rib. Pain concern within 4 months. Held conservative and physiotherapy with insufficient effect. According to MRI visualized circular protrusion Th7-Th8intervertebral disc. After positioning the patient on the table computed tomography, abdomen and processing the injection site alcohol 70% solution, do the scan. Choose the scan at the level of Th7- terminalnode holes. In light label CT scan at a distance of 10 cm from the midline at an angle of 70°after injection of the skin and subcutaneous tissue 2% solution of lidocaine, and paravertebral muscles, in a volume of 10 ml, the Tuohy needle No. 18 in G, after the needle rests in the many-faceted joint, it slides in a lateral direction, reaching terminalnode holes. After a short gain pain patient injected with a contrast agent. Next, perform a scan on the scanner on the frame level and get the path of propagation of the contrast along the nerve root and ganglion, many-faceted joint, posterior longitudinal ligament and into the epidural space. Then enter solution of bupivacaine 0.125 per cent to 2.0 ml and diprospan - 40 mg

On the table, the patient noted a significant decrease in pain in the left half of the chest. In neurological status radicular pain syndrome regressed within 20 minutes, motor and sensory deposition no.

Patient C., 34 HP, was admitted to the neurosurgery Department with complaints of pain in the lumbar region, radiating on the back of the thigh and lower leg to the right, worse when walking. Complaints arose after physical stress and worry for 5 months. Conservative symptomatic therapy with moderate short-term effect.

MRI is determined by the median hernia L5-S1intervertebral disk to the left to 7 mm. In neurological status without motor and sensory fallout.

After positioning the patient on the table computed tomography with Abed in the stomach roller and processing the injection site alcohol 70% solution made by scanogram. The selected scan at the level of the S1- terminalnode holes. In light label CT scan at a distance of 7 cm from the midline at an angle of 80° after the injection of the skin and subcutaneous tissue 2% solution of lidocaine, and paravertebral muscles, the volume 10 ml, the Tuohy needle No. 18 G introduced to the level terminalnode holes. After a short gain pain the patient is injected contrast agent volume to 2 ml Then carried out the scan on the scanner at this level and receive path of propagation of the contrast along the nerve root and ganglion, posterior longitudinal ligament and into the epidural space. Then within 3 minutes introduces the solution of bupivacaine 0.125 per cent to 2.0 ml and diprospan - 40 mg

On the table, the patient noted a significant decrease in pain in the left leg.

In neurological status radicular pain syndrome regressed within 15 minutes.

The application of this method allows to increase the effectiveness of the treatment because the drugs are distributed to all probable reflexogenic areas: along the nerve root and ganglion, in the epidural space, the posterior longitudinal ligament and many-faceted joint from one place of vcol. In addition, due to the exact layout of the level of insertion of the needle, the number of images is reduced to 2-3, which reduces the duration of the procedure by increasing the area of effect of drugs on all reflex area, which is the source of pain generation. The result is psychological comfort and early activization of patients.

Method of treatment the Oia radicular pain syndrome, including determination of the level required terminalnode holes and the introduction of drugs from posterolateral access paravertebral lumbar, sacral and thoracic levels and anterolateral access prevertebral at cervical level, characterized in that use Tuohy needle No. 16-20, lumbar, sacral and thoracic levels of the needle is injected, some distance 7-12 cm from the midline of the spine toward the intervertebral opening angle 50-80° to the table surface when the position of the patient on his stomach, after the needle stuck in the facet joint, slip it in a lateral direction; at cervical level needle enter in the direction of the intervertebral foramen at the position of the patient on the back and sliding it with the transverse process in ventral direction; while achieving short-term gain pain administered drugs.



 

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FIELD: medicine.

SUBSTANCE: method involves determining required foramen level. Needle is introduced at lumbar, sacral and thoracic segment level in paravertebral way with posterolateral access method and with anterolateral access at the cervical segment level. Tuochi 16-20 needle is applied. The needle is introduced 7-12 cm far from vertebral column median in the direction of intervertebral foramen at an angle of 50-80° to table surface in prone patient position at lumbar, sacral and thoracic segment level. The needle is brought in sliding in lateral direction after it has rested against joint facet. The needle is introduced towards the intervertebral foramen in dorsal patient position. Then, the needle slides from the transverse process in ventral direction. Short-term pain increase being the case, drugs are introduced.

EFFECT: enhanced effectiveness of treatment.

FIELD: medicine, oncology.

SUBSTANCE: the present innovation should be applied at adjuvant chemotherapy in case of tumors of central nervous system. Moreover, while carrying out lumbar puncture it is necessary to perform catheterization of subarachnoidal space. Moreover, one should daily sample liquor at the quantity of 10 ml to be incubated with chemopreparation in vitro for 30 min at 38 C. One should daily introduce chemopreparations upon autoliquor through catheter during the whole period of therapy course. The method enables to choose any mode and duration of endolumbar chemotherapy at its decreased toxicity.

EFFECT: higher efficiency of chemotherapy.

1 ex

FIELD: oncological diseases.

SUBSTANCE: invention is designed for use in complex treatment of urinary bladder cancer in case of propagation of tumor to sub-epithelium connective tissue. Method comprises transurethral resection and introduction of immune preparations and furacillin solution. Once transurethral resection completed, three-way Foli catheter is transurethrally introduced to patient, through which mixture of standard furacillin solution with 10·106 ME interferon α-2β is injected from the first postoperative day and over following 3-5 postoperative days bringing summary dose of interferon to 50·106 ME.

