Clinical effectiveness of complex differentiated rehabilitation of patients with vertebral thoracic pain due to degenerative-dystrophic pathology of the thoracic spine
DOI:
https://doi.org/10.14739/mmt.2024.4.315120Keywords:
degenerative-dystrophic pathology of the spine, thoracalgia, kinesiotherapy, rehabilitation, functional block, vertebral-motor segments, manual therapyAbstract
The aim of the study. To determine the effectiveness of complex differentiated rehabilitation in patients with degenerative-dystrophic pathology of the thoracic spine (DDPS) and thoracic back pain syndrome depending on the indicators of vertebrodynamics.
Materials and methods. Rehabilitation measures were carried out in 124 patients with DDPS complicated by thoracalgia syndrome at the post-acute stage of rehabilitation. The age of the patients was from 18 to 54 years. There were 51 (41.2 %) women, 73 (58.8 %) men. The duration of the disease was from 2 to 23 years. A rehabilitation examination was carried out with an assessment of vertebrodynamic disorders indicators according to the A. Stoddard method. All patients had functional block of the 2nd degree in the vertebral-motor segments of the thoracic spine. Patients were divided into 2 groups, comparable in age and disease severity. The first group (n = 56) received a basic complex of rehabilitation: massage, personalized sets of therapeutic exercises, physical methods of treatment (magnetotherapy, ultrasound therapy) against the background of drug treatment (nonsteroidal anti-inflammatory drugs, muscle relaxants, analgesics). Patients of the second group (n = 68) were prescribed, in addition, sessions of post-isometric and post-reciprocal muscle relaxation, mobilization techniques according to K. Lewit, R. Maigne, V. Gubenko, as well as the original methods of kinesiotherapy developed by us depending on the indicators of vertebrodynamics. The outpatient rehabilitation cycle lasted 14 days.
Results. The developed comprehensive scheme of of patients examination based on neurological, manual, instrumental studies, assessment of pain syndrome, insomnia and affective disorders allows early diagnosis of the disease, as well as dynamic monitoring during treatment. The developed and tested complex kinesiotherapeutic treatment method with the use of manual therapy leads to a faster regression of neurological symptoms, restoration of the lost range of motion in the thoracic spine, reduction of pain and the risk of DDPS exacerbation, shortening the time of treatment and rehabilitation of patients, and improving their quality of life.
Conclusions. The comprehensive differentiated rehabilitation with the use of manual therapy developed and researched in the work has confirmed its effectiveness, which allows recommending its use in clinical and rehabilitation practice, and provides significant economic effect in the treatment of this contingent of patients.
References
Koziolkin OA, Miedviedkova SO, Liakhova ІМ, Malakhovа SM, Lisova OO, Cherepok ОO. Complex treatment of patients with vertebral thoracalgia using manual therapy and physical rehabilitation. Zaporozhye medical journal. 2019;21(5):595-601. doi: https://doi.org/10.14739/2310-1210.2019.5.179421
Manchikanti L, Knezevic NN, Navani A, Christo PJ, Limerick G, Calodney AK, et al. Epidural Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Comprehensive Evidence-Based Guidelines. Pain Physician. 2021;24(S1):S27-S208.
Shiba H, Kenzaka T. Straight Back Syndrome Presented with Chest and Back Pain: A Case Report. Int Med Case Rep J. 2022;15:611-4. doi: https://doi.org/10.2147/IMCRJ.S385312
Hiraishi D, Iio K, Hataya H. Chest pain in straight back syndrome. Pediatr Int. 2024;66(1):e15730. doi: https://doi.org/10.1111/ped.15730
Oliveira CB, Maher CG, Ferreira ML, Hancock MJ, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4(4):CD013577. doi: https://doi.org/10.1002/14651858
Tan H, Elkholy MA, Raslan AM. Combined cervical and thoracic spinal cord stimulation for chronic pain: A systematic literature review. Pain Pract. 2023;23(8):933-41. doi: https://doi.org/10.1111/papr.13264
Zimmerman J, Allen C. Acute Thoracic Myelopathy. J Orthop Sports Phys Ther. 2020;50(12):723. doi: https://doi.org/10.2519/jospt.2020.9262
Maisch B, Dörr R. Leitlinien 2021 – im Rückblick der Blick voraus? [Guidelines 2021-is retrospective also a perspective?]. Herz. 2022;47(1):1-3. German. doi: https://doi.org/10.1007/s00059-021-05092-5
Rigoard P, Ounajim A, Goudman L, Bouche B, Roulaud M, Page P, et al. The Added Value of Subcutaneous Peripheral Nerve Field Stimulation Combined with SCS, as Salvage Therapy, for Refractory Low Back Pain Component in Persistent Spinal Pain Syndrome Implanted Patients: A Randomized Controlled Study (CUMPNS Study) Based on 3D-Mapping Composite Pain Assessment. J Clin Med. 2021;10(21):5094. doi: https://doi.org/10.3390/jcm10215094
