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