Method for treating herniated lumbar discs

Abstract

The invention relates to the field of medicine, and more particularly to neurology, traumatology, orthopaedics, immunology and therapy. The invention relates in general to medicine, and more particularly to manual therapy and orthopaedics, and is intended for diagnosing and correcting functional states of the spine and musculoskeletal system. The aim and technical result of the claimed invention is the use of manual therapy techniques to treat herniated discs of the lumbar spine. To achieve this aim, a method for treating herniated lumbar discs using manual techniques is proposed which includes mobilizing the vertebrae and intervertebral tissues of the lumbar spine in three planes, sagittal, frontal and horizontal, and realigning the vertebral bodies in the L3-L4 and L4-L5 segments, the method being characterized in that, in addition, the pelvis is gripped and then is realigned in a single procedure by rotating the sacrum and the iliac wings under ultrasound monitoring. The method according to claim 1 is characterized in that hernias having a minimum size of from 0.4 to 2.0 cm are treated.

Description

[0001] "Method of treatment of intervertebral hernias of the lumbar region"

[0002] The invention relates to the field of medicine, namely neurology, traumatology, orthopedics, immunology and therapy. In general, the invention relates to medicine, namely manual therapy and orthopedics. It is intended for diagnostics and correction of functional states of the spine and musculoskeletal system.

[0003] From the document Innovative patent of the Republic of Kazakhstan 22736, 16.08.2010, a method for prevention, treatment and rehabilitation of the musculoskeletal system is known, combined, and includes the sequential use of the following procedures: phytotherapy, thermal effects in the form of herbal compresses, ointments, "cakes" containing bischofite, ozokerite, paraffin, manual massage (general and local), hardware massage using vibration massagers, needle applicators, magnetic therapy, electrotherapy, manual therapy, acupuncture, acting on active points, restorative gymnastics. The method combines the above types of therapy in one treatment session. The duration of the treatment session is individual, from 40 minutes to 1.5 - 2 hours, depending on the disease and its pathology. The course of treatment is from 5 to 10 days, paying attention to the clinical form of the disease and the patient's response to the massage. The repetition of this course of treatment also depends on the pathology and can vary with intervals from 1 to 6 months.

[0004] From document RU2268700C2. 27.01.2006, a method of manual diagnostics and correction of functional states of the spine is known, including palpation with thumbs on both sides of the paravertebral muscles in a standing position, sitting at the level of S1-L5, L3-L2, Th12-Th 11, ThS-Th7, Th5-Tb4, Th2-Th1. C5-C4, C3-C2, without removing the fingers, ask the patient to bend forward or in a sitting or standing position to take a forced breath and by the movement of the fingers determine the asymmetry of muscle contractions, based on the information obtained, diagnose the functional state of the spine, lower limbs, pelvis, and correction is carried out with an insole and (or) a support under the buttock, starting from 0.3 - 0.4 mm until the asymmetry of muscle contraction is eliminated.

[0005] Thus, there is a need to further improve the method of manual therapy for diseases of the musculoskeletal system.

[0006] The closest analogue is document RU 2162312 C1, 27.01.2001, the document describes a method for treating intervertebral disc herniations using manual techniques.

[0007] The specified method involves the elimination of the coccyx displacement, post-isometric relaxation of the extensors of the lumbar spine and lumbosacral muscles, mobilization of the vertebrae and intervertebral tissues of the lumbar region, elimination of flexion and extension contractures in the knee joints, distraction of tissues between the sacrum and the thoracic spine, between the iliosacral joints and the hip joints, elimination of sacrum rotation and displacement of the ilium in the caudal direction, jerky distraction of the lumbar spine with simultaneous local pressure on the ventral region of the lumbosacral joint, in the projection of the anterior surface of the lumbar spine or in the area of ​​pain projection, subsequent strengthening of the muscles of the pelvis, spine, lower extremities.

[0008] The disadvantage of the closest analogue is that one-stage repositioning is not performed. In the method proposed by us, one-stage repositioning of the pelvis is performed by rotating the sacrum, the wings of the ilium and performing repositioning of the body of the L1, L4, L5 vertebra from retrolisthesis by rotational displacement of the vertebral bodies in the sagittal, frontal and horizontal axes.

[0009] Key facts

[0010] • Approximately 1.71 billion people worldwide suffer from musculoskeletal disorders and diseases.

