Osteochondrosis: a case of successful treatment using paravertebral blocks
Introduction
A 35-year-old woman presented to the clinic with lower back pain and numbness in her left leg.
Complaints
The pulling pain in the lower back radiated to the left leg, worsened with walking, bending, and changing positions from horizontal to vertical. The painful syndrome was accompanied by spasms of the lumbar muscle group.
The patient described the pain as “persistent and unrelenting.”
Before visiting the clinic, the woman independently used warming ointments and took Nise tablets twice a day for 5 days. The pain decreased only for a few hours and did not completely disappear.
Pain also decreased after sleep or when the patient lay down for several hours. Then the pain resumed, especially in a sitting position.
Medical history
The first episode of pain occurred about three years ago: the patient felt persistent spasms in the left leg with dull pain in the left lower back. The pain worsened in the autumn-spring period and after physical exertion.
Close relatives reported similar symptoms.
Examination
Palpation revealed pronounced tenderness in the center of the lumbar-sacral spine and to the left of the spinal column. Increased tone of the lumbar muscles on the left and decreased sensitivity of the LV and S1 vertebrae on the affected side were also noted.
When lifting the straightened leg to 45° from a lying position, painful sensations appeared (positive Lasegue’s sign).
MRI showed a 6 mm disc herniation at LIV-LV.
According to the results of the complete blood count:
- red blood cells — 4.1×109/L;
- hemoglobin — 100 g/L (below normal);
- leukocytes — 4.5×109/L.
Diagnosis
- Osteochondrosis. Disc herniation LIV-LV 6 mm. Pronounced muscular-tonic and pain syndromes.
Treatment
The patient was prescribed: - Milgamma — 2 ml for 10 days;
- Midocalm — 50 mg twice a day for 10 days;
- paravertebral lumbar blocks with Novocain + Dexamethasone — 8 mg every other day.
Several days after the first block, the woman noted a significant reduction in pain and muscle spasms in her lower back and left leg.
Based on the progress achieved, the patient was prescribed 7 blocks.
At the follow-up examination 10 days after the first block, the woman noted an improvement in overall well-being. Fatigue and general weakness disappeared.
After completing the course of blocks, pain and muscular-tonic syndromes decreased by 80%.
Conclusion
This clinical case demonstrates the effectiveness and simplicity of using therapeutic paravertebral blocks in patients with herniated discs, persistent pain, and muscular-tonic syndromes. Minimal drug therapy led to a quick and complete effect.