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1.
Arq. neuropsiquiatr ; 79(10): 900-903, Oct. 2021. graf
Article in English | LILACS, SES-SP, CONASS, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1345316

ABSTRACT

Abstract Background: Pruritus is a common complaint in dermatology. Wartenberg, in 1943, associated pruritus with neuropathy, relating it to the "posterior antebrachial cutaneous nerve neuropathy". In 1968, Waisman described patients with frequent pruritus complaints in the upper limb during the summer, which he named "brachioradial summer pruritus". Currently, this pruritus is named brachioradial pruritus (BRP). BRP is characterized by a chronic pruritus, usually localized, with a long duration, and without apparent cutaneous abnormalities. Neurological disorders both from the central and peripheral nervous systems, including multiple sclerosis, are associated with pruritus. Objective: To investigate correlations between symptomatic dermatomes and alterations in the myotomes, as evidenced by electroneuromyography (ENMG). Methods: Forty-six patients with BRP dermatological diagnoses were subjected to upper limb ENMG. Results: Among 46 patients with C5 to C8 dermatomal pruritus, we evaluated 113 symptomatic dermatomal areas. Overall, 39 (85%) patients had radicular involvement and 28 (60%) had agreement between complaint and the ENMG findings (p=0.015). A total of 80% of the patients with complaints at C7 and 47% at C6 had radicular involvement at the same level. Conclusions: Among the patients who presented complaints, 47 and 80%, respectively, had ENMG alterations in the C6 and C7 myotomes. We conclude that peripheral nervous system involvement is associated with BRP.


RESUMO Antecedentes: O prurido constitui queixa frequente e desafiadora na prática dermatológica. O primeiro estudo a relacionar prurido com neuropatia foi de Wartenberg, em 1943, que associou à "neuropatia do nervo cutâneo antebraquial posterior". Em 1968, Waisman descreveu pacientes com queixas recorrentes de prurido em membros superiores no verão, sendo denominado, então, "brachioradial summer pruritus". Atualmente, esse prurido é denominado como prurido braquiorradial (PBR). O PBR é caracterizado por prurido crônico, geralmente bem localizado, de longa duração e sem anormalidades cutâneas aparentes. Doenças neurológicas, tanto centrais, esclerose múltipla ou acidente vascular cerebral como do sistema nervoso periférico, estão associadas a prurido. Objetivo: Investigar os dermátomos sintomáticos pela eletroneuromiografia (ENMG). Métodos: Foram estudados 46 pacientes com diagnóstico dermatológico de PBR com a eletroneuromiografia dos membros superiores. Resultado: Foram avaliados 46 pacientes com queixa dermatológica de C5 a C8 somando 113 áreas dermatoméricas sintomáticas. Observou-se que 39 (85%) pacientes apresentavam comprometimento radicular, sendo que em 28 (60%) houve concordância plena entre as queixas e os achados da ENMG (p=0,015), e que 80% dos pacientes com queixa em território de C7 e 47% em C6 apresentavam comprometimento radicular no mesmo nível. Conclusões: As queixas mais frequentes foram as correspondentes aos territórios de C6 e C7, sendo que 47 e 80%, respectivamente, apresentaram alteração na ENMG nesses miótomos. Dessa forma, evidenciou-se correlação entre comprometimento do sistema nervoso periférico (i.e., radicular) com PBR.


Subject(s)
Humans , Pruritus , Peripheral Nervous System , Arm , Radiculopathy , Electromyography , Muscles , Nervous System Diseases
2.
Article in Chinese | WPRIM | ID: wpr-879402

