Keywords
How to Cite
Abstract
Aim. Explore different treatment approaches for degenerative-dystrophic damage of the spine and formulate the most effective treatment methods, their stage from accounting pathogenetic basis of pain syndromes.
Research methods – bibliosemantic, comparative, systemic.
Results. Diverse treatments for degenerative-dystrophic damage of the spine does not facilitate but even complicates general practitioner’s work due to the fact that information on clinical benefits of various drugs and techniques as well as various types of surgery is too contradictory; there is no single method of consistent, combination therapy for vertebrogenic pain. There is no universal therapy or surgery that would provide sustainable relief of symptoms of nonspecific back pain and/or radicular syndrome. The pathogenesis of development of specific clinical manifestations of the disease and the ratio of clinical manifestations and pathomorphological changes are crucial in choosing the treatment. The general principles of treatment are unchanged: rest, analgesics and movement should be combined in appropriate sanogenic proportions in each case. Reduction of oedema and swelling of the intervertebral disc and the spinal nerve root, nerve endings are crucial in regression of pain syndrome. There is no doubt that nonsteroidal anti-inflammatory drugs (NSAIDs) are the most effective in relieving lumbar and radicular pain at the beginning of treatment. In the absence of significant improvement after the use of NSAIDs and the necessary sanogenic motor loads, a more dynamic treatment should be used. First of all, different methods of local administration of pharmacological drugs: starting with the banal subcutaneous injection of painful areas and finishing with ultrasound and MRI-controlled injections directly into the area around the damaged nerve root, the epidural space, or the facet joint. In most cases, epidural injections can reach areas of disc-radicular conflict – after the drug is injected into the epidural space, favourable conditions are created for diffusion of glucocorticoids (or other pharmacological agents) into surrounding tissues, as well as the nerve root, regardless of its compression or irritation.
Conclusions. And only after the ineffectiveness of NSAIDs and puncture treatments, as well as epidural injection and in the case of persistent mechanical compression of nerve roots in comparison with clinical manifestations, appropriate surgical treatments, both minimally invasive and open, are necessary.
References
Machado, L. A., Kamper, S. J., Herbert, R. D., Maher, C. G., McAuley, J. H. (2009). Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology (Oxford), May, 48(5), 520–7. PMID:19109315. DOI:10.1093/rheumatology/ken470.
Wegner, I., Widyahening, I. S., van Tulder, M. W., Blomberg, S. E., de Vet H. C., Brønfort G., Bouter L. M., et al. (2013). Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev, Aug 19, (8), CD003010. DOI:10.1002/14651858.CD003010.pub5. PMID:23959683.
French, S. D., Cameron, M., Walker, B. F., Reggars, J. W., Esterman, A. J. (2006). A Cochrane review of superficial heat or cold for low back pain. Spine, Apr 20, 31(9), 998–1006. PMID:16641776. DOI:10.1097/01.brs.0000214881.10814.64.
Weinstein, J. N., Tosteson,T. D., Lurie, J. D., Tosteson, A. N., Hanscom, B., Skinner, J. S., et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA, Nov 22, 296(20). 2441–50. PMID:17119140. PMCID:PMC2553805. DOI:10.1001/jama.296.20.2441.
Karateev, A. E. (2013). Diseases of the musculoskeletal system in the practice of 2102 doctors of different specialties: structure pathology and expert opinion about the effectiveness of NSAIDs (preliminary data of the KORONA-2 epidemiological study). Consilium medicum, (9), 95–100.
Tsurko, V. V. (2005). Dorsopatii: faktory riska, mekhanizmy i anatomicheskiye istochniki boli, terapiya ksefokamom rapidom [Dorsopathies: risk factors, mechanisms and anatomical sources of pain, therapy with slow xerophage]. Vrach,12, 55–8.
Shostak, N. A., Klimenko, A. A., Pravdyuk, N. G. (2006). Bol' v spine – nekotoryye aspekty diagnostiki i lecheniya [Back pain – some aspects of diagnosis and treatment]. RMZH, 1, 87–9.
