Abstract
Objective. To analyze main causes of low back pain using data of clinical neurological and instrumental examinations and results of conservative and surgical treatment of patients. Material and Methods . A total of 405 patients with acute low back pain were examined and treated. Changes in vertebral bone mineral density indicating osteopenia and osteoporosis were revealed in 247 of them. Most patients had bulging disc detected during MRI and CT examinations. Conservative orthopedic treatment was performed in 340, and surgical in 65 patients. Results . Long-term results were evaluated in 35 patients in the surgical treatment group. Complete elimination of pain was registered in 30 of them, while five patients continued to suffer from pain in the trunk and extremities due to osteopenia and osteoporosis. They were treated with alendronates, bisphosphonates, calcium-based drugs, and vitamin D, and showed pain elimination. In the group of surgical treatment, the complete eradication of spinal instability symptoms was reported already the next day after surgery. Pain in extremities disappeared in all patients, though four patients were troubled by hypesthesia of some areas of foot skin, which regressed over time in two, and persisted in the other two patients. Conclusion . The disc prolapse should not justify making a hasty decision on surgical treatment. In the overwhelming majority of cases, conservative orthopedic treatment has a positive effect. The basis of such treatment must be orthopedic immobilization and unloading of the spine, as well as measures for the normalization of bone mineral density. Surgical treatment should be undertaken only after failure of orthopedic treatment and followed by further measures to normalize mineral density of bone structures.
Highlights
Complete elimination of pain was registered in 30 of them, while five patients continued to suffer from pain in the trunk and extremities due to osteopenia and osteoporosis
They were treated with alendronates, bisphosphonates, calcium-based drugs, and vitamin D, and showed pain elimination
Многочисленные сообщения об успешном применении межостистых конструкций типа DIAM также подтверждают, что для ликвидации нестабильности сегмента фиксация через остистые отростки обеспечивает достаточную стабилизацию позвоночника и не нарушает его биомеханики
Summary
Джалилов Азербайджанский НИИ травматологии и ортопедии, Баку, Азербайджан. Анализ причин возникновения поясничных болей по данным клинико-неврологического и инструментального обследований и результатам консервативного и хирургического лечения пациентов. У 340 человек использовали консервативно-ортопедическое лечение, у 65 – хирургическое. В одной группе хирургического лечения отдаленные результаты прослежены у 35 пациентов. Полное прекращение болевого синдрома отмечено у 30 из них, у 5 остались боли в туловище и конечностях, связанные с остеопенией и остеопорозом. Проведено лечение с применением алендронатов, бисфосфонатов, препаратов кальция и витамина D, отмечено прекращение болей. В подавляющем большинстве случаев консервативно-ортопедическое лечение дает положительный эффект. Основу такого лечения должны составлять ортопедические средства иммобилизации и разгрузки позвоночника, а также меры по нормализации минеральной плотности костей. Оперативное лечение должно быть предпринято только при неэффективности ортопедического лечения с последующим продолжением мер по нормализации минеральной плотности костных структур.
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