ABSTRACT

OBJECTIVE@#To explore the short-term clinical efficacy of single-stage cervical spondylotic radiculopathy (CSR) between the minimally invasive Key-hole technique and anterior cervical Zero profile intervertebral fusion system (Zero-P).@*METHODS@#A retrospective analysis was performed on 45 patients who underwent surgical treatment for CSR from January 2017 to January 2020, including 21 in Key hole group (12 males and 9 females), followed up for 10-22(13.2±2.3) months;24 cases in Zero-P group (14 males and 10 females), and the follow up period was 10 to 23(12.7±1.9) months. Perioperative conditions (incision length, intraoperative blood loss, operation time, length of hospital stay, and complications) were compared between two groups, and X-rays of cervical spine before and after surgery and at the final follow-up were taken to analyzed curvature of the cervical spine, visual analogue scale(VAS) of pain before and after surgery, Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) score of cervical spine were recorded to evaluate clinical efficacy.@*RESULTS@#In Key-hole group and Zero-P group, the surgical incision length, intraoperative blood loss, operation time, final follow-up Cobb angle and immediate postoperative VAS score respectively were (1.2±0.2) cm, (5.3±0.3) cm;(35.3±9.7) ml, (120.2±13.5) ml;(56.4±11.3) min, (90.6±12.6) min;(3.2±3.9)°, (7.3±3.8)°;(2.8±1.2)points, (3.8±1.1) points;the Zero-P group was larger than the Key hole group, with statistical significance(@*CONCLUSION@#The cervical spine Key-hole technology is similar to the anterior cervical Zero-P system in the treatment of CSR. The Key-hole technique has certain advantages in incision length, intraoperative blood loss, and operation time. It is a safe, effective and can be widely used cervical spine surgery method.


Subject(s)
Case-Control Studies , Cervical Vertebrae/surgery , Female , Humans , Male , Radiculopathy/surgery , Retrospective Studies , Spinal Fusion , Spondylosis/surgery , Treatment Outcome
4.
Article in Chinese | WPRIM | ID: wpr-827241

ABSTRACT

OBJECTIVE@#To explore the biomechanical characteristics of "three-dimensional balanced manipulation" for the treatment of cervical spondylotic radiculopathy(CSR).@*METHODS@#A CSR patient was treated with "three-dimensional balanced manipulation", and the mechanical changes during the manipulation were monitored by mechanical testing system. Using spiral CT to scan the neck of the patient to obtain DICOM data. The three-dimensional finite element model of cervical spondylotic radiculopathy was established by using Mimics software, Geographic Studio software. The "three-dimensional balance manipulation" was simulated and loaded, and the mechanical parameters of each part were replaced into the finite element model, and the finite element analysis was carried out by using ANSYS software to study the internal stress changes and displacement deformation of vertebral body and intervertebral disc under the action of "three-dimensional balance manipulation".@*RESULTS@#The established C-C finite element model of the CSR patient consisted of 5 vertebrae, 4 intervertebral discs and 3 ligaments, involving 153 471 nodes and 64 978 units. The stress of C-C vertebral body was mainly located in anterior and root of C spinous processes, arch, vertebral arch and the combination of the two after full loading of manipulation, and the maximum stress was 17.781 MPa. The deformation sites were mainly concentrated in articular processes and anterior transverse processes of C, superior articular processes and transverse processes of C, articular processes of C. The stress of C-C intervertebral disc mainly distributed in the anterior part of C intervertebral disc and the nucleus pulposus of C and C. The displace mentextended to the middle and posterior part of C nucleus pulposus, around the nucleus of C and C and anterior part of cervical intervertebral disc.@*CONCLUSION@#The establishment of three-dimensional finite element model of C-C cervical spondylotic radiculopathy can simulate the geometry and material properties of cervical spine, and also accurately reflects the biomechanical characteristics of cervical spine, verifys the internal mechanism of "three-dimensional balanced manipulation" on CSR, proves the safety and effectiveness of treatment, guides more standardized manipulation, and avoids medical accidents.


Subject(s)
Biomechanical Phenomena , Cervical Vertebrae , Finite Element Analysis , Humans , Intervertebral Disc , Radiculopathy , Range of Motion, Articular , Spondylosis
5.
Article in Chinese | WPRIM | ID: wpr-880800

ABSTRACT

OBJECTIVE@#To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain.@*METHODS@#We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment.@*RESULTS@#The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (@*CONCLUSIONS@#As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.


