Interventional treatment of lower back pain

Abstract

Introduction. Low back pain takes one of the leading places among all non-communicable diseases, reaching 70 % of outpatient visits. In 90 % of cases the non-specific nature of back pain is observed. The most common causes of low back pain are myofascial pain syndrome, facet joint arthrosis, spinal stenosis, spondylolisthesis, discal hernias. If NSAIDs and muscle relaxants are the «gold standard» in the treatment of low back pain, interventional treatment needs further studies. This trial was conducted in order to determine the effectiveness of therapeutic blockades. The goal of research — to study the effectiveness of selective injections of pharmaceuticals into pain sources in case of low back pain based on clinical and instrumental studies.Materials and methods. The prospective, controlled, randomized trial was conducted from January 2018 to January 2019 at the Department of Neurosurgery and Medical Rehabilitation of the Bashkir State Medical University. 42 patients with low back pain, aged from 24 to 54 years, of which 28 (66,7 %) were men and 14 (33,3 %) were women took part in the research and were randomly divided into 2 groups. Patients of the main group (30 people) underwent interventional therapy, from 2 to 7 injections, depending on the severity of the pain syndrome and the duration of the disease. Patients of the control group — 12 people, received treatment in accordance with the standard of medical care in low back pain (analgesics, NSAIDs, muscle relaxants), as well as physiotherapy for 2 weeks daily. The study of the effectiveness of therapy included, along with the neurological examination, a neuroorthopedic instrumental examination. The depth of the lumbar lordosis, flexion and extension restrictions were measured using a curvimeter-goniometer, which also allows measuring the angle of tension symptoms (Lasegue, Wasserman). In order to study rotation and lateroflexion, instruments with a graduated scale were used. Muscle tone and tenderness of the structures of the spine were examined using a myotonometer-tensoalgimeter and a visual analogue scale (VAS). To interpret the data of a comprehensive neuroorthopedic examination, the results were converted into comparable units with the calculation of the integral indicator.Results. After selective intervention therapy in the main group, a more rapid relief of pain, a regression of neurological symptoms, manifested by the complete elimination or significant reduction of biomechanical and tonus disorders in the lower back were noted.Conclusion. Selective injections of pharmaceuticals into pain sources in low back pain are more effective than treatment with the use of analgesics, NSAIDs, muscle relaxants and physiotherapy, which allows to recommend them for wider use in clinical practice.