The effectiveness of cervical transforaminal epidural steroid injection for the treatment of neck pain due to cervical disc herniation: long-term results.

AIM: To investigate the long-term effect of fluoroscopy guided cervical transforaminal epidural steroid injection on neck pain radiating to the arm due to cervical disc herniation. MATERIALS & METHODS: 64 patients (26 women [40.6%], 38 men [59.4%]; mean age, 44.9 ± 12.1 years) who had received fluoroscopy guided cervical transforaminal epidural steroid injection for neck pain due to cervical disc herniation at least 1 year before were included in the study. The effectiveness of transforaminal epidural steroid injection was assessed using data obtained by medical records and a standardized telephone questionnaire. Multiple linear regression analysis was applied to evaluate the factors affecting the pain reduction after injection and the duration of treatment effect. RESULTS: The mean duration of neck pain symptom was 23.3 ± 23.9 months. Most of the patients received a single injection (50 patients, 78.1%). The mean time since injection at the time of interview was 21.4 ± 9.4 months. There was a significant reduction in mean pain visual analog scale (VAS [10 cm]) score, from 8.6 ± 1.4 at baseline to 3.2 ± 2.5 at check visit two weeks after injection (p < 0.001). 52 patients (81.2%) reported pain relief of more than 50%. The mean duration of treatment effect was 13.3 ± 9.44 months. Greater pain on the VAS was found to predict strongly the higher pain reduction and longer treatment effect (p = 0.042 and 0.011, respectively). CONCLUSION: The results suggested that cervical transforaminal epidural steroid injections might be an effective treatment for neck back pain radiating to the arm due to cervical disc herniation.

Accuracy of ultrasound-guided suprascapular nerve block measured with neurostimulation.

Although the use of ultrasound (US) to perform suprascapular nerve block (SsNB) is rapidly gaining popularity, information about its accuracy is still lacking. The aim of this study was to investigate the proximity of the needle to suprascapular nerve under US guidance by means of neurostimulation current intensity in SsNB. The patients who were referred for SSnB due to shoulder pain were included in the study. The patients were placed in sitting position, and when the operator decided that the needle was in the correct place under US guidance, the time duration until that time and the current amplitude in that location were recorded. Current intensity was obtained by gradually increasing the amplitude until patient feels parestesia over the shoulder area or contractions of the supraspinatus or infraspinatus muscles. Out of 27 patients, in five patients current intensity was between 0.1 and 0.8 mA (successful) and time duration was 2.52 ± 1.67 min in this group; in 19 patients, current intensity was between 0.9 and 1.4 mA (semi-successful) and time duration was 1.86 ± 1.02 min in this group; in three patients, current intensity was ≥ 1.5 mA (unsuccessful) and time duration was 2.41 ± 1.02 min in this group. Our results show that the needle could not reach sufficient proximity to the suprascapular nerve with only US guidance by means of NS current intensity.

Consistency between physical medicine and rehabilitation specialists and a radiologist in interpretation of lumbosacral radiographs.

OBJECTIVE: To investigate intra- and inter-observer reliability among physical medicine and rehabilitation specialists and a radiologist in interpretation of plain lumbar spine X-ray films in patients with low back pain. METHODS: Three assessors (A: a resident of PM&R, B: an experienced PM&R specialist, C: an experienced radiologist) read the standard lumbosacral plain radiographs of 79 patients with 2-3 month time interval. Each assessor recorded the presence or absence of abnormalities on the radiograph according to a standardized assessment form. RESULTS: For assessors B and C, all kappa values were > 0.40. Transitional vertebrae abnormalities reached to the highest agreement ratio. The intrarater agreement showed higher kappas than the interrater agreement. The radiologists had the highest intrarater agreement, closely followed by the experienced PM&R specialist. Agreement among three assessors was substantial in sacralisation, lumbarisation and facet joint pathologies. CONCLUSION: We usually obtained a good intrarater agreement, especially for the experienced PM&R specialist and the radiologist indicating that experience increases diagnostic consistency. Besides the systematic differences in radiographic interpretation between the assessors, institutional specific conditions (esp. patient profile and regularities) may cause the phycians to pay more attention to a specific group of pathologies.

Inflammatory sacroiliitis in a man with spinal cord injury.

BACKGROUND: Inflammatory sacroiliitis associated with spinal cord injury (SCI) as an unusual cause of elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level has not been reported previously to our knowledge. OBJECTIVE: To represent a case of SCI associated with bilateral sacroiliitis causing ESR and CRP level elevation. METHODS: Case report of a man with T9 paraplegia. FINDINGS: ESR and CRP levels were high. Pelvic radiography was nearly normal, except for mildly blurred sacroiliac joints with normal margins. A 3-phase bone scan revealed bilateral sacroiliitis and heterotopic ossification at medial side of the left knee. Past history was significant for a recent urinary tract infection. Indomethacin and etidronate were prescribed. Significant decreases in ESR and CRP level were seen 1 month later. CONCLUSIONS: Sacroiliitis might be an unusual cause of elevated ESR and CRP levels in patients with SCI. Sensory and motor deficits may obscure the typical clinical presentation; therefore, imaging studies are essential for the diagnosis.