DOI: https://doi.org/10.22141/2224-1507.8.3.2018.144645

Method of epidural adhesiolysis in the treatment of patients with lumbar spinal stenosis

Ya.V. Fischenko, I.V. Roy, A.P. Kudrin

Abstract


Background. Degenerative lumbar spinal stenosis is a chronic process that eventually leads to a decrease in the size of the osseous ligamentous spine and is accompanied by the following clinical symptoms: neurodegenerative intermittent claudication (claudicatio intermittens), sciatica, muscle weakness in the lower extremities, and other vertebrogenic symptoms. The purpose of the study was to determine the effectiveness of epidural adhesiolysis in the treatment of lumbar spinal stenosis symptoms, and to assess the effectiveness of this method in the presence of concomitant degenerative deformities of the lumbar spine (degenerative scoliosis, degenerative spondylolisthesis). Materials and methods. We have analyzed the data of 148 patients (69 men and 79 women) aged 60 to 92 years who were treated and observed during one year in the department of rehabilitation of the Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine. Me­thods: quantitative and qualitative assessment of pain syndrome based on Visual Analogue Scale; the evaluation of the quality of life on the Roland Morris Disability and Oswestry Low Back Disability Questionnaires. The index of recovery characterizing the degree of recovery after conservative treatment was calcula­ted for each patient 7 days after the procedure, and 6 months after the treatment. Results. After epidural adhesiolysis and kinesitherapy, a statistically significant (p < 0.05) improvement in the condition of group 1 patients (with lumbar spinal stenosis) was established. In group 2 (diagnosed with lumbar spinal stenosis and degenerative scoliosis) and group 3 (diagnosis — lumbar spinal stenosis and spondylolisthesis), the results of conservative treatment are significantly worse, both at the primary and the late stage of observation. Conclusions. According to the results of observations at late stages, it was revealed that conservative treatment (epidural adhesiolysis and kinesitherapy) does not eliminate spinal stenosis and does not change the structure of the spinal canal, but allows eliminating almost all its manifestations without surgery. The presence of spine deformity and spondylolisthesis in patients with lumbar spinal stenosis allows them to be isolated into a group of unfavorable factors affecting the results of treatment.


Keywords


lumbar spinal stenosis; epidural adhesiolysis; the­rapeutic exercises

References


Isayenko AL. Lumbar stenosis - Clinic, diagnostics, surgical tactics (review). Ukrai'ns'kyj medychnyj al'manah. 1999;3(2):38-41. (in Russian).

Zozulya YA. Surgery for stenosis of the lumbar spine. In: Zozulya YA, Pedachenko EG, Slyn'ko EI, authors. Khirurgicheskoe lechenie neiro-kompressionnykh poiasnichno-kresttsovykh bolevykh sindromov [Surgical Treatment of Neural Compression Syndromes Due to Lumbar Degenerative Disc Disease: monography]. Kyiv: UIPK EksOb; 2006. 213-236 pp.

Prodan AI, Perepechai OA, Kolesnichenko VA, Podlipentsev VV, Chernyshev AG. Conservative treatment of lumbar spinal stenosis: current trends, conceptions and methods. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova. 2009;109(7):92-95.

Prodan AI. Stenoz poperekovogo viddilu hrebtovogo kanalu. Diss. Dokt. Med. Nauk [Stenosis of the lumbar spine. Dr. med. sci. diss.]. Kharkiv; 1994. 412 p.

Miyamoto H, Sumi M, Uno K, Tadokoro K, Mizuno K. Clinical outcome of nonoperative treatment for lumbar spinal stenosis, and predictive factors relating to prognosis, in a 5-year minimum follow-up. J Spinal Disord Tech. 2008 Dec;21(8):563-8. doi: 10.1097/BSD.0b013e31815d896c.

Fujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K. Association of the Japanese Orthopaedic Association Score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Short-Form 36. Spine (Phila Pa 1976). 2003 Jul 15;28(14):1601-7.

Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982 May;(165):110-23. doi: 10.1097/00003086-198205000-00015.

Malmivara A, Slätis P, Heliövaara M, et al. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976). 2007 Jan 1;32(1):1-8. doi: 10.1097/01.brs.0000251014.81875.6d.

Simotas A, Dorey FJ, Hansraj KK, Cammisa F Jr. Nonoperative treatment for lumbar spinal stenosis. Clinical outcome results and 3-year survivorship analysis. Spine (Phila Pa 1976). 2000 Jan 15;25(2):197-203; discussions 203-4.

Hirabayashi К, Miyakawa J, Satomi K, Maruyama T, Wakano K. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976). 1981 Jul-Aug;6(4):354-64. doi: 10.1097/00007632-198107000-00005.

Gevargez A, Groenemeyer D, Schirp S, Braun M. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint. Eur Radiol. 2002 Jun;12(6):1360-5. doi: 10.1007/s00330-001-1257-2.

Fishchenko YaV, Perepechai OO. Epidural adhesiolysis: our experience in patients with lumbar spinal stenosis. Visnyk ortopedii', travmatologii' ta protezuvannja. 2014;(83):36-41.

Yin W, Willard F, Carreiro J, Dreyfuss P. Sensory stimulation guided sacroiliac join radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976). 2003 Oct 15;28(20):2419-25. doi: 10.1097/01.BRS.0000085360.03758.C3.

Karaman H, Kavak GO, Tufek A, et al. Cooled radiofrequency application for treatment of sacroiliac joint pain. Acta Neurochir (Wien). 2011 Jul;153(7):1461-8. doi: 10.1007/s00701-011-1003-8.

Patel N, Gross A, Brown L, Gekht G. A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med. 2012 Mar;13(3):383-98. doi: 10.1111/j.1526-4637.2012.01328.x.




Copyright (c) 2018 PAIN. JOINTS. SPINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

   Seo анализ сайта