The results of treatment of patients with low lumbar pain syndrome with spondylarthrosis manifestations predomination using radiofrequency denervation of facet joints in combination with periarticular injection of local anesthetics and steroid preparation
Background. The high incidence of degenerative-dystrophic spinal cord injury with low effectiveness of spondylarthrosis therapy makes relevant the study on the treatment of low lumbar pain syndrome, caused mainly by spondyloarthrosis, with an innovative minimally invasive method of high-frequency denervation of the facet joints in combination with periarticular injection of a local anesthetic and steroid preparations. The purpose of the study: to determine the effectiveness of the of radiofrequency denervation of the facet joints in combination with the periarticular injection of local anesthetics and steroids to eliminate the pain in patients with lower lumbar pain syndrome with the predomination of spondyloarthrosis, taking into account early and long-term results of treatment. Materials and methods. The analysis of early and long-term results of treatment of 78 patients (37 men and 41 women aged 51 to 79 years) with lower lumbar pain syndrome, in which the leading clinical sign was arthrosis of the facet joints, who formed the main group, and high-frequency denervation of the facet joints were performed using RFG-1A/RFG-1B device (Radionics) in combination with periarticular injection of a local anesthetic and a steroidal drug. Assessment of the pain syndrome was carried out four times — in the preoperative and postoperative periods (during the week), in 3 months and in 1 year after treatment. The visual analogue scale of pain and the Oswestry index of disability index were used. The control group consisted of 136 patients (73 men and 63 women aged 44 to 81 years) with a lower lumbar pain, where spondyloarthrosis dominated, in whom only radiofrequency denervation of the facet joints was performed. Results. The reliable results of treatment of chronic low lumbar pain syndrome caused mainly by the articular joint decease were obtained immediately after the treatment and three months after it was carried out both in the main and control groups, which indicates the effectiveness of both treatment methods. At the same time, there is a clear and reliable difference between the main and control groups immediately after the treatment and 3 months after the treatment, which indicates a significantly higher efficiency of the method of high frequency denervation of facet joints in combination with periarticular injection of local anesthetic and steroidal drug in the early postoperative period. Conclusions. The results of treatment in the early and late periods after treatment testify to the efficacy and safety of both radiofrequency denervation of the facet joints and the radiofrequency denervation of the facet joints in combination with periarticular injection of the local anesthetic and steroid preparations in patients with low lumbar pain syndrome dominated by spondyloarthrosis. Relatively better results in the early period were obtained in the group of patients, who underwent radiofrequency denervation of the facet joints in combination with the periarticular injection of local anesthetic and steroidal drugs, whereas in the distant period (1 year after treatment), there is no such difference between the main and control groups. Periarticular administration of local anesthetics and steroids is effective in the short-term perspective, and radiofrequency denervation of the facet joints is effective both in the short-term and long-term perspective. Both methods can be recommended for inclusion in the treatment algorithm for facet syndrome with ineffectiveness of conservative treatment.
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