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椎間板ヘルニアで使われるブロック注射の種類

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椎間板ヘルニアに対する治療にはさまざまな種類がありますが、その中の1つにブロック注射があります。ブロック注射にもいくつかの種類がありますので、その種類について紹介します。

腰の痛みが辛い方は、治療方法の選択肢の一つとしてブロック注射を検討する際に参考にしてみてください。

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ブロック注射とは?

注射

ブロック注射とは、ヘルニアによる神経圧迫の痛みを緩和させるための注射です。痛みは、発痛→交感神経の異常緊張→血管収縮→血液循環の悪化→痛み物質の増加→痛みの増大という悪循環が起こり、耐えがたい辛さを生みます。この痛みの悪循環を断ち切る、ブロックするのがブロック注射です。

よく、腰に刺す注射は痛いという話を聞きますが、ブロック注射はあらかじめ痛み止めを注射してから行いますので、ほとんど痛みを感じることなく注射することができます。

ブロック注射の種類と効果

ブロック注射にはいくつかの種類がありますので、代表的なものを紹介します。合わせて、効果も述べます。

①局所ブロック注射

トリガーブロックとも呼ばれており、抑えて痛いところのある筋肉や筋肉の膜に麻酔薬やビタミンを注射します。

押して痛い部分は、神経の周囲や筋肉などの軟部組織の炎症を起こしていたり、筋肉の緊張生が高かったりする部位です。この部分が痛みの症状の原因となっている場合に、有効な注射方法です。痛みの悪循環を起こしている場合などに効果的です。

②神経根ブロック注射

ルートブロックとも呼ばれており、主にどの神経根が悪いかを診断するためのものですが、治療として使われることもあります。

痛んで炎症を起こしている神経に直接針を刺しますので、炎症を抑える効果が高いです。

選択的ブロックとして使われる場合、局所麻酔により、施術後一時的に下肢の麻痺が出ますが、炎症を起こしている神経をブロックすることにより、一時的に痛みが止まります。これが、神経に針を刺した瞬間の痛みの部位が合っているかという再現性と、麻酔薬を注入したことにより症状の改善が得られるかという有効性を見ることで、どの場所の手術をすればいいのか決定できるのです。

③硬膜外ブロック注射

神経ブロック注射とも呼ばれています。脊髄を覆う硬膜という膜と、黄色靭帯の間に数mmの隙間があり、この部分を硬膜外腔と言います。この硬膜外腔に局所麻酔を注入し、神経による痛みの伝達をブロックする治療法が、硬膜外ブロック注射です。効果が早いと、2~3週間は痛みが治まり、その後何度か繰り返し注射することで、注射しなくても痛みがなくなる効果が期待できます。

飛び出した椎間板ヘルニアがなくなるわけではありませんので、根本の治療にはなりませんが、椎間板ヘルニア患者の約80%がこの治療で対処していると言われています。

この硬膜外ブロックには、2種類の方法があります。

1つは、腰部硬膜外ブロックです。これは、患者はエビのように丸くなって横になります。そして、背骨の真ん中から注射針を刺し、脊髄の近くで硬膜の外の部分に局所麻酔薬を入れる治療です。場合によっては、炎症を抑えるステロイド剤を使用することもあります。もし、注射針が硬膜を貫いてしまうと、その場所から髄駅が漏れ出したり、髄液にバイ菌が混じって髄膜炎を発症したりする危険性がありますので、しっかりした専門医のいる病院で処置してもらうことをおすすめします。

2つ目は、仙骨部硬膜外ブロックです。これは、腰部硬膜外ブロックと同じ部分に薬剤を入れますが、お尻の先にある仙骨の方から針を刺します。うつ伏せになってお尻の部分に枕を置き、お尻を突き出す格好になったら、お尻の割れ目の高い部分に注射針を刺して局所麻酔薬を注入します。腰部硬膜外ブロックと比べると、仙骨部硬膜外ブロックは、硬膜を貫くというリスクはありませんので、安心感のあるブロック注射と言えます。しかし、仙骨部硬膜外ブロックをした後に、局所麻酔約による急性薬物中毒を起こして頭痛などを発症するという副作用もあります。

ブロック注射をする際の注意点

ブロック注射をする際に注意点には、以下のようなことが挙げられます。

  • 当日の入浴は避け、シャワー程度で済ませる。
  • ブロック注射後、絶対に運動をしない。

また、ブロック注射が可能かを検査する必要もあります。心臓病や脳血管障害、アレルギー体質などの発症例がある人は、合併症を引き起こす可能性がありますので、ブロック注射が受けられません。

まとめ:椎間板ヘルニアの治療の選択肢として、ブロック注射を取り入れよう

きちんと受診して、自分の症状に合ったブロック注射を取り入れ、痛みを和らげるようにしましょう。

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