Dr. Reinhard Schneiderhan of the interventional pain therapy centre at Taufkirchen-Munich describes

MIS FOR CHRONIC BACK PAIN

The epidural spinal catheter technique, a minimally invasive surgical (MIS) procedure developed by Prof. Gabor Racz in the US, is used to treat acute, unresolved severe pain as well as chronic pain in patients where other treatment have failed. These include protruding and slipped intervertebral discs, acute and chronic pain following surgery on herniated discs, postoperative scar tissue and fibrosis and other painful spinal degeneration.

Following a local anaesthetic in the sacral hiatus area or the interspinal area of the thoracic vertebral column, an introducer is inserted into the epidural area. After the contrast medium is introduced and the image intensifier checked, a special feather tipped catheter is inserted to touch the required area of the nerve root canal. A combination of several medications, including a local anaesthetic, cortisone and saline solution, and an enzyme preparation, is infused. The day after the operation, and the next day, the same combination of medicines is given twice daily. After the last injection, the catheter is re-moved. A patient can be discharged the following day.

Indication - Radicular and sometimes lumbar pain, constant for at least four weeks, definite nerve stretch pain (as per Lasague), confirmation of a protrusion or prolapse of a disc or postoperative epidu-ral scar tissue via CT or MRT scan. In the following prospective study, the efficiency of this method is tested throughout the first postoperative year in 63 patients. The importance of this treatment proce-dure as well as the indication are clearly defined during the examination. Material - Since its introduction up to 4th March 1999, 445 patients were treated by this method. The data of 63 of these were used in this prospective study. The patients (average age 41, 34 women, 29 men, levels operated: L3/L4 3 %, L4/L5 39 %, L5/S1 58 %) were assessed via a standardised ques-tionnaire at four weeks, three months and one year after their operations. Results - After four weeks, three months and one year respectively, patients were questioned about the following: subjective satisfaction, use of analgesics, postoperative development of pain, existing pain and symptoms, ability or inability to work, sportive activities, relapses, complications. Moreover, the total result was assessed with the help of the Mac-Nab criteria (see box). Satisfaction - Four weeks after the procedure, 90,5 % of patients were very satisfied or satisfied, 9,5 % were slightly dissatisfied, 0 % were totally dissatisfied. After three months 94 % were satisfied or very satisfied, 6 % slightly dissatisfied and 0 % totally dissatisfied. After the first year, 87.3 % were satisfied or very satisfied, 8,3 % were slightly dissatisfied an 4,4 % dissatisfied. Analgesics - Taking of painkillers postoperatively (in the first four weeks): 34 % of patients required analgesics in the first four weeks - 20 % taking up to 10 tables, 10 % between 10 and 20 tablets an 7 % needed up to 30 tablets in the first four weeks. Length of analgesics administration: 17 % of patients took them for seven days. 13 % for up to two weeks and 7 % for up to four weeks (non-steroid an-tiphlogistics, in rarer cases moderate to strong analgesics such as Tramal TM or Valoron N TM). Postoperative development of pain - 67 % of patients were immediately free of pain, another 10 % became free of pain within the first seven days, 83 % were free of pain after two weeks, 90 % after three weeks and at the end of the seventh week, 93 % of patients were free of pain.

Visual analogue scale - The classification of the intensity of pre- and postoperative pain was carried out after the procedure as well as a year later, using a 10-point-scale: 1 means "no pain", 10 means "strongest, unbearable pain". Development of low back pain - 77 % of patients rated themselves on the visual analoque scale as between 8-10 points. After one year, 57 % of patients rated the intensity as 0-1 points. 40 % of patients rated themselves s 2-4 points. Low back pain in patients who had previously had no pain was not observed in any of the patients.

Development of sciatic pain - Pre-operatively, 80 % of patients rated themselves 8-10 points, post-operatively 53% rated themselves 0-1 point, 37 % rated themselves 2-4 points. Radicul symptoms did not become worse in any of the patients. Incapacity for work - 60 % of patients were able to resume work within the first two weeks, 77 % after four weeks, 87 % after two months an 90 % of patients after three months.

Sports - 55 of the 63 patients did some kind of sport prior to their operations. Of these, 60 % could resume activities as before, 20 % with limitations and 10 % were not able to take up their sports again. Another 10 % did not provide any data on this issue. Relapses/Complications - Three patients had a relapse. In all cases, microsurgical operations were then carried out, and there were no further relapses.

Literature list on request.

mehr Informationen dazu: Dr. med. Reinhard Schneiderhan | www.orthopaede.com | info@orthopaede.com | telefon (089) 61 45 10 24

Zur rückenschmerzenpage/Startseite