Radiating Pain and Postural Balance with Pulsed Radiofrequency Treatment in Patients with Lumbosacral Radiculopathy

OBJECTIVE: To investigate the effect of pulsed radiofrequency (PRF) treatment on pain and balance in patients with lumbosacral radiculopathy.METHOD: This study included twenty-five patients who were diagnosed with chronic lumbosacral radiculopathy. They underwent PRF treatment in prone position under the fluoroscopic guidance. The effect of PRF was measured by the visual analog score (VAS). Patient ability to balance was evaluated by using the Tetra-ataxiometric posturography (Tetrax).RESULTS: After PRF all patients showed improvement in pain as measured by VAS (p < 0.001) and none of the patients reported any side effects. The posturographic balance, which was evaluated by Tetrax showed no significant decline after PRF treatment. The weight distribution index (WDI) with eyes open before treatment was 5.43 ± 2.88 and after treatment was 5.37 ± 2.65 (p=0.917). The mean stability index (SI) with eyes open before treatment was 16.52 ± 6.05 and after treatment was 16.61 ± 4.85 (p=0.906). The mean WDI with eyes closed before treatment was 5.66 ± 2.81 and after treatment was 5.16 ± 2.70 (p=0.470). Finally, the mean SI with eyes closed before was 25.88 ± 9.88 and after treatment was 25.99 ± 12.30 (p=0.962).CONCLUSION: The results suggest that PRF has an effect on pain in patients with chronic lumbosacral radiculopathy. The patients did not experience adverse effects, such as hypoesthesia, dysesthesia and decreased proprioception after PRF, and there were no significant declines in balance.

The outcome of epiduroscopy treatment in patients with chronic low back pain and radicular pain, operated or non-operated for lumbar disc herniation: a retrospective study in 88 patients

BACKGROUND: Patients with lumbar disc herniation are treated with physiotherapy/medication and some with surgery. However, even after technically successful surgery some develop a failed back syndrome with persistent pain. Our aim was to evaluate the efficacy of epiduroscopy in patients who suffer chronic low back pain and/or radicular pain with or without surgery and the gender difference in outcome. METHODS: A total of 88 patients were included with a mean age of 52 years (27-82), 54 women and 34 men. 66 of them were operated previously and 22 were non-operated. They all had persistent chronic back pain and radicular pain despite of medication and physical rehabilitation. Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) were evaluated preoperatively, after one month, six months and one-year after the epiduroscopy. RESULTS: All patients, and also the subgroups (gender and operated/non-operated) improved significantly in pain (VAS) and disability (ODI) at one month. A significant improvement was also seen at one year. No differences were found between men and woman at the different follow-up times. A slight worsening in VAS and ODI was noticed over time except for the non-operated group. CONCLUSIONS: Epiduroscopy helps to improve the back and leg pain due to lumbar disc herniation in the early stage. At one year an improvement still exists, and the non-operated group seems to benefit most of the procedure.

The Usefulness of Selective Nerve Root Block for Failed Back Surgery Syndrome / 대한정형외과학회잡지

PURPOSE: To retrospectively evaluate the improvement of symptoms and diagnosis using selective nerve root block (SNRB) for radiating pain after spine surgery. MATERIALS AND METHODS: From October 2012 to October 2013, 112 patients with failed back surgery syndrome (41 male and 71 female, with the mean age of 62.4 years and range of 35 to 78 years), who were admitted and underwent SNRB, were included. All patients were followed-up for more than 12 months. Three groups were classified: Group 1 included patients with no improvement or aggravation of symptoms, group 2 included those with improvement of radiating pain, and group 3 included those with recurrence of radiating. RESULTS: Among the 112 patients, there were 15 patients in group 1, 59 patients in group 2, and 38 patients in group 3. Laminectomy was the highest surgical procedure, inducing failed back surgery syndrome. In group 2, the occurrence of failed back surgery syndrome was higher in case that radiating pain was complained more than 1 year before the first surgery. There is statistically significant symptom improvement in accordance with the visual analogue scale and Korean version of Oswestry disability index on every group after SNRB (p<0.05). CONCLUSION: It is considered that SNRB is expected to improve the symptoms and to find the cause of symptoms as a diagnostic value even after spine surgery.

