Comparison of greater occipital nerve blockade with radiofrequency and steroid in chronic migraine.

OBJECTIVES: The study aims to retrospectively compare steroid and radiofrequency treatments for the greater occipital nerve(GON) under ultrasound guidance in chronic migraine. METHODS: Monthly average headache attack frequency, attack duration, visual analog scale(VAS) and the number of days analgesics were taken were recorded. Under ultrasound guidance, GON block was administered once a week for a total of four sessions. In the final session, 4 mg of dexamethasone was added to the local anesthetic for the steroid group (n:26). Pulsed radiofrequency (RF) treatment was applied to the RF group (n:25) just before the last session of the GON block. The pain course in the week following the procedure monthly average headache attack frequency, attack duration, VAS and the number of days analgesics were taken in a month were compared for both groups at 1-3-6 months. RESULTS: In the first month, a statistically significant decrease in attack frequency was observed in the RF group. However, no statistically significant differences were found between the groups in other findings at different time intervals. A significant decrease headache attack duration,VAS, and the number of days analgesics were taken in a month was observed in both treatment groups. Both treatments were found to be effective, but the effect size of the treatment was higher in the RF group compared to the steroid group. CONCLUSION: Although the results were better in the group receiving pulsed RF treatment, except for the attack frequency in the first month, no statistically significant superiority of one treatment method over the other was determined.

The Long-Term Effects of Plasma Disc Coagulation Therapy for Cervical Disc Hernia.

OBJECTIVES: Recently, plasma disc coagulation therapy (PDCT) has been used in the treatment of lumbar and cervical disc hernia (CDH), but the long-term effects of PDCT have not been well documented. The aim of this study was to assess the long-term effects of PDCT on pain score, disc volume and patient satisfaction in patients with CDH. METHODS: Eighty patients with CDH, who underwent PDCT treatment, were included in the study. The patients demographics and pain scores (visual analog scale-VAS) were recorded on the baseline and in the 1st, 3rd, 6th and 12th month after PDCT treatment. We evaluated patient satisfaction and disc volume on the 12th month after PDCT. RESULTS: A statistically significant and time-dependent decrease was determined in VAS score. The initial mean VAS score was 6.5 ± 0.9, and it decreased to 3.4 ± 0.2 on the final follow-up (p<0.01). According to magnetic resonance imaging pathology, VAS score after PDCT was higher in patients with an extruded disc when compared to patients with bulging and protruded discs at all times (p<0.05). After 12 months, 50 % of the patients were reported as excellent and 8.7 % of the patients reported as poor based on the Odoms' criteria. Disc volume decreased after PDCT treatment in the patients who reported that they were excellent based on the Odoms' criteria (p<0.01). CONCLUSIONS: This study demonstrated that PDCT is a safe, effective and minimally invasive treatment technique for adequately selected patients with CDH.

Intradiscal ozone therapy for lumbar disc herniation.

The rationale behind intradiscal O2-O3 therapy is the pain elicited by the mechanical compression of the nerve root, which is associated with periganglionic and periradicular inflammation. This study aimed to determine the effect of intradiscal ozone injection on pain score and satisfaction of patients with low back pain (LBP) secondary to disc herniation. Patients with LBP diagnosed with disc herniation were enrolled in this clinical trial. After prepping and draping the area, intradiscal injection of ozone/oxygen mixture (10 ml, 25µg/ml) was performed under fluoroscopy guide (c-arm). Pain score and patient satisfaction were assessed prior to the injection (baseline) and 1, 3, 6, 12 and 24 months after the injection. Sixty three patients (24 males, 39 females) with mean age of 53.3 ±2.0 y enrolled in the study. The mean±standard deviation (SD) of pain score before intervention was 6.968 ±0.11. Pain score was reduced to 4.25±0.19 at 1 month, 4.33±0.20 at 3 months, 4.87 ±0.21 at 6 months and 5.22 ±0.20 at 24 months. According to the modified MacNab scale success of pain relief was as follows: excellent: 4 (6.3%), good: 17 (26.98 %), sufficient: 13 (20.63 %), poor: 13 (20.63 %), no result: 11 (17.46%), negative: 4 (6.3 %). Intradiscal ozone therapy was determined to provide improved outcomes in patients with single level of bulging and protrusion.