Contents
In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
They are minimally invasive, bring relief and bring you back quickly. Thanks to them, in many cases classic surgery can be avoided. Unfortunately, such treatments are performed only in a few centers in Poland.
Back pain has become the bane of our time. According to research, every fourth person struggles with it almost every day. This applies not only to elderly and middle-aged people, but also to young people. The list of ailments caused by back problems is very long. Pain in the back of the neck, back pain or repeated pain in another part of the body distant from the spine, migraine and dizziness, tingling or numbness in the fingers and toes can throw you out of normal life.
Why does it hurt?
The most common cause of pain syndromes are overload-degenerative changes in the spine caused by “flattening” of the intervertebral discs (disks) that separate the adjacent vertebrae. The disc is made of a fibrous ring that surrounds the nucleus pulposus filled with a jelly-like substance. It acts as a ball bearing that allows movement between adjacent vertebrae. The disc keeps the vertebrae at appropriate intervals, absorbs shocks, takes the pressure force and distributes it evenly, e.g. while sitting, walking or running. As a result of “wear” of the disc (disc), the joints rub. The articular cartilage becomes thinner and thinner, it becomes scratched and uneven. The body tries to regenerate it, but the damage process continues. As a consequence, sooner or later, as a result of rupture of the fibrous ring, displacement of the nucleus pulposus, commonly referred to as dislocation of the disc. The resulting ridge may put pressure on the spinal cord or nerve roots. There is pain that makes it impossible to move. Much stronger pain, often associated with paresis, is caused by the hernia of the nucleus pulposus, the so-called slipped disc. Similar ailments can be caused by pressure on the nerves by cartilage and bone growths (osteophytes) that distort the joint.
Back pain can be caused by complications from osteoporosis. In advanced disease, ailments located in the thoracic or lumbar spine accompany almost all activities and are the result of slow spine fractures. The appearance of sudden, acute pain may indicate the so-called compression fracture.
Customized treatment
Any back pain that lasts more than 2 weeks, recurs or is severe, requires consultation, preferably an orthopedist, and treatment. Lower spine ailments lasting more than 3 months become chronic pain, which is more difficult to treat, and the fight with it brings worse results. Pain makes us try to move as little as possible and make us assume an unnatural posture. And this leads to muscle weakness and overload, aggravating degenerative changes.
Based on the history, medical examination and imaging tests, the doctor makes a diagnosis and applies treatment. If detected early, lifestyle changes usually help. Regular exercise is the best medicine to strengthen your muscles. Exercises selected by a rehabilitation specialist bring relief. You have to learn to do them under the supervision of a physiotherapist, then practice at home. If you do it wrong, you can hurt yourself.
Treatment is supported by physical therapy, which uses various physical stimuli to improve blood circulation, relieve pain and reduce muscle tension. Your doctor may prescribe medications that relieve pain and inflammation and reduce muscle tension, and in the case of osteoporosis, prevent bone loss.
When rehabilitation and drug treatment do not help, surgery may be the only effective treatment. Modern medicine has many effective methods at its disposal that are less invasive than classical surgery. They shorten the stay in the hospital from a few hours to a day and the convalescence time and do not leave a souvenir in the form of a long scar on the back. However, you need to be aware that no treatment can miraculously cure disc disease – it is only intended to eliminate, or at least reduce pain. Then you need to continue the treatment according to the doctor’s recommendations and avoid situations in everyday life that are not good for the spine (long sitting, lifting, lack of physical activity, stress). The choice of the best treatment method always depends on the type and severity of the disease and the general health of the patient.
value broplastyka
This mainly treats the pain associated with osteoporotic fractures, which could not be controlled by other methods for several weeks or months. The procedure is not performed in the case of fresh fractures, i.e. immediately after the fracture, but after a few days it is possible. The effectiveness decreases when the symptoms last longer than six months. It is also performed in people who have osteoporosis, which is at risk of fractures of the vertebral bodies, if they have had fractures in the past. This method is used in the treatment of hemangiomas and neoplastic metastases to the spine. The doctor qualifies for the procedure on the basis of computed tomography (contraindication is, for example, damage to the back wall of the vertebral body).
The procedure consists in filling the broken shaft with bone cement. For this purpose, under X-ray control, a special needle is inserted into the shaft through a punctual skin incision through which the cement is fed, while observing the growing “white cloud” on the monitor. Some doctors use a contrast agent to make sure there is no damage to the back wall of the vertebral body. Most often, 1-2 vertebrae are filled at once. Treatment on one vertebra usually takes less than half an hour. It is performed under local and intravenous anesthesia of the NLA type (neuroleptoanalgesia), while maintaining the patient’s awareness (it is about maintaining contact).
