Surgical treatment of pain syndrome in spondyloarthrosis using laser radiation

Abstract

An important issue of modern orthopedics is to relieve condition of patient with pain, which is often related to such conditions as spondylarthrosis, osteochondrosis, spondylosis, and others. Sometimes patients receive courses of conservative therapy for years, and in many cases, these therapies do not bring significant relief. In recent years, laser technologies have become rather widespread technique in the medical practice. This is also related to orthopedics. In particular, high-intensity laser irradiation have been applied for denervation of intervertebral joints recently.

We have set an objective to assess the efficacy of laser denervation of intervertebral joints in spondyloarthralgia.

Materials and methods. 37 patients with spondyloarthralgia syndrome have been treated by laser denervation of intervertebral joints on the site of orthopedics clinic of Transcarpathian Regional Clinical Hospital named after A. Novak (m. Uzhgorod). The age of patients ranged from 41 to 68 years; there were 19 males and 18 females. 17 patients had spondylarthrosis only, and in 20 patients it was combined with osteochondrosis. In 30 patients the pain was localized at the level of the thoracic spine and chest, and 7 patients felt the pain at Th3-Th4 level. Disease duration ranged from 1 year to 7 years. Patients repeatedly received courses of conservative therapy, but it did not bring significant relief, and in 2 patients it has been ineffective in general.

To predict the effectiveness before the surgery, diagnostic blockings of the medial branchlets of the dorsal rami of the spinal nerves with 1% lidocaine solution was performed. And as each joint is innervated by the same-name branchlet and by the above lying one, the blocking of both branchlets was carried out for an adequate assessment. If patients reported pain disappearance, or it reduced by more than 70% from baseline, the results of the diagnostic blocking were considered as positive, if more than 30-70% the findings were considered as doubtful, and the negative results was considered in case of pain reduction of less than in 30%. We observed those patients, whose result of diagnostic blocking was above 50% in low efficacy of conservative treatment; we performed denervation to them.

Surgical technique. Patient’s position on the operating table: prone position with legs bent at the hip and knee joints, or with rolls under the wings of both flank-bones and costal arches. After processing the surgical field with an antiseptic solution, in aseptic conditions of operating room the local infiltrative anesthesia by injecting 1% lidocaine was performed.

Skin puncture was performed, at 2-3 cm distance from acantha at the level of its lower edge. Needle of 18G diameter and 3.5 inches long were used for puncture. Passing of the needle was monitored by Siemens Siremobil 2000 image-converter tube.

After mandrel removal the optical fiber was inserted into the needle bore and joint denervation (Private Small Production Company “Photonica Plus” (Cherkasy city). Laser parameters were as follows: wavelength of 980 nm, power of 14 W, 50:50 modulated mode, duration 3.1 s, the total energy – from 90 to 170 J at each level. Then the optical fiber and the needle were removed. Aseptic bandage was applied at the skin puncture site. Results and discussion. All patients were mobilized in 30 minutes after laser denervation surgery. 14 patients felt relief being during surgery on the operating table. We did not observe complications in patients in our group within the intervention.

The complete pain disappearance after laser denervation was observed in 20 patients, 9 patients reported pain reduction by more than 70%, and 3 patients felt only slight reduction. In 5 cases denervation results coincided with the results of diagnostic blockings, i.e. reduction of pain by more than 50% from baseline under criteria of visual analogue scale (VAS). The observed efficacy of this method is 8% higher than radiofrequency denervation for excellent results, there are 3% less in good results, there are less than 5% of satisfactory results.

Conclusions. 1. Denervation by laser radiation is an easy and effective method of treatment of pain syndrome in spondyloarthralgia.

2. If done correctly, laser radiation denervation does not cause complications.