MR – ITALIAN JOURNAL OF REHABILITATION MEDICINE VOL. 27 – N. 2
41° CONGRESSO NAZIONALE SIMFER
UNIVERSITÀ CATTOLICA DEL SACRO CUORE (ROMA)
13-16 Ottobre 2013
369
TREATMENT OF ACUTE LUMBALGIA ASSOCIATED WITH CHRONIC NEURALGIA OF THE SCIATIC NERVE
RAOUL SAGGINI – LAURA DI PANCRAZIO – ALEXANDRA DI STEFANO – FLORENZO
CAPOGROSSO – MARCO SUPPLIZI – GIOVANNI BARASSI – ROSA GRAZIA BELLOMO – TEA
MAGHRADZE – STEFANIA D’ETTOLE
UNIVERSITÀ DEGLI STUDI “G. D’ANNUNZIO”, CHIETI, ITALIA
Introduction. Low back pain is a syndrome characterized by pain localized to the lumbar spine,
in the area between the lower edge of the last ribs and the gluteal region. There is 20% of causes
specific, vertebral or visceral: congenital and acquired anomalies of the spine, acute inflammations e
degenerative, trauma, vertebral fractures, discopathy, tumors, connective tissue diseases, pregnancy; and 80% of
non-specific causes: sedentary lifestyle, poor fitness, overweight, stress, depression, loss of
self-esteem, static, repetitive, unsatisfactory work, excessive physical training in sports. It often coexists
with a hernial formation, evident in the lumbar Rnm, protruding in the posterolateral area of the disc,
point of least resistance to the expulsive force of the nucleus as the posterior longitudinal ligament
thinning in a medio-lateral direction, it offers a valid reinforcement in the median area from which a minor one derives
frequency of median hernia compared to posterolateral. Sciatic neuralgia is characterized by
persistent neuropathic pain in the lower limb along the innervation area.
Materials and methods. In our study we enrolled 30 subjects between the ages of 30 and 65
years, suffering from acute low back pain with MRI finding of “herniated disc L5-S1”. All subjects presented
myofascial syndrome of the multifidus muscle and chronic sciatic neuralgia in the emergence of the crest
pelvic and along the course of the sciatic nerve to the leg. Subjects were treated for a period of 4
weeks using: Triple Therapy system for myofascial multifidus syndrome with a frequency of 3
times a week, So.Co.Short system for sciatic neuropathy with a frequency of 2 times a week
and with SPAD with a personalized program for each subject for postural re-education and rebalancing
body 3 times a week. Patients were assessed using the VAS pain scale, oswestry
disability index (ODI), earth-hands index for anterior trunk flexion, optoelectronic examination of the
3D posture with baropodometric examination before treatment (T0), after 2 weeks (T1), at the end of
treatment (T2) and through follow-up 30 days after the last treatment session (FW). The Triple
Therapy uses a diode laser scanning for therapeutic use. It consists of 2 laser sources
characterized by a wavelength of 808nm and 1064nm and a maximum power of 10W and 15W. These
two wavelengths are able to transfer the greatest percentage of energy into the tissue
subcutaneous. The program used provided for the supply of 8W for the 808nm diode (21J) and 12W for
the 1064nm diode (31J) in continuous mode, for a total of 52J for each session lasting 15
minutes. The So.Co.Short is instead a short-impulse controlled neurostimulation system that acts on
neuropathy; the “Acute Lumbago” program lasting 20 minutes was used. The SPAD is a
dynamic antigravitational postural system that allows to stimulate proprioceptors and mirror neurons
through visual feedback and a pneumatic body relief system with a lifting system
of the passenger on the pelvis, in the presence of a treadmill and a system of proprioceptive postural stimuli; all
as for the purpose of obtaining a complete re-education of the body dynamics and therefore of the posture.
Results. The results obtained showed at T0 an average pain value on the VAS scale
equal to 9, an oswestry disability index equal to 82%, T-M index of 54cm, a lumbar lordosis value equal to
23 °, dorsal kyphosis equal to 30 °, lateral-lateral misalignment equal to 15.7mm, a prevalence of
breech preceded in 78% of subjects. At T1, the pain decreased to a VAS scale of 4, yes
an ODI of 54% is recorded, a reduction in the T-M index of 42cm, a lumbar lordosis value of
28 °, dorsal kyphosis unchanged equal to 32 °, reduction of the lateral-lateral misalignment equal to 4.3mm (T1
11.4mm) a prevalence of the breech load in front of 58% of the subjects. At the end of the protocol a
T2 there was a significant reduction in pain assessed with the VAS scale, with an average value equal to
1, an ODI of 24%, a T-M index of 30cm, a lumbar lordosis of 38 ° and a dorsal kyphosis of 35 °, with a
MR – ITALIAN JOURNAL OF REHABILITATION MEDICINE VOL. 27 – No. 2
rear-placed breech load present in 70% of the subjects evaluated; the lateral-lateral misalignment is
further reduced by 2.2mm (FW 5.0mm).
Conclusions. From the results obtained we can affirm that a therapeutic approach integrated with
Triple Therapy, So.Co.Short and SPAD is effective in the treatment of acute low back pain syndrome
myofascial multifidus in chronic sciatic neuralgia with evidence of a herniated disc L5-S1. The evaluations carried out underlined the improvement of clinical symptoms, as well as of the parameters
associated with it and their maintenance over time, as a guarantee of effective treatment preventive of relapses.
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