Abstract
Relevance. Interventional pain management and minimally invasive surgery are common methods in the treatment of spinal pathology. The use of navigation in these interventions is obligatory and fluoroscopy is the basic method; however, intraoperative radiation exposure is not sufficiently studied. During pain interventions, a number of pharmacological substances are administered closet to neurovascular structures but possible complications are poorly described. Intention. To assess and analyze complications of the pharmacological treatment and radiation exposure during interventional and minimally invasive procedures in patients with various spine pathology. Methodology. 1353 interventions in 849 patients were analyzed, 1033 of them were interventions for pain syndromes (blockades, radiofrequency ablation, disk interventions), 320 – minimally invasive surgeries (endoscopic discectomy, vertebroplasty, percutaneous transpedicular fixation). Results and Discussion. Reactions to the local anesthetics were detected in 4.4 % of patients, 1 patient required intensive therapy. Contrast agents were not associated with complications. Adverse effects of glucocorticosteroids were most frequent (26.3% of patients); unsubstantiated repeated steroid infusions and blockades at the polyclinic stage were associated with an increased risk. The average effective dose ranged from (1.03 ± 0.4) mSv to (3.03 ± 1.9) mSv for interventions, from (1.92 ± 1.2) mSv and to (11.31 ± 4.9) mSv for minimally invasive operations and could exceed the recommended limits of effective doses of ionizing radiation from technogenic sources, especially with repeated interventions and previous diagnostic studies. Conclusion. The obtained data substantiate the necessity of controlling the use of glucocorticosteroids during interventions taking into account their administration at previous stages of treatment, and test blockades to confirm the causes of pain syndrome in unclear clinical situations. Radiation exposure of patients and staff can be reduced by improving intervention procedures, decreasing the number of projections used, as well as introduction of ultrasound-based navigation.
Highlights
The obtained data substantiate the necessity of controlling the use of glucocorticosteroids during interventions taking into account their administration at previous stages of treatment, and test blockades to confirm the causes of pain syndrome in unclear clinical situations
Radiation exposure of patients and staff can be reduced by improving intervention procedures, decreasing the number of projections used, as well as introduction of ultrasound-based navigation
ConclusionThe obtained data substantiate the necessity of controlling the use of glucocorticosteroids during interventions taking into account their administration at previous stages of treatment, and test blockades to confirm the causes of pain syndrome in unclear clinical situations
Summary
Трансфораминальная эндоскопическая диск 101 (31,6) эктомия тат – 40 мг, бетаметазонадипропионат – 7 мг, дексаметазон – 16 мг. Для снижения лучевой нагрузки режимы цифровой рентгенографии и непре рывной флюороскопии использовали только в случае крайней необходимости. Применяли передвижной рентгеновский аппарат с С-ду гой, оборудованный проходной ионизаци онной камерой и регистрирующий значения произведения дозы на площадь (ПДП) в авто матическом режиме. Исходя из методических указаний МУ 2.6.1.2944–11 [3] о контроле эффективных доз облучения пациентов, для каждой процедуры рассчитывали эффектив ную дозу облучения по формуле:. Е = ПДП ∙ Kd, где Е – эффективная доза облучения, мкЗв; Kd – коэффициент перехода от значения. Максимальную поглощенную дозу в коже не учитывали, так как в результате прове денных вмешательств не были превышены контрольные значения ПДП для предотвра щения детерминированных эффектов в коже [9]. С учетом частого использования в ходе процедуры нескольких проекций, в том чис ле и «нетипичных», оценивали максимальные значения коэффициента перехода для перед незадней проекции. В соответствии с этим для статистического описания показателей использовали сред нее арифметическое значение и стандартную ошибку средней величины (M ± m), а для про верки статистических гипотез – параметриче ские методы анализа
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