Методы интервенционного лечения болевого синдрома при дегенеративно-дистрофических изменениях позвоночника

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Боль в спине, обусловленная дегенеративно-дистрофическими изменениями позвоночника, является одной из самых частых причин обращения к врачу. Для лечения болевого синдрома обычно предлагается стандартное медикаментозное и физиотерапевтическое лечение. Иногда этого бывает недостаточно, и дополнительно могут применяться интервенционные методики. Основным принципом интервенционной терапии является введение лекарственных препаратов непосредственно в пораженную структуру позвоночно-двигательного сегмента. В статье рассмотрены основные интервенционные техники, показания для их применения и отличия друг от друга.

Об авторах

Артем Олегович Гуща

ФГБНУ «Научный центр неврологии»

Email: salyagina@list.ru
Россия, Москва

Елизавета Вадимовна Герасимова

ФГБНУ «Научный центр неврологии»

Автор, ответственный за переписку.
Email: salyagina@list.ru
Россия, Москва

Андрей Вячеславович Вершинин

ФГБНУ «Научный центр неврологии»

Email: salyagina@list.ru
Россия, Москва

Список литературы

  1. Hartvigsen J., Hancock M.J., Kongsted A. et al. What low back pain is and why we need to pay attention. Lancet 2018; 9; 391: 2356–2367. doi: 10.1016/S0140-6736(18)30480-X. PMID: 29573870.
  2. Bressler H.B., Keyes W.J., Rochon P.A. et al. The prevalence of low back pain in the elderly: a systematic review of the literature. Spine 1999; 24: 1813–1819. doi: 10.1097/00007632-199909010-00011. PMID: 10488512.
  3. Vos T., Abajobir A.A., Abate K.H. et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 16; 390: 1211–1259. doi: 10.1016/S0140-6736(17)32154-2. PMID: 28919117.
  4. Qaseem A., Wilt T.J., McLean R.M. et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017; 166: 514–530. doi: 10.7326/M16-2367. PMID: 28192789.
  5. Staal J.B., de Bie R.A., de Vet H.C. Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine (Phila Pa 1976) 2009; 34: 49–59. doi: 10.1097/BRS.0b013e3181909558. PMID: 19127161.
  6. Allegri M., Montella S., Salici F. et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Res 2016; 5::1530. doi: 10.12688/f1000research.8105.2. PMID: 27408698.
  7. Solomonow M., Baratta R.V., Zhou B.H., Burger E. et al. Muscular dysfynction elicted by creep of lumbar viscoelastic tissue. J Electromyogr Kinesiol 2003; 13: 381–396. doi: 10.1016/S1050-6411(03)00045-2. PMID: 12832168.
  8. Falla D., Cescon C., Lindstroem R., Barbero M. Muscle pain induces a shift of the spatial distribution of upper trapezius muscle activity during a repetitive task: a mechanism for perpetuation of pain with repetitive activity? Clin J Pain 2017; 33: 1006–1013. doi: 10.1097/AJP.0000000000000513. PMID: 28591080.
  9. Вейн А.М., Воробьева О.В. Болезненный мышечный спазм, спастичность. Алгоритм диагностики и терапии. Русский медицинский журнал 2003; 11: 438–442.
  10. Hirayama J., Yamagata M., Ogata S. et al. Relationship between low-back pain, muscle spasm and pressure pain thresholds in patients with lumbar disc herniation. Eur Spine J 2006; 15: 41–47. doi: 10.1007/s00586-004-0813-2. PMID: 15931510.
  11. Koes B.W., van Tulder M., Lin Chung-Wei Christine et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19: 2075–2094. doi: 10.1007/s00586-010-1502-y. PMID: 20602122.
  12. Wissel J. Treatment of spasticity-related pain syndromes. Pain Headache 2003; 14: 126–139. doi: 10.1159/000069633.
  13. Mense S. Muscle pain: mechanisms and clinical significance. Dtsch Arztebl Int 2008; 105: 214–219. doi: 10.3238/artzebl.2008.0214. PMID: 19629211.
  14. Lisiński P., Huber J. Evolution of muscles dysfunction from myofascial pain syndrome through cervical disc-root conflict to degenerative spine disease. Spine (Phila Pa 1976) 2017; 42: 151–159. doi: 10.1097/BRS.0000000000001691. PMID: 27196021.