Subject(s)
Humans , Injections, Epidural , Low Back Pain/drug therapy , Lumbar Vertebrae , Radiculopathy/drug therapy , Retrospective Studies , Treatment Outcome
6.
Article in English | WPRIM | ID: wpr-811122

ABSTRACT

BACKGROUND: Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.METHODS: In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions.RESULTS: Overall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%).CONCLUSIONS: Even though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.


Subject(s)
Chronic Pain , Diskectomy , Education , Emergency Medicine , Hospitals, Community , Humans , Internal Medicine , Minimally Invasive Surgical Procedures , Neurology , Neurosurgeons , Neurosurgery , Orthopedics , Pain Management , Pathology , Physicians, Primary Care , Radiculopathy , Referral and Consultation , Spine , Surgeons
7.
Article in Chinese | WPRIM | ID: wpr-828283

ABSTRACT

OBJECTIVE@#To explore the clinical efficacy and safety of posterior intervertebral foraminal discectomy via Delta channel for cervical spondylotic radiculopathy in the early phase.@*METHODS@#From September 2017 to July 2018, 10 patients with cervical spondylotic radiculopathy underwent posterior intervertebral foraminal discectomy via Delta channel. There were 6 males and 4 females, aged from 30 to 62 years old with an average of (41.5±4.3) years old. All of them had unilateral symptoms caused by cervical nerve root compression, including 2 cases of C, 5 cases of C and 3 cases of C. CT and MRI examination of all the patients did not show ossification of posterior longitudinal ligament or calcification of ligamentum flavum, and no cervical spine instability was present in dynamic radiographs. The clinical outcome was poor after more than 6 weeks of systematic non-surgical treatment. The VAS score, JOA score, NDI score, the cervical spine physiological curvature, and the height and stability of the compressed cervical vertebrae were measured before operation and at the latest follow-up.@*RESULTS@#All patients successfully completed the surgeries without any spinal cord, nerve root or major blood vessel injury. The operation time was 70 to 120 min with an average of 90 min. Intraoperative blood loss ranged from 30 to 90 ml with an average of 40 ml. All the 10 patients were followed up for 6 to 14 months with an average of 9 months. Postoperative nerve root pain got relievd and nerve function was improved in all patients. VAS score decreased from 7.15±2.01 before surgery to 1.59±0.83 at the latest follow-up;JOA score increased from 12.57±1.24 before surgery to 16.42±0.58 at the latest follow-up;NDI score increased from 41.82±4.71 before surgery to 9.59±3.52 at the latest follow-up. All the results above presented significant difference between latest follow-up and preoperative (0.05). At the latest follow-up, no cervical instability was observed on dynamic radiographs.@*CONCLUSION@#Treatment of cervical spondylotic radiculopathy by posterior intervertebral foraminal discectomy via Delta channel can obtain a satisfactory clinical outcome without affecting the stability of cervical vertebra. The surgery is safe, reliable and worthy of clinical application.


Subject(s)
Adult , Cervical Vertebrae , Diskectomy , Female , Humans , Male , Middle Aged , Radiculopathy , Retrospective Studies , Spinal Cord Diseases , Spinal Fusion , Spondylosis , Treatment Outcome
8.
Article in Chinese | WPRIM | ID: wpr-828278

ABSTRACT

OBJECTIVE@#To explore the safety, effectiveness and consistency of "Zoning Method" foraminotomy in posterior cervical endoscopic surgery.@*METHODS@#From March 2016 to October 2018, 21 patients with cervical spondylotic radiculopathy were enrolled. Endoscopic foraminotomy and nucleus pulposus enucleation were performed in the patients. There were 13 males and 8 females, aged from 35 to 56 years old with an average of (47.3±5.1) years. The surgical segment of 6 cases were C, 10 cases were C and 5 cases were C. The "Zoning Method" was proposed and used to complete the foraminotomy under endoscope, and then to perform nucleus pulposus removal and nerve root decompression. The operation length, intraoperative bleeding volume and complications were recorded, and NDI, VAS were evaluated before operation, 1 day after the operation and 1 week after the operation.@*RESULTS@#All the operations were successful. The operation length was(46.10±26.39) min, intraoperative bleeding volume was (50.10±18.25) ml, and there were no complications such as nerve injury, dural tear or vertebral artery injury. All 21 patients were followed up for 3 to 9 months, with a median of 6 months. Postoperative VAS and NDI were obvious improved (0.05).@*CONCLUSION@#Endoscopic foraminotomy with "Zoning Method" is safe clinically significant, and consistent.


