SOME ASPECTS OF LOW BACK PAIN SYNDROME PATHOGENESIS AND TREATMENT

Objective. To analyze main causes of low back pain using data of clinical neurological and instrumental examinations and results of conservative and surgical treatment of patients.

Material and Methods. A total of 405 patients with acute low back pain were examined and treated. Changes in vertebral bone mineral density indicating osteopenia and osteoporosis were revealed in 247 of them. Most patients had bulging disc detected during MRI and CT examinations. Conservative orthopedic treatment was performed in 340, and surgical in 65 patients.

Results. Long-term results were evaluated in 35 patients in the surgical treatment group. Complete elimination of pain was registered in 30 of them, while five patients continued to suffer from pain in the trunk and extremities due to osteopenia and osteoporosis. They were treated with alendronates, bisphosphonates, calcium-based drugs, and vitamin D, and showed pain elimination. In the group of surgical treatment, the complete eradication of spinal instability symptoms was reported already the next day after surgery. Pain in extremities disappeared in all patients, though four patients were troubled by hypesthesia of some areas of foot skin, which regressed over time in two, and persisted in the other two patients.

Conclusion. The disc prolapse should not justify making a hasty decision on surgical treatment. In the overwhelming majority of cases, conservative orthopedic treatment has a positive effect. The basis of such treatment must be orthopedic immobilization and unloading of the spine, as well as measures for the normalization of bone mineral density. Surgical treatment should be undertaken only after failure of orthopedic treatment and followed by further measures to normalize mineral density of bone structures. 

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