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Ovidiu Palea, Michelle Granville, Robert E Jacobson
The clinical effectiveness of percutaneous and transforaminal endoscopic discectomy procedures has been evaluated by the system used or compared to open laminectomy or micro-discectomy but are not evaluated based on the location and characteristics of the abnormal disc. This review proposes that outcomes are primarily related to disc size, biomechanics, location, and associated segmental fibrotic and bone changes as well as the surgeon's skill in using various systems rather than the specific system used...
January 20, 2018: Curēus
Tae June Park, Ho Jun Lee, Jae Seong Kim, Kiyeun Nam
BACKGROUND: Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors. OBJECTIVE: Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis...
March 9, 2018: Journal of Back and Musculoskeletal Rehabilitation
Nikhil Jain, Frank M Phillips, Tristan Weaver, Safdar N Khan
STUDY DESIGN: Retrospective, economic analysis. OBJECTIVE: To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar fusion (PLF) for degenerative spine disease. We also evaluated associated costs, risk factors, and adverse events related to long-term postoperative opioid use. SUMMARY OF BACKGROUND DATA: Chronic opioid use is associated with poor outcomes and dependence after spine surgery...
March 20, 2018: Spine
Michael Galgano, Jared Fridley, Adetokunbo Oyelese, Albert Telfian, Thomas Kosztowski, David Choi, Ziya L Gokaslan
Metastatic spinal disease is a source of significant morbidity in patients with cancer. Recent advancements in adjuvant oncologic therapy has led to increased survival for many patients who harbor neoplastic disease. As a result of this, the chance of developing metastatic spinal disease over the course of a cancer patient's lifespan has increased. Symptomatic metastatic spinal disease can cause significant morbidity including severe pain, neurologic deficit, and loss of ambulation. Current treatment of these patients typically involves the use of multiple modalities, including surgery, radiation, and chemotherapy...
March 21, 2018: Expert Review of Anticancer Therapy
Y Sasabuchi, H Yasunaga, H Matsui, A K Lefor, K Fushimi, M Sanui
BACKGROUNDS AND AIMS: Epidural analgesia is an option for pain control in patients with acute pancreatitis. The aim of this study is to describe characteristics, morbidity and mortality of patients with acute pancreatitis treated with epidural analgesia. PATIENTS AND METHODS: Data was extracted from a national inpatient database in Japan on patients hospitalized with acute pancreatitis between July 2010 and March 2013. A total of 44,146 patients discharged from acute care hospitals were included in this retrospective cohort study...
July 2017: Acta Gastro-enterologica Belgica
Cassandra Wasson, Telianne Chon
A 28-year-old term G3P0020 received an epidural with complete pain relief. Approximately 19 hours after the epidural placement, the pain increased. Sensory levels were rechecked and were bilateral and adequate at T8. Further discussion revealed that the pain was unrelated to her contractions; it was in her buttocks and radiating down the leg. The possibility of the fetus being positioned occiput posterior (OP) was discussed. The patient was placed into knee-chest position with instantaneous relief of her pain...
January 17, 2018: Curēus
Andrew W Artenstein, Jennifer Friderici, Paul Visintainer
Introduction: Spinal epidural abscess (SEA), a highly morbid and potentially lethal deep tissue infection of the central nervous system has more than tripled in incidence over the past decade. Early recognition at the point of initial clinical presentation may prevent irreversible neurologic injury or other serious, adverse outcomes. To facilitate early recognition of SEA, we developed a predictive scoring model. Methods: Using data from a 10-year, retrospective, case-control study of adults presenting for care at a tertiary-care, regional, academic medical center, we used the Integrated Discrimination Improvement Index (IDI) to identify candidate discriminators and created a multivariable logistic regression model, refined based on p-value significance...
March 2018: Western Journal of Emergency Medicine
Hyo-Jin Byon, Sung-Jun Hong, Dae-Yu Kim, O Joo-Hyeon, In-Gon Lee, Dong-Ho Seo, Gyoung-A Heo, Hyunzu Kim
BACKGROUND: The aim of this study was to compare the mean lengths of the posterior longitudinal ligament (PLL) as the acoustic window during the thoracic paramedian epidural approach after shoulder rotation, while subjects were in the lateral decubitus or in the sitting position. METHODS: Thirty-two adult male volunteers were placed in the right decubitus position or sitting position on a horizontal operating table. To obtain an optimal ultrasound view for the PLL on the right side, thoracic spinal ultrasonography was performed at the T6/7 interspace using the paramedian oblique sagittal plane...
