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.
Full Text:PDF (Українська)
Ayers C.E. Further case studies of lumbosacral pathology with consideration of in volvement of intervertebral discs and articular facets // N. Engl. J. Med. — 1935. — V. 21. — P. 716-721.
Ghormley R.K. Low back pain with special reference to the articular facets, with presentation of an operative procedure // JAMA. — 1933. — V. 101. — P. 1773-1777.
Goldthweit J.E. The lumbosacral articulation: an explanation of many cases of «lumbago», «sciatica» andparaplegia // Boston. Med. Surg. J. — 1911. — V. 164. — P. 365-372.
Rees W.S. Multiple subcutaneous denervation of segmental nerves in the treatment of the intervertebral disc syndrome // Ann. Gen. Pract. — 1971. — V. 16. — P. 126-127.
Сак Л.Д., Зубареков Е.Х., Шеметова М.В. Фасетный синдром позвоночника: клинико-диагностическая структура и малоинвазивные методики лечения. — Магнитогорск, 2001.
Niemisto L., Kalso E., Malmivaara A. еt al. Radio frequency denervation for neck and back pain: a systematic review with in the frame work of the Cochrane Collaboration Back Review Group // Spine. — 2003. — V. 28. — P. 1877-1888.
Saal S. General principles of diagnostic testing as related to painful lumbar spine disorders: a critical appraisal of current diagnostic techniques // Spine. — 2002. — V. 27. — P. 2538-2545.
Продан А.И. и др. Поясничный спондилоартроз. — Х., 1992. — 96 с.
Воробьева О.В. Подходы к терапии нерадикулярной хронической/рецидивирующей боли в спине // Сonsilium medicum. — 2015. — Т. 17, № 2. — С. 47-51.
Певзнер К.Б., Евзиков Г.Ю. Чрескожная радиочастотная деструкція суставных нервов как метод выбора в лечении поясничных болей // Невролог. — 2005. — № 2. — С. 45-49.
Dreyfuss P., Halbrook B., Pauza K. еt al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain // Spine. — 2000. — V. 25. — P. 1270-1277.
Komick C., Kramarich S.S., Lamer T.J. et al. Complication of lumbar facet radiofrequency denervation // Spine. — 2004. — V. 29. — P. 1352-1354.
Jackson R.P. The facet syndrome. Mythorreality? // Clin. Orthop. Relat. Res. — 1992. — № 279. — P. 110-121.
Kuslich S.D., Ulstrom C.L., Michael C.J. The tissue of origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar using local anesthesia // Orthop. Clin. North Am. — 1991. — Vol. 22. — P. 181-187.
Galagher J., Petricionedi Vadi P.L., Wedley J.R. et al. Radio frequency facet joint denervation in the treatment of low back pain: a prospective controlled double-blind study to asses sits efficacy // Pain Clinic. — 1994. — Vol. 7. — P. 193-198.
Dreyer S.J., Dreyfus P.H. Low back pain and the zygapophysial (facet) joints // Arch. Phys. Med. Rehabil. — 1996. — Vol. 77. — P. 290-300.
Алексеева Л.И., Чичасова Н.В., Мендель О.И. Рациональный выбор базисной терапии при остеоартрозе. Результаты открытого рандомизированного многоцентрового исследования препарата АРТРА в России // РМЖ. Ревматология. — 2005. — 13(24). — С. 1637-40.
Niemisto L., Kalso E., Malmivaara A. еt al. Cochrane Collaboration Back Review Group. Radio frequency denervation for neck and back pain: a systematic review with in the frame work of the Cochrane Collaboration Back Review Group // Spine. — 2003. — 28(16). — С. 1877-88.
Geurts J., van Wijk R., Stolker R., Groen G. Efficacy of radiofrequency procedures for the treatment of spinalpain: a systematic review of randomized clinical trials // Reg. Anesth. Pain. Med. — 2001. — 26(5). — С. 394-400.
Van Zundert J., Van Boxem Koen, Joosten E.A. Clinical trials in interventional pain management: Optimizing chances for success? // Pain. — 2010. — Vol. 151. — P. 571-574.
Коновалов Н.А., Прошутинский С.Д., Назаренко А.Г., Королишин В.А. Радиочастотная денервация межпозвонковых суставов при лечении болевого фасеточного синдрома // Вопросы нейрохирургии им. Н.Н. Бурденко. — 2011. — Т. 75, № 2. — С. 51-55.
Leclaire R., Fortin L., Lambert R., Bergeron Y.M., Rossignol M. Radio frequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy // Spine. — 2001. — Vol. 26. — Р. 1411-1416.
Ramos J.A. Spinal injection of local anesthetic during cervical facet joint in jection // Rev. Bras. Anestesiol. — 2014. — Vol. 14. — P. 127-125.
Watters W.C., Resnick D.K., Eck J.C. et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: in jection the rapies, low-backpain, and lumbar fusion // J. Neurosurg. Spine. — 2014. — Vol. 21(1). — P. 79-90.
- There are currently no refbacks.
Copyright (c) 2017 TRAUMA
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2017