Neuraxial pathology and regional anesthesia: an education guide to decision-making.

In current clinical practice, spinal anesthesia and analgesia techniques-including epidural and subarachnoid procedures-are frequently executed without imaging like X-ray or epidurography. Unrecognized spinal pathology has resulted in serious morbidity in the context of performing neuraxial anesthesia. Typically, preoperative consultations incorporate a patient's medical history but lack a detailed spinal examination or consideration of recent MRI or CT scans. In contrast, within the domain of pain clinics, a multidisciplinary approach involving anesthesiologists and neuroradiologists is common. Such collaborative settings rely on exhaustive clinical history and scrutinization of recent imaging studies, which may influence the decision to proceed with invasive spinal interventions. There are no epidemiological data concerning rates of the different baseline pathologies that would potentially pose morbidity risks from neuraxial procedures, but the most common among these is canal stenosis, which significantly affects almost 20% of people over 60 years of age. This paper aims to elucidate these critical findings and advocate for incorporating meticulous preoperative assessments for individuals slated for spinal anesthesia or analgesia procedures, thereby attempting to mitigate potential risks.

Prone Position MRI of the Lumbar Spine in Patients With Low Back Pain and/or Radiculopathy Refractory to Treatment.

BACKGROUND: There are patients with limiting low back pain (LBP) with or without radicular pain in whom conventional supine magnetic resonance imaging (MRI) show no causative pathology. Despite the limitations of dynamic axially loaded MRI examinations, these imaging studies have shown a striking ability to diagnose pathology unrecognized by conventional MRI. The difference in findings between supine and prone MRI with patient symptom correlation has not been studied. METHODS: Nineteen patients suffering from chronic moderate-to-severe LBP and/or radicular pain nonresponsive to conventional therapy or interventional treatment, were included in this study. Both supine and prone MRIs were performed and analyzed by a neuroradiologist. Specific supine and prone measurements were registered, including spinal canal area, lateral recess diameter, foraminal area, and ligamentum flavum thickness. Three-dimensional  MRI reconstructions of varying pathology patterns were created. RESULTS: The mean patient age was 48.7 years (range [R]: 30-69), 63% of patients were women. The mean numeric pain score  was 6.5 (R: 4-8). In 52.6% of cases, disc pathology/increased disc pathology was seen only on prone imaging. We observed significant buckling and increased thickness of the ligamentum flavum in 52.6 % of cases in the prone position that was absent from the supine MRIs. We also documented varying grades of spondylolisthesis and facet joint subluxation resulting in significant foraminal stenosis in 26.3% of prone cases not seen from supine MRIs. CONCLUSIONS: Four patterns of pathological findings have been identified by MRI performed in the prone position. These findings were not observed in the supine position. Prone MRI can be a significant and useful tool in the diagnosis and treatment of patients with back pain refractory to treatment whose conventional supine MRIs appeared unremarkable.

Anemia hemolítica autoinmune inducida por fármacos, como efecto adverso a vacuna frente a COVID-19, descripción de 1 caso y revisión de la bibliografía / Drug-induced autoimmune hemolytic anemia, as an adverse effect to a vaccine against COVID-19, description of 1 case and review of the literature

La anemia hemolítica autoinmune (AHAI) inducida por fármacos es un trastorno hematológico en cual se produce una destrucción inmnunitaria de los glóbulos rojos por anticuerpos. Los agentes más asociados son antibióticos y algunos quimioterápicos, pero también se han comunicadocasos asociados con diferentes vacunas, incluido tras las vacunas frente a la COVID 19. Presentamos un caso de AHAI cuyo probable desencadenante fue la vacuna COVID 19 Vaxzevria. (AU)

Drug-induced autoimmune hemolytic anemia (AIHA) is a hematological disorder in which an immune destruction of red blood cells by antibodies occurs. Frequent agents that produce this disorder are antibiotics and chemotherapeutic agents; cases associated with different vaccines have been reported, including COVID-19 vaccines. We report a AHAI probably induced by the COVID-19 Vaxzevria vaccine. (AU)

Neuralgia del pudendo: algoritmo de manejo diagnóstico y terapéutico desde una unidad del dolor / Pudendal neuralgia: algorithm for diagnostic and therapeutic management in a pain unit

Objetivo. Presentar un algoritmo de manejo del dolor perineal crónico severo con sospecha de neuralgia del trigémino. Casos. Se presentan 3 casos clínicos con etiología y evolución clínica diversa. Discusión. Análisis de los criterios diagnósticos y tratamientos vigentes. Evaluación de los casos a la luz del algoritmo de diagnóstico y tratamiento propuesto (AU)

Objective. To describe a new algorithm for the management of severe chronic perineal pain/pudendal neuralgia. Cases. We report 3 clinical cases with different etiologies and outcomes. Discussion. We analyze the diagnostic criteria and treatments and evaluate the rational management of these patients according to the algorithm (AU)