March 17, 2018: Anaesthesia, Critical Care & Pain Medicine
De-An Qin, Jie-Fu Song, Li-Ping Song, Gui-Sheng Feng
Background Pain management for multiple bone metastases is complex and often requires multidisciplinary treatment. We herein describe patient-centered multidisciplinary pain management for metastatic cancer. CASE PRESENTATION: A 61-year-old woman with multiple bone metastases of uterine cervical cancer developed intractable low back pain. After external beam radiotherapy failed, we performed lumbar spinal intralesional curettage, pedicle screw fixation, and nerve decompression. However, the neuralgia persisted...
January 1, 2018: Journal of International Medical Research
Yasmin Elkhashab, Andrew Ng
PURPOSE OF REVIEW: Coccygodynia is pain within the coccyx area. The diagnosis is made clinically with symptoms of pain in the coccyx region and worsening pain in sitting position. The initial treatment is conservative therapy. For patients who do not respond to conservative therapies, there are further interventions available. This includes local injection of local anesthetics and steroids, neurolysis of sacral nerve roots, caudal epidural block, pulse radiofrequency (PRF), intra-rectal massage and manipulation, ganglion impar block, levator ani massage and stretching, coccyx manipulation, and coccygectomy...
March 19, 2018: Current Pain and Headache Reports
M E Yaman, G Ergül, Y Güvenç, Y Öztürk, F K Erbay, T Tolunay, S Şentürk, C Kırçıl, G Bozkurt
Epidural fibrosis is a challenging topic in spinal surgery. Numerous clinical and experimental studies have been focused on this issue to clarify problems faced in spinal procedures for the patient as well as the surgeon and find out new methodologies. Dense cytokines and growth factors which are released from inflammatory cells have been suggested to play a major role in the inception and progression of fibrosis. One of the most investigated and important actor in epidural fibrosis is assumed to be the transforming growth factor-1β (TGF-1β) formation...
March 16, 2018: International Journal of Surgery
Amir Shaban, Toshio Moritani, Sami Al Kasab, Ali Sheharyar, Kaustubh S Limaye, Harold P Adams
BACKGROUND AND PURPOSE: Spinal cord hemorrhages are rare conditions that can be classified based on the primary location of bleeding into intramedullary (hematomyelia), subarachnoid hemorrhage (SAH), subdural hemorrhage, and epidural hemorrhage. We conducted a literature review to better understand the presenting symptoms, etiology, diagnosis, and treatment of spinal cord hemorrhages. METHODS: We performed a literature search using PubMed with the key words spinal hemorrhage, hematomyelia, spinal subarachnoid hemorrhage, spinal subdural hematoma, and spinal epidural hematoma RESULTS: Most commonly, spinal hematomas present with acute onset of pain and myelopathy but a more insidious course also may occur...
March 16, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Marco Ellis, Lisa Hwang, Ni-Ka Ford, Konstantin Slavin
BACKGROUND: Full-thickness scalp defects pose a reconstructive problem, especially in the setting of infection, chemotherapy/radiation, and underlying cranial defects. Current options include dermal matrices, skin grafts, and local flaps. Local flaps often fail, requiring subsequent microvascular free flap reconstruction. OBJECTIVE: To describe the visor flap, a novel bipedicled advancement flap design, and its role in reconstruction of scalp defects. METHODS: A retrospective review of 21 adult patients who developed scalp defects reconstructed using the visor flap from 2013 to 2017...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Daniel J Pak, Amitabh Gulati
The placement of thoracic epidural catheters is complicated by the layering of the vertebral lamina. Therefore, traditional blind palpation techniques require insertion of an epidural needle with likely contact of lamina with redirections into the epidural space. We discuss a safe and consistent technique using true real-time ultrasound visualization of the needle with a paramedian sagittal oblique view to improve the consistency of placing an epidural in the thoracic spine for postoperative analgesia. Successful epidural placement was achieved in every patient...