Pakhomov, G. A., Luppova, I. V. (2010). Optimizatsiya metodiki lazernoy vaporizatsii u bol'nykh s diskogennym koreshkovym sindromom razlichnykh otdelov pozvonochnika [Optimization of laser vaporization technique at patients with discogenic radicular syndrome at various spinal levels]. The Russian Journal of neurosurgery, 3, 52–61.
Isayeva, N. V., Dralyuk, M. G. (2010). Osnovnyye podkhody k lecheniyu i profilaktike posleoperatsionnogo epidural'nogo fibroza u bol'nykh s poyasnichnym osteokhondrozom pozvonochnika [The main approaches for treatment and prevention of postoperative epidural fibrosis at patients with lumbar osteochondrosis]. Russian journal of neurosurgery, 3, 74–79.
Karateev, A. E., Nasonova, V. A. (2008). Development and relapse of gastroduodenal ulcer in patients taking nonsteroid anti-inflammatory drugs: effects of standard risk factors. Ter Arkh., 80(5), 62–6. PMID:18590118.
Maslovskaya, S. G., Gorbunov, F. Ye. (2000). Fizioterapiya bol'nykh posle neyrokhirurgicheskikh vmeshatel'stv po povodu kompressionnogo vertebrogennogo sindroma. [Physiotherapy of patients after neurosurgical interventions for compression vertebrogenic syndrome] Ros. med. zhurnal., 5, 33–38.
Stambough, J. L., Templin, C. R., Collins, J. (2000). Subarachnoid drainage of an established or chronic pseudomeningocele. J. Spinal Disord., 1, 39-41. PMID:10710148. DOI:10.1097/00002517-200002000-00008 https://search.crossref.org/?q=Stambough+JL%2C+Templin+CR%2C+Collins+J.+Subarachnoid+drainage+of+an+established+or+chronic+pseudomeningocele.+J.+Spinal+Disord.+2000%3B1%3A39-41.+PMID%3A10710148.
Noskov, S. M. (2007). Revmatologiya. Aktual'naya terapiya [Topical therapy]. Rostov-on-Don : Feniks. 39 s.
Raspe, H. (2008). Management of chronic low back pain in 2007–2008. Curr Opin Rheumatol., May, 20(3), 276–81. PMID:18388518. DOI:10.1097/BOR.0b013e3282f94256.
Anan'yeva, L. P. (2008). Mestnoye lecheniye boli: effektivnost' i perenosimost' preparata «Versatis» – plastin s 5% lidokainom dlya nakozhnogo primeneniya [Local treatment of pain: effectiveness and tolerability of the drug "Versatis" – plates with 5% lidocaine for dermal application]. Consilium medicum, 7, 103–8.
Godzenko, A. A. (2008). Bol' v spine. Klinicheskiy algoritm. [Back pain. Clinical algorithm]. RMZH, 29, 19–23.
Lytkina, K. A., Vorob'yev, P. A., Tsurko, V. V. (2006). Bolevoy sindrom pri osteoartroze: problema ratsional'noy terapii [Pain syndrome in osteoarthritis: the problem of rational therapy]. Klin gerontol., 2, 23–28.
Malanga, G., Wolff, E. (2008). Evidence-informed management of chronic low back pain with nonsteroidal anti-inflammatory drugs, muscle relaxants, and simple analgesics. Spine J., Jan-Feb, 8(1), 173–84. PMID:18164465. DOI:10.1016/j.spinee.2007.10.013.
Kamchatnov, P. R. (2007). Ostraya spondilogennaya dorsalgiya – konservativnaya terapiya. [Acute spondylogenic dorsalgia – conservative therapy]. Russian medical journal, 15 (10), 64–74.
Roelofs, P. D., Deyo, R. A., Koes, B. W., Scholten, R. J., van Tulder, M. W. (2008). Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev., Jan 23, (1), CD000396. DOI:10.1002/14651858.CD000396.pub3. PMID:18253976.
See, S., Ginzburg, R. (2008). Choosing a skeletal muscle relaxant. Am Fam Physician., Aug 1, 78(3), 365–70. PMID:18711953.
