Study On The Efficacy Of Radial Extracorporeal Shock Wave Therapy In The Treatment Of Lumbar Disc Herniation

Objective:Lumbar disc herniation,a common clinical disease,seriously affects the quality of life for patients,but is still in lack of satisfactory treatment.Extracorporeal shock wave therapy has been widely used in a variety of musculoskeletal diseases.Previous studies on the treatment of lumbar disc herniation with extracorporeal shock wave therapy have mostly used various scales to assess the clinical efficacy,which is easily influenced by subjective factors.The aim of this study was to evaluate the clinical efficacy of radial extracorporeal shock wave therapy for lumbar disc herniation more objectively by using ultrasonic strain elastography.Methods:A total of 52 patients with lumbar disc herniation treated in the Department of Rehabilitation Medicine of the First Hospital of China Medical University from April2021 to November 2022 were enrolled.They were randomly divided into a shock wave group and a control group.The patients in the control group were treated by conventional physiotherapy and a topical drug for 14 days.Patients in the shock wave group were additionally given radial extracorporeal shock wave therapy on both sides of the painful spinous processes and bilateral paraspinal muscles besides the same treatment of the control group.The therapeutic dose of radial extracorporeal shock wave is as follows:R15 transmitter,1.5-2.5bar(0.18-0.30m J/mm~2),10Hz,moving at a constant speed of1-2cm/s,2000 pulses each time(1500 pulses on the side with more severe pain and 500pulses on the side with less pain),twice a week,4 times in total.Before treatment and after 14 days of treatment,Visual Analogue Score(VAS),Japanese Orthopaedic Association Score(JOA Score),Oswestry Disability Index(ODI)and ultrasonic strain elastography were used to evaluate the clinical efficacy of the two groups.Results:1.Compared with the values before treatment:After 14 days of treatment,the VAS and ODI decreased(P<0.001)and the JOA score improved(P<0.001)in both groups.The stiffness of multifidus on the more severe side as measured by ultrasonic strain elastography decreased compared with that before treatment in both groups(P<0.005).The ratio of the stiffness of multifidus on both sides of the spine decreased(closer to 1)in the shock wave group after treatment(P=0.001),while the difference of this ratio in the control group before and after treatment was not statistically significant(P>0.05).2.Comparison between the two groups:After 14 days of treatment,patients in the shock wave group had better improvement in VAS,JOA score,and ODI than those in the control group(P<0.001).The stiffness of multifidus on the more severe side in the shock wave group was lower than that in the control group after treatment as measured by ultrasonic strain elastography(P<0.05),and the ratio of the stiffness of multifidus on both sides of the spine in the shock wave group was lower than that in the control group(closer to 1)after treatment(P<0.05).3.The stiffness of multifidus on the more severe side correlated with VAS,JOA score,and ODI before treatment(P<0.05).Conclusion:The addition of radial extracorporeal shock wave therapy to conventional physiotherapy can further reduce pain,relieve muscle tension of the paraspinal muscles and reduce functional impairment in patients with lumbar disc herniation,which is a safe and effective treatment.