Efficacy of Ultrasonography-Guided Injections in Patients with Facet Syndrome of the Low Lumbar Spine

OBJECTIVE: To investigate the efficacy of ultrasonography (US)-guided injections in patients with low lumbar facet syndrome, compared with that in patients who received fluoroscopy (FS)-guided injections. METHOD: Fifty-seven subjects with facet syndrome of the lumbar spine of the L4-5 and L5-S1 levels were randomly divided into two groups to receive intraarticular injections into the facet joint. One group received FS-guided facet joint injections and the other group received US-guided facet joint injections. Treatment effectiveness was assessed using a visual analogue scale (VAS), physician's and patient's global assessment (PhyGA, PaGA), and the modified Oswestry Disability Index (MODI). All parameters were evaluated four times: before injections, and at a week, a month, and three months after injections. We also measured, in both groups, how long it took to complete the whole procedure. RESULTS: Each group showed significant improvement from the facet joint injections on the VAS, PhyGA, PaGA, and MODI (p0.05). Statistically significant differences in procedure time were observed between groups (FS: 248.7+/-6.5 sec; US: 263.4+/-5.9 sec; p=0.023). CONCLUSION: US-guided injections in patients with lumbar facet syndrome are as effective as FS-guided injections for pain relief and improving activities of daily living.

Balance Control and Knee Osteoarthritis Severity

OBJECTIVE: To investigate balance control according to the severity of knee osteoarthritis (OA) using clinical tests and Tetra-ataxiometric posturography (Tetrax(R)). METHOD: A total 80 patients with primary knee OA classified according to American College of Rheumatology criteria, and 40 age-matched controls were enrolled in this study. Of those with OA, 39 patients had mild OA (Kellgren-Lawrence [KL] grade 1, 2) and the other 41 had moderate to severe OA (KL grade 3, 4). The postural control capabilities of the subjects were assessed using the timed up and go test (TUG), Berg balance scale (BBS), and Tetrax(R), which utilizes two paired force plates to measure vertical pressure fluctuations over both heels and forefeet. The subjects were checked for their stability index (ST), Fourier index, weight distribution index (WDI), and synchronization index (SI) in eight positions using Tetrax(R). RESULTS: Patients with moderate to severe OA exhibited significantly higher stability indices in all positions than patients with mild OA. The Fourier index was also higher in patients with moderate to severe OA than in patients with mild OA. However, the weight distribution index and synchronization of both heels and forefeet were not significantly different in the three groups. CONCLUSION: These findings suggest that patients with moderate to severe OA have more deficits in balance control than those with mild disease. Therefore, evaluation of balance control and education aimed at preventing falls would be useful to patients with knee OA.

Multiple Lumbar Compression Fractures due to Hypopituitarism as a Late Complication of Hemorrhagic Fever with Renal Syndrome: A case report

Male osteoporosis is known to progress slowly and is less severe compared to female osteoporosis, and the incidence of lumbar compression fracture is considerably lower in male population. Hypogonadism which can develop from various causes including hypopituitarism is a common cause for secondary male osteoporosis. Hypopituitarism as a late complication of severe form of hemorrhagic fever with renal syndrome (HFRS) is known to occur occasionally but its clinical symptoms rarely appear. A 75-year-old male patient who had recovered from HFRS 13 years ago was admitted due to severe low back pain. He presented with gradually developed symptoms of hypogonadism and hypothyroidism resulting from hypopituitarism. MRI revealed collapsed pituitary gland and empty sella. This case presents with a male patient with multiple lumbar compression fractures due to severe osteoporosis secondary to hypogonadism, which resulted from hypopituitarism as a late complication of HFRS.