FIRST GUIDELINES OF CROATIAN INTEREST GROUP IN DIAGNOSING AND TREATING LOWER BACK AND RADICULAR PAIN USING MINIMALLY INVASIVE DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Autori:
Karlo Houra, Darko Perović, Dražen Kvesić, Ivan Radoš, Damir Kovač, Leonardo Kapural
Sažetak
Križobolja i lumboishijalgija su značajni javnozdravstveni problemi. Troškovi operacijskog liječenja iznimno su visoki, a radno sposobni ljudi s ovim bolestima često izostaju s posla. Kroničnu križobolju najčešće uzrokuju degenerativne promjene intervertebralnog diska, malih zglobova i sakroilijakalnog zgloba, dok lumboishijalgiju najčešće uzrokuje hernijacija intervertebralnog diska. Svaka minimalno invazivna dijagnostička procedura bolesnika predodređuje za specifični minimalno invazivni terapijski zahvat. Kod bolova u slabinskoj kralježnici uzrokovanih degenerativnim promjenama intervertebralnog diska, bolesniku se preporuča biakuplastika. Ukoliko je križobolja uzrokovana degenerativnim promjenama malih zglobova ili sakroilijakalnog zgloba, tada se primjenjuju procedure radiofrekventne neuroablacije. U slučajevima kada su akutna križobolja i lumboishijalgija uzrokovane stenozom spinalnog kanala, a bolesnici nemaju klaudikacije, istima se preporučuju epiduralne steroidne injekcije. Bolesnici s kroničnom lumboishijalgijom liječe se s nekom od metoda nukleoplastike ili im se može preporučiti perkutana radiofrekventna neuromodulacija. Svrha je ovih procedura, primjenom dugodjelujućih glukokortikoida i kratkodjelujućeg lokalnog anestetika, te primjenom radiofrekventne struje, bolesnika na duže vrijeme osloboditi bolova te mu poboljšati kvalitetu života.
Summary
Low back and radicular pain recently became a major public health problem. Medical expenses in general, and surgical procedures associated with overall care for the lower back pain are high and growing. Furthermore, these two chronic pain conditions are also leading causes for missed workdays. Degenerative changes of the intervertebral disc, facet joints, sacroiliac joint or disc herniation as described during imaging diagnostics may or may not be the cause of patients’ lower back pain. Diagnostic blocks often precede further interventions in order to confirm or dispute a source of the lower back pain. Chronic lower back pain caused by painful intervertebral disc should be treated using biacuplasty. If the pain of the lumbar spine is caused by facet joints or sacroiliac joint, patient can be offered neuroablative procedures using radiofrequency. In cases where the low back and radicular pain are caused by the central and foraminal spinal stenosis patients are advised epidural steroid injections, unless claudications are present. Patients suffering from the chronic radicular pain may be treated with various nucleoplasty procedures or they may be offered percutaneous radiofrequent neuromodulation. The purpose of above advised procedures is to relieve patients’ pain, allow optimal physical therapy, and improved functional capacity, consequently providing better quality of life.