Subject(s)
Adult , Cervical Vertebrae , Decompression, Surgical , Female , Foraminotomy , Humans , Male , Middle Aged , Neuroendoscopy , Radiculopathy , Spondylosis , Treatment Outcome
9.
Article in Chinese | WPRIM | ID: wpr-828088

ABSTRACT

Xiaoxuming Decoction is an ancient classic herbal formula for the treatment of stroke. In ancient times, the connotation of stroke was very extensive, including facial neuritis, acute cerebral infarction, acute cerebral hemorrhage, sequelae of cerebral hemorrhage, unexplained weakness of limbs, cervical spondylosis, acute myelitis, acute radiculitis, Guillain Barre syndrome, multiple sclerosis, myasthenia gravis, motor neuron disease, dermatomyositis, hypokalemic paralysis peripheral neuritis. It has been identified that: ①Xiaoxuming Decoction is very common in the treatment of cerebrovascular diseases, such as cerebral infarction, cerebral hemorrhage and other cerebrovascular diseases, facial neuritis, acute myelitis, acute radiculitis, Guillain Barre syndrome, unexplained limb weakness, multiple sclerosis, motor neuron disease, myasthenia gravis, and rheumatic and immune system diseases, such as dermatomyositis, and can not only alleviate symptoms, but also improve prognosis and the long-term survival rate. ②Sudden limb failure, facial paralysis, and hypoalgesia without heat syndrome are the key indications of Xiaoxuming Decoction. ③This is a special prescription for the treatment of acute facial neuritis, and can cure in one week in the combination with moxibustion. ④In the treatment of facial neuritis complicated with hypertension or acute cerebrovascular disease, Xiaoxuming Decoction generally has a certain antihypertensive effect, without any hypertensive effect, which reflected its two-way regulatory effect for blood pressure. ⑤In the treatment of unknown limb weakness, acute myelitis, acute radiculitis, Guillain Barre syndrome, Xiaoxuming Decoction can rapidly alleviate the symptoms. ⑥This is the basic formula for multiple sclerosis and motor neuron disease. Long term use of Xiaoxuming Decoction can alleviate the symptom of limb weakness, reduce the occurrence of complications and delay the progress of the disease, but with a poor long-term prognosis. ⑦In the treatment of myasthenia gravis, Xiaoxuming Decoction can significantly improve muscle strength, and gradually help stop hormone reduction. After thymoma surgery, Xiaoxuming Decoction is also applicable to some patients with recurrent myasthenia gravis. ⑧Xiaoxuming Decoction also plays a role in the treatment of dermatomyositis and cervical spondylopathy. ⑨Raw ephedra is the monarch drug of Xiaoxuming Decoction, which is the key to the effect. The dosage starts with 6 g is titrated in a small dose and increases gradually. In addition, this formula is forbidden for those with red face, fast heart rate, high blood pressure, blocked stool, red tongue, yellow fur, wiry and rapid pulse or powerful pulse, and spout pulse.


