METHOD OF TREATMENT OF DEGENERATIVE-DYSTROPHIC DISEASES OF THE SPINE (DORSOPATHIES)

Report

The invention relates to medicine and concerns a method for treating degenerative-dystrophic diseases of the spine, including those complicated by intervertebral disc protrusions. The method includes three main steps. The first is the compensatory stage, which uses well-known methods of drug combination treatment aimed at transferring to the subacute or compensated stage of the disease. At the recovery stage, chondrotropic peptide bioregulators VitOrgan are introduced according to a certain scheme. Moreover, these bioregulators are administered intravenously in a slow jet method based on 0.5% novocaine solution or saline solution mixed with 10 ml of 30% sodium thiosulfate solution, with a total volume of up to 20 ml of water. Or the introduction is carried out by drip, while the drug is dissolved in 100 or 200 ml of saline solution or 200 ml of Reamberin solution, the rate of administration is 50 -60 drops per minute. Intravenous administration of drugs is combined with subcutaneous or intramuscular administration of peptide bioregulators, in t. h. in combination with vascular and vasoactive agents. The rehabilitation stage includes the use of such techniques as massage, manual and osteopathic methods of treatment, physiotherapy, therapeutic gymnastics, as well as techniques aimed at cleansing the human body. Peptide bioregulators, vasoactive drugs, and chondroprotectors are also used. The method allows to significantly speed up the patient's recovery process and achieve a stable treatment result. 22 z. p. f\ - ly. 2 pr., 4 il.

Claim

1. Method of treatment of degenerative-dystrophic diseases of the spine (dorsopathies), including those complicated by herniated discs, including the following stages::

• compensatory stage, where treatment methods are used, the purpose of which is to transfer the acute stage of the disease to subacute or, if possible, to the stage as close as possible to the stage of remission (compensated stage), and where drugs selected from the group are used: nonsteroidal anti-inflammatory drugs, anesthetics, steroid anti-inflammatory drugs, analgesics, B vitamins, thioctic acid preparations, diuretics, venotonics, central muscle relaxants, anxiolytics, thymoleptics and antioxidant agents used both individually and in various combinations with each other and peptide bioregulators;
• a recovery stage aimed at restoring the function and structure of cartilage tissue, which includes the introduction of chondrotropic peptide bioregulators VitOrgan according to the following scheme: 5-10 injections are administered with a nanogram concentration of D7, followed by injections with a microgram concentration of D4, while the number of injections with a concentration of D4, as well as the duration of their use are determined by the patient's condition, and chondrotropic bioregulators are administered intravenously by a slow jet method based on 0.5% novocaine solution or saline solution mixed with 10 ml of 30% sodium thiosulfate solution, with a total volume of up to 20 ml or by drip method, in which the drug is dissolved in 100 or 200 ml of saline solution or 200 ml of Reamberin solution, while the rate of administration is 50 \ -60 drops per minute, or combining these methods of intravenous administration with subcutaneous or intramuscular administration, both individually and in combination with other peptide bioregulators and at least two vascular and one vasoactive agents;
• rehabilitation stage aimed at maintaining the processes of restoring the function and structure of cartilage tissue, which includes, in particular, the use of such techniques as massage, manual and osteopathic methods of treatment, physiotherapy, therapeutic gymnastics, methods aimed at normalizing metabolic processes in the body, cleansing the body of various toxins and toxins, and Also, the use of peptide bioregulators, vasoactive drugs and chondroprotectors.

2. The default method. 1, in which, in the case of an acute stage of the disease, the compensatory stage includes intravenous drip infusion of nonsteroidal anti-inflammatory drugs and pararadicular injections with anesthetics and steroid
anti-inflammatory drugs. 2, in which texamen or xefocam are used as non-steroidal anti-inflammatory drugs.
4. The method by n. 3, in which texamen or xefocam is administered to the patient by intravenous drip in the form of a solution prepared by dilution in saline, in combination with vasoactive drugs, in particular trental in combination with the drug Ginkgobakehl (Ginkgobakehl D4).
5. Method according to p. 1, in which non-steroidal anti-inflammatory drugs are administered orally or
rectally. 5, in which diclofenac, ketoprofen, meloxicam, nimesulide, celecoxib or arcoxia are used as nonsteroidal anti-inflammatory drugs.
7. The default method. 1, in which in the subacute stage of the disease with moderate inflammatory and pain syndrome, the compensatory stage includes the use of nonsteroidal anti-inflammatory drugs in combination with lasix and intramuscular administration of vitamin B12 or combilipen.
8. The default method. 1, in which chondrotropic peptide bioregulators are used separately and selected from the following drugs: NeyChon Nr. 68, Sanochond Nr. 92, NeyAthos Nr. 43, NeyDIL Nr. 75.
9. The method by n. 8, in which the drug NeyChon Nr. 68 is used as a chondrotropic peptide bioregulator, which is administered by intramuscular injections paravertebral, which are supplemented with the introduction of the drug along the damaged peripheral nerve.
10. The method by n. 1, in which peptide bioregulators are used as combinations of the following drugs: NeyChon Nr. 68, Sanochond Nr. 92, NeyAthos Nr. 43, NeyDIL Nr. 75, NeyDIL Nr. 59, NeyDIL Nr. 70, NeyDIL Nr. 12, NeyTroph Nr. 96, NeyDIL Nr. 4, NeyDIL Nr.72, NeyDesib Nr.78 и NeyNormin Nr. 65.
11. The method according to n. 10, in which the combination of drugs consists of NeyChon Nr. 68 and NeyDIL Nr. 59 during the primary course of treatment.
12. The method according to n. 10, in which the combination of drugs consists of NeyChon Nr. 68 and NeyDIL Nr. 70 during the primary course of treatment.
13. The method according to n. 10, in which the combination of drugs consists of NeyChon Nr. 68 and NeyDIL Nr. 12 and is used in the acute stage of the disease during the primary course of treatment.
14. The method according to n. 10, in which the combination of drugs consists of NeyChon Nr. 68, NeyDIL Nr. 12 and NeyDIL Nr. 70 and is used in the acute stage of the disease during the primary course of treatment.
15. The method according to n. 10, in which a combination of drugs consists of NeyChon Nr. 68, NeyDIL Nr. 70 and NeyTroph Nr. 96 and is used for diseases accompanied by radiculopathies, during the primary course of treatment.
16. Method according to n. 10, in which the combination of drugs consists of Sanochond Nr. 92, NeyDIL Nr. 4 and NeyDIL Nr. 59 and is used for repeated treatment.
17. Method according to n. 10, in which a combination of drugs consists of Sanochond Nr. 92, NeyDIL Nr.72 and NeyDIL Nr. 59 or NeyDIL Nr. 70 and is used during a repeated course of treatment.
18. Method according to n. 10, in which a combination of drugs consists of Sanochond Nr. 92 and NeyDesib Nr.78 and is used to desensitize the patient's body in the presence of an autoimmune conflict.
19. Method according to n. 10, in which a combination of drugs consists of Sanochond Nr. 92, NeyDesib Nr.78 and NeyNormin Nr. 65 and is used to desensitize the patient's body in the presence of an autoimmune conflict.
20. The method according to p. 10, in which the combination of drugs consists of Sanochond Nr. 92, NeyAthos Nr. 43 and NeyDIL Nr. 70, and it is used in the combination of dorsopathies with osteoarthritis of various localization.
21. The method by n. 1, in which subcutaneous or intramuscular administration of chondrotropic peptide bioregulators is applied paraarticularly or paravertebral, while the injection sites are acupuncture points related to channels passing in the area located as close as possible to the damaged spine, or in the projection of the damaged joint, or in its immediate distance.
22. The method by n. 1, in which, in acute pain syndrome, the first half of the dose of chondrotropic peptide bioregulators is administered intravenously, and the second half of the dose is administered locally paravertebral or along the nerve.
23. The method by n. 1, in which chondrotropic peptide bioregulators are administered together with 5 ml of pentoxifylline(trental) 20 mg/ml or 10 ml of a 2,4% eufillin solution and the vasoactive drug Ginkgobakel(Ginkgobakehl D4), and the number of injections of Ginkgobakel (Ginkgobakehl D4) is at least 15.

Description

Field of technology to which the invention relates

The invention relates to the field of medicine and concerns a method for treating degenerative-dystrophic diseases of the spine (dorsopathies), including those complicated by herniated discs.

State of the art

Treatment of degenerative diseases of the musculoskeletal system still remains an urgent task of modern medicine. The prevalence of pathology is currently approaching 100% among adults and the most able-bodied part of the population. The chronic, progressive course of the disease leads to a significant, often long-term, decrease in the patient's quality of life, deprives him of the opportunity to live and work fully.

It should be noted that in everyday clinical practice, doctors are increasingly faced not with the traditional "osteochondrosis of the spine", but with the developed secondary complications in the form of protrusions and sequestration of intervertebral discs (IVD).

In the progressive course of degenerative-dystrophic diseases of the spine with the development of secondary complications in the form of protrusions and sequestration of intervertebral discs, deforming spondyloarthritis, a frequent outcome of the disease is long-term disability and disability. There is an unjustified tendency to prescribe surgical treatment for herniated discs.

For example, Patent RU2414182 (publ. 20 .03 .2011) provides a method for surgical treatment of a thoracic intervertebral disc herniation, in which posterolateral surgical access to the spinal canal is performed by partial resection of the arch pedicle and articular processes of the vertebra while preserving their anatomical and functional integrity. Hernia removal is performed by resection of the posterior part of the intervertebral disc, partially adjacent vertebral bodies and the edge of the spinal canal within the middle support column of the spine, followed by removal of the remaining hernia from the spinal canal under endoscopic control.