EFFECT: prevented traumatism of urinary bladder due to single introduction of catheter and assured continuous action of drugs without development of immune complications.

FIELD: medicine, surgery.

SUBSTANCE: method involves carrying out an antibacterial therapy and additional administration of curative mixture consisting of one part of dimexide, two parts of 0.5% of novocaine solution with antibiotic eliciting high the bacteriostatic activity against microflora in duct secret. Administration of this curative mixture is carried out by catheter into injured duct directly by course 1-2 times. Invention promotes to topical sanitation of mammary gland duct and reducing time of disease. Invention can be used in treatment of galactophoritis.

EFFECT: improved method for treatment.

1 ex

FIELD: medicine, ophthalmology, pediatrics.

SUBSTANCE: method involves irrigation therapy (IT) by retrobulbar catheterization. Before carrying out IT the preparation "Ginkgo biloba" in capsules and age dosage and nasal drops "Semaks" by 1-2 drops for 1 month is prescribed to patient. Then in IT is carried out for 10 days in hospital by administration of cerebrolysin, riboflavin, agapurin, taufon and emoxipine in the dose 0.4 ml of each of them. Preparations are administrated successively, by fractional doses with interval for 2 h in combination with laser-pleoptic treatment at wavelength 0.63 mcm using device "SPEKL" for 10 min, by one procedure per a day for 10 days. After treatment in hospital glutamine and lecithin is prescribed by ambulatory treatment in age doses for 1 month. Method provides the prolonged remission of disease and reduced hospital period due to the complex effect of indicated curative factors on metabolism normalization in nervous cells, their resistance to stress injures, improvement of regenerative and microcirculating processes in eye tissues, frequency-contrast characterization of visual analyzer.

EFFECT: improved treatment method.

1 ex

FIELD: medicine.

SUBSTANCE: method involves introducing probe into the stomach via esophagus. Guiding probe in the stomach and intestine is carried out under laparoscopic control. After having placed the working end in the stomach, elastic conductor is introduced via its internal canal. Flexible tube is introduced as far as possible along the external surface into pyloric sphincter and is arranged on the stomach fundus on the greater curvature. Probe with conductor is introduced along the tube via the pyloric sphincter to duodenojejunal curve. The duodenojejunal curve angle is reduced in instrumental way and by turning the patient to the right side. The probe and conductor are brought behind the duodenojejunal curve by applying axial pressure to the external probe end.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.

FIELD: medicine; medical engineering.

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EFFECT: high accuracy in delivering drugs exactly to pathological focus.

11 cl, 4 dwg

FIELD: medicine.

SUBSTANCE: method involves carrying out thoracocentesis, introducing draining tube and fixing it in chest wall. The tube is fixed by introducing corrugated part of device for draining pleural cavity into trocar stiletto cylinder sleeve, moving it into the pleural cavity and fixing corrugation near costal part of parietal pleura. The device has trocar, draining tube, tubular pusher for moving the tube into the pleural cavity and external fixing member. The trocar is manufactured as stiletto having an enveloping cylinder sleeve. The draining tube has corrugation manufactured some distance away from draining tube end, the distance being equal to purulent cavity size determined in X-ray examination. The corrugation collapses when being introduced into the cylinder sleeve. The fixing member is manufactured as plate having a hole tightly embracing the draining tube.

EFFECT: enhanced effectiveness of treatment irrespectively of patient chest wall thickness; reliability and accuracy in tube fixation.

2 cl, 4 dwg

FIELD: medical equipment.

SUBSTANCE: catheter has flexible catheter tube and device for controlled deviation of distal end part of catheter tube. Device for controlled deviation of distal end part of flexible catheter tube is made in form of wire conductor made of springing elastic material. Conductor is capable of free moving along catheter tube into neutral position or initial position. As a result, when conductor is more or less pulled in relatively its initial position, end part of flexible catheter tube does move. Conductor has twisted spiral-shaped end part which when being in neutral or initial position takes place directly in opposition to external end of catheter tube. As a result, when wire conductor is pulled in relatively its initial position inside flexible tube, the end part of tube deflects at adjusted angle under influence of compression power of twisted spiral-shaped end part, which straightens forcedly.

EFFECT: minimal invasive surgery; ability of controlling catheter tube outside patient's body.

5 cl, 2 dwg

FIELD: medicine, oncology.

SUBSTANCE: method involves autoblood sample taking off in the amount 200-250 ml into a sterile flask with hemopreserving agent "Glugitsir" followed by centrifugation at 1500 rev/min for 30 min. Then supernatant plasma is placed into another sterile flask with a hemopreserving agent and cellular precipitate is reinfused. A single dose of a cytostatic agent is mixed with 10-100 ml of autoplasma, incubated at temperature 37°C for 1 h and administrated through catheter in abdominal cavity by puncture in lower quadrant of abdomen. Procedure is repeated if necessary. Method provides decreasing toxicity of chemotherapy, simple method and uniform distribution of volume of injected preparation for all abdomen cavity. Invention can be used in carrying out chemotherapy of abdomen cavity tumors with ascites.

EFFECT: improved method for treatment.

1 ex

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