Subject(s)
Dermatomyositis , Facial Nerve Diseases , Guillain-Barre Syndrome , Humans , Motor Neuron Disease , Multiple Sclerosis , Myasthenia Gravis , Myelitis , Radiculopathy , Spondylosis
10.
Chinese Acupuncture & Moxibustion ; (12): 1259-1262, 2020.
Article in Chinese | WPRIM | ID: wpr-877596

ABSTRACT

OBJECTIVE@#To analyze the rules of acupoint selection in the acupuncture treatment of cervical spondylotic radiculopathy by data mining.@*METHODS@#The randomized controlled trials (RCTs) regarding acupuncture for cervical spondylotic radiculopathy published from July 15 of 2009 to July 15 of 2019 were retrieved from databases of CNKI, VIP, Wanfang, SinoMed, PubMed and EMbase. A database was established with Microsoft Excel 2016. The frequency and total effective rate of high-frequency acupoints, meridians and acupoint combinations were analyzed, and the association rules of acupoints and meridians were analyzed by Apriori algorithm.@*RESULTS@#A total of 87 RCTs were included, involving 104 acupoints with a total frequency of 921. Among them, the high-frequency acupoints were cervical Jiaji (EX-B 2, 87 times), Fengchi (GB 20, 70 times), Houxi (SI 3, 54 times), etc. The frequently-used acupoints were mainly distributed in the hand @*CONCLUSION@#It is feasible to explore the acupoint selection and compatibility rules of acupuncture for cervical spondylotic radiculopathy by data mining. This study could provide corresponding reference for clinical treatment.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Data Mining , Humans , Meridians , Radiculopathy/therapy
11.
Article in English | WPRIM | ID: wpr-785312

ABSTRACT

BACKGROUND: Transforaminal epidural block (TFEB) is an effective treatment option for radicular pain. To reduce complications from intravascular injection during TFEB, use of imaging modalities such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA) has been recommended. In this study, we investigated whether DSA improved the detection of intravascular injection during TFEB at the whole spine level compared to RTF.METHODS: We prospectively examined 316 patients who underwent TFEB. After confirmation of final needle position using biplanar fluoroscopy, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under RTF; 30 s later, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under DSA.RESULTS: Thirty-six intravascular injections were detected for an overall rate of 11.4% using RTF, with 45 detected for a rate of 14.2% using DSA. The detection rate using DSA was statistically different from that using RTF (p=0.004). DSA detected a significantly higher proportion of intravascular injections at the cervical level than at the thoracic (p=0.009) and lumbar (p=0.011) levels.CONCLUSION: During TFEB at the whole spine level, DSA was better than RTF for the detection of intravascular injection. Special attention is advised for cervical TFEB, because of a significantly higher intravascular injection rate at this level than at other levels.


Subject(s)
Analgesia , Angiography, Digital Subtraction , Fluoroscopy , Humans , Needles , Prospective Studies , Radiculopathy , Spine
12.
Article in English | WPRIM | ID: wpr-763030

ABSTRACT

Ossification of the posterior longitudinal ligament (OPLL) can be defined as an ectopic ossification in the tissues of spinal ligament showing a hyperostotic condition. OPLL is developed mostly in the cervical spine and clinical presentations of OPLL are majorly myelopathy and/or radiculopathy, with serious neurological pathology resulting in paralysis of extremities and disturbances of motility lowering the quality of life. OPLL is known to be an idiopathic and multifactorial disease, which genetic factors and non-genetic factors including diet, obesity, physical strain on the posterior longitudinal ligament, age, and diabetes mellitus, are involved into the pathogenesis. Up to now, surgical management by decompressing the spinal cord is regarded as standard treatment for OPLL, although there might be the risk of development of reprogression of ossification. The molecular pathogenesis and efficient therapeutic strategy, especially pharmacotherapy and/or preventive intervention, of OPLL has not been clearly elucidated and suggested. Therefore, in this review, we tried to give an overview to the present research results on OPLL, in order to shed light on the potential pharmacotherapy based on molecular pathophysiologic aspect of OPLL, especially on the genetic/genomic factors involved into the etiology of OPLL.