After 2 hours, you can get out of bed, go home on the same day. You need to take an antibiotic for several days and, if necessary, take a painkiller. After 12-14 days, the stitches are removed, and after a few weeks you can return to normal activities. If your pain worsens, or if your arms or legs are numb, a CT scan or even an MRI should be done to check for cement leakage – this complication is rare. Recently, the procedure has been performed by some public centers in the country. In a private clinic you have to pay 4-8 thousand.
Balloon kyphoplasty
This innovative method has been used in the world for 10 years in spine fractures caused by osteoporosis, cancer or trauma. The indication for the procedure is a fresh fracture of the vertebral body confirmed by magnetic resonance imaging. The procedure is performed on an outpatient or inpatient basis. The patient is given local and intravenous anesthesia, as in the case of vertebroplasty. Through a centimeter incision of the skin under X-ray control, special balloons are inserted into the fractured vertebra on both sides and filled with contrast fluid. Expanding balloons are designed to recreate the broken walls of the vertebral body in the best possible way. The balloons are then emptied and removed, and the resulting space is filled with cement, thus recreating the height of the stem. During setting, the temperature of the cement rises to approx. 70 ° C, destroying the nerve endings inside the shaft (coagulation), which additionally has an analgesic effect. The risk of cement leakage in this case is minimal. The procedure takes about an hour (filling on one level). The patient is given an antibiotic and a strong pain reliever (cement tears the bone apart, causing pain). After waking up, the patient can walk and leaves the hospital within 12 hours. After 14-90 days, the stitches are removed, and after a few weeks, you go back to work. In 9 percent patients manage to eliminate the pain, in the remaining patients its intensity decreases. Cement strengthens the filled vertebrae, preventing them from breaking. Unfortunately, doctors saw a two-fold increase in fractures of adjacent cement-filled vertebrae. The treatment is reimbursed. In a private clinic, it costs 14-XNUMX thousand. zloty.
Nucleoplasty using the coblation technique
The method, developed in 1995, is a breakthrough in percutaneous lumbar disc surgery. It allows the disc tissue to be broken down and the pressure on the diseased nerve root is reduced with a temperature that is twice lower than in other procedures of this type, e.g. with a laser, reducing postoperative complaints and the risk of complications (nerve damage). The indication for the procedure is pain in the lumbar region that persists for more than 6 months despite the use of other methods of treatment (physical therapy, anti-inflammatory drugs, lifestyle changes). The back pain must be stronger than the leg pain, i.e. without true root symptoms. Patients with the so-called closed hernia (disqualified hernia accompanied by a rupture of the fibrous ring and the falling of a fragment of the disc into the spinal canal), with minor degenerative changes, the basis of the narrowing of the lumen of the spinal canal and without lowering the height of the interbody space. For this reason, most elderly people cannot receive this treatment. Before the procedure, an intravenous antibiotic is administered, as well as a sedative and anesthetic (the patient is asleep, but without intubation, while maintaining awareness – the point is to be able to react to pain caused by, for example, nerve damage). The procedure itself is performed under local anesthesia. Under X-ray control, the disc is punctured and the contrast is dispensed inside to ensure that the fibrous ring is not completely broken. If it turns out that it is interrupted, you refrain from continuing the operation with this method, because it will not bring the expected results. Then, through a special tube, an electrode is introduced into the nucleus of the pulmonary nucleus, which at its end produces a plasma arc (as if shining with cold light), breaking the disk particles into water and carbon dioxide particles. This is done at a temperature of 40-50oC, thanks to which the adjacent tissues are not damaged and the risk of complications is reduced. The resulting material is removed by a suction unit attached to the electrode. During the procedure, the electrode changes its position in six directions, reducing the volume of the nucleus pulposus by 1-20%. As a result, the pressure inside the disc is significantly reduced, allowing the protuberance to withdraw.
The approximate time of the procedure is 40 minutes. A few hours after the operation, the patient may be discharged home. In the first few days, many patients complain of severe pain with discomfort at the puncture site. It can be relieved by applying ice and taking non-steroidal painkillers. Significant improvement begins 1-2 weeks after surgery. Rest is recommended for 1-2 days, long sitting should be avoided for 2 weeks (the limit is 30-40 minutes). Most patients can theoretically return to sitting work after a few days, but they cannot stay in one position longer than the prescribed limit. For the first 2 weeks, you are allowed to lift up to 1 kilogram. In the second week, the doctor will recommend rehabilitation. Physical activity is recommended, but the selection of exercises should be consulted with a doctor. The disc takes 4-6 weeks to heal. Complications are extremely rare (eg infection of the intervertebral disc or, most often, temporary sensory disturbance in the hand or leg (depending on the section of the spine on which the operation was performed). The procedure is reimbursed. In a private clinic, the estimated cost is PLN 5-7 thousand. .