Patent RU2311146\ (publ. 27.11\ .2007) discloses a method for surgical treatment of thoracic intervertebral disc hernias, which includes steps in which anterolateral surgical access to the spinal canal is performed, the rib head is removed, and the hernia is accessed extrapleurally, and the posterior part of the intervertebral disc is resected within the middle support column spine, along the edge of the spinal canal, resection of the bodies of adjacent vertebrae is performed to a depth of 2/3 of the diameter of the thoracic vertebral body, followed by removal of the remains of a hernia in the spinal canal under endoscopic control.
However, those skilled in the art are well aware that surgical methods of treatment are quite traumatic and often accompanied by various complications.
Methods of conservative treatment of herniated discs are also known from the prior art, which use anti-inflammatory drugs, analgesics, therapeutic blockades, physiotherapy procedures, kinesitherapy, massage, manual therapy, laser therapy.

For example, patent RU2190384 (publ. 10 .09 .2000) discloses a method for treating hernias based on longitudinal stretching of the spine together with the effect on the hernia of transverse adjustable vacuum reduction from the abdomen and vibration from the back.

Patent RU2493889\ (publ. 27.09\ .2013) describes a method for conservative treatment of intervertebral hernia of the lumbar and cervical spine, consisting in injectable resorption therapy with drugs with enzymatic properties, and further joint exposure to a constant magnetic field and pulsed low-power optical radiation in the visible and near-IR range with an indication of certain therapy regimens and the means used.

Another approach to the treatment of dorsopathies is the use of methods aimed at restoring the structures of spinal segments.

Document RU2195940 (publ. 27 .06 .2002) describes a method for the regeneration of articular cartilage, including intra-articular administration of human chondrocytes, where fetal cartilage tissue is used as a chondroprotector.

A number of documents disclose methods for treating diseases of the spine based on the introduction of dispersed Alloplant biomaterial diluted in saline solution into various parts of the spine, indicating certain schemes of therapy.

Patent RU2556959\ (publ. 20.07\ .2015) offers a method for treating degenerative lesions, protrusions and herniated discs, including injecting dispersed biomaterial Alloplant, diluted in saline, by injecting it into the paravertebral soft tissues, in which, unlike the prototype, a solution of dispersed biomaterial Alloplant of 10-20 ml per injection is injected into the space between the paravertebral muscles and the transverse process of the vertebra or inter-transverse ligament, and immediately after each injection of the biomaterial, a saline solution is administered in the amount of 20 \ -100 ml until radiating unpleasant or painful sensations are obtained, creating additional pressure that ensures the advancement of the biomaterial along the hydraulically expanded interstitial, perineural and paravascular spaces to the zone after that, the patient is positioned on the abdomen for 12-24 hours for gravitational distribution of the solution to the anterior spine, and the treatment is carried out in a course that includes 3 -5 injections of unilateral or bilateral biomaterial administration, followed by the introduction of saline solution after each injection of the biomaterial with an interval between injections of 8-12 days, and the dispersed biomaterial is Alloplant for injection, dilute in the ratio of 50 mg of biomaterial per 20 ml of saline solution.

The authors of patent RU2577508\ (publ. 20.03\ .2016) proposed a method for treating dorsopathy, which is carried out as follows. Identify a degeneratively altered segment of the spine that is exposed to the sun. Next, a solution of Alloplant biomaterial is prepared, for which 50 mg of dry dispersed biomaterial is mixed (in standard packaging in a sterile 15 ml "penicillin" bottle) to 5 -15 ml of saline solution. The number of injections when exposed to one vertebral segment is 3 -9, from 1.5 to 5.0 ml of the administered solution in each injection, the number of procedures is 1 -10 with a break between them of 1 -7 days. The choice of the affected segment(s) of the spine, the volume of drug administered and the number of injections, the feasibility of anesthesia and the choice of anesthetic, the use of additional medical and physiotherapy effects are determined by the doctor individually in each specific case.

However, existing methods of treating degenerative-dystrophic diseases of the spine, in particular those complicated by hernias, are not aimed at the pathogenetic basis of the disease, which is a progressive destruction of the cartilage tissue of the spine as a result of exposure to a combination of etiological factors, and also cannot be considered regenerating, i.e. aimed at restoring the damaged structure and impaired connective tissue function, as well as maximally potentiating this recovery process.

According to some authors, the main place in the use of regenerating methods of treatment is occupied by cellular bioregulators, for example, VitOrgan peptide preparations, which, having organ and tissue specificity, have a regenerative effect on homologous organs and tissues. The use of chondrotropic peptide bioregulators VitOrgan is currently the main pathogenetic or basic stage of treatment of degenerative-dystrophic diseases of the spine(Krug E., Kugler K.-H. Zur VitOrgan \ - Therapie entzundlicher und degenerativer Gelenkerkrankungen. / / Erfahrungs-Heilkunde (Acta medica empirica). 1984. 10. 33. 691-695), since their action is aimed at restoring the structure of damaged tissue and normalizing the work of cartilage cells (chondrocytes) and it is thus aimed at restoring its function.
The closest approach to the treatment of degenerative-dystrophic diseases of the spine is the use of complex peptidotherapy in combination with reflexology and manual therapy. Yavid D. A. Complex peptidotherapy of degenerative-dystrophic diseases of the spine. Abstract of the dissertation for the degree of Candidate of Medical Sciences. Moscow. 2013. 38 s.).

The method of treatment disclosed in the above source includes reflexology, which is carried out according to the following method: pharmacopuncture with simultaneous warming of the abdominal area. Immediately after the pharmacopuncture, percussion massage of the back muscles is performed using a relaxing or toning technique, depending on the patient's initial condition. The course of pharmacupuncture consists of 10 -12 procedures performed every other day. After a break of 15 -20 days, the course of treatment should be repeated.

Regulatory peptides such as NeyDIL Nr. 4, NeyAthos Nr. 43, NeyChon Nr. 68, Sanochond Nr. 92, and homeopathic medicines such as Traumel C are used as agents introduced into acupuncture points. (Traumel S), Discus compositum (Discus compositum), and Zeel compositum \ (Zeel compositum).

The above-mentioned method of treatment also includes manual therapy, in particular the use of myofascial releasing techniques, which are based on a soft layer-by-layer relaxation of muscles and connective tissue to the full depth of the skin. If necessary, other methods of manual medicine can be used, such as post-isometric muscle relaxation, craniosacral therapy, visceral manual therapy, as well as various therapeutic massage techniques aimed at leveling muscle-fascial tension. The course of manual therapy is carried out 2 times a week in parallel with the course of reflexology.

It should be noted that in the case of an active stage of the disease, especially complicated by the formation of herniated discs, which occurs with a pronounced pain syndrome, much more serious and active methods of relieving the severity of the process and transferring the disease to a compensated stage of development are required. The above method of treatment does not involve a stage aimed at transferring the acute stage of the disease to subacute or compensated form. In addition, there is a need to develop schemes for the use of peptide bioregulators, as well as their dosages and methods of administration, which provide more effective treatment of degenerative-dystrophic diseases of the spine, including those complicated by herniated discs.

Thus, the objective of the present invention is to develop an effective method for treating degenerative-dystrophic diseases of the spine (dorsopathies), including those complicated by herniated discs.

Speaking of a" herniated disc", the classic implication is that there are three possible conditions:

• With bulging of the fibrous ring, it is customary to speak of protrusion of the disc;
• When the pulpous nucleus leaves the fibrous ring, prolapse is reported(or, in some sources, "extrusion").\ );
• When separating fragments of the pulpous nucleus from the bulk of the disk \ - about sequestration.

The problem is solved thanks to the proposed method of treatment of degenerative-dystrophic diseases of the spine (dorsopathies), including those complicated by herniated discs, including:

• compensatory stage, where treatment methods are used, the purpose of which is to transfer the acute stage of the disease to subacute or, if possible, to the stage as close as possible to the stage of remission (compensated stage). At this stage, the use of pharmacological preparations selected from the group is indicated: nonsteroidal anti-inflammatory drugs, anesthetics, steroid anti-inflammatory drugs, analgesics, glucocorticoids, B vitamins, thioctic acid preparations, diuretics, venotonics, central muscle relaxants, anxiolytics, thymoleptics, and antioxidant agents used both individually and in various combinations with each other and / or with peptide bioregulators;
• the recovery stage aimed at restoring the function and structure of cartilage tissue, which includes the use of chondrotropic peptide bioregulators VitOrgan, used both individually and in combination with other peptide bioregulators, as well as vasoactive agents, for the introduction of which intravenous and intramuscular methods of administration are used;
• rehabilitation stage aimed at maintaining and optimizing the processes of cartilage tissue restoration, which includes, in particular, physical treatment methods such as massage, manual and osteopathic methods of treatment, physiotherapy, therapeutic gymnastics, methods aimed at cleansing the body, as well as the further use of peptide bioregulators.

The technical result achieved by using the claimed method of treating degenerative-dystrophic diseases of the spine(dorsopathies), including those complicated by herniated discs, is to increase the effectiveness of the treatment. It should be noted that the terms "restorative "and" revitalizing", as well as the phrases" regulatory peptides"," peptide bioregulators "and" peptide preparations", as well as derivatives of these words are used interchangeably in this document. The proposed method of treating degenerative-dystrophic diseases of the spine (dorsopathies) is based on the principles of phasing and complexity. Phasing in the context of this invention should be understood as a clear separation of the stages of therapy performed. Complexity implies the impact on all etiological factors that affect the development of the disease in each specific case. The proposed method of treatment includes three main stages of treatment. 