Subject(s)
Diabetes Mellitus , Diet , Drug Therapy , Extremities , Ligaments , Longitudinal Ligaments , Obesity , Ossification, Heterotopic , Paralysis , Pathology , Quality of Life , Radiculopathy , Spinal Cord , Spinal Cord Diseases , Spine
13.
Asian Spine Journal ; : 544-555, 2019.
Article in English | WPRIM | ID: wpr-762975

ABSTRACT

STUDY DESIGN: Prospective observational cohort study. PURPOSE: This study aims to evaluate the safety and efficacy of bone morphogenetic protein-2 (BMP-2) in transforaminal lumbar interbody fusion (TLIF) with regard to postoperative radiculitis. OVERVIEW OF LITERATURE: Bone morphogenetic protein (BMP) is being used increasingly as an alternative to iliac crest autograft in spinal arthrodesis. Recently, the use of BMP in TLIF has been examined, but concerns exist that the placement of BMP close to the nerve roots may cause postoperative radiculitis. Furthermore, prospective studies regarding the use of BMP in TLIF are lacking. METHODS: This prospective study included 77 patients. The use of BMP-2 was determined individually, and demographic and operative characteristics were recorded. Leg pain was assessed using the Visual Analog Scale (VAS) for pain and the Sciatica Bothersome Index (SBI) with several secondary outcome measures. The outcome data were collected at each follow-up visit. RESULTS: Among the 77 patients, 29 were administered with BMP. Postoperative leg pain significantly improved according to VAS leg and SBI scores for the entire cohort, and no clinically significant differences were observed between the BMP and control groups. The VAS back, Oswestry Disability Index, and Short-Form 36 scores also significantly improved. A significantly increased 6-month fusion rate was noted in the BMP group (82.8% vs. 55.3%), but no significant differences in fusion rate were observed at the 12- and 24-month follow-up. Heterotopic ossification was observed in seven patients: six patients and one patient in the BMP and control groups, respectively (20.7% vs. 2.1%). However, no clinical effect was observed. CONCLUSIONS: In this prospective observational trial, the use of BMP in TLIF did not lead to significant postoperative radiculitis, as measured by VAS leg and SBI scores. Back pain and other functional outcome scores also improved, and no differences existed between the BMP and control groups. The careful use of BMP in TLIF appears to be both safe and effective.


Subject(s)
Arthrodesis , Autografts , Back Pain , Bone Morphogenetic Proteins , Cohort Studies , Follow-Up Studies , Humans , Leg , Lumbosacral Region , Ossification, Heterotopic , Outcome Assessment, Health Care , Prospective Studies , Radiculopathy , Sciatica , Spinal Fusion , Spine , Visual Analog Scale
14.
Article in English | WPRIM | ID: wpr-765629

ABSTRACT

STUDY DESIGN: Retrospective study. OBJECTIVES: In the current study, we aimed to (1) evaluate the early and late therapeutic effects of selective nerve root block (SNRB) for cervical radiculopathy, and (2) to determine the optimal time point for predicting the long-term effectiveness of cervical SNRB. SUMMARY OF LITERATURE REVIEW: Although SNRB is an important option for cervical radiculopathy, various studies of cervical SNRB have failed to specify its efficacy, especially long-term effectiveness. MATERIALS AND METHODS: We retrospectively enrolled 35 patients with cervical radiculopathy who were regularly followed-up for at least 1 year after SNRB. Clinical outcomes were evaluated using a visual analogue scale (VAS) for pain intensity and the modified Kim's method for patient satisfaction at regular follow-up intervals. In the correlation analysis, stepwise multiple linear regression was used to identify selected and unselected factors. RESULTS: The average VAS score decreased over time (p<0.05); the values just before the injection and at 1 week, 3 weeks, and 1 year of follow-up were 6.11, 3.29, 2.89, and 1.37, respectively. In the stepwise multiple regression analysis, the 1-week VAS score was related to the initial VAS score, the 3-week VAS score was related to the 1-week VAS score, and the last VAS score was related to the 3-week VAS score and symptom duration before the injection. The degree of satisfaction at the 1-year follow-up point was significantly associated with the 3-week VAS score (p=0.011). CONCLUSIONS: The current study showed that pain intensity at the 3-week time point after cervical SNRB might be the optimal time point for predicting long-term effectiveness.


