Ultrasound-guided cervical selective nerve block: A case series.

BACKGROUND: Cervical radiculopathy is characterized by pain, numbness, tingling, and weakness, mostly in an affected extremity, reflecting compression of a nerve in the neck is compressed or irritated where it emerges from the spinal cord. Diagnosis requires a detailed anamnesis, physical examination, and imaging. Physical therapy, exercise, medical therapy, and injections are the preferred treatments, but injections into the cervical region are only indicated if conservative treatment is ineffective. OBJECTIVE: This study explored the utility of selective cervical nerve root blocks (SNRBs) performed at various levels under ultrasound guidance (USG). METHODS: We evaluated patients diagnosed with cervical radiculopathy via physical examination and magnetic resonance imaging from November 2019 to March 2020. We included those who did not respond to conservative treatment and therefore received SNRBs at various levels. Sixty-three patients were evaluated over 6 months in terms of pain, functional status, and complications. RESULTS: We retrospectively evaluated patients with cervical herniated discs who received SNRBs at various levels between C4-7 under USG. Pain and functional status improved in month 1 and was maintained until at least month 6. CONCLUSION: SNRB injections performed under USG effectively treated pain and poor functional status in selected patients. The procedure is safe (especially) for patients who do not respond to conservative treatment.

Caudal epidural steroid injection for chronic low back pain: A prospective analysis of 107 patients.

BACKGROUND: Low back pain affects 80% of people worldwide at least once in a lifetime and reduces the quality of life and causes absence from work. OBJECTIVE: To evaluate the pain and functional status of patients with lumbar disc disease who received blind caudal epidural injections (CEI) for pain relief. METHODS: The records of 107 patients who had been given CEI between September 2017 and January 2018 were retrospectively analyzed. The inclusion criteria were age > 18 years, > 3-month history of low back pain, and diagnosis of lumbar disc disease by magnetic resonance imaging. The epidural injection solution consisted of 2 mL of betamethasone sodium and 8 mL saline. Follow-up examinations were conducted 3 and 6 months post-injection and the patients were evaluated using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: The most common disc pathology was at the L4-L5 level. The VAS and ODI scores indicated significantly reduced pain at 3 and 6 months compared with the pre-injection baseline. Two patients experienced total anesthesia and paresis of the lower limbs, but recovered fully after 2 weeks. Blood was aspirated during the injection in two patients, but second-attempt injections were successful in both cases. No other complications were observed. CONCLUSION: Our results suggest that the blind method is safe for administering CEI to patients with chronic low back pain in the absence of radiological screening and results in significant pain relief with improved functional capacity.

Autonomous image segmentation and identification of anatomical landmarks from lumbar spine intraoperative computed tomography scans using machine learning: A validation study.

PURPOSE: Machine-learning algorithms are a subset of artificial intelligence that have proven to enhance analytics in medicine across various platforms. Spine surgery has the potential to benefit from improved hardware placement utilizing algorithms that autonomously and accurately measure pedicle and vertebral body anatomy. The purpose of this study was to assess the accuracy of an autonomous convolutional neural network (CNN) in measuring vertebral body anatomy utilizing clinical lumbar computed tomography (CT) scans and automatically segment vertebral body anatomy. METHODS: The CNN was trained utilizing 8000 manually segmented CT slices from 15 cadaveric specimens and 30 adult diagnostic scans. Validation was performed with twenty randomly selected patient datasets. Anatomic landmarks that were segmented included the pedicle, vertebral body, spinous process, transverse process, facet joint, and lamina. Morphometric measurement of the vertebral body was compared between manual measurements and automatic measurements. RESULTS: Automatic segmentation was found to have a mean accuracy ranging from 96.38% to 98.96%. Coaxial distance from the lamina to the anterior cortex was 99.10% with pedicle angulation error of 3.47%. CONCLUSION: The CNN algorithm tested in this study provides an accurate means to automatically identify the vertebral body anatomy and provide measurements for implants and placement trajectories.

The incidence of impingement syndrome in cases of cervical radiculopathy: An analysis of 220 cases.

BACKGROUND: We hypothesized that cervical radiculopathy (CR) has a role in subacromial impingement syndrome (SAIS) etiology, which cannot be directly connected to anatomical causes. OBJECTIVE: We aimed to investigate the presence of cervical radiculopathy in patients with SAIS diagnosed clinically and radiologically. METHODS: Patients who had a clinical and radiological SAIS diagnosis between 2014 and 2016 were included in the study. Patients with secondary causes that led to SAIS were excluded. Cervical MRI of all patients with SAIS was examined for cervical radiculopathy. RESULTS: A significant (p< 0.05) relationship was found between SIAS and the presence of root compression on the same side. 35% of the patients with SIAS had root compression on the same side. CONCLUSIONS: Cervical radiculopathy and shoulder impingement syndrome can be easily confused due to the similarity of the symptoms and the anatomical proximity of the lesions. Although both diseases can occur with different mechanisms, we believe that there is a cause and effect relationship between them.