The first stage of the method is the so-called "compensatory stage", the purpose of which is to transfer the acute stage of the disease to the subacute or, if possible, to the stage as close as possible to the remission stage(compensated stage). At this stage, treatment methods are used to eliminate inflammation, pain syndrome, local ischemic component, edema, venous dysgemia, muscle-tonic syndrome and manifestations of autoimmune conflict. This stage, in particular, involves the use of standard pharmacotherapy using drugs selected from the group: non-steroidal anti-inflammatory drugs, anesthetics, steroid anti-inflammatory drugs, analgesics, glucocorticoids, B vitamins, thioctic acid preparations, diuretics, venotonics, central muscle relaxants, anxiolytics, thymoleptics, and antioxidant agents that can be used as both individually and in various combinations with each other and/or with various peptide bioregulators.

As non-steroidal anti-inflammatory drugs, traditional drugs(NSAIDs) used in the treatment of degenerative-dystrophic diseases of the spine can be used, for example, such as diclofenac, ketoprofen, meloxicam, nimesulide, celecoxib, arcoxia, texamen, xefocam, etc.

In one embodiment, in the case of an acute stage of the disease, the compensatory stage includes intravenous drip infusion of nonsteroidal anti-inflammatory drugs and pararadicular injections with anesthetics and steroid anti-inflammatory drugs. In one preferred variant of the method according to the invention, in the acute stage of the disease, non-steroidal anti-inflammatory drugs use texamen(tenoxicam) or xefocam, which are preferably administered to the patient intravenously in the form of a solution prepared by dilution in saline in combination with vasoactive drugs, in particular trental in combination with Ginkobakehl). At the same time, the number of droppers with the above combination of drugs should not exceed 5%. As the patient's pain syndrome subsides, non-steroidal anti-inflammatory drugs used during the compensatory stage can be administered orally or rectally. Such nonsteroidal anti-inflammatory drugs may include diclofenac, ketoprofen, meloxicam, nimesulide, celecoxib, or arcoxia. The duration of use of the above nonsteroidal anti-inflammatory drugs is 10-14 days, and in the presence of gastric pathology, their use should be combined with antacids. 

If necessary, at the first stage of the proposed method, the patient can undergo para-radicular, epidural or muscle blockages, trigger point blockages using anaesthetics, B vitamins, glucocorticoids (for example, dexamethasone, diprospan). In addition, for severe pain syndromes, intramuscular, oral or rectal administration of tramadol at a dose of 50, 100 or 200 mg is recommended. In addition, it is possible to use the drug Ambene 2.0, administered intramuscularly daily or after 1 day, with a course of no more than 3 injections.

To enhance the decongestant effect at the first stage of treatment of the patient, diuretics can be used (for example, lasix 20-40 mg, i / m, N 1 -2) and venotonics (troxevasin, phlebodia, detralex, antistax).

In the subacute stage of the disease and/or with moderate root pain(less than 6 points on YOUR score), the compensatory stage may be limited to the use of nonsteroidal anti-inflammatory drugs in combination with lasix and intramuscular administration of vitamin B12(100 -2000 mcg) or combilipen. In some cases, a positive effect can be achieved by using flupirtin or catadolone in a dosage of up to 600 mg per day.

To normalize muscle tone, central muscle relaxants can be used, for example, such as tolperizone (mydocalm), used in a dosage of 100 mg(1 ml) intramuscularly or orally 150 mg 2 times a day, tizanidine (sirdalud) in a dosage of 2 -4 mg 3 times a day, baclofen in a dosage of 5 mg 3 times a day (you can titrate the dose to 75 mg / day).).

To improve microcirculation, it is optimal to use pentoxifylline (trental) in a dosage of 100-400 mg 3 times a day.

Since pain stress causes disorganization of the limbic-reticular complex, impaired synthesis of monoamines, opiates, and dysfunction of the central antinociceptive systems, a short(5 -15 days) course of anxiolytics(afobazole, atarax, grandaxin) and the appointment of thymoleptics, preferably SSRIs(paxil, prozac) is indicated to prevent the development of anxiety-depressive disorders and chronic pain.

B vitamins(kombilipen, milgamma), thioctic acid preparations(espa-lipone, thiogamma, thioctacid) and mexidol are indicated for improving tissue trophism.
The next stage of the proposed method of treating diseases of the spine is the so-called "restorative" or "revitalizing" stage. The purpose of this study is to restore the function and structure of cartilage tissue, which is achieved through the use of chondrotropic peptide bioregulators VitOrgan, used both individually and in various combinations with other peptide bioregulators, as well as with drugs of other pharmaceutical groups.

When implementing the method according to the invention, VitOrgan peptide preparations are used, which, by activating regenerative processes, such as the renewal and synthesis of structural components of cartilage tissue, are able to normalize metabolic processes in damaged tissues and cause regression of organic damage to cartilage tissue. VitOrgan peptide bioregulators contain cytoplasmic cell content material obtained from animal embryos and containing extracts of biomolecules with tissue and organ specificity, but at the same time devoid of species specificity(due to their undifferentiation) and capable of having a regenerative effect on homologous organs.

The active substance of VitOrgan preparations is peptide-protein bioregulators and other intracellular biomolecules from all histogenetic series of cells from stem to semi-stem and mature.

Once in the bloodstream, bioregulatory peptides can activate the formation and maturation of healthy cartilage cells – chondrocytes, which are responsible for the synthesis of those components of cartilage that determine its physical properties, in particular the ability to establish communication with water molecules(t.e. depreciation properties).

The following VitOrgan peptide preparations can be used in this invention: NeyChon Nr. 68, Sanochond Nr. 92, NeyAthos Nr. 43, NeyDIL Nr. 75, NeyDIL Nr. 59, NeyDIL Nr. 70, NeyDIL Nr. 12, NeyTroph Nr. 96, NeyDIL Nr.4, NeyDIL Nr.72, NeyDesib Nr.78 и NeyNormin Nr. 65.

Peptide preparations used in the proposed method for the treatment of degenerative-dystrophic diseases of the spine (dorsopathies), including those complicated by herniated discs, can be divided into several main groups:

• basic preparations of rehabilitation therapy, which include chondrotropic peptide bioregulators NeyChon Nr \ .68, Sanochond Nr.92, NeyAthos Nr.43 and NeyDIL Nr.75;
• drugs used in addition to the basic drugs, which include the peptide bioregulators NeyDIL Nr. 59, NeyDIL Nr. 70, NeyDIL Nr. 12, NeyTroph Nr. 96, NeyDIL Nr.4, NeyDIL Nr.72, NeyDesib Nr.78 and NeyNormin Nr. 65.

NeyChon Nr \ .68 is a chondrotropic peptide composite of cellular bioregulators extracted from various organs and tissues, such as Thymus fet., Hypophysis totalis juv., Diencephalon juv., Medulla spinalis juv., Glandula suprarenalis juv., Testis juv., Hepar juv., Pancreas juv., Musculi juv., Columna vertebralis fet., Articuli fet., Ren juv., Placenta mat. and Nucleus pulposus juv.. Peptides of the pulpous nucleus of the intervertebral disc (Nucleus pulp. juv.) are necessary to restore its structure, and hence its physical properties. Cellular peptides of fetal joints\ (Articuli fet.,) necessary to compensate for spondyloarthritis, which is an inevitable companion of dorsopathies. Peptide bioregulators Diencephalon juv. perform the role of optimizers of the work of nervous structures. Hypophysis tot. juv., Gl. Suprarenalis juv., Testis juv. - control the processes of metabolism of bones, ligaments, muscles and synovial membranes. Peptides of the fetal thymus (Thymus fet.They have a desensitizing effect and reduce the effect of autoimmune reactions on the course of the degenerative-dystrophic process. Peripheral blood flow and microcirculation are activated by a peptide preparation of the maternal placenta (Placenta mat).

The result of the synergistic action of peptides included in the NeyChon Nr. 68 composite is a regenerative and revitalizing(structure and function) effect on the cartilage tissue of the vertebral motor segment (PDS) – the pulpous nucleus of the intervertebral disc, the tissues of the fibrous ring, arched joints, ligaments (see fig. Reiter R. NeyAthos Nr.43 und NeyChon Nr.68 in der Orthopadischen Praxis. //Therapiewoche. 1988. 38. 6. 139–140).

The preparation Sanochond Nr. 92 belongs to chondro-and osteotropic preparations and contains cellular peptides of the cartilage and bone tissues of the spinal column (Columna vertebralis fet).

NeyAthos Nr. 43 chondrotropic peptide composite is a cytoplasmic extract of regulatory peptides of fetal joints Articuli fet., Cartilago juv. cartilage, Synovia juv. synovial fluid.

The drug NeyDIL Nr. 75 (Corpus vitreum) contains vitreous peptides as an active component.

NeyDIL Nr. 59 (Vasa) has a vasoactive, antiatherogenic effect and acts as a vasodilator, geroprotector and vascular revitalizer.

NeyDIL Nr.70 (Placenta mat.) is a preparation made from peptides of the maternal placenta Placenta mat. \ (decidua) and combines mesodermal and endodermal properties. The scope of its therapeutic application is the activation of histo - and organogenesis processes in the postnatal period.

NeyDIL Nr.12 \ (Diencephalon fet.) as an active component contains peptides of the midbrain. This drug is recommended for use as an anti-inflammatory and analgesic agent for severe pain syndromes.

NeyTroph Nr \ .96 contains peptides extracted from Epiphysis, Cortex cerebri, Diencephalon, Medulla spinalis, Myocardium, Musculi, Thymus fet. The peptide bioregulator NeyTroph Nr. 96 is recommended for use as" pinching " along the nerve in the case of sciatica or radiculopathy, or the cervical-collar zone, for example, in cervicobrachialgia.

