E.L. Sokol, L.E. Kornilova, N.I. Garabova
(Faculty of Nervous Diseases and Neurosurgery, Russian University of Children’s Neurosurgery, Municipal Clinical Hospital N 64, Moscow)
Today the rate of failed back surgery syndrome (FBSS) varies from 4% up to 20%. Thus, operation time and indications for surgical management of discal hernias are still rather important problems. According to the osteogenic theory of neuroorthopedic diseases, a mechanism, responsible for development of lumbar osteochondrosis clinical manifestations (LOCM), is connected with facilitation of segmental afferent and motor responses under conditions of increased intraosseous pressure in vertebrae and pelvic bones.
The Study Goal: To estimate efficacy of intraosseous blockades in cases with FBSS and patients with LOCM, who did not undergo interventions for discal hernias.
Materials and Methods. We observed 20 cases with FBSS, aged 37-74. They had pain syndrome relapse and other clinical manifestations of lumbar osteochondrosis. Indications for removal of discal hernias, having been performed some time ago, included durable pain syndrome and a hernia size of 7 mm and more (according to data of MRI examination). Only one patient of this group had been treated with paravertebral blockades before operation. The second (control) group consisted of 100 cases with LOCM and discal hernias. They had persistent pain syndrome. An average size of the biggest discal hernia, revealed during MRI examination, was 7.9 mm. A neuroorthopedic state and pain syndrome were estimated before and after a course of treatment with intraosseous blockades. Assessment of pain syndrome was carried out on the basis of special questionnaires. Diagnosis was confirmed by X-ray and MRI examination of lumbar spine. Drugs were administered into spinous processes of lumbar vertebrae and spina iliaca posterior superior.
Results. Intraosseous blockades resulted in 50% (or more) reduction of pain syndrome in 10 cases with FBSS. As for the control group the identical reduction or complete disappearance of pain syndrome with considerable regression of LOCM were watched in 90 cases.
Conclusion. The study has demonstrated, that intraosseous blockades are a highly effective pathogenetic method of treatment of cases with LOCM and discal hernias, as well as of patients with FBSS. Low efficacy of these blockades should be regarded as an indication for discal hernia removal.