An Exploration Of Clinic Effect And Mechanism Of Managing Spinal Exogenous Lumbago With Neurolysis Of Posteiror Branch Of Lumbar Nerves

ObjectiveTo summarize clinical experience and clinical curativeeffect of treatment of lumbar facet joints cause low back pain，with closing needle debonding the medial posterior branch of lumbarnerves.And explore clinical mechanisms of managing SEL withneurolysis of posterior branch of lumbar nerves,to provide thetheoretical basis for clinical practice.MethodsFrom Oct2011to Mar2013, according to the diagnosticcriteria of cases, included standards and exclusion criteria,100patients with lumbar facet joints cause low back pain were selected.And these patients were divided into treatment group and comparisongroup according to the type of treatment. Treatment group,52casesin control group48cases.Treatment group with lumbar punctureneedle debonding the medial posterior branch of lumbar nerves,underthe C-arm X-ray machine fluoroscopy and location.Control groupusing drugs that invigorate the circulation, strengthenbone,anti-inflammatory and relieve pains,and combined withtraditional Chinese medicine(TCM) internal treatment, externalapplication and fumigation of Chinese medicine and functionalexercise of lower-back muscles.2weeks for a course of treatment.According to system of VAS scores and the Japanese backpain assessment of new standard JOA score,Observe the clinicaleffect of cases by different treatment with comparing and analyzingscores of two groups before and after treatment and recoveryrate(RR).Through reviewing the knowledge of anatomy and mapping,Italso makes a sound exposition of critical theory,skills andindications of neurolysis of medial posterior branch of lumbarnerves.ResultThere had no significant statistical difference with twogroups before treatment.But through the treatment,two groups hadremarkable clinical effect and the treatment group lower than theother:treatment group,excellent in27cases,good in16cases,5cases could be poor in4cases,efficiency92.3%;control group,excellent in19cases,good in17cases,3cases could be poor in9cases,efficiency85.1%.There had higher total effective rate forthe treatment group,while no significant statistical differencebetween the two groups(P>0.05).ConclusionIt had well Curative efficacy of the method in neurolysis ofmedial posterior branch of lumbar nerves treating lumbar facetjoints cause low back pain,with less trauma, easy and simple tohandle,low cost,short time,accurate positioning,less side-effectand worth clinical promotion.The anatomical studies show: medialposterior branch of lumbar nerves is fixed in tunnel consisted ofbone and fabric,dominating the tissue structure within theattachment of zygapophyseal joint,and lateral posterior branch ina comparatively position out of foramen intervertebrale,dominating the tissue structure without the attachment of zygapophysealjoint.The neurolysis of posterior branch of lumbar nervesincluds two aspects:nerve destroy and self regenerative repair,notanatomically neurolysis.Due to the characteristics of overlappingneural distribution,it has no feeling and functional impact.It hadclinical efficacy of lumbar zygapophysial jointsosteoarthrosis.Through anatomical studies and literaturereview,The writer considered it that neurolysis of medial posteriorbranch of lumbar nerves was suitable for transverse processsyndrome of third lumbar vertebra,AS and PKP analgesia.A fewpatients with lower back pain symptoms improved after treatment,itcan reflex on the phenomenon of homological nerves.