The Therapeutic Effect of Postganglionic Nerve Block for Symptomatic Schmorl Nodule: A Retrospective Case Series

STUDY DESIGN: Retrospective case series. OBJECTIVES: We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs). SUMMARY OF LITERATURE REVIEW: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs. MATERIALS AND METHODS: From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure. RESULTS: Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the follow-up period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p < 0.05). Complications were not reported in any cases. CONCLUSIONS: Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.

Rami Communicans Nerve Block for the Treatment of Symptomatic Schmorl's Nodes: A Case Report

Histologically, Schmorl's nodes are defined as the loss of nuclear material through the cartilage plate, growth plate, and end plate into the vertebral body. Most Schmorl's nodes are asymptomatic, although there are some reports of symptomatic Schmorl's nodes, which should be treated similarly to vertebral compression fractures, with conservative treatment as the first choice. We report the case that we reduced the pain by blocking the ramus communicans nerve in a patient with Schmorl's node.

Radiofrequency Neurotomy of the Gray Ramus Communicans for Lumbar Osteoporotic Compression Fracture

OBJECTIVE: The aim of this study was to determine the efficacy of percutaneous radiofrequency neurotomy(RFN) of grayramus communicans nerve in patients suffering from severe low back pain due to osteoporotic compression fracture. METHODS: Twenty two patients with lumbar osteoporotic compression fracture who had intractable back pain for less than two weeks and were performed with RFN at L1-L4 from May 2004 to December 2005 were retrospectively analyzed. Clinical outcome using visual analogue scale(VAS) pain scores and modified MacNab's grade was tabulated. Complications related to the procedure were assessed. RESULTS: Twenty-two female patients (age from 63 to 81 years old) were included in this study. The mean VAS score prior to RFN was 7.8, it improved to 2.6 within postoperative time of 48 hours, and the mean VAS score after 3 months was 2.8, which was significantly decreased. Eighteen of 22 patients were graded as excellent and good according to modified MacNab's criteria at final follow up. All patients recovered uneventfully, and the neurologic examination revealed no deficits. Two patients showing poor results worsened in symptom. Percutaneous was performed eventually resulting in symptom improvement. There were no significant complications related to the procedure such as sensory dysesthesia, numbness or permanent motor weakness. CONCLUSION: RFN is safe and effective in treating the painful osteoporotic compression fracture. In patients with intractable back pain due to lumbar osteoporotic compression fracture, RFN of gray ramus communicans nerve should be considered as a treatment option prior to vertebroplasty.

Gray Ramus Communicans Nerve Block: A Useful Therapeutic Adjuvant for Painful Osteoporotic Vertebral Compression Fracture

OBJECTIVE: There are limited treatment options for patients with painful osteoporotic vertebral compression fracture(OVCF) in whom surgery is not strongly indicated or when pain persists even after vertebroplasty. Conservative treatments generally do not provide adequate or prolonged pain relief since the pain in these patients is thought to originate from within and surrounding vertebra. The purpose of this study is to verify the usefulness of percutaneous nerve block on gray ramus communicans in these patients. METHODS: We retrospectively analyzed 36 patients in whom nerve blocks on gray ramus communicans were performed for painful OVCF after failure of conservative therapy and/or after percutaneous vertebroplasty. Bilateral nerve blocks were done on the gray ramus tracts of the somatic nerve roots corresponding with OVCF under C-arm fluoroscopic guidance. Patient-reported pain scores and amount of analgesic medication were measured. RESULTS: All patients tolerated procedures well. Significant initial pain relief was noted in 34 (94.4%) patients and the pain relief was durable in 30(88.2%) of these 34 patients at last visit (at least 4 months after procedure). None of these patients required surgeries during the follow-up period. Decreased analgesic requirement was documented in 30(83.3%) of patients. There was no procedure related complication. CONCLUSION: Prompt and relatively prolonged improvement of pain without complication after this procedure in majority of patients with persistently painful OVCF supports its effectiveness and safety. Thus, it may be considered a useful adjuvant therapeutic option in these clinical settings.

The Efficacy of Radiofrequency Neurotomy of the Ramus Communicans Nerve for Intractable Chronic Discogenic Pain / 대한마취과학회지

BACKGROUND: Chronic discogenic pain is commonly intractable to various conservative treatments and anatomic correction through operation. Nowadays, a radiofrequency thermocoagualation technique applying the pathophysiologic mechanism that cause discogenic pain and the pathways of transmission of discogenic pain have been successfully tried. This study was performed to evaluate the efficacy of radiofrequecy thermocoagulation of the ramus communicans nerve in patients who suffered from intractable discogenic pain even after intradiscal electrothermal therapy. METHODS: The authors evaluated 13 cases in which radiofrequency thermocoagulation of the ramus communicans nerve was used for patients suffering from chronic discogenic pain even after intradiscal electrothermotherapy. Ten weeks after the procedure, we compared VAS scores of the pre- procedure and post-procedure state. RESULTS: Fifty-four percent of patients had an excellent decrease in the VAS score (VAS < 3). One patient complained of a mild motor weakness of the lower extremity but recovered completely by postoperative day 26. CONCLUSIONS: In the cases of intractable chronic discogenic pain, it is valuable to perform a rhizotomy of the ramus communicans nerve with radiofrequency.

OBSERVATIONS ON THE VASCULAR ARCHITECTURE OF THE GALL-BLADDER IN THE FULL TERM FETUS UNDER THE SCANNING ELECTRON MICROSCOPE / 解剖学报

The SEM specimens of the blood vessels of the gall-bladder in the full term fetus were produced with the methyl methacrylate cast. The specimens were dryed and gilded with EIKO. IB-3. and then observed under scanning electron microscope. The microvessels of the wall of gall-bladder obviously were divided into three layers, namely: serous vessels, muscular vessels and mucous vessels. The serous and muscular vessels are similar to that of the intestinal canal. However the mucous vessels were characterized by subepithelial capillary networks and veins of large calibre in the lamina propria. The capillary networks were connected directly with the venous plexus by the capillaries. There are fewer arterioles passing and branching among the venous plexuses. Each arteriole was connected to capillary networks. The short capillary was seen frequently between the arterioles and the venous plexus, serving as communication between them.