Fishchenko I. Conservative treatment of pain syndrome of the lumbar-sacral spine in degenerative-dystrophic diseases

Dissertation work solves a scientific problem, which is connected with conservative treatment of patients with pain syndrome of the lumbar-sacral spine in degenerative-dystrophic diseases. The results of the experiment confirmed the possibility of exogenous influence on the biological substrate of pain syndrome, ie the formation of a rough connective tissue scar, as a consequence of the inflammatory process in the epidural space in the background of degenerative-dystrophic diseases. So simultaneous epidural administration of hyaluronidase and betamethasone showed a significant increase in antiphibrotic activity. Due to anti-inflammatory action and the ability to inhibit the formation of coarse connective tissue, this complex is effective for the purposeful regulation of the activity of the fibrosis process of the spinal canal and the reduction of the effectiveness of the pain syndrome. The results of the study confirmed that the use of nonsteroidal anti-inflammatory drugs and muscle relaxants are effective in the treatment of pain syndrome of the lumbar spine. Using medical gymnastics in treatment of patients with protrusions and herniated disc provides increased treatment efficiency, stable and prolonged remission, as evidenced by the polls at the stages of observation. With the lack of effectiveness of medical treatment, we used different types of blockades: epidural, caudal, and interlaminar and transforaminal. Thus, caudal epidural blockade was an effective method for the treatment of pain syndrome of the lumbosacral spine in the short term. Interlaminar epidural blockade is a more effective treatment for pain lumbosacral spine in the background of lumbar spinal stenosis, and transforaminal - monoarticular pain of lumbosacral spine in degenerative-dystrophic diseases. In case of insufficient or short-term efficacy of various epidural blockades, patients were advised to undergo an epidural adjectious procedure. It has been established that epidural adhesion is the most effective method of conservative treatment of pain syndrome of the lumbar-sacral spine in degenerative-dystrophic diseases. 220 epidural adhesion analyzed by us confirmed the safety of the procedure. Estimation of prognostic factors of efficacy of epidural adhesion has shown that the prognostic adverse factors included the presence of degenerative lumbar scoliosis and arthrosis of hip joints in the patient. The presence of spondylolisthesis, instability in the lumbar spine and osteoarthritis of the knee did not significantly impact the treatment of pain lumbosacral spine with degenerative diseases using epidural adhesion. Another significant potential source of pain syndrome of the lumbosacral spine is the sacroiliac joint. Our study showed that the Hanslen test has the highest sensitivity (81%) and validity (74%) for its diagnosis, which enables us to recommend a diagnostic blockade, even with negative results of other tests. The combination of hip power test / Hanslen test and the Hanslen test / Patrick test gives us a high sensitivity (97%) and a rather low specificity (7%), which allows us to consider this combination of tests to be the most reliable for the diagnosis of the syndrome of the sacroiliac joint. In order to treat the pain of the sacroiliac joint, intra-articular injections of corticosteroids were used, and with their lack of or short-term efficacy, radiofrequency neuroablation. Based on the obtained data, we developed a diagnostic-treatment scheme of the pain syndrome of the lumbar-sacral spine with degenerative-dystrophic diseases.