Effects of L4-5 Transforaminal Epidural Steroid Injection in L5 Radiculopathy

OBJECTIVE: The aim of this study was to compare the therapeutic and functional values between the L5-S1 transforaminal epidural steroid injection (TFESI) and L4-5 TFESI in patients with L5 radiculopathy. METHOD: Among 30 patients with unilateral herniated nucleus pulposus (HNP) and L5 radiculopathy, 15 patients received L5-S1 TFESI and 15 patients received L4-5 TFESI. All patients were checked visual analogue scale (VAS) and functional score before injection, after 1 day, 2 weeks and 4 weeks. RESULTS: The VAS of before injection, after 1 day, 2 weeks and 4 weeks were 6.6, 4.0, 3.0, and 2.8 in L5-S1 TFESI, 6.2, 3.9, 2.7, and 2.6 in L4-5 TFESI, respectively. The functional score of before injection, after 1 day, 2 weeks and 4 weeks were 1.8, 2.3, 2.6, and 3.0 in L5-S1 TFESI, 1.6, 2.2, 2.5, and 2.8 in L4-5 TFESI, respectively. There was no statistical difference between the groups (p>0.05). CONCLUSION: This study suggested that either L5-S1 TFESI or L4-5 TFESI could be a valuable treatment of L5 radicular pain.

Spinal Mobility and Radiologic Change after Comprehensive Rehabilitative Management of Ankylosing Spondylitis

OBJECTIVE: To investigate the evidence of improvement of spinal mobility and the radiologic change of ankylosing spondylitis with comprehensive rehabilitative management. METHOD: We retrospectively studied spinal mobility index and radiologic changes of the twenty eight patients who had met the modified New York criteria of ankylosing spondylitis. RESULTS: Patients comprised 25 men and 3 women with age ranged from 22 to 63 (mean 44.9) years. With spinal mobility index, including Schober index, lumbar lateral bending, chest expansion, occiput to wall, and finger to floor, all in dices showed improvement after comprehensive rehabilitative management. When we evaluated the correlation between spinal mobility index and radiologic change scored by Bath ankylosing spondylitis radiology index (BASRI), patients with mild radiologic change (BASRI grade 0-2) showed improvement in spinal mobility. Radiologic change from initial visit to after one year showed no statistical difference. CONCLUSION: We found that intensive rehabilitative management increases spinal mobility of the patients with ankylosing spondylitis.

Brachial Plexopathy Caused by Pancoast Tumor: A case report

Pancoast tumor is a specific lung carcinoma that has symptoms according to the location. It often involves the extrathoracic structure more than parenchyme of lung, that cause shoulder pain. A 61-years old man had been complaining of shoulder pain and limitation of range of motions of shoulder joint. Conservative management of the shoulder pain was not effective with physical therapy and injection therapy and the symptom of right upper extremity radiating pain had been aggravated. We had examination of the eletro-diagnostic test in 17 months after shoulder pain was developed. The findngs of the electrodiagnostic test was suspected as the injury of lower trunk of brachial plexus, so we had checked MRI on brachial view. The pancoast tumor was found in the extrathoracic region that invaded the lower trunk of the brachial plexus. The shoulder pain related with tumor was rare and could cause brachial plexopathy.