[0011] • Lumbago accounts for the largest burden of musculoskeletal diseases, affecting 568 million people worldwide.

[0012] • Musculoskeletal disorders and diseases are a leading cause of disability worldwide, and lumbago remains the leading cause of disability among these diseases in 160 countries.

[0013] • Musculoskeletal disorders and diseases significantly limit mobility and motor skills, leading to premature termination of work activity, decreased well-being and reduced opportunities for participation in society.

[0014] • Due to population growth and aging, the number of people with musculoskeletal disorders and diseases is rapidly increasing.

[0015] • The burden of disability caused by these diseases continues to increase and is projected to continue in the coming decades.

[0016] The scale of the problem

[0017] Musculoskeletal disorders and diseases are more than 150 health disorders that affect the musculoskeletal system. They vary widely: from acute and short-term phenomena - fractures, sprains and dislocations to lifelong disorders accompanied by a constant decrease in functional capabilities and disability. Musculoskeletal disorders and diseases are usually characterized by pain (often of a permanent nature), decreased mobility, deterioration of motor skills and functional capabilities in general, which limits a person's ability to work.

[0018] Musculoskeletal disorders and diseases include those affecting:

[0019] • joints, in particular osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis;

[0020] • bone tissue, in particular osteoporosis, osteopenia and associated fractures due to bone fragility or trauma;

[0021] • muscles, in particular sarcopenia;

[0022] • spine, in particular, lumbago and cervicalgia;

[0023] • various parts of the body or body systems, in particular regional and widespread pain syndromes and inflammatory diseases such as connective tissue diseases and vasculitis characterized by musculoskeletal symptoms, or systemic lupus erythematosus.

[0024] Moreover, musculoskeletal disorders and diseases are the single largest contributor to the global need for rehabilitation services. They are among the leading causes of demand for such services for children, and approximately two-thirds of the adult population requiring rehabilitation services are people with musculoskeletal disorders and diseases.

[0025] This method has proven its effectiveness in patients seeking treatment in a group with various diseases of the musculoskeletal system:

[0026] 1. S-shaped scoliosis I-III degree

[0027] 2. Violation of the biomechanism of joints (elbow, knee and hip).

[0028] 3. Pelvic tilt

[0029] 4. Highly compressive pressure (protrusion of intervertebral disc, hernia) As a result of reflex conflict Lumbar radiculopathy (radicular syndrome)

[0030] 5. Vertebrobasilar insufficiency (VBI) - a disorder of the brain due to weakening of blood flow in the basilar or vertebral arteries during 2012 to 2022. As a result of this manual therapy with the provision of MRI images before and after the procedure and complex therapy, 5 patients noted an immediate decrease in the intensity of pain syndrome on the Visual Analogue Scale (VAS) from 8 to 4-5 points. Also, on control images of magnetic resonance imaging (MRI) studies, patients showed a significant decrease in the size of the disc herniation by 2-4 times.

[0031] This method is used for various intervertebral disc diseases that are not directly caused by a fracture or spinal contusion. Before manual therapy, manual muscle testing is performed using the method of Dr. Maksutov.

[0032] The method includes a one-stage reposition of the pelvis by rotating the sacrum and iliac wings in three planes (sagittal, frontal and horizontal) under the control of an ultrasound machine. During manual therapy, the body of the LI, L4, L5 vertebra is repositioned from retrolisthesis by rotating the vertebral bodies in the sagittal, frontal and horizontal axes. Rotational displacement of the bodies of the LI, L4, L5 vertebrae is eliminated. The method changes the angle of the kyphotic arch of the thoracic spine at the level of Tn5-Tn6-Tn7-Tn8 and Tn11-Tn12, due to which the compression pressure on the lumbar intervertebral discs is reduced, which in turn, due to the "vacuum effect", reduces disc prolapse into the spinal canal cavity with an immediate decrease in the degree of pain on the VAS scale by half.

[0033] The patient has pain syndrome and limited rotation in the neck, pain and numbness in the hands, pain in the shoulder area and above the shoulders, intensity according to VAS 6-7 points. Method: manual muscle testing was performed. Elimination of kyphotic deformity of the cervical spine due to: Elimination of antelithiasis of the bodies of the Tn1, Tn2, Tn3 vertebrae, which provoked kyphotic displacement of the bodies of the C3, C4, C5, C6 cervical vertebrae. Rotational displacement of all cervical vertebrae and reposition of these vertebrae along the sagittal, frontal and horizontal axis under the control of ultrasound navigation were eliminated, due to which cervical lordosis was restored. As a result of the author's manual therapy, the intensity of the pain syndrome according to VAS immediately decreases (decreased to 4 points).

