Some aspects of clinical rehabilitation and long-term results of treatment of patients operated on for a narrow spinal canal in the lumbar level
Science Articles / / August 12, 2017
V.V.Markov, Department of Neurology and reflexology Kazan Medical Academy.
Among patients operated on the lumbar vertebral syndromes, patients with lumbar stenosis currently make up the 7 to 9%.chastotakompressy nerve structures stenosis ranges from 6.3 to 12%.and in 8-10% of cases it is combined with a herniated disc, but a limited number of research does not allow to install a real rate and the incidence of lumbar stenosis (according to some data, about 11.5 cases per 100 000 population per year, and the ratio between men and womenis 1.28).
Objective: To evaluate the functional state of the locomotor system in patients operated on for a narrow spinal canal in the lumbar level, at different times of the rehabilitation period.
Materials and Methods: Between January 1999 and February 2003 were examined and treated 38 patients with a narrow spinal canal in the lumbar level before and after the operation, 27 of them men (71.05%) and 11 women (28.95%).The average age of patients was 51.6 years (range 3
most frequent localization process at the level of LIV-LV vertebrae in 26 (68.42%) of 38 patients.All the patients underwent a clinical neurological examination and neuroorthopedic, spondylography in two projections, lumbar myelography with omnipak in two projections, computerized axial tomography, or MP -tomografiya.
According to clinical manifestations were distributed: sciatica - 9 people (23,68%) - I group;radicular syndrome, radiculopathy - 15 (39,74%) - II group;neurogenic intermittent claudication (neurogenic intermittent claudication) - 10 (26,32%) - III group;compression of the roots of cauda equina syndrome (cauda equina syndrome) with lower flaccid paraparesis - 4 (10,53%) - IV group.In 9 patients (23.68%) were observed dysfunction of the pelvic organs, mainly in the different severity of urination.In assessing the results of treatment were taken into account: the general health of patients and their complaints, the ability to walk a certain distance, or perform their professional duties, the data of the clinical neurological and orthopedic examinations.
Results: Of 38 patients operated on excellent and good results immediately after surgery were observed in 25 (68.78%) - 7 from Group I, II of from 11, 6 and 1 from III of IV;satisfactory - 7 (18.42%) - 2 1 2 of II, III and 2 of one of the group IV;6 patients (15.8%) - 0 out of I, 2 of II, III, and 2 of 2 from IV - operative treatment had no effect.
in 4 (44.44%) of 9 people has improved the function of the pelvic organs.The main complaints after surgery were: persistent pain in the lumbar spine (82%), different types of sensory loss in one or both legs (68%), difficulty in walking (53%).After 1-1.5 years after the operation marked deterioration 5 people (13.16%) - 1 of 1 group, 3 of II of, 1 of III, will 0 of IV;and the excellent and good results in 20 patients (52.63%).However, the Group is a significant difference in the evaluation of treatment outcomes has been identified: excellent and good results in group I in 6 (66.67%) of 9 people;8 (53.34%) of 15 in group II;5 (50%) of a III group 10;in Group IV in 1 (25%) of 4 persons.
Conclusion: Clinical and neurological symptoms neuroorthopedic not always correspond to the severity of lumbar stenosis.The frequency of positive outcomes of surgical treatment of patients in the different groups varies, but long-term results of operations slightly worse than the next.All the patients in the postoperative period is necessary to conduct a comprehensive rehabilitation treatment.