  15. Chen С.K., Nizar A.J. Myofascial pain syndrome in chronic back pain patients. Korean J Pain 2011; 24: 100–104. doi: 10.3344/kjp.2011.24.2.100. PMID: 21716607.
  16. Lucas N., Macaskill P., Irwig L. et al. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain 2009; 25: 80–9. doi: 10.1097/AJP.0b013e31817e13b6. PMID: 19158550.
  17. Maigne J.Y., Cornelis P., Chatellier G. Lower back pain and neck pain: is it possible to identify the painful side by palpation only? Ann Phys Rehabil Med 2012; 55: 103–111. doi: 10.1016/j.rehab.2012.01.001. PMID: 22341057.
  18. Malanga G.A., Cruz Colon E.J. Myofascial low back pain: a review. Phys Med Rehabil Clin N Am 2010; 21: 711–724. doi: 10.1016/j.pmr.2010.07.003. PMID: 20977957.
  19. Вершинин А.В. Применение противоболевых блокад и эпидуральных инъекций. В кн.: Хирургия дегенеративных поражений позвоночника. Национальное руководство / под ред. А.О. Гущи, Н.А. Коновалова, А.А. Гриня. М., 2019: 208–220.
  20. Fricton J. Myofascial pain: mechanisms to management. Oral Maxillofac Surg Clin North Am 2016; 28: 289–311. doi: 10.1016/j.coms.2016.03.010. PMID: 27475508.
  21. Cheng J., Abdi S. Complications of joint, tendon, and muscle injections. Tech Reg Anesth Pain Manag 2007; 11: 141–147. doi: 10.1053/j.trap.2007.05.006. PMID: 18591992.
  22. Nelemans P.J., de Bie R.A., de Vet H.C. et al. Injection therapy for subacute and chronic benign low back pain. Cochrane Database Syst Rev 2000; (2): CD001824. doi: 10.1002/14651858.CD001824. PMID: 10796449.
  23. Девликамова Ф.И. Результаты пострегистрационного исследования «ПАРУС» по оценке эффективности и безопасности препарата Мидокалм-Рихтер в локальной инъекционной терапии миофасциальной триггерной зоны // Терапевтический архив 2018; 90(6): 81–88. doi: 10.26442/terarkh201890681-88. PMID: 30701909.
  24. Shirokov V.A., Iun O.P., Bakhtereva E.V. Efficiency local injection therapy with preparation mydocalm in myofascial pain syndrome cervicobrachial region. Zh Nevrol Psikhiatr Im S S Korsakova 2009; 109(6): 78–80. PMID: 19688873.
  25. Manchikanti L., Boswell M.V., Singhn V. et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord 2004; 5: 15. doi: 10.1186/1471-2474-5-15. PMID: 15169547.
  26. Gellhorn A.C., Katz J.N., Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 2013; 9: 216–224. doi: 10.1038/nrrheum.2012.199. PMID: 23147891.
  27. Eubanks J.D., Lee M.J., Cassinelli E., Ahn N.U. Prevalence of lumbar facet arthrosis and its relationship to age, sex, and race: an anatomic study of cadaveric specimens. Spine (Phila Pa 1976) 2007; 32: 2058–2062. doi: 10.1097/BRS.0b013e318145a3a9. PMID: 17762805.
  28. Коновалов Н.А., Древаль О.Н., Гринь А.А. и др. Клинические рекомендации по диагностике и лечению фасеточного синдрома пояснично-крестцового отдела позвоночника: приняты на Пленуме Правления Ассоциации нейрохирургов России 02.06.2015; г. Казань. URL: http://ruans.org/Text/Guidelines/lumbar_facet_syndrome.pdf
  29. Закиров А.А. Перкутанные хирургические методы при лечении вертеброгенного болевого синдрома: дис. канд. мед. наук. М., 2012. 146 с.
  30. Patel V.B., Wasserman R., Imani F. Interventional therapies for chronic low back pain: a focused review (efficacy and outcomes). Anesthesiol Pain Med 2015; 5: e29716. doi: 10.5812/aapm.29716. PMID: 26484298.
  31. Cohen S.P., Raja S.N. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology 2007; 106: 591–614. PMID: 17325518.
  32. O’Коннор Т.К., Эйбрам С.Э. Атлас по инъекционным методам лечения боли. М., 2015. 168 с.
  33. Perolat R., Kastler A., Nicot B. et al. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging 2018; 9: 773–789. doi: 10.1007/s13244-018-0638-x. PMID: 30090998.
  34. Yoon K.B., Kim S.H., Park S.J. et al. Clinical effectiveness of ultrasound-guided costotransverse joint injection in thoracic back pain patients. Korean J Pain 2016; 29: 197–201. doi: 10.3344/kjp.2016.29.3.197. PMID: 27413487.