Subject(s)
Follow-Up Studies , Humans , Linear Models , Methods , Patient Satisfaction , Radiculopathy , Retrospective Studies , Therapeutic Uses
15.
Article in Korean | WPRIM | ID: wpr-765623

ABSTRACT

STUDY DESIGN: Case report. OBJECTIVES: To document unilateral biportal endoscopy (UBE) as a treatment for acute radiculopathy after osteoporotic vertebral fracture. SUMMARY OF LITERATURE REVIEW: Acute radiculopathy after osteoporotic vertebral fracture leads to claudication. Treatment of osteoporotic vertebral fractures with accompanying radiating pain is challenging. MATERIALS AND METHODS: A 74-year-old woman was diagnosed with an osteoporotic vertebral fracture at L3 after slipping and falling. Vertebroplasty was performed for the osteoporotic vertebral fracture at L3. She still complained of right lower extremity radiating pain. UBE was performed to treat acute radiculopathy. RESULTS: Foraminal decompression using UBE was performed at the L3–4 right foraminal area. Her symptoms resolved after surgery. CONCLUSIONS: UBE is a useful treatment method for acute radiculopathy after osteoporotic vertebral fracture.


Subject(s)
Accidental Falls , Aged , Decompression , Endoscopy , Female , Fractures, Compression , Humans , Lower Extremity , Methods , Radiculopathy , Vertebroplasty
16.
Article in Korean | WPRIM | ID: wpr-765434

ABSTRACT

PURPOSE: This study examine the functioning level and quality of life (QoL) of people with non-specific neck pain and neck pain with radiculopathy using the neck disability index (NDI), functional rating index (FRI), and short form of health survey 36 (SF-36) and each of linked lCF code lists of those scales. METHODS: Each item of the NDI, FRI, and SF-36 were linked conceptually to the ICF code, and the lCF code lists of those scales were produced as iNDI, iFRI, and iSF-36, respectively. Seventy-nine patients with neck pain filled the instruments and its linked ICF code lists. The subjects were divided into two groups based on the diagnosis, non-specific neck pain (Group1), and neck pain with radiculopathy (Group2). A group comparison was performed using an independent t-test. The Pearson correlation coefficient was also used to analyze the relationships between each scale and the linked ICF code list. RESULTS: The participants in Group 2 experienced more difficulties in their daily activities than those in Group 2 when examined in NDI and FRI (p<0.05). This result was also found consistently in the ICF code lists, iNDI and iFRI (p=0.05). On the other hand, the QoL did not show a difference between groups (p=0.06). A strong correlation was observed between the instruments and linked ICF code lists: NDI and iNDI (r=0.90), FRI and iFRI (r=0.91), and SF-36 and iSF-36 (r=−0.61). CONCLUSION: These findings suggest that the concept of each item in NDI and FRI could be linked to the ICF codes when examining patients with neck pain, but the items of SF-36 were found to be linked and expressed in ICF.


Subject(s)
Diagnosis , Hand , Health Surveys , Humans , Neck Pain , Neck , Quality of Life , Radiculopathy , Weights and Measures
17.
Article in English | WPRIM | ID: wpr-762247

ABSTRACT

A 15-year-old male patient presented with a slow progression of painless right shoulder weakness over the previous six weeks. The magnetic resonance imaging revealed right C4–5 foraminal stenosis caused by right foraminal disc protrusion. The needle electromyography and nerve conduction studies revealed acute C5 and/or C6 radiculopathy. Instead of the initial surgical management modalities, we performed a cervical epidural steroid injection at the C4–5 level. From the day after the patient received the cervical epidural steroid injection, his right shoulder motor weakness improved progressively. Two weeks after the procedure, his right shoulder motor function had fully recovered.


