Comparison of Two Methods of Epidural Steroid Injection in the Treatment of Recurrent Lumbar Disc Herniation

STUDY DESIGN: Prospective study. PURPOSE: We compared the effects of two methods of epidural steroid injection in patients with recurrent disc herniation. OVERVIEW OF LITERATURE: To our knowledge, there is no previous report of such a comparison in these patients. METHODS: The study was performed with 30 patients with relapsed lumbar disc herniation whose pain was not relieved by conservative remedies. The patients were divided into two groups, each of 15 patients, and entered the study for caudal or transforaminal injections. The degree of pain, ability to stand and walk, and the Prolo function score were evaluated in both groups before the injection and 2 months and 6 months after the injection. RESULTS: The degrees of pain reduction in the caudal injection group in the second and sixth months were 0.6 and 1.63, respectively, and in the transforaminal injection group were 1.33 and 1.56, respectively. The difference between the two methods was not statistically significant. Similarly, no other evaluated criterion showed a significant difference between the methods. CONCLUSIONS: In the current study, the caudal and transforaminal steroid injection methods showed similar outcomes in the treatment of relapsed lumbar disc herniation. However, more detailed patient categorizing may help in finding possible subgroups with differences.

efficacy of decompressive craniectomy in treatment of patients with massive hemispheric cerebral infarction

Massive cerebral infarction is often accompanied by early death, secondary to brain edema and trans-tentorial herniation. Several reports indicate beneficial effects of decompressive craniectomy in this situation, but the efficacy of this procedure is still a matter of debate. An experimental study in a period of 3 years was done on 23 patients with brain edema due to massive cerebral infarction; 11 patients were subjects and were operated, and 12 were in the non-operated group who only underwent conservative treatment. All patients in this study had GCS below 8. The mean age of the operated patients was 54.5 years and for the unoperated patients 64.4 years. Mean GCS in the operated cases was 7.00 and in the unoperated cases was 7.66. In the operated group 4 of 11 patients lived [36.4%] and in the unoperated group 1 of 12 cases lived [8.3%]. In the living operated cases, 1 had GOS 4 and 3 cases had GOS 3. In unoperated cases 1 patient lived who had a GOS of 2. These results show that decompressive craniectomy can be an effective lifesaving procedure for malignant brain edema after cerebral infarction and can also give acceptable functional recovery