VitOrgan-NeyDIL Nr. 4(Mesenchym) represents peptides of stem and semi-stem cells of mesenchymal origin.

NeyDIL Nr .72 (Funiculus umbilicalis) contains umbilical cord peptides extracted from stem and mesenchymal cells. NeyDIL Nr .72 is the main preparation of mesoderm peptides affecting all mesodermal tissues.

Both drugs (NeyDIL Nr. 4, NeyDIL Nr. 72) are the main bioregulatory drugs for the revitalization and regeneration of connective tissue in general, for diseases of cartilage, bones, ligaments and muscles, as well as for the elimination of slagging syndrome.

NeyDesib Nr.78 contains peptides extracted from Musculi, Cor, Cortex cerebri, Medulla spinalis, Diencephalon, Epiphysis, Thymus fet. and it is used as an immunosuppressive, anti-inflammatory agent.

NeyNormin Nr.65 is a preparation containing peptides extracted from Thymusfet., Gl.suprarenalis, Gl.parathyreoidea, Lien, Lymphonodi, Medulla ossium, Hepar, Ren, Pancreas, Funiculus umbilicalis, Hypophysis, Diencephalon, Mucosa miscae, Cutis, Vasa and is used as immunosuppressive, anti-inflammatory, an anti-allergic agent, as well as an agent whose action is aimed at revitalizing the immune and endocrine systems.

In one preferred embodiment of the invention, chondrotropic peptide bioregulators are used separately and selected from the following preparations: NeyChon Nr. 68, Sanochond Nr. 92,NeyAthos Nr. 43 and NeyDIL Nr. 75.

In another embodiment of the invention, the peptide bioregulator is NeyChon Nr. 68, which is administered by intramuscular injections paravertebral, which are supplemented by the introduction of the drug along the irritated peripheral nerve.

In another preferred embodiment of the method according to the invention, peptide bioregulators are used in the form of various combinations of VitOrgan preparations selected from the following group: NeyChon Nr. 68, Sanochond Nr. 92, NeyAthos Nr. 43, NeyDIL Nr. 75, NeyDIL Nr. 59, NeyDIL Nr. 70, NeyDIL Nr. 12, NeyTroph Nr. 96, NeyDIL Nr. 4, NeyDIL Nr.72, NeyDesib Nr.78 и NeyNormin Nr. 65.

It has been found that in the treatment of dorsopathies, osteoarthritis and a number of other somatic problems associated with pain, the pain syndrome is relieved significantly more successfully when a basic chondrotropic peptide drug (for example, NeyChon Nr. 68 or Sanochond Nr.92) is used in combination with NeyDIL Nr. 12 (Diencefalon), NeyNormin Nr. 65 and NeyTroph Nr. 96.

In the present invention, the following most optimal combinations of VitOrgan peptide bioregulators are proposed::

1. Combination of NeyChon Nr. 68 and NeyDIL Nr. 59;
2. Combination of NeyChon Nr. 68 and NeyDIL Nr. 70;
3. Combination of NeyChon Nr. 68 and NeyDIL Nr. 12;
4. The drug combination consists of NeyChon Nr. 68, NeyDIL Nr. 12 and NeyDIL Nr. 70;
5. A combination of NeyChon Nr. 68, NeyDIL Nr. 70 and NeyTroph Nr. 96;
6. A combination of Sanochond Nr. 92, NeyDIL Nr. 4 and NeyDIL Nr. 59;
7. A combination of Sanochond Nr. 92, NeyDIL Nr.72 and NeyDIL Nr. 59 or NeyDIL Nr. 70;
8. A combination of Sanochond Nr. 92 and NeyDesib Nr.78;
9. A combination of Sanochond Nr. 92, NeyDesib Nr.78 and NeyNormin Nr. 65;
10. A combination of Sanochond Nr. 92, NeyAthos Nr. 43 and NeyDIL Nr. 70.

The first and second combinations of drugs are universal and can be used for any stage and severity of the disease, with any combination of etiological factors.

The third and fourth combinations of drugs are used in acute stages of the disease, accompanied by severe pain syndrome.

The fifth combination of drugs is used for diseases accompanied by various variants of radiculopathies.

It should be noted that combinations of drugs from the first to the fifth are used during the primary course of treatment.

The sixth and seventh combinations of peptide preparations are the most effective in spondylopathies, when one of the leading etiological factors in the development of pathology is connective tissue dysplasia, as well as in metabolic syndromes in order to eliminate slagging of the connective tissues of the body(slagging syndrome).

These combinations should be used during repeated revitalizing courses of treatment.

The eighth and ninth combinations are used to desensitize the body in the presence of an autoimmune conflict.

The tenth combination of peptide bioregulators is used in the combination of dorsopathies with osteoarthritis of various localization (spondyloarthritis, arthrosis of the sacroiliac joints, arthrosis of large joints, shoulder and hip periarteritis, etc.).

In all cases of peptidotherapy, the classical scheme of drug administration is used, which begins with injections of nanogram concentrations of D7 bioregulators in the amount of 5-10 injections. After that, the transition is made to a more concentrated form of the drug – in a microgram concentration of D4. The number of D4 injections depends on the patient's condition, and the duration of treatment is selected individually.

In general, the total number of injections is calculated individually, depending on the following parameters::

• the severity of the process and the severity of the pain syndrome,
• the degree of severity of organic changes;
• predominance of reflex or compression symptoms in the clinical picture;
• presence or absence of sequestration;
• patient's age;
• state of psychosomatic status;
• constitutional features;
• presence of scoliosis;
• presence or absence of obesity, as well as concomitant endocrine and somatic diseases;
• state and degree of training of the muscular system;
• the degree of professional and habitual household loads, etc.

Usually, drugs are administered at intervals of 2-3 times a week.

In exceptional cases, when the patient is limited in time, daily administration of the drug is used for 10 days: 5 days of D7 injection, the next 5 days – D4. With this scheme of drug administration, the positive effect may occur with some delay, and in some cases a temporary deterioration of the patient's condition is possible.
It is known that the classic methods of administration of peptide drugs are paravertebral or paraarticular, intramuscular or subcutaneous injections, similar to the introduction of many drugs of natural origin.

However, it was found that intravenous administration of drugs is more effective in achieving both immediate and long-term therapeutic results. This is explained by the fact that peptide bioregulators entering the bloodstream do not undergo transformation, but, penetrating through histohematological barriers into cells and intercellular space, reach the target organ, which has tissues homologous to peptides. Blood, as well as lymph, is in this case a liquid medium that acts as a transport and information system. The main method of penetration of bioregulators into the cell is diffusion, which allows peptides to enter the interstitial tissue freely enough. Bioregulators are characterized by rapid overcoming of membrane barriers, which is due to their organo-tissue tropism. In general, it can be noted that, having reached a homologous tissue, bioregulatory peptides penetrate equally well both into the extracellular space and into the cell, which makes them one of the strongest biomimetics.

In preferred embodiments of the invention, peptide bioregulatory drugs are administered intravenously in one of the following ways::

• a slow jet method of administration based on saline solution mixed with 10 ml of 30% sodium thiosulfate solution and a total volume of up to 20 ml; or
• a drip method of administration, in which the drug is dissolved in 100 or 200 ml of saline solution or 200 ml of reamberin solution. The rate of administration is 50-60 drops per minute.

In acute pain syndrome( the first stage of treatment), as well as in the implementation of the restorative(second) stage of treatment, it is preferable to use a combination of methods of administration of peptide drugs. In this case, half of the dose of the drug (1 ml) or a combination of drugs (each 1 ml) is administered intravenously, and the second half of the dose of the drug (1 ml) or a combination of drugs (also each 1 ml) is administered topically (subcutaneously or intramuscularly) paravertebral or by the course of the nerve.

According to the proposed method, the introduction of peptide bioregulators should be combined with active vascular therapy.

Thus, for intravenous drip administration of peptide bioregulators, it is preferable to use at least two vascular preparations, for example, use 5 ml of pentoxifylline(trental) 20 mg/ml or 10 ml of a 2,4% eufillin solution in combination with the vasoactive drug Ginkgobakehl(Ginkgobakehl D4), used in an amount of at least 15 mg / ml. injections.

Subcutaneous and intramuscular administration of drugs is used paraarticularly or paravertebral. The places of choice for this method of drug administration are acupuncture points related to channels passing in the area located as close as possible to the damaged spine or in the projection of the damaged joint or in its immediate distance. In dorsopathies, the points of the bladder canal and the Hua-To line located between the central median line of the back, determined by the vertices of the spinous processes, and the 1st lateral line of the back, points A-Shi-points of "pain", trigger points and zones, zones of Zakhar'in – Ged are preferred. Such localization of drug administration is optimal, but it is not an immutable rule and VitOrgan-drugs can also be successfully administered intramuscularly, paraarticularly in the area of joint projection or paravertebral in the area of the projection of the trunk of the extensor muscles of the back.

For lumbar and sacral pain, it is effective to introduce the drug into the projections of the sacral points Ba-Liao ("eight pits") corresponding to the projections of the sacral openings. The four upper points of Ba corresponding to the two pairs of upper sacral openings must be used for subcutaneous "chipping" in herniated discs of the lower lumbar spine and in osteoarthritis of the sacroiliac joints. In the latter case, it is used in combination with local points of the KPS \ projection.

For neuritis and radiculopathy, it is recommended to inject the drug into the projection area of the nerve trunks.

In the case of a patient in the subacute stage of the disease, the phase of subsiding exacerbation, the compensatory and restorative stages of the disease can be combined.