March 16, 2018: Regional Anesthesia and Pain Medicine
Yu-Ching Lin, Meei-Ling Gau, Ghi-Hwei Kao, Hung-Chang Lee
BACKGROUND: The physical positions that are adopted by women during childbirth significantly impact their childbirth outcomes and experiences. Literature studies have associated using a squatting position with reduced childbirth pain and increased comfort and pushing efficiency. However, the major disadvantage of the squatting position is that women may lack the muscular fitness and stamina necessary to sustain this position for a long period. PURPOSE: The aim of this study was to compare the pushing experiences and birth outcomes of three different pushing positions during the second stage of labor...
March 16, 2018: Journal of Nursing Research: JNR
Fabian Grass, Matthieu Cachemaille, David Martin, Nicolas Fournier, Dieter Hahnloser, Catherine Blanc, Nicolas Demartines, Martin Hübner
The purpose of this prospective cohort study was to compare multimodal pain management and pain perception after open vs. laparoscopic colorectal surgery within enhanced recovery care. Pain scores at rest and at mobilization were prospectively assessed in consecutive patients using Visual Analog Scales (VAS 0-10) and consumption of different analgesics was recorded daily until 96 hours postoperatively. Uni- and multivariate risk factors for pain peaks (≥ 4/10) were identified by logistic regression and compared between two propensity score matched groups (open vs...
2018: Bioscience Trends
Tao Yang, Fei Wang, Chaoshi Niu
The majority of spinal cavernous angiomas (CAs) originate from the vertebral bodies with or without epidural space extension. Solitary epidural CAs are rare. In the present study, we retrospectively reviewed the records of 12 patients who underwent microsurgery for solitary spinal epidural CAs. All patients had performed pre- and postoperative magnetic resonance imaging. The patients were 7 females and 5 males with the mean age of 52.1 years. Two tumors were located in the cervicothoracic spine, nine in the thoracic spine and one in the lumbar spine, respectively...
April 2018: Oncology Letters
Shu-Jun Lin, Lu-Xi Cao, Shao-Bing Cheng, Qiu-Fu Dai, Ji-Huan Lin, Liu Pu, Wei-Hao Chen, Yu-Juan Zhang, Shu-Lian Chen, Yi-Min Zhang
OBJECTIVE: To study the effect of acupuncture on the TLR2/4-NF-κB signalling pathway in the cortex of Sprague-Dawley rats following traumatic brain injury (TBI), and investigate the possible mechanism underlying the effects of acupuncture on scar repair. METHODS: TBI was established using Feeney's free-falling epidural percussion model. In total, 108 rats were randomly divided into a normal group (n=18), untreated TBI model group (TBI group, n=36) and manual acupuncture-treated TBI group (TBI+MA, n=36)...
March 17, 2018: Acupuncture in Medicine: Journal of the British Medical Acupuncture Society
Yun-Sik Dho, Hyoungmin Kim, Kyu-Chang Wang, Seung-Ki Kim, Ji Yeoun Lee, Hee Young Shin, Kyung Duk Park, Hyoung Jin Kang, Il Han Kim, Sung-Hye Park, Ji Hoon Phi
PURPOSE: s: Spinal epidural lymphoma with compressive myelopathy is a rarely found condition. The aims of this study are to describe the clinical features and to analyze its treatment outcome and prognostic factors. MATERIALS & METHODS: We searched for all pediatric patients with newly diagnosed spinal epidural lymphoma from 1999 to 2014 in our institution. We evaluated the clinical features, including neurological status, time interval to treatment, treatment modality, and outcomes...
March 14, 2018: World Neurosurgery
Min Kyoung Kim, Sung Eun Sim, Yong-Chul Kim, Jung Soo Kim, Seok Min Kwon, Yongjae Yoo, Chang-Soon Lee, Jee Youn Moon
BACKGROUND: Percutaneous cervical nucleoplasty (PCN) is an effective treatment for cervical herniated intervertebral disc (C-HIVD). In this retrospective study, we evaluated clinical predictors that affect the successful outcome of PCN. METHODS: Fluoroscopy-guided PCN was conducted for C-HIVD by one pain physician. Successful outcome was defined as a combination of > 50% pain relief on the numerical rating scale (NRS) pain score, no increase in analgesics, and no cervical epidural steroid injection during the 3-month follow-up period...
March 13, 2018: World Neurosurgery
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