[ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME IN THE ABDOMINAL WALL].

INTRODUCTION: Anterior cutaneous nerve entrapment syndrome (ACNES) is one of the causes of chronic abdominal pain. Symptoms include intense focused chronic abdominal pain, affected by posture changes and exertion. Particularly noticeable are the lack of pathological findings in laboratory and imaging tests, from the most basic to the more advanced. Proper diagnosis and appropriate treatment depend on raising the clinical suspicion with typical findings on physical examination. Confirmation of the diagnosis is obtained by significant alleviation of pain following injection of local anesthetics into the maximal tender point. Acceptable treatment includes local injections (local anesthetics and occasionally corticosteroids), radiofrequency neurotomy and, if failed, surgery. Accurate diagnosis and proper treatment result in pain relief in most patients.

[ILIOHYPOGASTRIC NERVE ENTRAPMENT IN A CHILD - A RARE CAUSE FOR CHRONIC ABDOMINAL AND PELVIC PAIN IN CHILDREN].

INTRODUCTION: Entrapment of the iliohypogastric nerve is a rare cause of abdominal pain in children. We present a case report of a 12 year old girl with abdominal pain following a fall accompanied by nausea, vomiting and odynuria. Thorough investigation was normal and a non-organic cause was proposed. With no lasting improvement after local analgesic infiltration, a surgical attempt to disconnect sensory innervation was conducted but pain continued. A second surgical exploration was performed. A tear of the external oblique aponeurosis was found, entrapping terminal branches of the iliohypogastric nerve. A complete clinical resolution followed resection of the nerve and repair of the aponeurosis tear. Entrapment of abdominal cutaneous nerves should be considered in cases with chronic abdominal pain accompanied by localized tenderness and various visceral complaints. Normal laboratory and imaging findings are typical.

Nucleoplasty is effective in reducing both mechanical and radicular low back pain: a prospective study in 87 patients.

STUDY DESIGN: A prospective study of all patients with either mechanical back pain or radicular back pain who underwent nucleoplasty and were followed up prospectively. OBJECTIVE: To investigate the effectiveness of nucleoplasty procedure in terms of pain and quality of life using the visual analog scale and Oswestry disability questionnaires. SUMMARY OF BACKGROUND DATA: Nucleoplasty is a method of increasing popularity in the past few years. It has a role when dealing with pain of spinal origin either radicular or both radicular and mechanical after conservative treatment has failed and before open procedure. METHODS: Eighty-seven patients with a minimal follow-up of 1 year were prospectively followed after they underwent nucleoplasty procedure for either radicular or a combination of radicular and mechanical low back pain. All patients underwent physical examination and completion of visual analog scale score and Oswestry Disability questionnaires after 1, 3, 6, and 12 months. Thirty-nine of them were followed after 2 years. RESULTS: After 1 month, 66 patients (76%) were satisfied with the results. After 3 months, 60 patients (69%) had significant pain relief, whereas in 27 cases (31%) there was no improvement. After 6 months of follow-up, 57 patients (66%) had pain relief and in 30 cases (34%) there was no effect. At 12 months of follow-up, 55 patients (65%) showed good results and 30 patients (35%) had no effect. In the case of the 39 patients who were followed for 24 months, 23 patients (59%) had significant pain relief. A statistically significant reduction in the Oswestry index was also noted for the series in all intervals. Minor complication occurred in 23 patients (26%) who had transient discomfort and burning pain at the insertion site of the nucleoplasty wire. CONCLUSIONS: We concluded that the nucleoplasty technique is a safe and effective procedure for radicular or combined radicular and mechanical low back pain and should be used in selected cases before open surgery after conservative treatment has failed.

The correlation between Spurling test and imaging studies in detecting cervical radiculopathy.