Effects of psychological factors on the clinical outcomes of fifth metacarpal neck fractures and their relation to injury etiology.

BACKGROUND: The fifth metacarpal neck fracture injuries are commonly found in patients who applied to emergency clinics. The mechanism of trauma in these types of injuries seems to be different and, in some cases, appears to be intentional. Psychological factors play an important role in the treatment and rehabilitation, as well as in the etiology of metacarpal neck fractures. However, to the best of our knowledge, no research has yet compared the clinical outcomes of patients with fifth metacarpal neck fractures caused intentionally with those of patients with such fractures caused by unintentional injuries. Our goal is to investigate the relationships between the mechanism of injury, socioeconomic status, and clinical outcomes of patients with fifth metacarpal neck fractures. METHODS: The study included 59 patients with fifth metacarpal neck fractures. The patients were separated into two groups. Group 1 consisted of patients with intentional injuries, and Group 2 consisted of patients with unintentional injuries. Both groups were evaluated in terms of the anger analysis, impulsivity, and the level of anxiety in relation to somatic findings Visual Analogue Scale (VAS) and The Disabilities of the Arm, Shoulder and Hand Score (QDASH). In addition, the relationship between anger, impulsivity, and anxiety scores with the socioeconomic status and educational level was assessed. RESULTS: It was observed that the anger and impulsivity values of Group 2 patients were lower than the Group 1, and the decrease in Group 2 was correlated with the VAS and Q-DASH values. Group 1 barrat impulsivity score 61.5 (42-78), anxiety score 64 (55-77), state anger score 20 (16-30), and Group 2 barrat impulsivity score 61 (55-69), anxiety score 66 (58-72), and anger score 19 (14-26) were found as mean values. The impulsivity score and anger score were found to be lower in Group 2 at the low educational level. The number of patients with a low income was found to be high in both groups, and the impulsivity score and the anger score were higher in Group 1, while the anxiety score was higher in Group 2. CONCLUSION: Sociodemographic factors and the etiology of intentional injuries could not be detected, but psychological factors play a role in the clinical sequelae of intentional fifth metacarpal fractures, their effects thereof on the hand function and the pain course after treatment.

Comparison of Intra- and Extramedullary Implants in Treatment of Unstable Intertrochanteric Fractures.

INTRODUCTION: Comparison was made of the clinical and radiological results of the surgical treatments of proximal femoral nail (PFN), dynamic hip screw (DHS) or proximal femoral locking compression plate (PF-LCP) in patients with AO 31A2.2/2.3 unstable intertrochanteric femoral fracture(ITF). METHODS: Evaluation was made of a total of 91 patients in respect of age, gender, time from fracture to surgery, operating time, amount of blood replacement, total hospitalisation, follow-up period, time to full weight-bearing, time to union, complications and Harris hip scores(HHS). RESULTS: A statistically significant difference was determined between the groups in respect of perioperative operating time, blood replacement and hospitalisation period with the values of the PFN group seen to be superior to those of the other two groups (p < 0.001). No significant difference was determined beween the DHS and PFN groups in respect of time to union and in the long-term HHS, both groups were seen to be superior to the PF-LCP group (p < 0.001). Full weight-bearing was statistically significantly earlier in the PFN group (p < 0.001). The numbers of implant failures was statistically significantly higher in the PF-LCP group (p < 0.001). CONCLUSION: The new generation intra-medullar nails are easy to apply and have more successful clinical results compared to extra-medullar implants in the treatment of A2 unstable ITF. Due to the high rates of implant failure, PF-LCP should not be preferred in these fractures.

Unexpected Diagnosis in Gluteal Region -A Primary Intramuscular Hydatid Cyst: A Case Report.

INTRODUCTION: Primary hydatid cyst is rarely seen in musculoskeletal system. This paper presents a case of an intramuscular hydatid cyst in gluteal region. CASE OF REPORT: We present the case of a 36-year-old woman affected by pain and a mass in her right gluteal region. Serological tests and radiographies were inconclusive. Ultrasonography showed a 52 mm × 47 mm diameter hypoechoic intramuscular cyst with septations. Computed tomography showed a cystic lesion located between muscle groups. The mass was excised under spinal anesthesia. It was a well-demarcated cystic lesion with 5 cm diameter. Albendazole chemotherapy was prescribed postoperatively. CONCLUSION: Hydatid cysts must be considered in differential diagnosis in patients with cystic masses in musculoskeletal system, especially in patients living in endemic areas.

Efficacy of subcutaneous lidocaine injection in venous insufficiency: a prospective, randomized, controlled study, and new treatment protocol.

