Usefulness of the Computed Tomography Venography for Evaluation of Leg Edema Including Deep Vein Thrombosis in Rehabilitation Patients

OBJECTIVE: To investigate the usefulness of computed tomography venography (CTV) for evaluation of leg swelling, especially deep vein thrombosis (DVT), in rehabilitation patients. METHODS: A hundred twenty-three patients, who had performed CTV performed because of suspected DVT in our clinic, were enrolled. We performed chart reviews retrospectively and categorized CTV findings as follows: DVT distal to inguinal ligament and no compression lesion; DVT proximal to inguinal ligament and no compression lesion; DVT distal to inguinal ligament and anatomical variant (for example, May-Thurner syndrome); DVT due to compression of mass (cancer or cyst); DVT and other incidental abnormal finding; and no DVT and other possible causes of leg swelling. RESULTS: DVTs were found in 65 (53%) patients. DVTs were found at distal level (thigh or lower leg) to inguinal ligament in 47 patients. DVTs were found at proximal to inguinal ligament, usually undetectable with duplex ultrasonography, in 6 patients. DVTs caused by external compression, such as femoral vein and cancer mass, were found in 12 patients (10%), which are also not easily detected with duplex ultrasonography. Other various causes of leg edema without DVT were found in 22 (18%) patients. CONCLUSION: CTV can evaluate more extensively venous problems in the pelvis and abdomen and detect other possible causes of leg swelling. Therefore, CTV can be a useful tool not only for easy detection of DVT but also for evaluating differential diagnosis of leg edema in rehabilitation patients.

Efficacy of Translaminar Epidural Steroid Injection versus Combined Translaminar Epidural Steroid Injection with Selective Nerve Root Injection in Spinal Stenosis

OBJECTIVE: To compare treatment effects of translaminar epidural steroid injections (TLESIs) only and selective nerve root injections (SNRIs) with TLESIs in lumbosacral spinal stenosis. METHOD: Thirty-four patients diagnosed with magnetic resonance imaging (MRI), somatosensory evoked potential (SEP) and electromyography (EMG) were included. 16 patients who had somatosensory pathway dysfunction or abnormal spontaneous activity received combined SNRIs with TLESIs and 20 patients received only TLESIs. The visual analogue scale (VAS) and functional rating index (FRI) were measured before injection, 1 week and 3 months after 3 times injection. RESULTS: The mean values of VAS before injection, 1 week and 3 months after 3 times injection were 7.55, 3.22, 3.61 in only TLESIs and 7.37, 2.06, 2.31 in SNRIs with TLESIs. The mean values of FRI before injection, 1 week and 3 months after 3 times injection were 25.16, 16.00, 15.83 in only TLESIs and 22.50, 8.37, 8.31 in SNRIs with TLESIs. In the mean values of VAS and FRI were significantly lower SNRIs with TLESIs than only TLESIs (p<0.05). CONCLUSION: Combined SNRIs with TLESIs were more effective treatment for reduction of pain and improvement of function than only TLESIs in lumbosacral spinal stenosis.