Neurotomy of the medial posterior branches of spinal nerves under endoscopic control in the treatment of lumbar syndrome spondyloarthralgiy
Keywords:lumbar facet joints spondiloartralgy syndrome, en¬doscopic neurotomy, medial posterior branches of spinal nerve branches, anatomical variation nerves
Pain in patients with lumbar spondyloarthrosis in some cases, becomes resistant to conservative treatments, interventional approaches such as medical diagnostic blockade and denervation of facet joints (FJ) are distributed. But none of these methods allow you to visualize the target nerves in their destruction.
Objective: To evaluate the results of treatment in patients with lumbar spondyloarthrosis after medial posterior branches of spinal nerves (SN) neurotomy under endoscopic control.
Methods: the study group consisted of 13 patients (5 men, 8 women, age 29 to 78 years).
Results: it is determined that the variation of the location of branches of the medial posterior branches of SN in LIII–LIVand LIV–LVsegments observed from ⅓ to ⅔ of the length of the upper articular and transverse processes in 18 cases (26 %), and in segments LV–SI— 10 (14 %). The intensity of the VAS pain score after FJ denervation in 9 patients (69.2%) decreased by 80% in 3 (23.1 %) — 90 %, in 1 (7.7 %) — 50 %. Dynamics by Roland Morris vital capacity in 11 patients (84.6 %) was improved by 60–80 % in 2 (15.4 %) — 50 %. In LІІІ–SIsegments noted decrease in the frequency and amplitude of biopotentials by 20–30 % in the paravertebral muscles in all patients within 6 months.Conclusions: The denervation of the FJ in the form of medial posterior branches of SN neurotomy under endoscopic control through direct visualization enables you to cut the nerves with minimally invasive approach via mechanical destructor. Intersected nerve branches segments excision and local administration of neurotoxic substances prevent the recurrence of pain and reinervation at the level of destroyed nerves in the early postoperative period. Due to the anatomical variation of the medial posterior SN branches FJ denervation without visual control may be incomplete and leads to reinnervation.
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