BACKGROUND: Cervical spine symptoms are a major cause of visits to general or spinal orthopedic surgeons or even primary care physicians. Although in this era the imaging studies can precisely rule out or diagnose pathologies in the spine, all of these studies have limitations. Computerized tomography (CT) scan consists of radiation exposure to the patients and it should be done with caution. Magnetic resonance imaging (MRI) is a highly effective imaging tool, but in many countries it is still costly. The goal of our study was to determine whether a simple clinical test can help the clinician to identify the patients who need to be sent for these imaging studies. METHODS: Two hundred fifty-seven patients with clinical cervical radiculopathy underwent complete physical examination that also included the Spurling test. After that, all patients were sent to imaging studies of the cervical spine (CT and/or MRI). Correlation between the physical examination using the Spurling test to the imaging studies was done. RESULTS: Sensitivity of the Spurling test to nerve root pathology was 95% and specificity was 94%. CONCLUSION: This paper demonstrate that patients with positive Spurling test have probable nerve root pressure and should be sent for further imaging studies. In patients with negative Spurling test, the possibility of nerve root pressure is less likely.

Long-term outcome of decompressive surgery for lumbar spinal stenosis in octogenarians.

The purpose of our prospective study is to evaluate the surgical outcome among patients aged 80 years and above, who underwent surgery for lumbar spinal stenosis. We assessed patients' clinical and demographic data, procedures, perioperative complications, preoperative and postoperative pain intensity, basic activities of daily living (BADL), patients' satisfaction, the need for repeated surgery, and overall mortality. Thirty-nine patients more than 80 years of age were operated in our institution in the last decade. Twenty-five of them were followed-up with a mean 36.8 months after the operation. The Barthel index was used to evaluate pre and postsurgery ADL, and the visual analogue scale (VAS) was used to evaluate pain. The satisfaction rate of the patients before and after the operation and the complication rate were also evaluated. A significant reduction in VAS (P < 0.001) and a significant increase in the Barthel index (P < 0.001) were recorded. Seventy-six percent of the patients were very satisfied or somewhat satisfied with the operative results. Fifty-two percent of the patients had complications (0.9 complications per patients), however, about half of them were minor. No operative or perioperative mortality was noticed and the overall hospital stay for these elderly patients was 3.6 days on average. Surgery in very old elderly patients is safe and effective in the treatment of spinal stenosis, who did not respond well to the conservative treatment. The surgery did not increase the associated morbidity and mortality and most of the patients benefited from the surgery in terms of reduction in pain, increase in ADL and walking ability and overall increase in the satisfaction rate.

[Pulsed radiofrequency treatment of severe radicular pain].

UNLABELLED: Radiofrequency (RF) lesions have been used for over 25 years in the treatment of intractable pain of spinal origin. The conventional idea is that the heat generated in the tissue surrounding the electrode tip leads to destruction of nerve fibers. In case of mechanical back pain, an electrode positioned adjacent to the medial branch of the dorsal root may reduce the input of noxious nerve stimuli and alleviate pain. For treatment of patients with severe radicular pain the authors often apply pulsed radiofrequency current. This technique enables the application of a relatively high voltage near the dorsal root ganglion, avoiding the deleterious thermal effect of the current. It was found to exert a beneficial effect in cases of intractable radicular pain. This study reports the result of pulsed RF in 28 patients suffering from severe radicular pain treated by pulsed radiofrequency current with follow-up at periods of 3, 6 and 12 months after treatment. There were 20 cases of low back pain and 8 with neck pain, with an average age of 56.7 years. The first follow-up after 3 months revealed the following results: excellent results in 2 cases (7.1%), good results in 12 cases (42/9%), fair in 9 (32/1%) and 5 (17/9%) reported that their condition have not changed. Results after 6 and 12 months were excellent in 2 (both groups), good in 7 and 6 respectively, 11 fair (both groups) and unresponsiveness to treatment was noticed in 8 patients after 6 and 9 after 12 months. Significant reduction was found in the Visual Analog Scale for pain from an average of 8.8 to 4.2 after 3 months, 4.8 after 6 months and 4.9 after 1 year. CONCLUSION: Pulsed RF treatment is a safe and simple procedure to control radicular pain in the cervical and lumbar regions. Following the current study the authors stress the need for further prospective, double-blind studies for better investigation of this technique.