In one embodiment, in the case of a subacute stage of a disease or a disease that is in remission, the compensatory and restorative stages of treatment are performed simultaneously. In one embodiment of the treatment method, nonsteroidal anti-inflammatory drugs are used in combination with chondrotropic peptide bioregulators. The third stage of the proposed method is necessary for the most effective course of the processes of further restoration of the function and structure of the cartilage tissue. Also at this stage, it is important to create the right muscle balance, minimizing areas of muscle tension and evenly distributing loads on the discs and joints of the spine. 

The rehabilitation stage includes, in particular, the use of such techniques as massage, manual and osteopathic methods of treatment, physical therapy and therapeutic gymnastics. In the presence of concomitant diseases of the body, for example, diseases of the gastrointestinal tract and endocrine system, at this stage it is also necessary to use methods aimed at normalizing metabolic processes in the body, at cleansing the body of various toxins and toxins. In addition, further use of peptide bioregulators, vasoactive drugs, and chondroprotective drugs may be indicated at this stage.

Brief description of drawings

The essence of the invention is explained by drawings and examples of the implementation of the proposed method of treatment, given below.

In Fig. 1 shows an MRI image of the lumbar spine(sagittal projection) of a patient before treatment, which shows a sequestered "ascending" herniated disc L5-S1.

In Fig. 2 shows an MRI image of the lumbar spine(axial projection) of the patient before treatment, which shows a paramedian sequestered herniated disc L5-S1 with pronounced compression of the dura mater and spinal space.

Fig. 3 is an MRI image of the lumbar spine (sagittal projection) of the patient after 6 months of therapy, which shows a significant reduction in the size of the sequestered IVD hernia L5-S1.

In Fig. 4 shows an MRI image of the lumbar spine(axial projection) of the patient after 6 months of therapy, which shows a significant reduction in the size of the sequestered IVD hernia L5-S1 and a significant leveling of the degree of compression of the dura mater and spinal space.

Implementation of the invention

The developed method, based on the complex application of a traditional treatment regimen in combination with the use of bioregulatory peptides VitOrgan, can be illustrated by the following clinical example.

Clinical example 1

Patient A., 40 years old, complained mainly of "compression" symptoms resulting from damage to the IVD tissue at the lumbar spine level, including right-sided L5 radiculopathy. The severity and intensity of the pain syndrome limited the patient's ability to move and maintain herself. MRI revealed a massive "ascending" sequestered herniated disc L5-S1 with pronounced compression of the dura mater and spinal space (Fig. 1 and 2).

Prior to treatment, the patient was admitted to a hospital, where she underwent standard therapy, including the use of nonsteroidal anti-inflammatory drugs (diclofenac sodium, meloxicam), paravertebral blockades with steroid anti-inflammatory drugs (glucocorticoids), B vitamins and anesthetics. Vasoactive agents, venotonics, analgesics(zaldiar, catadolone), diuretics, herbal remedies, reflexology were also used.

The above-mentioned therapy gave short (up to several hours) periods of regression of symptoms, but in general the pain syndrome persisted. After 1 month of therapy, repeated MRI performed in a hospital showed no positive dynamics, and therefore surgical treatment(discectomy) was recommended.

Treatment of the patient included the following stages, carried out in accordance with the proposed method of treatment.

The compensatory stage was performed on an outpatient basis and included the continuation of the course of anti-inflammatory therapy. Infusions with non-steroidal anti-inflammatory drugs (xefocam), vasoactive drugs (pentoxifylline, Ginkobakehl D4)were performed\ ), NeyDIL Nr \ .12 midbrain neuropeptides. To enhance the decongestant effect and compensate for the autoimmune conflict that is always present in sequestered IVD hernias, a paravertebral pararadicular injection was performed with a 2% solution of novocaine 15 ml and diprospan 1 ml.

Regression of symptoms was achieved on the 4th day of therapy, after which the recovery stage of the method was performed. From day 5 of therapy, the chondrotropic peptide composite NeyChon Nr.68 D7 and placental peptides NeyDIL Nr. 70 were added to the infusion formulation.

Partially NeyChon Nr. 68 and NeyDIL Nr. 70 were injected paravertebrally at the level of the lumbar spine (first and second lateral lines of the back at the level of the interspinous spaces).

As the therapy progressed, the symptoms regressed, the symptoms of the inflammatory process and radiculopathy were reduced.

Injectable therapy using NeyChon Nr \ .68, NeyDIL Nr.12, NeyDIL Nr.70, as well as oral Chondron was performed for 1 month. As a result of such complex therapy, the complaints completely disappeared.

Further rehabilitation included chondroprotectors (Chondron, Alflutop, Piascledin 300), physical therapy and sublingual NeyChon Nr .68 oral.

A second course of revitalizing therapy (performed 3 months after the end of the first revitalizing course) included injections of Sanochond Nr .92 vertebral column peptide bioregulators, NeyDIL Nr .4 mesenchyma (Mesenchym) and NeyDIL Nr .59 vessels (Vasa) with oral administration of Chondron chondroprotective drug.

6 months after the end of the revitalizing course of therapy, the clinical manifestations of the disease were practically absent. On MRI, a significant reduction in the size of the herniated protrusion of the IVD L5-S1(cm) was observed. Fig. 3 and 4).

Clinical example 2.

Patient K, 18 years old, complained of long-term, regularly occurring sensations of discomfort, often turning into pain, in the thoracic spine. The sensations could resemble stiffness, aches, heaviness, lasting up to several hours and occurring without connection with physical exertion and other obvious provoking factors. Static positions of the torso may have contributed to the appearance and increase of pain. Also, pain manifestations occurred in the morning hours after sleep.

During physical exertion, such as lifting weights, working in the torso tilt position, there were pain manifestations in the lumbar region, which passed after resting in the supine position or taking analgesics or NSAIDs. Massage courses that the patient regularly conducted gave a temporary improvement in the condition, usually lasting from 1 to 2 weeks, after which the pain manifestations resumed. MRI revealed degenerative-dystrophic changes in the thoracic and lumbar spine, as well as Rg signs indicating the presence of cartilage dysplasia in the patient-osteochondropathy of the spine(Scheyerman's disease-Mau). In this situation, degenerative-dystrophic changes in the spine were of a secondary nature, since the pathogenetic trigger cause of the disease was functional weakness of the cartilage tissue of the spine due to the presence of dysplastic changes in it.

At the first stage of treatment, the patient was prescribed anti-inflammatory therapy, including 4 injections of xefocam, after which the therapy was continued by oral administration of the NSAID arcoxia for 7 days. Muscle relaxants and B vitamins were prescribed.

The second "recovery" stage of treatment was started simultaneously and in parallel with the first one.

NeyChon Nr. 68 chondrotropic peptide composite was used intravenously in combination with vasoactive drugs(pentoxifylline, ginkobakel) based on 200 milliliters of saline solution. The use of peptide bioregulators was carried out according to the classical scheme. Treatment was started with the use of NeyChon Nr \ .68 with a low concentration of peptides \ (high dilution) \ - D7 in an amount of 5, after which treatment was continued with the drug in a lower dilution - D4 in an amount of 10 injections.

Partially NeyChon Nr .68 was injected paravertebral at the level of the lumbar and thoracic spine (first and second lateral lines of the back at the level of the interspinous spaces).

As a result of such complex therapy, after 3 days of treatment, complaints were consistently leveled.

Further rehabilitation included chondroprotectors (Chondron, Alflutop, Piascledin 300), physical therapy and sublingual NeyChon Nr .68 oral. Physical methods of treatment were actively used: massage, manual medicine techniques, physical therapy, therapeutic gymnastics.

A second course of revitalizing therapy (performed 3 months after the end of the first revitalizing course) included injections(intravenous+ intramuscular paravertebral) of Sanochond Nr .92 vertebral column peptide bioregulators, NeyDIL Nr .4 mesenchym (Mesenchym), taking into account the initial dysplastic background of the disease, with oral administration of Chondron. After that, the patient also underwent active physical rehabilitation treatment.

6 months after the end of the revitalizing course of therapy, when a follow-up examination was performed, the clinical manifestations of the disease were practically absent. Further observations during the year recorded a stable positive clinical result.

Documents cited in the search report

Publication DocumentDate Numberautomyname
RU2511650C12014.04. 10yakusheva Alfiya Nazhmetdinovna (EN)METHOD FOR CORRECTION OF DISORDERS OF OPTIMAL MUSCULOSKELETAL SYSTEM STATICS IN YOUNG AND MATURE INDIVIDUALS WITH LUMBAR REGION DORSOPATHY
RU2433844C12011.11. 20Beydik Oleg Viktorovich (RU)METHOD OF TREATMENT OF DEGENERATIVE-DYSTROPHIC DISEASES OF THE MUSCULOSKELETAL SYSTEM AND POST-TRAUMATIC PAIN SYNDROMES
RU2536289C12014.12. 20luchkin Vladislav Aleksandrovich (EN)METHOD OF TREATMENT OF DEGENERATIVE-DYSTROPHIC DISEASES OF THE MUSCULOSKELETAL SYSTEM

Documents with links to the patent
Publication DocumentDate Numberautomyname
RU2758988C12021.11. 08Agasarov Lev Georgievich (EN)Method of treatment of patients with lumbosacral dorsopathy by local stimulation "Anatomical path"
RU2722936C12020 \ .06. 05muntyan Anton Mikhailovich (EN)METHOD OF PHYSICAL REHABILITATION
RU2755579C12021.09.17Lesteva Natalia Aleksandrovna (RU)Method of treatment of arm spasticity in patients with chronic unconsciousness
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The technical result achieved by using the described method is a high efficiency of therapy, the possibility of outpatient treatment, the absence of scarring, the absence of postoperative complications, and a low probability of recurrence of a herniated disc.

The claimed technical result is achieved by implementing a method for treating morphological and anatomical pathologies of intervertebral discs, which is carried out in three stages.