  35. Bogduk N. Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy. Spine J 2008; 8: 56–64. doi: 10.1016/j.spinee.2007.10.010. PMID: 18164454.
  36. Cohen S.P., Huang J.H., Brummett C. Facet joint pain — advances in patient selection and treatment. Nat Rev Rheumatol 2013; 9: 101–116. doi: 10.1038/nrrheum.2012.198. PMID: 23165358.
  37. Manchikanti L., Singh V., Falco F.J.E. et al. Evaluation of lumbar facet joint nerve blocks in managing chronic low back pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Int J Med Sci 2010; 7: 124–135. doi: 10.7150/ijms.7.124. PMID: 20567613.
  38. Никитин А.С., Асратян С.А., Смирнов Д.С., Шалумов А.З. Эффективность блокад фасеточных суставов у больных с поясничным остеохондрозом. Нейрохирургия 2017; 3: 57–62.
  39. Slipman C.W., Bhat A.L., Gilchrist R.V. et al. A critical review of the evidence for the use of zygapophysial injections and radiofrequency denervation in the treatment of low back pain. Spine J 2003; 3: 310–316. doi: 10.1016/s1529-9430(03)00025-1. PMID: 14589192.
  40. Cohen S.P., Doshi T.L., Constantinescu O.C. et al. Effectiveness of lumbar facet joint blocks and predictive value before radiofrequency denervation: The Facet Treatment Study (FACTS), a randomized, controlled clinical trial. Anesthesiology 2018; 129: 517–535. doi: 10.1097/ALN.0000000000002274. PMID: 23165358.
  41. Peh W.C.G. Image-guided facet joint injection. Biomed Imaging Interv J 2011; 7: e4 doi: 10.2349/biij.7.1.e4. PMID: 21655113.
  42. Wernecke C., Braun H.J., Dragoo J.L. The effect of intra-articular corticosteroids on articular cartilage a systematic review. Orthop J Sports Med 2015; 3: 2325967115581163. doi: 10.1177/2325967115581163. PMID: 26674652.
  43. Manchikanti L., Pampati V., Kaye A.D., Hirsch J.A. Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial. Korean J Pain 2018; 31: 27–38. doi: 10.3344/kjp.2018.31.1.27. PMID: 29372023.
  44. Falagas M.E., Bliziotis I.A., Mavrogenis A.F. et al. Spondylodiscitis after facet joint steroid injection: a case report and review of the literature. Scand J Infect Dis 2006; 38: 295–299. doi: 10.1080/00365540500372689. PMID: 16718934.
  45. Thomson S.J., Lomax D.M., Collett B.J. Chemical meningism after lumbar facet joint block with local anaesthetic and steroids. Anaesthesia 1991; 46: 563–564. PMID: 1862897.
  46. Orpen N.M., Birch N.C. Delayed presentation of septic arthritis of a lumbar facet joint after diagnostic facet joint injection. J Spinal Disord Tech 2003; 16: 285–287. doi: 10.1097/00024720-200306000-00010. PMID: 12792344.
  47. Alcock E., Regaard A., Browne J. Facet joint injection: a rare form cause of epidural abscess formation. Pain 2003; 103: 209–210. doi: 10.1016/s0304-3959(02)00326-3. PMID: 12749975.
  48. Коновалов Н.А., Прошутинский С.Д., Назаренко А.Г., Королишин В.А. Радиочастотная денервация межпозвонковых суставов при лечении болевого фасеточного синдрома. Вопросы нейрохирургии им. Н.Н. Бурденко 2001; 75: 51–55.
  49. Mathis J.M. Epidural steroid injections. Neuroimaging Clin N Am 2010; 20: 193–202. doi: 10.1016/j.nic.2010.02.006. PMID: 20439015.
  50. Benoist M., Boulu P., Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. Eur Spine J 2012; 21: 204–213. doi: 10.1007/s00586-011-2007-z. PMID: 21922288.
  51. Manninen P., Riihimaki H., Heliovaara M. Incidence and risk factors of low-back pain in middle-aged farmers. Occup Med 1995; 45: 141–146. doi: 10.1093/occmed/45.3.141. PMID: 7605976.
  52. Murphy D.R., Hurwitz E.L., Gerrard J.K., Clary R. Pain patterns and descriptions in patients with radicular pain: does the pain necessarily follow a specific dermatome? Chiropr Osteopat 2009; 17: 9. doi: 10.1186/1746-1340-17-9. PMID: 19772560.