[0034] This manual therapy was also used in the case of congenital pelvic tilt, with a difference in acetabular angles of up to 7-8 degrees in a child patient. Incomplete immersion of the left femoral head was detected. During manual therapy, reposition was performed by moving the pelvic bones and sacrum along a vector equal to zero with the installation of complete immersion of the femoral head on the left. After the method, the difference in acetabular angles was 1 degree on control radiography. As a result of this manual therapy, the pelvic tilt was eliminated. The pain syndrome was immediately relieved, the patient began to walk without limping.

[0035] Based on the above-mentioned clinical cases, under ultrasound control, it is proposed to use the method of the author's manual therapy, for various diseases of the musculoskeletal system, hernia and pain syndrome of the spinal column and pelvic tilt, patients of different ages, this method is very effective in comparison with the standard treatment protocol. This method allows you to effectively treat hernias with a minimum size of 0.4 cm and a size of up to 2.0 cm without surgery and without subsequent relapse. Pain syndrome is immediately eliminated, quickly return to the previous way of life without social and psychological stress.

[0036] The task and technical result of the claimed invention is the use of the method of the author's manual therapy, for various diseases of the musculoskeletal system, hernia and pain syndrome of the spinal column and pelvic tilt, patients of different ages, this method is very effective in comparison with the standard treatment protocol. This method allows you to effectively treat hernias with a minimum size of 0.4 cm and a size of up to 2.0 cm without surgery and without subsequent relapse. Pain syndrome is immediately eliminated, quickly return to the previous way of life without social and psychological stress.

[0037] To solve the above problems, manual therapy is proposed for the treatment of diseases of the musculoskeletal system, which includes a one-stage reposition of the pelvis by rotating the sacrum and the wings of the ilium in three planes under the control of an ultrasound examination device (US), in which, during manual therapy, repositioning of the body of the L1, L4, L5 vertebra from retrolisthesis is performed by rotational displacement of the vertebral bodies in the sagittal, frontal and horizontal axes, while eliminating rotational displacement of the bodies of the LI, L4, L5 vertebrae. Moreover, the angle of the kyphotic arc of the thoracic spine at the level of Tn5-Tn6-Tn7-Tn8 and Tn11-Tn12 is also changed, due to which the compression pressure on the lumbar intervertebral discs is reduced, which in turn, due to the “vacuum effect”, reduces the prolapse of the discs into the cavity of the spinal canal with an immediate reduction in the degree of pain on the VAS scale by half.

[0038] The invention is illustrated by the following drawings.

[0039] Fig. 1 Image of the lumbar spine of patient No. 1 Patient M before therapy. Fig. 2 Image of the lumbar spine of patient No. 1 Patient M after therapy.

[0040] Fig. 3. Lumbar spine image of patient No. 2 Patient C before therapy.

[0041] Fig. 4. Lumbar spine image of patient No. 2 Patient C after therapy.

[0042] Fig. 5 Lumbar spine image of patient #3 Patient P before therapy. MRI scan in November 2017 before treatment.

[0043] Fig. 6 Lumbar spine image No. 3 of Patient P before therapy. Interim MRI (December 2017) 1 month after treatment.

[0044] Fig. 7. Lumbar spine image No. 3 of Patient P after therapy. MRI study-control February 2022. No clinical complaints.

[0045] Fig. 8. Cervical spine image No. 4 of Patient G before therapy. MRI examination 05 / 05 / 2020 before treatment.

[0046] Fig. 9. Cervical spine image No. 4 of Patient G after therapy. MRI examination (interim) after the first course of treatment 11 / 21 / 2020.

[0047] Fig. 10. Cervical spine image No. 4 of Patient G after therapy. MRI examination after treatment 11 / 16 / 2021.

[0048] Fig. 11. X-ray of hip joint No. 5 of Patient D before therapy.

[0049] Fig. 12. X-ray of hip joint No. 5 of Patient D after therapy.

[0050] Examples of implementation of the invention.

