Perfiliev O. Denervation of facet joints in lumbar spine in treatment of spondyloarthralgia syndrome under endoscopic control

Object: spondyloarthralgia syndrome of arthrosis of of facet joints in lumbar spine. Purpose: to improve the effectiveness of minimally invasive surgical treatment of patients with a spondyloarthralgia syndrome of facet joints arthrosis in the lumbar spine by improvement of the diagnostics, reasoning and developing an access and method to perform neurotomy of the medial twigs of posterior branches of the spinal nerves. Methods: clinical examination and therapeutic-diagnostic blockades - to identify the spondyloarthralgia syndrome in the lumbar spine; magnetic resonance imaging - to identify degenerative changes and to plan for minimally invasive access to denervation of lumbar facet joints; experimental anatomical and topographic - to study the variation in the placement of medial twigs of the posterior branches of the spinal nerves which participating in the innervation of the facet joints in the lumbar spine and determine the optimal access and method for minimally invasive neurotomy of the medial twigs of the posterior branches of the spinal nerves; electrophysiological - for registration of biopotentials of paravertebral muscles before and after denervation of arcuate joints; statistical - to ensure the evidence of the obtained results. For the first time the variation of the placement of the lumbar medial twigs of the posterior branches of the spinal nerves on the bony landmarks in the lumbar spine has been studied in detail. The diameter of articular nerve twigs was measured on the anatomical cadaver material. For the first time on the basis of anatomical and topographical studies, the "triangle of medial twigs" of the posterior branches of the spinal nerves, where the placement of these nerves is possible, was determined. The individual characteristics of the lumbar spine were taken into account. New knowledge about the anatomical variation of the location of nerve branches on the bony landmarks in the lumbar spine was obtained intraoperatively during the denervation of the facet joints under endoscopic control in patients with normal spine configuration and concomitant deformity. New knowledge of electromyographic changes in the lumbar paravertebral muscles after denervation of the facet joints was found. Improvement of medical and diagnostic blockages made it possible to select patients more clearly before performing denervation of facet joints, reduce false negative and false positive results, as well as patient costs for other diagnostic manipulations. The developed device for mechanical neurotomy with denervation of facet joints makes it possible to perform complete interruption of target nerves at the required distance, prevents reinnervation at the site. The use of the developed method of denervation of facet joints allowed to increase the positive results of treatment of patients with lumbar spondylarthrosis and spondyloarthralgia syndrome, patients quickly return to daily life, and people of working age to professional duties. Determination of the anatomical variation in the location of the medial twigs of the posterior branches of the spinal nerves allowed substantiate the need for endoscopic control due to perform a complete denervation of the facet joints in order to reduce the cost of repeated denervation after 6-12 months. The results of the research are introduced in clinical practice in SI "Sytenkо Institute of Spine and Joints Pathology National Academy of Medical Sciences of Ukraine", KZZ "Kyiv City Clinical Hospital No. 1", KUZ "Kharkiv City Clinical Hospital of Emergency and Emergency Medical Care named after prof. A.I. Meshchaninov", KZZ "Regional Clinical Hospital - the center of emergency medical care and medicine of catastrophes", as well as in the educational process of the Department of Traumatology and Orthopedics of the Kharkov National Medical University, Ministry of Health of Ukraine. Traumatology and Orthopaedics.