Talutis SD, Ulloa JG, Gelabert HA. Adolescent athletes can get back in the game after surgery for thoracic outlet syndrome. J Vasc Surg. 2023;77(2):599-605. doi: https://doi.org/10.1016/j.jvs.2022.10.002
Billot M, Naiditch N, Brandet C, Lorgeoux B, Baron S, Ounajim A, et al. Comparison of conventional, burst and high-frequency spinal cord stimulation on pain relief in refractory failed back surgery syndrome patients: study protocol for a prospective randomized double-blinded cross-over trial (MULTIWAVE study). Trials. 2020;21(1):696. doi: https://doi.org/10.1186/s13063-020-04587-6
Guffey R, Abuirqeba AA, Wolfson M, Fingerman ME, Liu Q, Ohman JW, et al. Erector Spinae Plane Block versus Continuous Perineural Local Anesthetic Infusion for Postoperative Pain Control After Supraclavicular Decompression for Neurogenic Thoracic Outlet Syndrome: A Matched Case-Control Comparison. Ann Vasc Surg. 2021;77:236-42. doi: https://doi.org/10.1016/j.avsg.2021.05.067
Kozyolkіn O, Medvеdkova S, Lisova O. [Manual therapy of vertebral thoracic neurological syndromes]. International neurological journal. 2021;0(5):33-40. Ukrainian. doi: https://doi.org/10.22141/2224-0713.5.107.2019.176704
Fortner MO, Woodham TJ, Haas JW, Oakley PA, Harrison DE. Failed back surgery syndrome successfully ameliorated with Chiropractic Biophysics® structural rehabilitation improving pain, disability as well as sagittal and coronal balance: a Chiropractic Biophysics® case report with a 6 year follow-up. J Phys Ther Sci. 2024;36(1):44-50. doi: https://doi.org/10.1589/jpts.36.44
Erdem HR, Koçak FA, Kurt EE, Tuncay F. Superior cluneal nerve entrapment neuropathy due to lower crossed syndrome: A case with low back pain. Agri. 2022;34(4):311-5. English. doi: https://doi.org/10.14744/agri.2020.21703
Rigoard P, Ounajim A, Goudman L, Louis PY, Slaoui Y, Roulaud M, et al. A Novel Multi-Dimensional Clinical Response Index Dedicated to Improving Global Assessment of Pain in Patients with Persistent Spinal Pain Syndrome after Spinal Surgery, Based on a Real-Life Prospective Multicentric Study (PREDIBACK) and Machine Learning Techniques. J Clin Med. 2021;10(21):4910. doi: https://doi.org/10.3390/jcm10214910
Ziegler AL, Shannon Z, Long CR, Vining RD, Walter JA, Coulter ID, et al. Chiropractic Services and Diagnoses for Low Back Pain in 3 U.S. Department of Defense Military Treatment Facilities: A Secondary Analysis of a Pragmatic Clinical Trial. J Manipulative Physiol Ther. 2021;44(9):690-8. doi: https://doi.org/10.1016/j.jmpt.2022.03.009
Hegarty AK, Hsu M, Roy JS, Kardouni JR, Kutch JJ, Michener LA. Evidence for increased neuromuscular drive following spinal manipulation in individuals with subacromial pain syndrome. Clin Biomech (Bristol, Avon). 2021;90:105485. doi: https://doi.org/10.1016/j.clinbiomech.2021.105485
Chapman KB, Groenen PS, Patel KV, Vissers KC, van Helmond N. T12 Dorsal Root Ganglion Stimulation to Treat Chronic Low Back Pain: A Case Series. Neuromodulation. 2020;23(2):203-12. doi: https://doi.org/10.1111/ner.13047
Santillan A, Goldberg JL, Carnevale JA, Kirnaz S, Hartl R, Knopman J. Anterior spinal artery syndrome caused by thoracic disc herniation. J Clin Neurosci. 2020;77:211-2. doi: https://doi.org/10.1016/j.jocn.2020.05.040
Ounajim A, Billot M, Louis PY, Slaoui Y, Frasca D, Goudman L, et al. Finite Mixture Models Based on Pain Intensity, Functional Disability and Psychological Distress Composite Assessment Allow Identification of Two Distinct Classes of Persistent Spinal Pain Syndrome after Surgery Patients Related to Their Quality of Life. J Clin Med. 2021;10(20):4676. doi: https://doi.org/10.3390/jcm10204676
Makizono T, Uchikado H, Ando T, Kikuchi J, Hattori G, Morioka M. A case of mid-thoracic osteoporotic vertebral fracture with the inability to belch syndrome. Surg Neurol Int. 2022;13:458. doi: https://doi.org/10.25259/SNI_839_2022
Rigoard P, Ounajim A, Goudman L, Banor T, Héroux F, Roulaud M, et al. The Challenge of Converting "Failed Spinal Cord Stimulation Syndrome" Back to Clinical Success, Using SCS Reprogramming as Salvage Therapy, through Neurostimulation Adapters Combined with 3D-Computerized Pain Mapping Assessment: A Real Life Retrospective Study. J Clin Med. 2022;11(1):272. doi: https://doi.org/10.3390/jcm11010272
Volk AM, Mathkour M, Iwanaga J, Dumont AS, Tubbs RS. A Comprehensive Review of Congenital Lumbar Synostosis and Associated Findings. Cureus. 2021;13(10):e19013. doi: https://doi.org/10.7759/cureus.19013
Locher H. Manuelle Medizin, manuelle Therapie : Grundlagen, Wirkmechanismen, Indikationen und Evidenz [Manual medicine, manual treatment : Principles, mode of action, indications and evidence]. Unfallchirurg. 2021;124(6):433-45. German. doi: https://doi.org/10.1007/s00113-021-01004-8
