Resource-saving peloidotherapy techniques in the rehabilitation of patients after microdiscectomy

BACKGROUND: Intervertebral disc herniations are a common neurosurgical problem. However, there is practically no information about the effectiveness of using non-thermal gentle methods of peloid therapy using peat mud in patients after spinal surgery for disc herniations, about the indications for their use depending on the existing clinical and functional characteristics.

AIM: to develop and scientifically substantiate the use of resource-saving non-thermal peloidotherapy techniques in the rehabilitation of patients after spinal surgery for herniated discs.

MATERIALS AND METHODS: 74 patients aged 20 to 65 years were examined 4–9 weeks after microdiscectomy. Patients underwent clinical and functional examination before and after the rehabilitation course, pain intensity was determined using a visual analog scale (VAS). Functional activity was assessed using the "Get up and go" test (3 and 6 meters). Infrared thermography of the back and lower extremities was performed. The study used the Oswestry questionnaire, as well as the HADS Anxiety and Depression Scale. By simple randomization, all patients were divided into 2 main groups (25 people each) and a control group (24 people). The control group received basic treatment ― therapeutic gymnastics and massage of the lower limb on the affected side. In the I main group, 10 procedures of thin-layer mud applications were additionally prescribed. In the II main group, 10 procedures of fluctuophoresis of peat mud solution were prescribed for basic treatment. The rehabilitation course lasted 14–15 days.

RESULTS: Repeated examination after the course of treatment showed a significant decrease in the VAS index in both main groups, more significant in group II, whereas in the control group the changes were not significant. In all the studied groups, there was a reduction in the execution time of the "Get up and Go" test, but it was most significant in both main groups. Positive shifts on the Oswestry scale were also observed in all groups, including the control group, but some advantage was determined in the main groups receiving peloid therapy. Analysis of repeated results of remote infrared thermography revealed a decrease in local hyperthermia in the area of surgical intervention in persons receiving non-thermal peloid therapy techniques, the most significant in the II main group. Indicators of anxiety on the HADS scale decreased by the end of rehabilitation in all the studied groups, and subclinical manifestations of depression ― only in the I and II main groups.

CONCLUSION: The inclusion of non-thermal resource-saving peloidotherapy techniques in the rehabilitation complex of patients after microdiscectomy makes it possible to more effectively relieve pain syndrome, eliminate microhemodynamic disorders and increase the motor activity of patients, which contributes to the normalization of their psychoemotional state and the quality of their life. These methods are not load-bearing, have a minimum number of contraindications to the appointment, does not require significant material costs and can be applied in various medical organizations.