Subject(s)
Adolescent , Constriction, Pathologic , Electromyography , Humans , Magnetic Resonance Imaging , Male , Needles , Neural Conduction , Radiculopathy , Shoulder
18.
The Korean Journal of Pain ; : 280-285, 2019.
Article in English | WPRIM | ID: wpr-761711

ABSTRACT

BACKGROUND: Pulsed radiofrequency (PRF) is a treatment modality that alleviates radicular pain by intermittently applying high-frequency currents adjacent to the dorsal root ganglion. There has been no comparative study on analgesic effect according to the position of the needle tip in PRF treatment. The objective of this study is to evaluate the clinical outcomes of PRF according to the needle tip position. METHODS: Patients were classified into 2 groups (group IP [group inside of pedicle] and group OP [group outside of pedicle]) based on needle tip position in the anteroposterior view of fluoroscopy. In the anteroposterior view, the needle tip was advanced medially further than the lateral aspect of the corresponding pedicle in group IP; however, in group OP, the needle tip was not advanced. The treatment outcomes and pain scores were evaluated at 4, 8, and 12 weeks after applying PRF. RESULTS: At 4, 8, and 12 weeks, there were no significant differences between the successful response rate and numerical rating scale score ratio. CONCLUSIONS: The analgesic efficacy of PRF treatment did not differ with the needle tip position.


Subject(s)
Analgesics , Fluoroscopy , Ganglia, Spinal , Humans , Low Back Pain , Lumbosacral Region , Needles , Observational Study , Pulsed Radiofrequency Treatment , Radiculopathy , Retrospective Studies , Spinal Nerve Roots
19.
The Korean Journal of Pain ; : 147-159, 2019.
Article in English | WPRIM | ID: wpr-761703

ABSTRACT

Lumbar foraminal pathology causing entrapment of neurovascular contents and radicular symptoms are commonly associated with foraminal stenosis. Foraminal neuropathy can also be derived from inflammation of the neighboring lateral recess or extraforaminal spaces. Conservative and interventional therapies have been used for the treatment of foraminal inflammation, fibrotic adhesion, and pain. This update reviews the anatomy, pathophysiology, clinical presentation, diagnosis, and current treatment options of foraminal neuropathy.


Subject(s)
Constriction, Pathologic , Decompression , Diagnosis , Electric Stimulation , Fibrosis , Foraminotomy , Ganglia, Spinal , Inflammation , Lumbosacral Region , Pain Management , Pathology , Radiculopathy , Spinal Nerve Roots
20.
The Korean Journal of Pain ; : 196-205, 2019.
Article in English | WPRIM | ID: wpr-761698

ABSTRACT

BACKGROUND: Hypertonic saline (HS) injections for decompressive neuroplasty (DN) can cause pain. We assessed whether a continuous infusion of HS through an infusion pump would reduce injection-related pain compared with repeated bolus administrations. METHODS: Fifty patients scheduled for DN were randomized to either the bolus injection or the continuous infusion group. After appropriately placing the epidural catheter, 4 mL of 5% NaCl was injected as four boluses of 1 mL each at 15-minute intervals or infused over 1 hour using an infusion pump. The severity of pain induced by HS injection, as measured by the 11-point numerical rating scale (NRS), was the primary outcome. The severity of low back or lower extremity pain, as measured by the 11-point NRS and Oswestry Disability Index (ODI), 3 months following the procedure, was the secondary outcome. RESULTS: Data from 21 patients in the bolus group and 23 in the continuous infusion group were analyzed. No statistically significant difference in injection-related pain was identified between the two groups during the initial HS administration (P = 0.846). However, there was a statistically significant reduction in injection-related pain in the continuous infusion group compared to the bolus injection group from the second assessment onwards (P = 0.001, < 0.001, and < 0.001, respectively). No significant between-group differences in the NRS and ODI scores 3 months post-procedure were noted (P = 0.614 and 0.949, respectively). CONCLUSIONS: Our study suggests that administering HS through a continuous infusion is a useful modality for reducing HS injection-related pain during DN.


Subject(s)
Catheters , Chronic Pain , Humans , Infusion Pumps , Injections, Epidural , Low Back Pain , Lower Extremity , Radiculopathy , Saline Solution, Hypertonic , Spinal Stenosis
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