Witenko, C., Moorman-Li R., Motycka, C., Duane, K., Hincapie-Castillo, J., Leonard, P., et al. (2014). Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T., Jun, 39(6), 427–35. PMID:25050056. PMCID:PMC4103716.
Koes, B. W., van Tulder, M., Lin, C. W., Macedo, L. G., McAuley, J., Maher, C. (2010). An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J., Dec, 19(12), 2075–94. PMID:20602122. PMCID:PMC2997201. DOI:10.1007/s00586-010-1502-y.
Isaikin, A. I., Ivanova, M. A. (2016). Blockade in the treatment of lumbar pain: agree.
Treatment of diseases of the nervous system, 18(1), 29–37.
McGrath, J. M., Schaefer, M. P., Malkamaki, D. M. (2011). Incidence and Characteristics of Complications from Epidural Steroid Injections. Pain Medicine, May, 12(5), 726–31. PMID:21392252. DOI:10.1111/j.1526-4637.2011.01077.x.
Lee, J. H., An, J. H., Lee, S. H. (2009). Comparison of the effectiveness of interlaminar and bilateral transforaminal epidural steroidinjections in treatment of patients with lumbosacral disc herniation and spinal stenosis. Clin J Pain, Mar-Apr, 25(3), 206–10. PMID:19333170. DOI:10.1097/AJP.0b013e3181878f9e.
Gnezdilov, A., Zagorulko, O., Medvedeva, L., Samoylova, N. (2011). Treatment radicular pain syndrome caused by pathologyin the lumbar spine in the acute period. European Journal of Anaesthesiology, Jun, 28. 204. DOI:10.1097/00003643-201106001-00660.
Malanga G., Wolff E. (2008). Evidence-informed management of chronic low back pain with trigger point injections. The Spine Journal, Jan, 8(1), 243–52. DOI:10.1016/j.spinee.2007.10.029. PMID:18164472.
Dynamics of neurological interrelation of lumbar pains in patients with degenerative diseases of the spine with use of algorithm of regional blockades in process of treatment (2009). Kuban Scientific Medical Bulletin, 2(107), 79–88.
Gnezdilov A. V. (1999). Diagnostika i lecheniye fantomnogo i vertebrogennogo bolevykh sindromov [Diagnosis and treatment of phantom and vertebrogenic pain syndromes]. Moscow.
Abram S. E., Marsala M., Yaksh T. L. (19940. Analgesic and neurotoxic effects of intrathecal corticosteroids in rats. Anesthesiology, Nov, 81(5), 1198–205. DOI:10.1097/00000542-199411000-00013. PMID:7978478.
Genevay, S., Finckh, A., Payer, M., et al. (2008). Elevated levels of tumor necrosis factor-alpha in periradicular fat tissue in patients with radiculopathy from herniated disc. Spine, Sep 1, 33(19), 2041–6. DOI:10.1097/BRS.0b013e318183bb86. PMID:18758358.
Cuellar, J. M., Golish, S. R., Reuter, M. W., Cuellar, V. G., Angst, M. S., Carragee, E. J., et al. (2010). Cytokine evaluation in individuals with low back pain using discographic lavage. Spine J., Mar, 10(3), 212–8. DOI:10.1016/j.spinee.2009.12.007. PMID:20207331.
Ellenberg, M. R., Ross, M. L., Honet, J. C., Schwartz, M., Chodoroff, G., Enochs, S. (1993). Prospective evaluation of the course of disc herniation in patients with proven radiculopathy Arch. Phys. Med. Rehabil., 74(1), 3–8. PMID:8420516.
Dubnov, B. L. Poyasnichnyy diskoz [Lumbar discosis]. Kiev: Zdorov'ye, 1967. 250.
Rybak, V. A., Gordeeva, I. E, Matokhina, N. V., Babushkin, Ya. H. (2010). Poetapnoye mikroinvazivnoye lecheniye bolevykh sindromov v oblasti spiny. [Step-by-step microinvasive treatment of pain syndromes in the back area]. Volgograd: Print.
Zagorul'ko, O. I. (1996). Integratsiya traditsionnykh i sovremennykh metodov klinicheskoy refleksoterapii v diagnostike i lechenii bolevykh sindromov [Integration of traditional and modern methods of clinical reflexology in the diagnosis and treatment of pain syndromes]. Moscow.
