The Relationship between the Lower Lumbar Disc Herniation and the Morphology of the Iliolumbar Ligaments Using Magnetic Resonance Imaging

OBJECTIVE: This research aimed to define the relationship between the lower lumbar disc herniation and the morphology of the iliolumbar ligaments using magnetic resonance imaging. METHOD: 24 male and 36 female patients were classified into two groups according to their disc herniation grade- those in whom the L5-S1 disc was less herniated than L4-5 disc, those in whom the L5-S1 disc was more herniated than the L4-L5 disc on magnetic resonance images. The lengths of iliolumbar ligaments were measured on T1- weighted coronal images. The angles of iliolumbar ligaments were measured on T1-weighted axial images. RESULTS: The length of iliolumbar ligament was not different between L4-L5 disc herniation and L5-S1 disc herniation. The degree of iliolumbar ligament angle difference (asymmetry of direction) at L5-S1 disc herniation was more deviated in paracentral disc herniation compared with central disc herniation. CONCLUSION: The morphology of the iliolumbar ligament, especially its asymmetry of direction, may be a factor influencing the development of disc herniation at L5-S1.

Poststreptococcal Reactive Arthritis in Sternoclavicular Joint: A case report

We report a patient with reactive arthritis induced by recent streptococcal infection. A 27 year man had suffered from fever, sore throat and pain on left sternoclavicular joint. Arthritis occurred two days after tonsillitis and involved left sternoclavicular joint. Left sternoclavicular joint showed redness, swelling and tenderness. There were no growth of microorganism in blood cultures, no evidence of group Abeta-streptococcus in throat cultures, but antistreptolysin-O (ASO) and c-reactive protein (CRP) serum titers were elevated in sequential monitoring. Bone scan showed focal hot uptake at left sternoclavicular joint and Gallium scan showed diffuse inflammation at left sternoclavicular joint and soft tissue biopsy around sternoclavicular joint showed mild chronic inflammation. We suspected septic arthritis and prescribed empirical antibiotics but his symptoms were wax and wane. From the poor responsiveness to antibiotics, sustained high titers of ASO and recent history of tonsillitis, we confirmed poststreptococcal reactive arthritis, and attempted high-dose anti-inflammatory drug (aspirin 6 gram). Left sternoclavicular and shoulder pain improved.

Effects of Translaminar Approach and Transforaminal Approach in Lumbar Epidural Steroid Injection

OBJECTIVE: The goal of this study was to compare the therapeutic and the functional value between translaminar approach and transforaminal approach of epidural steroid injection in patient with refractory radicular pain. METHOD: Among 31 patients with unilateral herniated nucleus pulposus (HNP) which was confirmed by physical examination and magnetic resonance imaging (MRI), 17 patients received a transforaminal approach and 14 patients received a translaminar approach. All patients were evaluated by independent observer and were checked by visual analogue scale (VAS), functional score before and 1 day, 2 weeks and 4 weeks after injection. RESULTS: The VAS of transforaminal approach was significantly lower than that of translaminar approach after 2 weeks and after 4 weeks (p<0.05), although there were no statistical difference before and 1 day after injection. The functional score of transforaminal approach was significantly higher than that of translaminar approach after 4 weeks (p<0.05), although there were no statistical difference before and 1 day, 2 weeks after injection. The translaminar approach needs more frequent injection (p<0.05). CONCLUSION: This study suggests that both translaminar approach and transforaminal approach could be valuable to the initial management of refractory radicular pain, but the duration of therapeutic effects was relatively short in translaminar approach. Transforaminal approach will be the promising treatment of refractory radicular pain, because it has better therapeutic efficacy, safety and longer duration of therapeutic effects than translaminar approach.