Treatment improvement of patients with compression lumbosacral radiculopathies caused by degenerative-dystrophic changes in the spine

Neurological complications of degenerative-dystrophic spinal diseases are among the leading causes of disability in the adult population, alongside cardiovascular pathology, and significantly impact quality of life. Almost all degenerative-dystrophic changes in the spinal motor segment can lead to intervertebral disc herniation, spinal canal narrowing, and intervertebral foramen stenosis, forming stenotic lesions. For a long time, the issue of recovery of patients with compressive lumbosacral radiculopathies (LSR), caused by degenerative-dystrophic lesions of the spine, has been relevant due to the lack of a comprehensive approach to treatment measures taking into account the features of the lesion of the spinal motor segment with secondary root damage, the nature of vertebrogenic disorders and the pathophysiological characteristics of the compressed root. Objective — to improve the effectiveness of treatment of patients with lumbosacral radiculopathies, taking into account the nature of vertebrogenic disorders and the pathophysiological characteristics of the compressed nerve root. Materials and methods. 100 patients were examined and divided into two groups. The main group consisted of 45 people in whom compressive LSR was caused by discogenic pathology in combination with a stenotic process in the spinal canal and/or lateral openings. The comparison group included 55 people with compressive LSR that arose against the background of only intervertebral disc pathology at one level of spinal motor segment. Each group was divided into subgroups depending on the treatment received. The first subgroup received basic therapy, and the second — complex. Basic therapy included drug treatment according to European and American recommendations. Complex treatment combined basic therapy with vibrotractive postisometric myorelaxation (VPIMR) with biomechanical stimulation of the muscles of the paravertebral corset. The effectiveness of treatment was assessed based on the results of the study of the severity of pain and muscle-tonic syndromes, violations of static and dynamic function of the spine, and indicators of neural conduction. Results and discussion. It was established that all indicators that characterized the features of the formation of compressive lumbosacral radiculopathies at the stages of the study during complex treatment in patients of both groups approached normal values compared to patients who received only drug treatment (p < 0.05). Accordingly, during the usage of basic therapy by the end of treatment, muscle-tonic and pain syndromes decreased by more than half, and when adding VPIMR, significant positive dynamics were noted almost from the first days (p < 0.05) — by the end of treatment, the severity of pain decreased by almost 4 times. Conclusions. The usage of complex treatment (VPIMR with biomechanical stimulation of paravertebral muscles) affects the pathophysiological mechanisms of formation, clinical manifestations and course of compressive LSR caused by variations of degenerative-dystrophic changes of the spine in the spinal motor segment.