Ahadian, F. M., McGreevy, K., Schulteis, G. (2011). Lumbar transforaminal epidural dexamethasone: a prospective, randomized, double-blind, dose-response trial. Reg. Anesth. Pain. Med., 36, 572.
Kondrashov, A. A., Polishchuk, N. E. (2010). Effektivnost' epidural'nogo vvedeniya steroidov u patsiyentov s foraminal'nymi gryzhami mezhpozvonkovykh diskov poyasnichnogo otdela pozvonochnika i koreshkovym sindromom [The effectiveness of epidural steroids in patients with foraminal hernias of intervertebral discs of the lumbar spine and radicular syndrome]. Odes Med Zhurn., 3, 50-55.
Olkhov, V., Buyanov, O., Horbatyuk, K., Kudina, O., Ventskivskiy, L., Borodenko, O., et al. (2015). Epidural administration of anesthetics and corticosteroids in treatment of acute radicular pain syndrome of lumbar spine in neurosurgical department. Ukrainian Neurosurgical Journal, 1, 51-54. Available at: http://theunj.org/article/view/42709.
Byrod, G., Otani, K., Brisby, H., Rydevik, B., Olmarker, K. (2000). Methylprednisolone reduces the early vascular permeability increase in spinal nerve roots induced by epidural nucleus pulposus application. J Orthop Res., Nov, 18(6), 983–7. PMID:11192260. DOI:10.1002/jor.1100180619.
Lundin, A., Magnuson, A., Axelsson, K., Nilsson, O., Samuelsson, L. (2005). Corticosteroids peroperatively diminishes damage to the C-fibers in microscopic lumbar disc surgery. Spine, Nov 1, 30(21), 2362–7; discussion 2368. PMID:16261109.
Baqai, A., Bal, R. (2009). The mechanism of action and side effects of epidural steroids. Techniques in Regional Anesthesia and Pain Management, 13(4), 205–11. DOI:10.1053/j.trap.2009.06.009.
Candido, K. D., Raghavendra, M. S., Chinthagada, M., Badiee, S., Trepashko, D. W. (2008). A prospective evaluation of iodinated contrast flow patterns with fluoroscopically guided lumbar epidural steroid injections: the lateral parasagittal interlaminar epidural approach versus the transforaminal epidural approach. Anesth Analg., Feb., 106(2), 638–44. PMID:18227326. DOI:10.1213/ane.0b013e3181605e9b.
Manchikanti, L. (2006). Medicare in interventional pain management: a critical analysis. Pain Physician., Jul, 9(3),171–97. PMID:16886027.
Ter Meulena, B., Weinsteina, H., Ostelob, R., Koehlerd, P. (2016). The Epidural Treatment of Sciatica: Its Origin and Evolution Eur Neurol., 75(1-2), 58–64. DOI:10.1159/000443729. PMID:26820578.
Gatchel, R. J., Gardea, M. A. (1999). Psychosocial issues: their importance in predicting disability, response to treatment, and searchfor compensation, Feb, 17(1), 149–66. DOI:10.1016/s0733-8619(05)70119-5. PMID:9855676.
Rossignol, M., Arsenault, B., Dione, C., et al. (2007). Clinic in low back pain in interdisciplinary practice (CLIP). Guidelines: Montreal.
Khyzhnyak, M., Priymak, E. U. (2013). Puncture surgical technology in treatment of discogenic pain syndrome of the lumbar spine. Ukrainian Neurosurgical Journal, 2, 35–38.
Kaye, A. D., Manchikanti, L., Abdi, S., Atluri, S., Bakshi, S., Benyamin, R., et al. (2015). Efficacy of Epidural Injections in Managing Chronic Spinal Pain: A Best Evidence Synthesis. Pain Physician, Nov, 18(6), E939-1004. PMID:26606031.
Boos, N., Aebi, M. (2008). Spinal disorders: fundamentals of diagnosis and treatment. Springer-Verlag Berlin Heidelberg. DOI:10.1007/978-3-540-69091
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.