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

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

 

The invention relates to medicine, namely to physiotherapy and neurology, and can be used for the treatment of patients with protrusion or herniation of intervertebral disks with irritative-or radicular compression-radicular syndrome.

Vertebral pathology, namely herniated discs are the most common cause of reduction (loss) of disability in persons younger and middle age.

Treatment is traditionally held with medication (non-steroidal anti-inflammatory drugs, analgesics, vitamins gr. In etc), physical methods of correction (diadynamic therapy, amplipulse therapy, ultrasonic therapy and others), aimed at relief of pain (Veselovsky VP, Ivancev GA, Popeljanskij YA and other Principles of complex treatment of patients with osteochondrosis of the spine: a manual. - L., 1985, 61 S., Balneology and physiotherapy (manual) Ed. by V.M. Bogolyubov, M.: Medicine, 1985, Vol.2, s-224, strelkov NI Physical methods of treatment in neurology. M.: Medicine, 1991, s-176, and others). All of these methods, unfortunately, do not eliminate the cause of the disease, often cause side effects such as gastro-intestinal tract and the hepatobiliary system. Often the ineffectiveness of the above treatment methods resort to manual therapy. About the however, for some patients the techniques of manual therapy can cause complications, related to insufficiently qualified the actions of the physician and individual anatomical and physiological characteristics, which lead to the development of impaired spinal blood circulation, spinal injuries, compression fractures of the vertebrae, etc.

Abroad (Anglo-American school) is widely used treatment of hernias of intervertebral disks method hardware traction (Parson W, Cummings J. Mechanical Traction in Lumbar Disc Syndrome. - Can.Med.Assoc. - J. 77:7-11, 1957, V. Larsson Et al.: Auto-Traction for Treatment of Lumbago Sciatica. - Acta Orthop. Scand. 51:791-798, 1980, Onel d, Tuzlaci M., H. Sari et al. Computed Tomographic investigation of the effect of traction on lumbar disc herniations. - Spine, 1989, v.14, No.1, p.82-90). Unfortunately, despite the etiopathogenetic validity, this technique is not widely spread in Russia due to a reflex motonishi reactions in response to traction and gain some pain syndrome after carrying out a medical procedure.

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

The technical result - the more effective the particular treatment due to the rapid relief of pain syndrome and long-term remission, reducing the time and painless treatment.

The proposed method is as follows: spend complex treatment that includes:

1) First conduct therapeutic exercises, individual positional correction of discogenic disorders (Bonev L., Guide kinesitherapy. Medicine and physical culture, Sofia, 1978, S. 248-256, Therapeutic physical culture: Ref. Ed. Waipawa, M., 1987, S.43-52 and others). Therapeutic exercise is used to strengthen the back muscles, abdomen and extremities, eliminate myofascial unit, incorrect posture. To eliminate axial load on the spine are the source of exercises, lying (back, side, stomach). Apply isometric exercises to strengthen the muscles without increasing mobility. Patients with compression-radicular syndromes produce flexion of the leg in the hip and knee joints with subsequent straightening. Contraindicated exercises with the trunk bent forward. Invalid hoists direct legs in the lying and sitting, sudden rotational movement;

2) classic treatment of segmental massage, which is carried out paravertebral by sparing methodology in order to reduce the severity myotonica violations (White N.A., a Guide to therapeutic massage, M., 1983, s, Kunchev L.A. Therapeutic massage, 1985, S-31). Is tactile pressure (semiserious kneading) painful muscle knots and areas of hypertonicity. Initially coarse movements given area of the bundle, then use your fingertips close to the epicenter of the knot, increasing kneading efforts. Direct impact on vertebral segments is by using the technique of "saw". Apart 1st and 2nd fingers of both hands placed on the sides of the spinous processes so that between the fingers formed dermal roller. He shifted sawing motions of both hands in opposite directions. So, by massaging the surface of the segment to the segment from the bottom up. The main indicators to massage are myotonica, neurodystrophic disorders;

3) drug phonophoresis with chondroprotective paravertebral lumbar-sacral spine and in the presence of radicular syndrome additionally phonophoresis with hydrocortisone and Vit. B12the projection of the affected spine with an intensity of 0.4-0.6 W/cm2in the pulse mode to enhance Tropico-reparative processes in the intervertebral discs and increase its elasticity, increase the speed of conduction of impulses in the affected nerve root (trunk) and acceleration of processes of myelination (Balneology and physiotherapy is erapy (manual) edited Vmmolotova, M.: Medicine, 1985, T.1, c.504-519. Technique and methods of physiotherapeutic procedures (Handbook), Ed. Vmmolotova. - M.: Medicine, 1983, P.236-241);

4) hardware traction on the traction table "Triton-M" with individual load level and mode of procedure followed hard careerbeam 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 a horizontal surface traction table Triton-M". The procedure begins with the insertion of breast bodice and lumbar corset. Traction is carried out with individual load, taking into account its own weight, since 1/4 of body weight, gradually increasing to 4-5 procedure to 1/3-1/2 of its weight of the patient step-by-step amplification of the load. The procedure is performed within 20-40 minutes, after which the patient within 20 minutes is in the horizontal position with the use of orthopedic devices. After the treatment session is held rigid corethrogyne for 2 hours.