[Purpose] The purpose of this study was to evaluate the efficacy of subcutaneous injection with lidocaine in patients with chronic venous insufficiency in the early stage. [Subjects and Methods] Patients (n=50) randomized to the treatment group received subcutaneous injections from a mixture of physiological saline sterile solution and lidocaine once a week to both legs below the knee for 5 sessions. Patients in the treatment group were also given ankle pumping exercises and compression stockings throughout the treatment. Patients randomized to the control group (n=50) received only ankle pumping exercises and compression stockings. Patients were evaluated using the visual analog scale (VAS) for pain and Chronic Venous Disease Quality of life Questionnaire (CIVIQ-20) for quality-of-life at months 1, 3, 6, at the end of month 12, and at the end of the injection treatment for 5 sessions. [Results] CIVIQ-20 and VAS results were significantly lower in the treatment group, than in the control group at months 1, 3 and 6. However, CIVIQ-20 and VAS results were not significantly different, compared with the pre-operative period at month 12. [Conclusion] We observed that 5-week subcutaneous lidocaine injection treatment was effective in patients who do not respond to oral medical treatment or in whom surgery is not considered.

Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options.

PURPOSE: This study was performed to compare the efficacy of treatment in three groups of patients with knee osteoarthritis (OA) given an intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid (HA) or ozone gas. METHODS: A total of 102 patients with mild-moderate and moderate knee OA who presented at the polyclinic with at least a 1-year history of knee pain and VAS score ≥4 were randomly separated into three groups. Group 1 (PRP group) received intra-articular injection of PRP × 2 doses, Group 2 (HA group) received a single dose of HA, and Group 3 (Ozone group) received ozone × four doses. Weight-bearing anteroposterior-lateral and Merchant's radiographs of both knees were evaluated. WOMAC and VAS scores were applied to all patients on first presentation and at 1, 3, 6 and 12 months. RESULTS: At the end of the 1st month after injection, significant improvements were seen in all groups. In the 3rd month, the improvements in WOMAC and VAS scores were similar in Groups 1 and 2, while those in Group 3 were lower (p < 0.001). At the 6th month, while the clinical efficacies of PRP and HA were similar and continued, the clinical effect of ozone had disappeared (p < 0.001). At the end of the 12th month, PRP was determined to be both statistically and clinically superior to HA (p < 0.001). CONCLUSION: In the treatment of mild-moderate knee OA, PRP was more successful than HA and ozone injections, as the application alone was sufficient to provide at least 12 months of pain-free daily living activities. LEVEL OF EVIDENCE: Therapeutic study, Level I.

Comparison of daytime and after-hours surgical treatment of supracondylar humeral fractures in children.

Reports on different types of surgical procedures show that night-time surgeries are often associated with a high number of complications than daytime surgeries. However, there are no data, and hence evidence that relate the outcome of supracondylar humeral fractures in children to the time of the day when the respective surgical procedure is implemented. In this study, we analyze the clinical and radiological outcomes of pediatric supracondylar humeral fractures surgically treated during daytime and night-time hours. In total, 91 patients with Gartland type-3 fractures were included; 47 patients treated between 0800 and 1700 h were defined as the daytime group and 44 patients treated between 1701 and 0759 h were defined as the after-hours group. Age, sex, affected side, fracture type, and day and time of operation were recorded. Any preoperative neurovascular injuries, open fractures, or ipsilateral fractures were noted. The surgical method, use of a medial pin or pins, operation time, any postoperative neurovascular complications, extent of successful reduction, fixation rate, any resultant deformity, and functional loss rate were evaluated. The two groups did not differ significantly in terms of operation time, open reduction rate, rate of poor reduction, extent of poor functional outcomes, or induction of deformity (P>0.05). The poor fixation rate was significantly greater in the after-hours group than in the daytime group (P<0.05). No significant between-group differences were evident in age, sex, affected side, or length of postoperative follow-up (all P-values>0.05). After-hours treatment of displaced supracondylar humeral fractures in children is associated with a higher poor fixation rate compared with daytime procedures. LEVEL OF EVIDENCE: therapeutic study (retrospective comparative study), Level III.

An Unexpected Complication after Headless Compression Screw Fixation of an Osteochondral Fracture of Patella.

This study evaluated complications associated with implant depth in headless compression screw treatment of an osteochondral fracture associated with a traumatic patellar dislocation in a 21-year-old woman. Computed tomography and X-rays showed one lateral fracture fragment measuring 25 × 16 mm. Osteosynthesis was performed with two headless compression screws. Five months later, the screws were removed because of patella-femoral implant friction. We recommend that the screw heads be embedded to a depth of at least 3 mm below the cartilage surface. Further clinical studies need to examine the variation in cartilage thickness in the fracture fragment.