FIRST GUIDELINES OF CROATIAN INTEREST GROUP IN DIAGNOSING AND TREATING PAIN CONDITIONS OF CERVICAL AND THORACIC SPINE USING MINIMALLY INVASIVE PROCEDURES
Autori:
Karlo Houra, Darko Ledić, Dražen Kvesić, Darko Perović, Ivan Radoš, Leonardo Kapural
Sažetak
Bolni sindromi vratne i prsne kralježnice važni su javnozdravstveni problemi. Troškovi operacijskog liječenja iznimno su visoki, a radno sposobni ljudi s ovim bolestima često svakodnevno izostaju s posla. Kroničnu vratobolju najčešće uzrokuju degenerativne promjene malih zglobova. Cervikobrahijalni sindrom najčešće uzrokuje hernijacija vratnoga intervertebralnog diska. Svaka minimalno invazivna dijagnostička procedura, koja se radi s ciljem identifikacije izvora boli, bolesnika istodobno predodređuje za specifični minimalno invazivni terapijski zahvat. Ako su vratobolja ili bol u prsnoj kralježnici uzrokovane degenerativnim promjenama malih zglobova, tada se, nakon pozitivnih dijagnostičkih blokova, primjenjuju procedure radiofrekventne neuroablacije. Kod boli u vratnoj kralježnici uzrokovanih degenerativnim promjenama intervertebralnog diska bolesnicima se preporučuju intradiskalne dekompresije. U slučajevima kada su akutna vratobolja i radikularna bol bez mišićne slabosti uzrokovane stenozom spinalnog kanala, bolesniku se preporučuju epiduralne steroidne injekcije. Svrha je minimalno invazivnih terapijskih procedura primjenom kortikosteroida i kratkodjelujućega lokalnog anestetika te primjenom radiofrekventne struje bolesnika na duže vrijeme osloboditi boli te mu poboljšati kvalitetu života.
Summary
Pain syndromes originating from cervical and thoracic spine remain to be a major public health problem. Medical expenses in general and surgical procedures associated with overall care for the neck and thoracic pain are high and growing. Furthermore, these two chronic pain conditions are also leading causes for missed workdays. Chronic pain syndromes originating from cervical spine are most commonly caused by degenerative changes of the facet joints. Cervicobrachial syndrome is most commonly caused by herniated discs. Diagnostic controlled blocks, performed in order to identify the source of pain, often predetermine patient for further therapeutic minimally invasive interventions. If the chronic pain syndromes of the cervical and thoracic spine are caused by degenerative facet joints, patient can be offered neuroablative procedures using radiofrequency. In patients suffering from chronic cervical and thoracic pain caused by painful intervertebral disc minimally invasive intradiscal decompression procedures can be performed. In cases where the neck pain and radicular pain are caused by the central and foraminal spinal stenosis patients are advised epidural steroid injections. The purpose of above advised procedures, using steroids, local anesthetics and RF current, is to relieve patients’ pain, allow optimal physical therapy, and improved functional capacity, consequently providing a better quality of life.
