The problem of the pathology of the facet joints of the lumbar spine remains significant and is medical and social due to persistent pain syndrome, high incidence of morbidity and frequent disability outcomes. The complex anatomical and topographic relationships of the facet joints, intervertebral discs and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. A pair of facet joints and an intervertebral disc constitute a functional unit - a "three-component complex" and are interconnected with each other. The article examines the anatomical and morphological features and radiological classifications of degenerative changes in the facet joints, which are currently used in clinical practice. Facet joint pathologies are the most common nosological form of degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and the formation of chronic pain syndrome. The features of facet syndrome diagnostics are presented on a clinical example of surgical treatment by means of laser dereception of facet joints.
Боль в позвоночнике является одним из наиболее распространённых патологических состояний и стоит на втором месте по значимости причин выхода пациентов на инвалидность и потери трудоспособности во всём мире. Болевой синдром оказывает большое влияние на функциональные возможности позвоночника и профессиональную деятельность человека, что несёт в себе серьёзную социальную и экономическую проблему. Основными причинами боли в области позвоночника являются патология межпозвонковых дисков и дугоотростчатых суставов, динамическая нестабильность позвоночно-двигательного сегмента, спондилёз, стеноз позвоночного канала и дурального мешка с компрессией сосудисто-невральных структур, спондилолистез, остеопоротические компрессионные переломы позвонков, инфекционные заболевания позвоночника и т. д. В связи с выше озвученным, особый интерес у клиницистов вызывает патология дугоотростчатых суставов (спондилоартроз), его диагностика, целенаправленное этиопатогенетическое лечение с использованием пункционных хирургических технологий в лечении фасет-синдрома. В настоящей работе представлены результаты и особенности пункционных хирургических технологий в лечении фасет-синдрома при дегенеративно-дистрофических поражениях дугоотростчатых суставов поясничного отдела позвоночника. В основу взят анализ 55 источников отечественных и зарубежных авторов. В статье приводятся данные по анатомо-топографическим особенностям дугоотростчатых суставов, их биомеханике, иннервации и их функции. Рассмотрены этиопатогенетические особенности болевого синдрома при дегенерации фасеточных суставов. Проанализированы эффективность применения методик использования радиочастотной и лазерной денервации дугоотростчатых суставов в лечении фасет-синдрома. В материалах статьи описаны методики применения хемодерецепции, криодеструкции и внутрисуставного введения препаратов гиалуроновой кислоты.
The purpose of the study: assessment of the use of laser vaporization of the disc with hernial protrusion on the lumbar spine and its effectiveness in the treatment of pain. Material and methods. We analyzed the effectiveness laser vaporization in 230 patients with degenerative-dystrophic diseases of the lumbar spine (protrusions and hernias of the intervertebral discs) treated in the neurosurgical department of the Irkutsk Scientific Centre of Surgery and Traumatology for the period from 2011 to 2018. There were 122 men and 108 women. The average age of the patients was 41 years. The duration of the disease before surgical treatment is 11 ± 3 weeks. Clinical and neurological examination revealed lumbalgia in 102 patients (44.3 %), lumbar ischalgia in 98 (42.6 %) and radiculopathy in 30 patients (13.1 %). Median hernias of the intervertebral discs were revealed in 130 patients (56.4 %), lateral hernias -in 41 (17.8 %) and protrusions -59 (23.8 %). The leading localization of the pathological process was the L IV -L V segment (138 patients, 60 %). Assessment of the effectiveness of surgical treatment was carried out using VAS and Macnab scales. Results. In 100 % of cases were laser vaporization was applied a decrease in the intensity of the pain syndrome was achieved in terms of up to 3 months. The analysis of the long-term results of this treatment in 124 patients from 3 months to 3 years by Macnab scale revealed excellent results in 25 (20.1 %) patients, good results -in 50 (40.3 %), satisfactory -in 42 (33.8 %), and unsatisfactory results -in 7 (5.6 %) cases. Conclusion. Thus, laser vaporization of hernias of the intervertebral disc is effective in the treatment of pain, which does not stop with conservative treatment for 4-6 weeks; with a hernia of up to 6 mm; with a median localization and with no signs of sequestration.
Thermography and electroneuromyography parameters were studied in 34 patients with vertebrogenic pain syndrome associated with lumbar spine stenosis. All patients were treated in the neurosurgical department of the Irkutsk Scientific Centre of Surgery and Traumatology. We determined the changes in temperature values in the lumbar spine and lower extremities under the condition of disorder in peripheral nerves functional state.Purpose of the study: to evaluate the parameters of thermography and electroneuromyography in patients with lumbar spine stenosis.Materials and methods. The article presents the results of thermography and electroneuromyography of 34 patients with severe pain syndrome associated with degenerative stenosis of the lumbar part of spinal canal in preoperative period. Thermal-imaging study was carried out using a thermovision camera SVIT-004, the study of the peripheral nerves function of the lower extremities was carried out using the Neuromian-1-04 neuromyoanalyzer. The skin temperature recording points corresponded to the projection of stimulating and pickup ENMG electrodes on the spinous processes of the LIV, LV, SI vertebrae and paravertebrally.Results. Thermography parameters in patients with degenerative lumbar spine stenosis on the pain side were higher than on the intact side at all measurement points by 1–2 °C. At the same time, electroneuromyographic parameters in these patients indicated a decrease in the activity of the peripheral and central motor apparatus.Conclusion. The change in thermography parameters in patients with lumbar spine stenosis in the lumbar part and the area of pain irradiation in the lower extremities occurs alongside with the disorder of the peripheral nerves functional state.
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