ABSTRACT
Piriformis syndrome consists of pain, tingling sensation, and paresthesia in areas innervated by sciatic nerve and is one of the main causes of low back pain. A 43-year-old male made a visit for continuous left buttock pain and tingling sensation in lower limbs for three years. Medication, epidural block and sacroiliac joint block were performed, but without effect. Sciatic nerve block with local anesthetics and steroid, however, showed some improvement for a short period of time. The patient's symptoms, physical examination, and the fact that sciatic nerve block showed improvement for a while led to the suspicion of piriformis syndrome. Thus, pulsed radiofrequency was performed on sciatic nerve twice. Visual analog scale (VAS) was 8-9 on first visit, which decreased to 1 after treatment and lasted for more than 18 months.
Subject(s)
Adult , Humans , Male , Anesthetics, Local , Buttocks , Catheter Ablation , Low Back Pain , Lower Extremity , Paresthesia , Physical Examination , Piriformis Muscle Syndrome , Sacroiliac Joint , Sciatic Nerve , SensationABSTRACT
Hiccups occur due to sudden glottic closure connected to inspiratory muscle and diaphragm's involuntary spasm. Hiccups have been known to be caused organically, psychologically, and by some unknown causes, yet, their pathophysiologic mechanism is still unknown. There are non-drug treatments such as hyperventilation, drinking water, pharynx and larynx stimulation, and Valsalva maneuver: and drug treatments such as antipsychotics and antiepileptics. Nerve block can be also considered. A 67-year-old man, who was hospitalized due to his months' long hiccup, had begun hiccups 5-6 months after an operation of radical subtotal gastrectomy with Billroth I anastomosis due to his early gastric cancer. During follow-ups of 4 weeks and 12 weeks after one treatment of bilateral SGB, the patient no longer complained hiccups. In conclusion, SGB treatment for intractable hiccup is an alternative method to palliative therapy or pharmacotherapy when either method is ineffective as a cure.
Subject(s)
Aged , Humans , Anticonvulsants , Antipsychotic Agents , Drinking Water , Follow-Up Studies , Gastrectomy , Gastroenterostomy , Hiccup , Hyperventilation , Larynx , Muscles , Nerve Block , Palliative Care , Pharynx , Spasm , Stellate Ganglion , Stomach NeoplasmsABSTRACT
The transforaminal epidural injection (TFEI) has been preferred in many cases because it can deliver the injected dose of medication closer to the nerve root and better facilitate ventral epidural flow compared to other methods. However, in patients with deformities not demonstrated on fluoroscopic imaging, the needle may enter unwanted locations. We treated two cases of intradiscal injection of contrast dye, during the TFEI, in patients with lumbar disc herniation.
Subject(s)
Humans , Congenital Abnormalities , Discitis , Injections, Epidural , NeedlesABSTRACT
BACKGROUND: When applying pulsed radiofrequency on dorsal root ganglia for treating chronic lower back pain, maximum efficiency can be expected when a needle is placed 1-2 cm peripheral to the dorsal root ganglion. The object of this study is to analyze images taken after adding contrast to transforaminal epidural injection, categorize root ganglia according to anatomical position, and provide a reference for efficient needle positioning in applying pulsed radiofrequency on dorsal root ganglia. METHODS: From January 2008 to January 2009, 457 patients who visited our hospital for root pain or radiculopathy were treated with transforaminal epidural injection on the nerve roots based on the dermatome of the painful area. Anteroposterior views were taken after injection of contrast. A virtual line was made by connecting the internal and external parts of the spinal pedicle from the contrast images. Then the dorsal root ganglia were categorized as intraspinal (IS), intraforaminal (IF), or extraforaminal (EF). RESULTS: In the fourth lumbar spine, dorsal root ganglia positions were 48% IF, 41% IS, and 6% EF. In the fifth lumbar spine, dorsal root ganglia positions were 75% IF, 10% IS, and 6% EF. In the first sacral spine, dorsal root ganglia locations were 8% IF and 83% IS. CONCLUSIONS: Positional categorization of dorsal root ganglia according to contrast images was proven to be good anatomical references for effective radiofrequency or blocking of dorsal root ganglia.