This complex of therapeutic measures is carried out in one day step by step, without interruption, 2-3 times per week, per course 7-12 procedures.

Authors in science-medicinskoi and patent literature not found information about the popularity of the proposed phased comprehensive treatment of hernias of intervertebral discs of the lumbar and lumbosacral spine. Thus, the present invention meets the criteria of patentability "world novelty."

The authors of the clinical trials was first established that the sequence of the distinctive features of the method allows to achieve an effective cure for a prolonged period of remission, fast relief of pain, mitigate pain syndrome 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, came with complaints of pain in the lumbar-sacral spine, radionovela on posterolateral surface of the left leg, zatrudnieniu gait. Ill for about 5 years, increasing 2-3 times a year, repeatedly treated permanently. Last flare lasted about 4 months, therapy was ineffective. The patient was sent for surgical treatment in the Department of neurosurgery, but from the operation refused. During the inspection revealed a sharp restriction of movement in the lumbar-sacral spine, the lack of lumbar lordosis with protective scoliosis in the lumbar spine to the right. Sharply positive symptoms of tension to the left at an angle of 30�B0; , pain along the nerve trunks, oppression knee and Achilles reflexes on the left. Wasting and hypotonia of the muscles of the lower leg to the left. Violation surface sensitivity according to the type of pain hypesthesia in the field of nerve roots L4-L5 on the left. On computed tomograms of the lumbosacral spine revealed protrusion of disks L2-L3 size 3 mm, L3-L4 size of 2-3 mm, L4-L5 4 mm, median disc herniation size 12 mm at the level of L5-S1 with left-sided lateralization and compression of the spine to the left.

Held 9 sessions complex therapy with an interval of 1-2 days. The reduction in pain intensity and an increase in active movements were observed after 4 sessions, complete relief of pain occurred after 7 session a comprehensive physiotherapy. By the end of the treatment the patient recovered volume of active movements, regressed symptoms of "loss" of the spine to the left. After the end of treatment had a repeat CT scan of the lumbosacral spine. In the result noted decrease in the size of the intervertebral discs from 12 to 4 mm. of Protrusions of intervertebral discs during repeat study was not identified.

Example 2. Patient 3., 29 years old, profession is sports gymnast for 8 years was worried about the constant is passed back pain after suffering a "whiplash" injury. The deterioration was said about 1 year, ongoing conventional therapy had no positive effect. The examination revealed a sharp restriction of movement in the lumbar spine with marked mythicism violations, the smoothness of the lumbar lordosis, tenderness to palpation of the paravertebral points in the lumbar spine. Radiographically detected osteochondrosis of the lumbar spine with an offset of L2 vertebral bodies anteriorly by 2 mm with respect to L3 with rotation of the vertebral body L2. MRI detected a median disc herniation size 9 mm at the level of L2-L3 with protrusion into the lumen of the spinal canal and compression of the dural sheath 2-3 mm. was Conducted 10 sessions complex physiotherapy. The reduction in pain intensity and an increase in active movements was observed already after 3 treatments. By the end of treatment pain was almost docked, the volume of active movements fully restored, syndromic myotonica disorders regressed. When conducting after 4 months of repeated CT scan of the lumbosacral spine revealed a reduction in the size of the herniated disc to 3 mm.

The proposed method treated 53 patients with osteochon what Rotom lumbar-sacral spine, complicated hernia of intervertebral disks with sizes from 5 to 12 mm, the Advantage of this method is the high efficiency (up to 100%)due to pathogenetically justified therapies, painless and comfort techniques, no side effect on the digestive organs. It can be used both in ambulatory and in hospital. Thus, the present invention conforms to the criterion "industrial applicability".

The use of the proposed method is the possibility of conservative treatment of patients with herniated discs irritative-or radicular compression-radicular syndromes, both as monotherapy and in combination with medication drugs.

1. The method of complex treatment of hernias of intervertebral discs of the lumbar and lumbosacral spine, including a hardware traction and influence of ultrasound, wherein the treatment is carried out consecutively without a break in four phases with the first phase will cover physiotherapy with positional correction of discogenic disorders, in the second phase, carried out the classical treatment of segmental massage paravertebral on a delicate method, the third phase will phonophoresis with chondroprotective paravertebral on pojasnitj what about the lumbosacral spine, in the presence of radicular syndrome is conducted additionally phonophoresis with hydrocortisone and vitamin b12the projection of the affected spine with an intensity of 0.4-0.6 W/cm2in pulsed mode, complete the treatment hardware traction, this treatment 2-3 times per week, rate of 7-12 procedures.

2. The method according to claim 1, characterized in that the traction spend hard corethrogyne within 2 hours



 

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