Abstract

Low back pain is one of the oldest and one of the widespread human diseases, and nowadays its treatment is still a very topical problem. The average expenditure of U.S. budget on vertebrogenic radiculopaties makes up annually up to 100 billion dollars. And in Britain (the population is about 56 million people) 13.2 million working days are lost annually because of discogenic pathology of the spine The above causes of the problem are considered to be not only medical, but social as well. Study purpose. To analyse results of treatment patients with protrusion and non-sequestered hernias of lumbar intervertebral discs using diode laser 940 nm. Materials and methods. On the base of orthopedics clinic of Transcarpathian regional clinical hospital 64 patients (31 male and 33 female) with protrusion and non-sequestered hernias of lumbar intervertebral discs have been treated using percutaneous laser disc decompression (PLDD). Patients have been divided by their age: less than 30 years 16 patients, 31-40 years 12 patients, 41 50 years 17 patients, 51 60 years 15 patients, more than 60 years 4 patients. Illness duration before the operation held has been: less than 6 months 10 patients, 6-12 months 19 patients, 1-2 years 21 patients, more than 2 years 14 patients. By the level of destruction the division has been the following: L3-4 - 22 patients, L4-5 - 46 patients, L5-S1 - 41 patients. 64 patients have been defined to have the pathology of 109 intervertebral discs. To make indications for operation all the patients have been examined by orthopedic surgeon and neurologist. 35 patients have had radicular symptoms, and 29 patients have had distinct miotonic and pain syndrome. To clarify the diagnosis we have used magnetic-resonance tomography and computer tomography. PLDD of 1 disc was performed in 27 patients, 2 discs in 29 patients and 3 discs in 8 patients. We have used home diode laser Lika-hirurg with wavelength of 940 nm in our work. Indications for PLDD were the following: the presence of confirmed protrusion or non-sequestered hernias of intervertebral discs 6 mm or less with or without radicular symptoms and with or without light paresis (4 scores) on CT or MRT; pain syndrome; positive Laseque sign; absence of the effect after the conservative treatment for the period of less than 6 weeks. Experimental study. We have conducted the research of influencing of constant and modulated radiation modes of diode laser with wavelength of 940 nm on white rats` nail intervertebral discs. The results have showed, that the best influence for the tissue regeneration of nucleus pulposus has a low power laser radiation. Results. Pain syndrome has been assessed by visual analogue scale (Your 0-10). The effectiveness of treatment has been evaluated according to the modified Macnab criteria [6], where: excellent complete absence of pain or any other symptom, no limitations in movement, ability to return to normal work and activity; good patient is generally satisfied, reduction of pain, come back to work and usual daily activities, taking analgesics from time to time; satisfactory minor improvement of functional activity, ability to work is not restored, bad no improvement, existing radicular symptoms, there is a need for re-surgery; the worst clinical symptoms have become worse than before treatment. The next day after surgery pain symptom decreased from 7.2 to 4.2 points. 29 (of 35) of patients with neurological symptoms the day after the operation were characterised by: considerably decreasing area of destructed sensitivity or its recovery; as well as by increase of muscle strength. Patients were directed to out-patient treatment to the place of residence within 2-3 days after surgery. The period of stay in hospital was from 2 to 5 days. Patients were not recommended to take a sitting position for a month. Advance review has been conducted after 1, 3, 6 and 12 months. After 1 month, 62 patients have been examined, after 3 months 54 patients have been examined, after 6 months 41 patients, in 1 year 27 patients. Neurologic symptoms have been observed in 6 patients. Pain syndrome has averagely been 2.4 according to the visual analogue scale. According to the modified Macnab criteria in 12 patients have been defined to have an excellent result, 8 good, 4 satisfactory, 3 bad. Thus, the successful outcome has been defined in 20 patients (74%). Complications associated with surgery have not been observed in any case. Open surgery due to unsuccessful dermal laser vaporization has not been conducted. Conclusions. 1. Diode laser with wavelength of 940 nm is optimal for the realization of vaporisation of intervertebral discs. 2. According to experimental data, this type of laser provides the most pronounced reparative processes in tissues of the disc. 3. You must comply with strict indications and contra-indications for the use of this technique.