The Usefulness of Selective Spinal Nerve Root Block in Neuropathic Pain Patients with Radiculopathy / 대한정형외과학회잡지

PURPOSE: This study was conducted in order to evaluate effect and efficiency of selective spinal nerve root block for neuropathic pain patients with lower leg radiating pain. MATERIALS AND METHODS: A total of 113 patients were evaluated and follow-up periods were a minimum of 12 months. They were divided into two groups: group A included 41 patients with neuropathic pain and group B included 72 patients with simple lower leg radiating pain. RESULTS: Fourteen (34.1%) patients in group A and 45 (62.5%) patients in group B had favorable results for selective spinal nerve block (p<0.05). Visual analog scale (VAS) was improved from 7.57 to 5.23 at 12 months in group A and from 7.11 to 3.49 at 12 months in group B. CONCLUSION: The initial treatment period for group A was significantly later than in group B. For patients with neuropathic pain and radiculopathy, early assessment was recommended and early selective spinal nerve block could be a good treatment option for neuropathic pain patients.

Efficacy of Epidural Neuroplasty Versus Transforaminal Epidural Steroid Injection for the Radiating Pain Caused by a Herniated Lumbar Disc

OBJECTIVE: To compare the treatment effects of epidural neuroplasty (NP) and transforaminal epidural steroid injection (TFESI) for the radiating pain caused by herniated lumbar disc. METHODS: Thirty-two patients diagnosed with herniated lumbar disc through magnetic resonance imaging or computed tomography were included in this study. Fourteen patients received an epidural NP and eighteen patients had a TFESI. The visual analogue scale (VAS) and functional rating index (FRI) were measured before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment. RESULTS: In the epidural NP group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.00+/-1.52, 4.29+/-1.20, 2.64+/-0.93, 1.43+/-0.51 and those of FRI were 23.57+/-3.84, 16.50+/-3.48, 11.43+/-2.44, 7.00+/-2.15. In the TFESI group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.22+/-2.05, 4.28+/-1.67, 2.56+/-1.04, 1.33+/-0.49 and those of FRI were 22.00+/-6.64, 16.22+/-5.07, 11.56+/-4.18, 8.06+/-1.89. During the follow-up period, the values of VAS and FRI within each group were significantly reduced (p<0.05) after the treatment. But there were no significant differences between the two groups statistically. CONCLUSION: Epidural NP and TFESI are equally effective treatments for the reduction of radiating pain and for improvement of function in patients with a herniated lumbar disc. We recommend that TFESI should be primarily applied to patients who need interventional spine treatment, because it is easier and more cost-effective than epidural NP.

Effectiveness of Selective Nerve Root Block for the Treatment of Radiculopathy in Degenerative Lumbar Scoliosis

STUDY DESIGN: Level III, Retrospective studies. OBJECTIVES: This study was conducted to evaluate the effects and usefulness of the selective nerve root block in advance for the Degenerative Lumbar Scoliosis patients, with radiating pain, who were scheduled for an operation. SUMMARY OF LITERATURE REVIEW: Selective nerve root block was introduced in 1971, by Macnab and it was used to make improvements for radiating pain, as a treatment of multiple lesions or a tool to help making a surgical decision, and to predict the result. After an introduction by Cooper, selective root block on degenerative sclerosis, with lower leg radiating pain, showed fine results on a short term follow-up and moderate to good results on long term follow-up. MATERIALS AND METHODS: Between January 2005 to December 2009, 47 cases were selected from the patients, who underwent selective nerve root block, before the operation. The mean follow-up period was 38.4 months and the mean age was 67.1 years. The patients were divided into the operation group and the only selective nerve root block group. The treatment results in the SNRB group and the operation group were analyzed using Kim's criteria and the Visual Analog Scale score. The groups were radiologically evaluated for the neural compression rate. RESULTS: Among the 47 cases that were scheduled for an operation, 30 cases did not proceed to the operation. The average VAS score for the selective root block group and the operation group were 7.56 and 8.12, at the preoperative state and the preinjection state, respectively. After the selective nerve root block and surgical treatment, the scores were 3.71 and 2.64 at 1year follow up, respectively. There was no correlation with statistical significance between the initial VAS score and the degree of stenosis noted in the MRI (P>0.05). There was no statistical significant correlation between the initial relief from selective nerve root injections and the degree of stenosis noted in the MRI (P>0.05). However, there was a correlation with statistical significance between the operation rate and the degree of stenosis noted in the MRI (P<0.05). CONCLUSION: Selective nerve root block is considered to be an effective treatment for the Degenerative Lumbar Scoliosis patients with radiating pain, who are scheduled for an operation.