At the first stage of treatment, at least one course of complex therapy is carried out aimed at maximizing the softening of the herniated disc(determined by ultrasound results), as well as at suppressing the inflammatory response and relieving pain.

Complex therapy at the first stage of treatment includes microwave heating of the musculoskeletal system in the affected area, medicinal iontophoresis with homeopathic preparations (Discus compositum, Traumel, Placenta compositum), electromyostimulation of the affected nerve with interference currents, and medicinal anti-inflammatory therapy.

Microwaves are electromagnetic radiation between radio waves and infrared, t. e. at a wavelength between 1 m and 1 cm at a frequency of 300 MHz to 30 GHz. In medicine, three microwave frequencies and lengths are used: 2450 MHz(12 .245 cm), 915 MHz(32 .79 cm), and 433 .9 MHz(69 .14 cm). 

In Europe, all three frequencies of microwave therapy are used, while in the United States, only the first two frequencies are used. 

The physiological effects of microwave therapy on a living organism are: increased metabolic activity of all cells, reduced viscosity in all fluids, increased extensibility of collagen, increased blood flow, and an effective effect on the nervous system.

The therapeutic effect of microwave radiation manifests itself as an analgesic (due to direct action on the pain gate, accelerated removal of irritating factors and due to increased blood flow, reduced muscle spasm, sedative effect), reduction or complete cessation of muscle spasm due to direct action on the fusiform muscle structures, acceleration of recovery due to increased metabolic activity, which has the following effects: influence on the post-traumatic process and on the course of the chronic infectious process, softening of collagen tissues, scar tissue and other fibroses, treatment of muscle tissue due to increased intramuscular blood flow.

Medicinal iontophoresis is based on a combination of the physiological action of galvanic current in combination with medicinal products. In general, this mechanism can be represented as follows: pain gates produce an effect on A-delta (fast) and C (slow) pain fibers in the posterior horns of the spinal cord as a result of stimulation of mechanoreceptors (A-beta) fibers by high-frequency low-intensity electric current and in combination with selected medications produce a morphine-like effect on the C-fibers of the system for the production of encephalin by inter-nerve stimulation of the A-delta fibers of pain receptors, as a result of which the ion balance around the cells changes, the healing of skin wounds and bones accelerates, the fibrous tissue is restored, cellular metabolism increases and the potential of cell membranes is restored, microcirculation increases.

Interference current therapy consists of passing two different medium-frequency pulses simultaneously through the same field. As a result, a new toxin is formed in the tissues. The amplitude of the new current consists of the amplitudes of two electric current flows. If the current amplitudes are of the same direction, the amplitude of the new current is maximal. If the current amplitudes are directed in different directions, no new current is generated.

The frequencies of both current streams are also summed up: if the frequency of one of the streams is 4000 Hz and the other is 4100 Hz, the frequency of the new current will be 4050 Hz. Medium-frequency currents are much easier to pass through the skin and experience less resistance when using short pulses of electricity. 
At a frequency of 4000 Hz, each individual phase lasts 0.125 milliseconds, which corresponds to a very high intensity of nerve stimulation. This produces a potentiated effect that is never achieved by low-frequency therapy and brain stimulation. 

This flow is much easier to pass through the tissues, since it is mid-frequency, and nerve stimulation is provided by amplitude modulation.

The analgesic effect of the interference current is provided by the activation of the gate of the analgesic mechanism due to the stimulation of a large diameter and low threshold excitability of nerve fibers with high-frequency currents-approximately 100 Hz, activation of A-delta and C-fibers, which produces encephalin and endorphin. 

Activation of their production occurs under the influence of a current frequency of 10 -25 Hz, the possibility of high-frequency current (more than 50 Hz) to form a block in the endings of myelin and non-myelin fibers, a local increase in fluid flow and tissue fluid output as a result of moderate muscle contractions and stimulation of the autonomic nervous system contribute to the release of chemicals from the nerve endings, blocking the conduct of pain impulses.

Local and / or general anti-inflammatory therapy consists of paravertebral blockage of the affected disc. As analgesics, mainly Lidocaine and / or homeopathic preparations are used – Discus compositum, Traumel, Placenta compositum. If necessary, in the case of an acute inflammatory process, therapy is enhanced by intramuscular administration of nonsteroidal anti-inflammatory drugs NSAIDs (Voltaren 75 mg) once a week. 

In exceptional cases, it is recommended to prescribe small doses of corticosteroids (Diprospan 5 mg) of 0 .25 -0 .5 mg as part of paravertebral blockades, provided that the total amount of the substance administered does not exceed 1 .5 mg (1/3 ampoule) per week.

In the treatment of the thoracic spine, the dose of medications is increased by 25-30% compared to the cervical therapy described above, and in the treatment of the lumbar spine, the dose is increased by another 10-15%.

The success of the first stage of treatment is determined by the results of repeated magnetic resonance imaging(MRI) images of the affected disc, which determine the dynamics of changes in the consistency of the disc herniation. In some cases, contrast enhancement of MRI images may be required.

At the second stage of treatment, at least one session of focused extracorporeal shock wave therapy is used, aimed directly at the area of the pathological focus – a herniated disc (protrusion). The number of sessions depends on the anatomical and physiological characteristics of the herniated disc (the size of the herniated sac, the length of the crack – gate of the herniated sac, the consistency of the internal contents, etc.).)

The method of focused extracorporeal shock wave therapy used at the second stage of treatment is based on a short-term (0.1-0.3 seconds) application of a high-energy focused low-frequency shock sound wave to the area of the disease, which radically improves local blood circulation, loosens calcium deposits and fibrous foci that cause inflammation and pain. One of the most important effects of the shock wave is the stimulation of the development of a new microvascular bed in the problem area of the brain.

The theoretical aspects of F\ - SWT are based on generating a shock wave with a high flux density that focuses on a limited target area. This should ensure that the shock waves develop their full energy exclusively in the area chosen for therapy, without causing damage to the surrounding tissues of the body. The hyperbaric effect of F-SWT is based on the ability of acoustic vibration to form micro-cavities in tissues as a result of the transition of liquid to gas and its exit to the outside.
 This component of F-SWT therapy is crucial in the treatment of protrusions and herniated discs. Stabilization of microcirculation around cavities: F-SWT performs micro-massage, which is very important in the treatment of edema.

 In the acute stage of the inflammatory process, shock waves help remove histamine from tissues and prevent the formation of other risk factors in cells, which is associated with increased diffusion of calcium ions through the cell membrane.

The result of this process is a decrease in the intensity of inflammation in the tissues of the body. In the granulation stage of the inflammatory process, the formation of fibroblasts is stimulated for the new vascular network, as well as the collagen system and the new capillary network. Thus, various effects produced on the tissue can lead, for example, to reversible deformation of cell membranes as a result of mechanical shock waves or stimulate the healing process due to the intensification of the metabolic process, as, for example, in cases observed in orthopedic practice in the treatment of inflammatory-degenerative changes in the intervertebral discs.

The parameters that determine the success of extracorporeal therapy are mainly energy and energy flow density. These parameters depend on the morphological and anatomical features of the disc herniation and are selected for each patient individually. The mechanical or acoustic energy of a shock wave is determined by the pressure amplitude and duration, the acoustic properties of the medium (density and acoustic velocity), and the spatial propagation of the shock wave. To achieve a noticeable effect in the tissues, the energy of the shock wave must be focused on a precisely limited target area, where it will exceed the threshold values and produce a therapeutic effect.

Shock waves are considered to be effective if the pressure reaches 50 Bar (5 MPa) or more. This zone corresponds to the so-called 5 MPa focus. In this case, only the positive component of the shock wave amplitude is taken into account, and the negative component(the stretching wave) is ignored. Extracorporeal shock wave therapy is performed at a threshold energy value selected from the range of 3-12 MPa. At the same time, the optimal course of focused extracorporeal shock wave therapy is considered to be selected in this way, when the hernia decreases by 0 \ .2-0\in one session.3 millimeters.

Studies have shown that to achieve such an effect in the treatment of the cervical spine, it is optimal to achieve the energy threshold value in the focus of a herniated disc of 3-5 MPa, for the thoracic spine, the threshold value increases to 6-8 MPa,and for the lumbosacral region to 10-12 MPa.

The energy flow density is set by the device settings during the session 

F-SWT, and the pulse frequency (from 2 to 8 Hz) is determined by the doctor depending on the dynamics of the effectiveness of the therapy.

If the patient begins to experience painful sensations even with a properly focused flow of shock waves, it is necessary to reduce their energy by 1 \ .0-1.4 MPa. You can also lower the pulse frequency by 1 \ -2 Hz. As practice shows, in most cases this is quite sufficient with a relatively small decrease in the effectiveness of therapy. To achieve the maximum effect of wave penetration into body tissues, it is advisable to use gel conductors, for example, a conductive gel for ultrasound therapy / diagnostics. In this case, the head of the F-SWT emitter is pressed tightly against the surface of the body, slowly moving along the surface so that the radiation focus always remains focused in the area of the affected disk. As mentioned above, the F\ - SWT course consists of a significant number of sessions. To reduce the size of a herniated disc by 1 mm, it takes from 3 to 6 procedures. 

Then we start the third stage:

The healing effect of laser radiation is based on biostimulation and acceleration of cellular processes, which leads to suppression of pain and faster recovery from injuries.

Initially, high-intensity laser devices were used in surgery. 

Now high-intensity lasers are also used for therapy in pain relief and recovery from injuries.

BTL has developed the first automated HIGH-INTENSITY LASER, reaching a power output of up to 30 W at a wavelength of 1064 nm.