  53. Minkalis A.L., Vining R.D. What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis. J Can Chiropr Assoc 2015; 59: 300–310. PMID: 26500365.
  54. Lin J.H., Chiang Y.H., Chen C.C. Lumbar radiculopathy and its neurobiological basis. World J Anesthesiol 2014; 3: 162–173.
  55. doi: 10.5313/wja.v3.i2.162.
  56. Sun Z., Zhang M., Zhao X.H. Immune cascades in human intervertebral disc: the pros and cons. Int J Clin Exp Pathol 2013; 6: 1009–1014. PMID: 23696917.
  57. Pountos H., Panteli M., Walters G. et al. Safety of epidural corticosteroid injections. Drugs R D 2016; 16: 19–34. doi: 10.1007/s40268-015-0119-3. PMID: 26715572.
  58. Bartleson J.D., Maus T.P. Diagnostic and therapeutic spinal interventions Epidural injections. Neurol Clin Pract 2014; 4: 347–352. doi: 10.1212/CPJ.0000000000000043. PMID: 29473564.
  59. Гнездилов А.В., Долбнева Е.Л., Крюков С.П. и др. Терапия острой боли на предоперационном этапе в клинике хирургии позвоночника. Российский журнал боли 2018; 1: 28–35. doi: 10.25731/RASP.2018.01.005.
  60. Chou R., Hashimoto R., Friedly J. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med 2015; 163: 373–381. doi: 10.7326/M15-0934. PMID: 26302454.
  61. Murthy N.S., Geske J.R., Shelerud R.A. et al. The effectiveness of repeat lumbar transforaminal epidural steroid injections. Pain Med 2014; 15: 1686–1694. doi: 10.1111/pme.12497. PMID: 25039323.
  62. White A.H., Derby R., Wynne G. Epidural injections for the diagnosis and treatment of low-back pain. Spine (Phila Pa 1976) 1980; 5: 78–86. PMID: 6444766.
  63. Schäufele M.K. Interventional and semi-invasive procedures for low back pain and disc herniation. In: Minimally Invasive Spine Surgery. A Surgical Manual. Berlin-Heidelberg, 2006: 249–259. doi: 10.1007/3-540-29490-2.
  64. Fish D.E., Lee P.C., Marcus D.B. The S1 «Scotty Dog»: report of a technique for S1 transforaminal epidural steroid injection. Arch Phys Med Rehabil 2007; 88: 1730–1733. doi: 10.1016/j.apmr.2007.07.041. PMID: 18047894.
  65. Kim D.H., Yoon D.M., Yoon K.B. Incidence of intravascular injection and the spread of contrast media during S1 transforaminal epidural steroid injection by two approaches: anteroposterior vs oblique. Anaesthesia 2015; 70: 975–984. doi: 10.1111/anae.13079. PMID: 25850817.
  66. Rho M.E., Tang C.T. The efficacy of lumbar epidural steroid injections: transforaminal, interlaminar, and caudal approaches. Phys Med Rehabil Clin N Am 2011; 22: 139–148. doi: 10.1016/j.pmr.2010.10.006. PMID: 21292150.
  67. Watts R.W., Silagy C.A. A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intens Care 1995; 23: 564–569.66. doi: 10.1177/0310057X9502300506. PMID: 8787255.
  68. Pandey R.A. Efficacy of epidural steroid injection in management of lumbar prolapsed intervertebral disc: a comparison of caudal, transforaminal and interlaminar routes. J Clin Diagn Res 2016; 10: RC05–RC11. doi: 10.7860/JCDR/2016/18208.8127. PMID: 27630917.
  69. Pinto R.Z., Maher C.G., Ferreira M.L. et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med 2012; 157: 865–877. doi: 10.7326/0003-4819-157-12-201212180-00564. PMID: 23362516.
  70. Luijsterburg P.A.J., Verhagen A.P., Ostelo R.W.J.G. et al. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 2007; 16: 881–899. doi: 10.1007/s00586-007-0367-1. PMID: 17415595.
  71. Manchikanti L., Buenaventura R.M., Manchikanti K.N. et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician 2012; 15: E199–E245. PMID: 22622912.
  72. Катаев А.Е. Эпидуральные блокады с использованием глюкокортикоидов. Современная ревматология 2016; 10: 87–94. doi: 10.14412/1996-7012-2016-3-87-94.
  73. Ackerman W.E., Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg 2007; 104: 1217–1222. doi: 10.1213/01.ane.0000260307.16555.7f. PMID: 17456677.
  74. Epstein N.E. Major risks and complications of cervical epidural steroid injections: An updated review. Surg Neurol Int 2018; 9: 86. doi: 10.4103/sni.sni_85_18 PMID: 29740507.