Endoscopic disk removal
It is a minimally invasive surgical technique used to remove a protrusion, hernia or a prolapsed nucleus. The operation is performed under general anesthesia under X-ray control. At a distance of approx. 15 cm from the spine (on the side), the doctor makes a small incision in the skin (1,5-2 cm, while during classic surgery – 5-10 cm), through which an endoscope (a device with a built-in camera) is inserted through the optical fiber transmits the image of the operating field to the monitor). The surgeon observes the inside of the spinal canal on the monitor and uses special tools to remove the disc. After the operation is completed, the endoscope is removed, a suture and a dressing are put on. The patient is given an antibiotic and a painkiller. You can leave the hospital within 12-24 hours. After 12-14 days, the sutures are removed. Convalescence takes 1-3 weeks. The treatment is reimbursed. In a private hospital, the operation costs 8-10 thousand. zloty.
Spine blocks
The indications for the procedure are spinal pain caused by narrowing of the spinal canal (stenosis), displacement of one vertebral body in relation to the other (spondylolisthesis), pain syndromes related to degenerative disease and symptoms of herniated disc, e.g. sciatica. The blockade is performed on an outpatient basis, under local anesthesia, usually under the control of X-ray-TV or computed tomography. Using a special needle, the doctor introduces a glucocorticosteroid (a drug, popularly known as a steroid), which in some cases can be combined with anesthetic drugs. During the procedure, the patient feels a local prickle of the anesthetic needle. There may be local pain as the needle passes through the bag of a joint and a feeling of distension when injecting when the joint is almost full. After blocking, the symptoms immediately disappear, which is related to the action of the anesthetic that is added to the steroid. However, after a few hours, the pain sometimes comes back. After 15-20 minutes you can go home. The effect of the therapy is noticeable with a delay, after 1-2 days, and the pain gradually subsides within 3-7 days. Some doctors recommend the routine use of a series of 3 injections. Others repeat the treatment as needed, not exceeding 3, with 10-14 days intervals between injections. In over 50 percent. patients, pain symptoms disappear and you can start intensive rehabilitation. The effective operation of the blockade lasts for several weeks or even over a year. Due to the side effects of steroids (exacerbation of infection, increase in blood pressure, unstable diabetes), however, they should not be administered more often than 3-4 times a year.
Dyskoliza ozonowa
Developed in Italy 10 years ago, known in Poland for less than a year. – This is a minimally invasive method of treating lumbar discopathy using the healing properties of ozone – says Dr. Jarosław Ryterski, MD, a radiologist from the Radiologica Private Healthcare Center in Warsaw, the first center using this method in Poland. – We qualify patients for the procedure on the basis of a current magnetic resonance imaging examination. We perform treatments in one of our laboratories in Warsaw, Choroszcz near Białystok and in Rumia near Gdynia. The indication is pain in the lumbar region lasting more than a month, possibly with radiation to the leg, without improvement after conservative treatment. Contraindications include the prolapse of a part of the nucleus pulposus, advanced degenerative changes and pressure on the motor part of the nerve root.
The procedure is performed on an outpatient basis, under local anesthesia (it is about the cooperation of the patient with the doctor). Under the control of the visual path in computed tomography, the doctor punctures the intervertebral disc through the skin and injects a therapeutic gas mixture. The duration of the procedure is usually up to 30 minutes. Then the patient rests for 2 hours, then he is discharged home. The method is safe, the risk of complications is similar to that of an intramuscular injection. Ozone in a mixture with oxygen leads to a reduction in the volume of the disk and the degree of its convexity. Improvement may be felt immediately after the procedure. Moderate symptoms or slight deterioration may persist for up to 2 weeks. The full therapeutic effect should be achieved within 8 weeks, with the symptoms subsiding. In 75-80 percent. of cases, complete pain relief is observed, in 70-80 percent. passes the numbness and tingling of the leg. For some, the effect lasts a year, for others 2-3 years. The results are better in patients who also undergo rehabilitation treatment and avoid situations that harm the spine. The price of the procedure is 1,5-2,5 thousand. zloty.
Read more…