The unique combination of these parameters allows you to work in the depth of the tissue, most effectively and in a short time relieving pain through the thermal effect.

PARAMETERS FOR A HIGH-INTENSITY LASER

Maximum power 7W continuous operation 12W continuous operation

Wavelength 810 / 980 nm / 1064 nm

Operating mode Constant, pulsed and single pulses

DEPENDENCE OF LASER THERAPY ON PARAMETERS SUCH AS THE SPECTRAL RANGE OF RADIATION AND ITS INTERACTION WITH BIOLOGICAL TISSUES — A SCIENTIFIC REVIEW

Marshall RP, Vlková K. / Marshal R. P., Vlkova K.
RasenBallsport Leipzig GmbH, Cottaweg 3, D-04177 Leipzig, Germany; Faculty of Biomedical Engineering,
Czech Technical University in Prague, Prague, The Czech Republic
Published: Insights Biomed 5 (1):1 /
Rasenbalschport Leipzig GmbH, Kottaveg 3, D-04177 Leipzig, Germany; Faculty of Biomedical
Engineering, Czech Technical University in Prague, Prague, Czech Republic
Published by: Insight Biomed Magazine 5 (1): 1

KEY POINTS

Laser radiation with a certain wavelength is widely used
in medicine for diagnostic and therapeutic purposes. There are 4 studies
that analyze the effect of wavelength on human tissue.
• In this case, various articles on the influence of the spectral
region of radiation on the reflection, refraction and absorption of light are considered.

The results show a decrease in the absorption
and refractive index in melanin at a longer wavelength, as well
as a decrease in the absorption of hemoglobin.

A longer wavelength increases the probability of interaction
with water particles and their absorption of radiation.

Conclusion: At a wavelength of more than 1000 nm, the reflection and absorption of melanin
are negligible, which allows more
laser energy to penetrate the skin's tissues.

Absorption by water particles increases with increasing wavelength.

The refractive index and absorption of hemoglobin are reduced.

It is absolutely necessary to perform control magnetic resonance imaging (MRI images) of the treated spine every 10-15 sessions to control the regression process. Completion of the second stage should also be accompanied by a final MRI examination.

The third stage of treatment is the final one and serves to consolidate the result obtained, as well as to restore the affected nerve through a complex that includes electromyostimulation, massage and physical exercises. Experience shows that the number of fixing procedures at the third stage is determined by the degree of previous nerve compression and can be 3 -15 sessions. At the third stage of treatment, B vitamins and / or intraneural injections of homeopathic medicines, for example, Neuralgo 1.0 and Goal 2.0, 1 ml 2 -3 times a week, can also be administered intramuscularly.

The table below compares traditional invasive methods of treating herniated discs (discectomy, disc replacement, endoscopic aspiration or thermocoagulation) with the patented method of focused extracorporeal shock wave therapy.

INVASIVE METHODS OF TREATMENT THE DOBROSENSKY METHOD

• Inpatient treatment (from 4 to 45 days) that requires the patient to be hospitalized for the duration of treatment.
• Outpatient treatment that allows the patient to maintain their usual lifestyle for the duration of treatment
• Cicatricial changes in the area of the operated tissues, leading in the long term to compression of the nerve plexuses
• No scarring
• Relatively high rate of relapse(up to 38%) of a herniated disc*
• Relatively low recurrence rate (less than 4 %) of a herniated disc*
• Relatively high rate of postoperative complications (up to 8 %), including complications after anesthesia*
• No postoperative complications
• The outcome of invasive intervention depends relatively little on compliance with the postoperative regimen
• The outcome of therapy is largely determined by compliance with the treatment regimen

*According to statistical data obtained by Spine

Thus, the advantage of the method of focused extracorporeal shock wave therapy in comparison with invasive intervention is its high efficiency, physiology and a small number of complications (including in the long-term period).

These conclusions were made based on the results of 5 years of experience in managing 7000 patients with various diseases of the intervertebral discs. Some of the patients underwent surgical intervention in various clinics. The other part underwent a course of focused extracorporeal shock wave therapy. According to a combination of factors – the effectiveness of treatment, the number of complications, the presence of indications and contraindications – the effectiveness of the DOBROSENSKY METHOD is 97 % compared to discectomy-42 %, and endoscopic intervention – 83%.

As an illustration of the above material, we can consider several cases of successful application of focused extracorporeal shock wave therapy (F-SWT) on the example of patients of the Spine Medical Center Patient K-a Olga Sergeevna, 30 years old, has been noticing low back pain for the past few months, which increases with walking and physical activity the\load. Pain radiates to the left leg. Increasing weakness in the left leg. Anamnesis of the disease: Considers herself ill for 3 years, when back and left leg pain first appeared. She was treated by a chiropractor with negative dynamics of development.

Spine: Palpation of the spinous processes shows marked pain in the lumbar spine L1-L5. Pain during palpation of the lumbar spine in the paravertebral region and along the left sciatic nerve. Palpation of the exit points of the sciatic nerve is painful on the left. When causing the phenomenon of the intervertebral foramen, pain radiates from the herniated point. Neri and Lasega tension syndromes are positive on the left. The"tripod" symptom. The condition of the back muscles is homolateral tension of the paravertebral muscles on the left, the range of motion of the spine is limited in the lower lumbar region.

On the MRI of the lumbosacral spine performed by OKB g.Khanty-Mansiysk, it is noted: intervertebral disc L5-S1 forms a left-sided central-paramedial hernia with foraminal spread, protruding towards the spinal canal up to 13 mm, extrusion. The funnel of the left spinal root is sharply narrowed at the level of the entrance. Diagnosis: herniated disc L5-S1 (13mm), neuropathy of the left sciatic nerve. Surgical intervention(laminectomy) is indicated.

Treatment was performed in accordance with the described method.

At the first stage, a course of physiotherapy was prescribed, consisting of 5 sessions of Robotic Laser Therapy HIL BTL 6000 of the lumbosacral spine, 5 sessions of High-intensity magnetic therapy SIS BTL 6000, 5 sessions of electromyostimulation of the lumbosacral nerve plexus with interference currents, 3 sessions of drug iontophoresis, and 3 paravertebral blockades with lidocaine and homeopathic medicines. drugs. 

After the first stage, according to the results of the control MRI, a change in the consistency (softening) of the above-described herniated disc L5-S1 was observed.

Next, a course of focused extracorporeal shock wave therapy was performed. The course included 20 sessions of. After the course of F-SWT, the symptoms of sciatic nerve compression completely disappeared, and there are no complaints. On repeated MRI performed in the same medical institution: Positive dynamics compared to the data of the previous study, a history of L5 – S1 disk protrusion within 2 mm (previously 13 mm), residual phenomena.

Epicrisis: the patient was discharged after successfully completing a course of focused extracorporeal shock wave therapy, her condition is completely healthy.

Another case is when the patient did not complete the initiated course of treatment, being satisfied with the achieved intermediate state. Nevertheless, it was possible to cancel the planned surgical intervention and return the patient to his usual lifestyle.

Patient K-y Alexander Viktorovich, 32 years old, has been experiencing cutting pains in the lower back over the past few days, which increase with walking and physical exertion. Forced position "petitioner's pose". Pain radiates to the left leg. Increasing weakness in both legs. Medical history: considers himself ill for several days after an unsuccessful fall into the pool from a tower. Not treated. Hospitalized for emergency reasons

Spine: palpation of the spinous processes shows marked pain in the lumbar spine L1-L5. Pain during palpation of the lumbar spine in the paravertebral region and along the left sciatic nerve. Palpation of the exit points of the sciatic nerve is painful on the left. When causing the phenomenon of the intervertebral foramen, pain radiates from the herniated point.

 Neri and Lasega tension syndromes are positive on the left. The"tripod" symptom. The condition of the back muscles is homolateral tension of the paravertebral muscles on the left, the range of motion of the spine is limited in the lower lumbar region.

On the MRI of the lumbosacral spine, performed in OKB g.Khanty-Mansiysk, it is noted: at the level of the L5-S1 segment, against the background of disc protrusion, there is a right-sided foraminal hernia up to 10 mm deep, compressing the right S1 nerve root. 

At the level of the L4-L5 segment, there is a median hernia up to 10 mm deep, with a slight laterization to the left, migrating caudally up to 14 mm, causing spinal canal stenosis up to 3 mm and deformity of the initial parts of the left L5 nerve root. In the L2 vertebra, the hemangioma is 9 mm. Diagnosis: herniated disc L4 - L5(14 mm), L5-S1 (10 mm), neuropathy of both sciatic nerves. Surgical intervention(laminectomy) is indicated, which the patient refused.

Treatment was performed in accordance with the described method.

At the first stage, a course of physical therapy was prescribed, consisting of 10 sessions of Robotic Laser Therapy HIL BTL 6000 of the lumbosacral spine,5 sessions of High-intensity magnetic therapy SIS BTL 6000 of the lumbosacral spine, 8 sessions of electromyostimulation of the lumbosacral nerve plexus with interference currents, 5 sessions of drug iontophoresis, and 5 sessions of therapeutic ionophoresis. paravertebral blockades with lidocaine and homeopathic medicines.

After the first stage, according to the results of control MRI, a change in the consistency (softening) of the above-described herniated discs L4-L5, L5-S1 was observed.

Next, a course of focused extracorporeal shock wave therapy was performed. The course included 25 sessions of. After the course of F-SWT herniated disc L4-L5, the symptoms of sciatic nerve compression were largely eliminated, and there were no complaints. On a repeated MRI performed at the G\Design Bureau.Khanty-Mansiysk : in comparison with the data of the previous study, there is a positive dynamics, at the level of L4-L5 – posterior disc protrusion on a wide base up to 4 mm(initially 14 mm) with compression of the anterior subarachnoid space.