[0051] №1 Patient M., born in 1982, was admitted with complaints of pain in the lumbar spine, radiating to the right leg along the back surface (in the innervation zone of the S1 root). Numbness in the right shin and foot. The intensity of the pain syndrome on the VAS scale is 8 points. See Fig. 1. X-ray of the lumbar spine of patient №1

[0052] Patient M before therapy.

[0053] Course conducted:

[0054] Method: manual muscle testing was performed. One-stage reposition of the pelvis by rotating the sacrum and ilium wings in three planes (sagittal, frontal and horizontal). Reposition of the LI, L4, L5 vertebral body from retrolisthesis by rotational displacement of the vertebral bodies in the sagittal, frontal and horizontal axes. Elimination of rotational displacements of the LI, L4, L5 vertebral bodies. Change in the angle of the kyphotic arch of the thoracic spine at the level of Tn5-Tn6-Tn7-Tn8 and Tn11-Tn12, due to which there was a decrease in compression pressure on the lumbar intervertebral discs, which in turn, due to the "vacuum effect", reduced disc prolapse into the spinal canal cavity. As a result, the intensity of the pain syndrome according to VAS decreased to 4-5 points;

[0055] Additionally, the following was recommended: non-steroidal anti-inflammatory drugs (NSAIDs), intra-tissue electrical stimulation (ITES) - 2 courses of 5 procedures - pain syndrome was relieved, sensory disorders regressed; a course of therapeutic physical training (LFK) on the REDCORD suspended rehabilitation trainer system - no relapse of pain syndrome.

[0056] Control MRI scan 5 months after treatment: the size of the L4-L5 disc herniation has decreased by 2 times, L5-S1 by 3 times. See Fig. 2. Lumbar spine scan of patient No. 1 Patient M after therapy.

[0057] №2 Patient S., born in 1977, was admitted with complaints of pain in the lumbar spine, radiating to the right leg along the back surface (in the innervation zone of the S1 root). Numbness along the anterior surface of the right thigh (in the innervation zone of the external cutaneous nerve of the thigh), the fifth toe of the right foot. The intensity of the pain syndrome on the VAS scale is 7-8 points. See Fig. 3. X-ray of the patient's lumbar spine

[0058] No. 2 Patient C before therapy.

[0059] Course conducted:

[0060] Method: manual muscle testing was performed. The procedure was performed under ultrasound control: one-stage reposition of the pelvis by rotating the sacrum and ilium wings in three planes (sagittal, frontal and horizontal). Reposition of the LI, L4, L5 vertebral body from retrolisthesis by rotational displacement of the vertebral bodies in the sagittal, frontal and horizontal axes. Elimination of rotational displacements of the LI, L4, L5 vertebral bodies. Change in the angle of the kyphotic arch of the thoracic spine at the level of Tn5-Tn6-Tn7-Tn8 and Tn11-Tn12, due to which there was a decrease in compression pressure on the lumbar intervertebral discs, which in turn, due to the "vacuum effect", reduced disc prolapse into the spinal canal cavity. Also, changing the angular relationship between the base of the sacrum and the L5 vertebra, as well as between the apex of the sacrum and the base of the coccyx, which minimized the vector magnitude of gravity.

[0061] As a result, the intensity of the pain syndrome according to VAS decreased to 4-5 points;

[0062] Additionally, the following was recommended: NSAIDs, VTES therapy 2 courses of 7 procedures, platelet-activated autoplasma blockade 5 procedures once every 10 days - the pain syndrome was relieved, sensory disturbances regressed;

[0063] Control MRI scan 3 months after treatment: hernia size decreased by 4 times. See Fig. 4. Lumbar spine scan of patient #2 Patient S after therapy. #3 Patient P, born in 1956. Prolapsed disc herniation L4-L5 on the right with complaints of pain in the lumbar spine, radiating to the right leg along the outer surface of the thigh and shin, weakness of extension of the right foot up to 3 points (in the innervation zone of the L5 root). Numbness in the right shin and foot. Pain intensity according to the VAS scale 8-9 points.

[0064] The course was completed: Manual muscle testing was performed. Under ultrasound control, a procedure was performed: one-stage pelvic reposition by rotating the sacrum and ilium wings in three plural axes (sagittal, frontal and horizontal). Reposition of the LI, L4, L5 vertebral body from retrolisthesis by rotational displacement of the vertebral bodies in the sagittal, frontal and horizontal axes. Elimination of rotational displacements of the L4, L5 vertebral bodies. Change in the angle of the kyphotic arch of the thoracic spine at the level of Tn5-Tn6-Tn7-Tn8 and Tn11-Tn12, due to which there was a decrease in compression pressure on the lumbar intervertebral discs, which in turn, due to the "vacuum effect", reduced disc prolapse into the spinal canal cavity.

