Method of epidural adhesiolysis in the treatment of neurocompression pain syndrome of the lumbosacral spine

摘要

The purpose of this study – to analyze our own treatment results of neurocompression pain syndrome of the lumbosacral spine due to degenerative-dystrophic diseases and determine the prognostic factors that influence the treatment results.Materials and methods. 218 patients were examined, mean age 60.3 ± 2.1 years (age range between 18 and 94 years). According to MRI data, neurocompression factors were identified, such as protrusions (78.6 %) or herniated intervertebral discs (48.0 %),stenosis of the spinal canal (74.5 %) and / or spondylarthrosis (92.3 %). The presence of scoliosis, spondylolisthesis and instability in the lumbar spine was determined by X-ray data. Quantitative and qualitative assessment of pain was performed based on the VAS pain. The Oswestry Disability Index (ODI) and the Roland-Morris Disability Questionnaire (RDQ) were used to assess the degree of disability. To interpret the treatment results, the Recovery Index (RI) was used. All the patients underwent inpatient treatment in the Rehabilitation Department of the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” from 2015 to 2018.Results. Our study showed high efficiency of epidural adhesiolysis. Thus, a significant reduction in pain according to the VAS reported 67.7–82.7 % of patients in different follow-up periods. According to the Roland-Morris, 84.1 % of patients showed significant(more than 4 points) symptoms regression in 12 months. According to the ODI, 89.1 % of patients reported an improvement in the quality of life indicators at the time of the final examination compared to baseline. In terms of recovery index in 12 months, 160 patients showed excellent treatment results, 40 – good and 20 – satisfactory. Prognostically unfavorable factors for the treatment of pain in the lumbosacral spine using the epidural adhesiolysis method are the diagnoses of degenerative lumbar scoliosis and hip joints arthrosis in a patient.Conclusions. The study showed high efficacy of epidural adhesiolysis in the treatment of neuro-compression pain syndrome in various degenerative-dystrophic diseases of the lumbosacral spine. A significant decrease in pain according to VAS data at various observation periods was noted by 67.7–82.7 % of patients