 At the L5 – S1 level, a posterior right-sided disc herniation is visualized up to 5.7 mm (initially 10 mm). L2 hemangioma was completely eliminated.

Epicrisis: the patient was discharged at his insistence after completing an incomplete course of focused extracorporeal shock wave therapy, in satisfactory condition. The patient has returned to his usual way of life, and does not make any complaints.

Another example of a successfully completed course of focused extracorporeal shock wave therapy.

Patient C-a Alexander Alexandrovich, 46 years old, complaints at the time of examination: pulling pains in the lumbosacral spine, increasing with movement. A year ago, acute pain in the lumbosacral spine suddenly appeared, and the acute pain syndrome persisted for 5 days. As a result of anti-inflammatory therapy, the acute pain syndrome was removed. Over the past year, pulling pains in the lumbosacral spine, limited mobility, and forced restriction of sports activities have persisted.

Spine: palpation of the spinous processes shows marked pain in the lumbar spine L1-L5. Pain during palpation of the lumbar spine in the paravertebral region. Palpation of the exit points of the sciatic nerve is painful on both sides of the body.

 When causing the phenomenon of the intervertebral foramen, pain radiates from the herniated point. Neri and Lasega tension syndromes are positive on both sides of the body. The condition of the back muscles is homolateral tension of the paravertebral muscles on the left, the range of motion of the spine is limited in the lower lumbar region.

On the MRI of the lumbar spine, performed in OKB g.Khanty-Mansiysk: in the L5-S1 segment, a local protrusion of the disk along the posterior and right-hand paramedial contour with a depth of up to 7 mm is determined.

 The anterior contour of the dural sac is deformed, the lateral pockets are narrowed, more right, the entrance to the right m/n opening is narrowed, the root at the entrance is deformed. In the segment L4-L5, an uneven circular protrusion of the disc is determined, more pronounced along the posterolateral contours, on the right 5.5 mm, on the left up to 6 mm. In the L3-L4 segment, moderate protrusions of the disc along the posterolateral contours are determined. Diagnosis: spondyloarthrosis of the lumbar spine. Disc herniation of the spine L4 \ -L5 (6 mm), L5-S1(7 mm). Initial spinal stenosis.

Treatment was performed in accordance with the described method.

At the first stage, a course of physiotherapy was prescribed, consisting of 12 sessions of Robotic Laser Therapy HIL BTL 6000 of the lumbosacral spine, 6 sessions of High-intensity magnetic therapy SIS BTL 6000 of the lumbosacral spine, 4 sessions of electromyostimulation of the lumbosacral nerve plexus with interference currents, 5 sessions of drug iontophoresis, as well as 5 paravertebral blockades with lidocaine and homeopathic medicines. After the first stage, according to the results of control MRI, a change in the consistency(softening) of the above-described herniated discs L3 -L4, L4\ – L5, L5-S1\was observed.

Next, a course of focused extracorporeal shock wave therapy was performed. The course included 36 sessions of. After the course of F-SWT, the symptoms of lumbar plexus compression were completely eliminated, the patient does not complain. On the control MRI performed at the OKB g.Khanty-Mansiysk in the L5-S1 segment without pathology (previously a hernia of 7 mm), in the L4-L5 segment the disc prolapses in the subcutaneous space by 3 mm (previously 6 mm), in the L3-L4 segment without pathology.

Epicrisis: the patient was discharged after a successful course of focused extracorporeal shock wave therapy with significant improvement, and is practically healthy.

The following case of treatment of a patient started 2 days before laminectomy is also indicative: the patient was literally "removed" from the operating table.
Patient: T-n Vitaly Vyacheslavovich, complaints of cutting pains in the lumbosacral spine radiating to the right leg, which increase during movement. The situation is forced. Progressive weakness of both lower limbs. Surgical intervention (laminectomy) L3-L4, L4-L5 with subsequent plastic surgery of the lumbar spine\was prescribed.

Spine: on palpation of the spinous processes, there is a pronounced pain in the lumbar spine L1-L5. Pain during palpation of the lumbar spine in the paravertebral region and along the right sciatic nerve. Palpation of the exit points of the sciatic nerve is painful on the right. When causing the phenomenon of the intervertebral foramen, pain radiates from the herniated point. Neri and Lasega tension syndromes are positive on the right. The "tripod" symptom.

On the MRI of the lumbosacral spine, performed in OKB g.Khanty-Mansiysk : At the L3-L4 level, the posterior protrusion of the disc is determined on the right up to 4 mm, centrally up to 3 mm, on the left up to 4 mm, with the lateral channels overlapping by 2/3 of the disc elements. At the level of L4-L5, the posterior protrusion of the disc is determined on the right up to 4 mm, centrally up to 4 mm, on the left up to 4 mm, with COMPLETE overlap of the lateral channels by the elements of the disc. 

At the level of L5-S1, the posterior protrusion of the disc on the right is determined to be up to 5 mm, centrally up to 10 mm, with massive disembolization of the prolapsing part of the disc, with COMPLETE overlap of the lateral channels by disk elements, and signs of pronounced pressure on the structures of the spinal canal. Diagnosis: spinal stenosis. Herniated disc L3-L4, L4\ - L5, L5\ - S1. Neuropathy of both sciatic nerves. Laminectomy followed by laminoplasty L3-L4, L4-L5\is shown.
Treatment was performed in accordance with the described method.

At the first stage, a course of physiotherapy was prescribed, consisting of 8 sessions of Robotic Laser Therapy HIL BTL 6000 of the lumbosacral spine, 5 sessions of High-intensity magnetic therapy SIS BTL 6000 of the lumbosacral spine, 5 sessions of electromyostimulation of the lumbosacral nerve plexus with interference currents, 7 sessions of drug iontophoresis, and 7 sessions of medical ionophoresis. paravertebral blockades with lidocaine and homeopathic medicines. After the first stage, according to the results of control MRI, a change in the consistency(softening) of the above-described herniated discs L3 -L4, L4\ – L5, L5-S1\was observed.

Next, a course of focused extracorporeal shock wave therapy was performed. The course included 35 sessions of. After completing the course of F-SWT in the L3-L4, L4-L5 divisions, the patient felt significant relief.

On the control MRI performed by OKB g.Khanty-Mansiysk: segments L3-L4, L4\ - L5 without pathology (previously complete overlap of lateral channels by disk elements). In the L5-S1 segment, the intervertebral foramina narrowed by 2/3 (previously, the lateral channels were completely blocked by disk elements), and it was decided to postpone therapy for this segment for a year.

Epicrisis: after completing a course of focused extracorporeal shock wave therapy for two segments of the spine L3-L4, L4-L5, the patient was discharged with complete recovery at this level, the condition is satisfactory. The patient has returned to his usual way of life, and does not make any complaints. L5 - S1 segment therapy is recommended after 1 year.

Focused extracorporeal shock wave therapy shows its high effectiveness even in cases where it is a pathology with a very long history – 20 or more years.
Patient: S-I Natalia Leonidovna, 37 years old. Complaints: over the past few years, he has noticed lower back pain, which increases with walking and physical exertion. Pain radiates to the right leg. Increasing weakness in the right leg. Medical history: considers herself sick since the age of 17, after suffering a spinal injury during diving. Relapses have been particularly frequent over the past 10 years. She was treated by a chiropractor with negative dynamics of development.

Spine: palpation of the spinous processes shows marked pain in the lumbar spine L1-L5. Pain during palpation of the lumbar spine in the paravertebral region and along the right sciatic nerve. Palpation of the exit points of the sciatic nerve is painful on the right. When causing the phenomenon of the intervertebral foramen, pain radiates from the herniated point. 

Neri and Lasega tension syndromes are positive on the right. The"tripod" symptom. The condition of the back muscles is homolateral tension of the paravertebral muscles on the right, the range of motion of the spine is limited in the lower lumbar region.

On the MRI of the lumbar spine performed by OKB g.Khanty-Mansiysk : At the level of L5-S1, a right-sided paramedial disc herniation with dimensions of 7 mm, base 20 mm, with compression of the right lateral canal and deformation of the dural sac is noted. 

Diagnosis: herniated disc L5 \ -S1 (20 mm). Neuropathy of the right sciatic nerve.

Treatment was performed in accordance with the described method.

At the first stage, a course of physiotherapy was prescribed, consisting of 12 sessions of Robotic Laser Therapy HIL BTL 6000 of the lumbosacral spine, 5 sessions of High-intensity magnetic therapy SIS BTL 6000 of the lumbosacral spine, 5 sessions of electromyostimulation of the lumbosacral nerve plexus with interference currents, 5 sessions of drug iontophoresis, and 5 sessions of therapeutic ionophoresis. paravertebral blockades with lidocaine and homeopathic medicines. After the first stage, according to the results of the control MRI, a change in the consistency (softening) of the above-described herniated discs L5-S1 was observed.

Next, a course of focused extracorporeal shock wave therapy was performed. The course included 35 sessions of. At the final stage, 10 sessions of physical therapy were prescribed for the right sciatic nerve (electromyostimulation with drug iontophoresis)

After the course of treatment, the patient's condition improved significantly, there were no complaints. On the control MRI performed by OKB g.Khanty-Mansiysk : When compared with previous MRI studies, a positive trend is noted, at the level of L5-S1, a posterior disc herniation of 4.6 mm(previously 20 mm) is visualized.

Thus, the above examples show the high efficiency of the proposed method of non-invasive treatment of morphological and anatomical pathologies of intervertebral discs by focused extracorporeal shock wave therapy (F-SWT) and allows it to be used in cases where invasive intervention was previously indicated.
The article was submitted to the editorial office