Transiliac sacroplasty for Denis 3 fracture: Two cases report

We present two cases of percutaneous sacroplasty for sacral body fracture (Denis 3) and sacral alar fracture under multislice computed tomography (MSCT) guidance and discuss the clinical results and technical considerations. Sacroplasty is often recommended for the treatment of painful sacral insufficiency fractures, which destabilize the sacrum. However, sacroplasty for Denis zone 3 is rare because of the lack of validating controlled studies or unique technical considerations related to sacral anatomy. We performed sacroplasty for Denis zone 3 via the transiliac approach. Precise needle placement and polymethylmethacrylate cement injection were performed safely under the MSCT system. No complications occurred related to this procedure, such as iliac fracture, vascular leakage, or epidural leakage. MSCT-guided transiliac sacroplasty was a useful and effective solution in treating sacral body fracture.

Short-term effectiveness of percutaneous endoscopic lumbar discectomy in treatment of buttock pain associated with lumbar disc herniation / 中国修复重建外科杂志

Objective: To evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation. Methods: Between June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L 4, 5 in 15 cases and L 5, S 1 in 19 cases; 2 cases had lumbar disc herniation at both L 4, 5 and L 5, S 1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up. Results: All patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores ( P0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%. Conclusion: PELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.

Buttock Pain Secondary to Segmental Neurofibromatosis: A case report

Neurofibromatosis (NF) is a dysplastic disease which consists of multiple cafe-au-lait spots and neurofibromas from neural sheath. The 61-year-old male patient complained of sudden severe pain on the left buttock started one month ago. On physical examination, multiple "lentigines" were seen on his left buttock which spreaded to the thigh and small soft protruding nodules were observed on the right side of the back and left shoulder. Histopathologic finding of a specimen obtained from a nodule was consistent with neurofibroma. Magnetic resonance imaging (MRI) and ultrasonography revealed asymmetrical hypertrophy of neurovascular bundle located in the left greater sciatic foramen. On diagnosing as NF, he was treated with medication, physical modalities and therapeutic intervention (caudal block). Visual analogue scale (VAS) went down to 3/10 with these treatments and he was discharged. We report successful treatment of buttock pain rarely associated with segmental neurofibromatosis.

Effects of Intraarticular Prolotherapy on Sacroiliac Joint Pain

BACKGROUND: Sacroiliac (SI) joint pain is a challenging condition that causes lower back or buttock pain; however, there is no universally accepted long-term treatment. There have been several reports of ligament prolotherapy for SI joint pain, but these have had inconsistent results, probably due to the lack of a specific diagnosis for patient selection and variability in the volume, number and sites of injection. Therefore, this study was conducted to assess the efficacy of intraarticular prolotherapy for relieving SI joint pain diagnosed by local anesthetic intraarticular injection. METHODS: Twenty-two patients with SI joint pain confirmed by 50% or more improvement in response to local anesthetic block underwent intraarticular prolotherapy with 25% dextrose water every other week three times. The numeric rating scale (NRS) for pain and Oswestry disability index (ODI) were assessed at the initial visit and after completion of a series of prolotherapy and the NRS was checked during monthly follow-up sessions to evaluate the long-term effectiveness of this technique. RESULTS: Twenty patients completed prolotherapy and followed up as scheduled. The NRS and ODI were significantly improved from 6 (4-8) and 34.1 +/- 15.5 to 1 (0-3) and 12.6 +/- 9.8 (P < 0.01), respectively, at 1 month after prolotherapy. The mean duration of pain relief of 50% or more was 12.2 months (95% CI, 10.0-14.3) as determined by Kaplan-Meier survival analysis. CONCLUSIONS: Intraarticular prolotherapy provided long-term relief of sacroiliac joint pain and may have more benefits than ligament prolotherapy or neurolysis.

Rehabilitation Treatments for the Sports Injuries on the Lumbar Spine, Hip & Pelvis / 한양의대학술지

Low back pain is a common problem seen in both atheletes and general population. The elite athlete losing significant playing time because of a back injury. Although an actual pain generator is not always found , the majority of athletes with low back injuries are likely to have pain from a benign source. These athletes will be expected to respond well to non operative treatment. However some athletes may experience pain from more severe stuructural sources such as fracture or tumor. In these cases, different management may be indicated. The clinician evaluating athletes with LBP must have overall understanding about back problems for making proper decision and therapeutic regimen. In this article, the authors discuss common back pain related injuries in the atheletic population, typical mechanisms of injury and the treatment methods include rehabilitation exercise for these problems.

Rehabilitation Treatments for the Sports Injuries on the Lumbar Spine, Hip & Pelvis / 한양의대학술지

Low back pain is a common problem seen in both atheletes and general population. The elite athlete losing significant playing time because of a back injury. Although an actual pain generator is not always found , the majority of athletes with low back injuries are likely to have pain from a benign source. These athletes will be expected to respond well to non operative treatment. However some athletes may experience pain from more severe stuructural sources such as fracture or tumor. In these cases, different management may be indicated. The clinician evaluating athletes with LBP must have overall understanding about back problems for making proper decision and therapeutic regimen. In this article, the authors discuss common back pain related injuries in the atheletic population, typical mechanisms of injury and the treatment methods include rehabilitation exercise for these problems.

L1-2 Disc Herniations: Clinical Characteristics and Surgical Results

OBJECTIVE: Among upper lumbar disc herniations, L1-2 disc herniations are especially rare. We present the specific clinical features of L1-2 disc herniation and compared results of different surgical options. METHODS: The authors undertook a retrospective single institution review of the patients who underwent surgery for L1-2 disc herniation. Thirty patients who underwent surgery for isolated L1-2 disc herniations were included. RESULTS: Buttock pain was more frequent than anterior or anterolateral thigh pain. Standing and/ or walking intolerance was more common than sitting intolerance. The straight leg raising test was positive only in 15 patients (50%). Iliopsoas weakness was more frequent than quadriceps weakness. Percutaneous discectomy group demonstrated worse outcome than laminectomy group or lateral retroperitoneal approach group. CONCLUSION: Standing and/or walking intolerance, positive femoral nerve stretch test, and iliopsoas weakness can be useful clues to the diagnosis of L1-2 disc herniation. Posterior approach using partial laminectomy and medial facetectomy or minimally invasive lateral retroperitoneal approach seems like a better surgical option for L1-2 disc herniation than percutaneous endoscopic discectomy.