  75. Lee J.H., Lee S.H. Comparison of clinical efficacy between interlaminar and transforaminal epidural injection in patients with axial pain due to cervical disc herniation // Medicine (Baltimore) 2016; 95: e2568. doi: 10.1097/MD.0000000000002568. PMID: 26825899.
  76. Parr A.T., Manchikanti L., Hameed H. et al. Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician 2012; 15: E159–E198. PMID: 22622911.
  77. Akuthota V. (ed.) North American Spine Society. Lumbar Transforaminal Epidural Steroid Injections Review and Recommendation Statement 2013. URL: https://www.spine.org/documents/researchclinicalcare/ltfesireviewrecstatement.pdf
  78. Benedetti E.M., Siriwetchadarak R. Selective nerve root blocks as predictors of surgical outcome: Fact or fiction? Acta Neurochir (Wien) 2004; 146: 559–565; disc.565. doi: 10.1007/s00701-004-0241-4. PMID: 15168223.
  79. Horlocker T.T., Wedel D.J., Benzon H. et al. Regional anesthesia and the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med 2003; 28: 172–197. doi: 10.1053/rapm.2003.50046. PMID: 12772135.
  80. Cohen S.P., Bicket M.C., Jamison D. et al. Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med.. 2013; 38: 175–200. doi: 10.1097/AAP.0b013e31828ea086. PMID: 23598728.
  81. Wadhwa R., Sharma S., Poddar D., Sharma S. Pleural puncture with thoracic epidural: A rare complication? Indian J Anaesth 2011; 55: 163–166. doi: 10.4103/0019-5049.79898. PMID: 21712874.
  82. Gajraj N.M. Selective nerve root blocks for low back pain and radiculopathy. Reg Anesth Pain Med 2004; 29: 243–256. PMID: 15138911.
  83. Datta S., Pai U. Selective nerve root block — is the position of the needle transforaminal or paraforaminal? Call for a need to reevaluate the terminology. Reg Anesth Pain Med 2004; 29: 616–617. doi: 10.1016/j.rapm.2004.07.219. PMID: 15635523.
  84. Leif Anderberg L., Mårten Annertz M., Urban Rydholm U. et al. Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur Spine J 2006; 15: 794–801. doi: 10.1007/s00586-005-0931-5. PMID: 16151714.
  85. Hodler J., Boos N., Schubert M. Must we discontinue selective cervical nerve root blocks? Report of two cases and review of the literature. Eur Spine J 2013; 22(Suppl 3): 466–470. doi: 10.1007/s00586-012-2642-z. PMID: 23328873.
  86. Eastley N.C., Spiteri V., Newey M.L. Variations in selective nerve root block technique. Ann R Coll Surg Engl 2013; 95: 515–518. doi: 10.1308/003588413X13629960048073. PMID: 24112500.
  87. Hogan Q.H., Abram S.E. Neural blockade for diagnosis and prognosis. A review // Anesthesiology 1997; 86(1):216-41 PMID: 9009957
  88. Slipman C.W., Plastaras C.T., Palmitier R.A. et al. Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps? Spine (Phila Pa 1976) 1998; 23: 2235–2242. PMID: 9802168.
  89. Harshavardhana N.S., Dabke H.V. The furcal nerve revisited. Orthop Rev (Pavia) 2014; 6: 5428. doi: 10.4081/or.2014.5428. PMID: 25317309.
  90. Van Goethem J.W.M., Parizel P.M., Jinkins R. Imaging of the postoperative lumbar spine. Neuroradiology 2002; 44: 723–739. doi: 10.1007/s00234-002-0790-2. PMID: 12221444.
  91. Manchikanti L., Abdi S., Atluri S. et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 2013; 16(2 Suppl): S49–S283. PMID: 23615883.
  92. Cyteval C., Fescquet N., Thomas E. et al. Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. AJNR Am J Neuroradiol 2006; 27: 978–982. PMID: 16687527.
  93. Arun-Kumar K., Jayaprasad S., Senthil K. et al. The outcomes of selective nerve root block for disc induced lumbar radiculopathy. Malays Orthop J 2015; 9: 17–22. doi: 10.5704/MOJ.1511.002. PMID: 28611904.
  94. Gossner J. Safety of CT-guided lumbar nerve root infiltrations analysis of a two-year period. Interv Neuroradiol 2014; 20: 533–537. doi: 10.15274/INR-2014-10082. PMID: 25363255.

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