Effects of Combination of a Transforaminal Nerve Root Block and an Epidural Steroid Injection for Chronic Radiating Pain / 대한마취과학회지

BACKGROUND: We evaluated the effects of combination of a transforaminal nerve root block and an epidural block using corticosteroid and local anesthetics, for the management of radiating pain to the lower extremities. METHODS: Thirty patients who suffered from chronic radiating pain that resistant conservative treatments including epidural steroid injection (ESI) were enrolled. Following a transforaminal nerve root block under fluoroscopic visualization, an ESI was administered at the level of the intervertebral space showing an obstacle to cephalad epidural spread of the dye injected during a transforaminal nerve root block. Twenty to forty mg of triamcinolone with 0.5% lidocaine was injected in divided doses. The patients received these nerve blocks at intervals of 1 2 weeks until the patients were satisfied with the results. If the pain reappeared, repeated blocks were administered at intervals of 2 months. Treatment results were evaluated twice using a pain relief scale and categorized as excellent, good, fair, or poor. RESULTS: Pain improvements of more than 50% of the initial pain intensity, graded excellent or good, were observed in 66.7% at 1 week after the 1st blocks and 73.3% at 3 months after the final blocks. CONCLUSIONS: These findings suggest that a combination of a transforaminal nerve root block and ESI is an effective procedure for radiating pain not responding to ESI. However, comparative prospective studies to determine the effects of this combination therapy versus classical transforaminal injections may be mandatory.

Descriptive Patterns of Radiating Pain for Lumbar Herniated Intervertebral Disc / 대한척추외과학회지

STUDY DESIGN AND OBJECTIVE: To evaluate the descriptive patterns of radiating leg pain due to lumbar herniated intervertebral disc, and the correlation between the patterns and various factors such as age, gender, occupation, education, duration of symptom, straight leg raising test, and degree of disc herniation on magnetic resonance imaging. MATERIALS AND METHODS: One hundred and three patients who had lower back pain and radiating leg pain were diagnosed with lumbar herniated intervertebral disc. We investigated the descriptions of their radiating leg pain, and standardized and classified 44 adjective words to 11 groups by the Korean McGill pain questionnaire. We analyzed the frequencies of each word and the correlation between the frequencies and the various factors. RESULTS: The pattern of pain descriptions tended to exhibit certain characteristic traits. The word 'flashing' was the most common (72.8%), followed by the word 'jerking'(62.1%). Descriptions of most patients included either the word 'flashing' or 'jerking'(92.2%). However, there was no significant relation between the frequencies of each word and any factors (p>0.05, chisquare). CONCLUSIONS: The pattern of patients' descriptions for radiating pain of lumbar herniated intervertebral disc is either the word 'flashing'or 'jerking'. This is a useful description to diagnosis and plan for the treatment of lumbar herniated intervertebral disc.

The Effect of Nerve-Root Injection on Pain Relief in the Management of Osteoporotic Vertebral Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the efficacy of a nerve-root injection for the alleviation of pain in osteoporotic vertebral fracture. MATERIALS AND METHODS: Eighteen patients with pain from osteoporotic vertebral fracture, without improvement after conservative treatment, were included in this study. The group consisted of sixteen women and two men, and had with a mean age of 71 years. Patients underwent a nerve-root injection with lidocane, bupivacane and depomedrol, and were allowed as many as three injections. The mean follow-up period was 13.5 months. RESULTS: The average pain scores at pre-injection, 1 month and 6 months after the injection and final follow-up were 85, 24.9, 14.1 and 17.4, respectively. According to the criteria used to assess clinical results, there was one excellent, thirteen good and four fair results. A newly developed compression fracture was noted in one patient. No complication was related to the injection. CONCLUSION: Our data show that nerve-root injections are effective at improving pain. This suggests that patients with pain from osteoporotic vertebral fractures should be considered for treatment with nerve-root injections prior to being considered for percutaneous vertebroplasty or operative intervention.

Abdominal Aortic Aneurysm Simulating Disc Disease: A Case Report / 대한정형외과학회잡지

Abdominal aortic aneurism can cause lower back pain that is usually severe, constant, and unaffected by posture. However, back pain caused by abdominal aortic aneurysm associated with radiating pain to the lower extremities can lead to a misdiagnosis. We pre-sent a rare case of a huge abdominal aortic aneurysm with chronic lower back pain. It presented as a radiating pain which was sus-pected as disc disease. Radiologic examinations, however, revealed a huge abdominal aortic aneurysm. After bypass operation, both back pain and radiating pain disappeared without any other orthopaedic management.