Efficacy of Preliminary Magnetic Resonance Imaging Measurement in Ultrasonography-Guided L4 Selective Nerve Root Block / 대한정형외과학회잡지

Purpose@#This study examined the utility of preliminary magnetic resonance imaging (MRI) measurements in the ultrasound-guided L4 selective nerve root block. @*Materials and Methods@#As a retrospective study, 71 patients, who met the criteria for outpatient visits from March 2016 to December 2017, were included. From March 2016 to February 2017, 31 patients who underwent an L4 nerve root block without MRI were classified as group A, and 40 patients who underwent an L4 nerve root block through MRI measurements from March 2017 to December 2017 were classified as group B. Group A was injected under ultrasound-guidance through the pararadicular approach without a pre-interventional MRI evaluation, and group B was injected under ultrasound-guidance according to the preliminary MRI measurements. The results were assessed using the numeric rating scale scores before, three hours, and two, six, and 12 weeks after the procedure. @*Results@#At three hours after the procedure, the proportion of patients better than good results were 51.6% in group A and 67.5% in group B. At two weeks after the procedure, the proportion of patients with better than good results were 48.4% and 70.0% in groups A and B, respectively; 58.1% and 62.5% of patient of groups A and B, respectively, showed better than good results after six weeks. In 12 weeks after the procedure, the results of group A and B were 67.7% and 62.5%, respectively. At three hours and two weeks after the procedure, group B showed significant symptom improvement than group A (p<0.05). The procedures were repeated 2.8 and 1.7 times in groups A and B, respectively, between two and six weeks for satisfactory pain relief (p<0.05). @*Conclusion@#A pre-interventional MRI evaluation might improve pain relief within the initial two weeks after ultrasound-guided L4 selective nerve root block by improving the success rate of the procedure.

Arthroscopic Treatment of a Type II Superior Labrum Anterior to Posterior (SLAP) Lesion Combined with a Bankart Lesion: Comparative Study between Debridement and Repair of Type II SLAP Lesion by the Status of Lesion

BACKGROUND: The purpose of this study is to evaluate results of superior labrum anterior to posterior (SLAP) repairs and debridement of type II SLAP lesions combined with Bankart lesions. METHODS: Between 2010 and 2014, total 58 patients with anterior shoulder instability due to a Bankart lesion combined with a type II SLAP lesion were enrolled. Patients were divided into two groups: group C consisted of 30 patients, each with a communicated Bankart and type II SLAP lesion and group NC consisted of 28 patients, each with a non-communicated Bankart and type II SLAP lesion. Bankart repairs were performed for all patients. SLAP lesions were repaired in group C and debrided in group NC. Clinical results were analysed to compare groups C and NC by using the visual analogue scale pain score, American Shoulder and Elbow Surgeons score, Constant scores, Rowe score for instability and range of motion assessments. RESULTS: The clinical scores were improved in both groups at final follow-up. Also, there were no differences between two groups. No significant difference was found in terms of the range of motion measured at the last follow-up. The number of suture anchors used was significantly higher in group C than in group NC (5.6 vs. 3.8; p=0.021). CONCLUSIONS: In this study, it is considered that Bankart repair and SLAP debridement could be a treatment option in patients with a non-communicated type II SLAP lesion combined with a Bankart lesion (study design: IV, therapeutic study, case series).

Treatment Options of Osteoporotic Vertebral Compression Fractures

This paper reviews previous studies on the treatment of osteoporotic vertebral compression fractures in elderly patients to determine what factors should be considered for successful treatment. In osteoporotic vertebral compression fractures, the primary treatment is conservative treatments. Other treatments include osteoporosis treatment, pain control, orthosis, and physical therapy. Recently, percutaneous catheterization or balloon plasty is performed for rapid pain recovery and early ambulation. Percutaneous catheterization or balloon posterior plasty is effective in reducing pain and improving the activity ability. Surgical treatment should be considered in cases of nonunion or osteonecrosis, dent, deformation, and spinal cord compression after conservative treatment has failed. In surgical treatment, posterior spinal fixation and vertebroplasty are more advantageous in terms of the amount of bleeding, operation time compared to the anterior approach, but the most appropriate method should be selected through the patient's condition and understanding of each surgical method.