[0065] As a result, the intensity of the pain syndrome according to VAS decreased to 3-4 points;

[0066] Medicinal anti-inflammatory, anti-edematous therapy for 7 days: pain syndrome dynamically regressed to 2-3 points.

[0067] MRI scan in November 2017 before treatment: See Fig. 5 Lumbar spine scan of patient #3 Patient P before therapy. MRI scan in November 2017 before treatment.

[0068] MRI examination, mid-term (December 2017), 1 month after treatment: the size of the hernia remains the same, but the “density” of the disc fragment has significantly decreased, i.e. the hernia is “softer”. See Fig. 6. Lumbar spine image No. 3 of Patient P before therapy. MRI examination, mid-term (December 2017), 1 month after treatment.

[0069] MRI study-control February 2022. No clinical complaints. The disk fragment was lysed, no signs of spinal cord root compression. See Fig. 7. Lumbar spine image No. 3 of Patient P after therapy. MRI study-control February 2022. No clinical complaints.

[0070] No. 4 Patient Zh., born in 1974, Complaints of pain and limited rotation in the neck, pain and numbness in the hands, pain in the shoulders and supraclavicular area, intensity according to VAS 6-7 points.

[0071] Course conducted:

[0072] Manual muscle testing was performed. Under ultrasound control, a procedure was performed to eliminate kyphotic deformation of the cervical spine by: 1. Elimination of antelysthesis of the bodies of the Tn1, Tn2, Tn3 vertebrae, which provoked kyphotic displacement of the bodies of the C3, C4, C5, C6 cervical vertebrae.

[0073] 2. The rotational displacement of all cervical vertebrae was eliminated and these vertebrae were repositioned along the sagittal, frontal and horizontal axes under ultrasound navigation, thereby restoring cervical lordosis.

[0074] As a result, the intensity of the pain syndrome according to VAS decreased to 4 points; additionally: NSAIDs, VTES therapy 2 courses of 7 procedures, platelet-activated autoplasma blockades - the pain syndrome was relieved, sensory disorders regressed; a course of physical therapy on the RECORD suspended rehabilitation trainer system.

[0075] MRI examination 05 / 05 / 2020 before treatment: See Fig. 8 Image of the cervical spine No. 4 of Patient G before therapy. MRI examination 05 / 05 / 2020 before treatment.

[0076] MRI examination (interim) after the first course of treatment 11 / 21 / 2020: See Fig.

[0077] 9 Cervical spine image No. 4 of Patient G after therapy. MRI examination (interim) after the first course of treatment 11 / 21 / 2020.

[0078] MRI examination after treatment 11 / 16 / 2021: See Fig. 10. Cervical spine image No. 4 of Patient G after therapy. MRI examination after treatment 11 / 16 / 2021.

[0079] No. 5 Patient D. Child, 9 years old: complaints of pain in the area of ​​the left hip joint, limps on the left side, and swings his left leg to the side when walking.

[0080] On radiography: congenital pelvic tilt, with a difference in acetabular angles of up to 7-8 degrees. Incomplete immersion of the left femoral head. See Fig. 1 1 X-ray of hip joint No. 5 of Patient D before therapy.

[0081] Repositioning was performed by moving the pelvic and sacral bones along a vector equal to zero with the establishment of full immersion of the femoral head. On the control radiography: acetabular angles with a difference of 1 degree. Pelvic tilt was eliminated.

[0082] Clinically: The pain syndrome was immediately relieved. The child walks without limping. See Fig. 121. X-ray of hip joint No. 5 of Patient D after therapy.

Claims

Invention formula 1. A method for treating intervertebral hernias of the lumbar region using manual techniques, including mobilization of the vertebrae and intervertebral tissues of the lumbar region in three planes: sagittal, frontal and horizontal, repositioning of bodies in segments L3-L4, L4-L5, characterized in that, in addition to fixing the pelvis, a one-stage reposition of the pelvis is performed by rotating the sacrum and wings of the ilium under the control of an ultrasound examination.

2. The method according to paragraph 1, characterized in that treatment is carried out for hernias with a minimum size of 0.4 to 2.0 cm.