Sonography guided lumbar nerve and facet blocks: The first report of clinical outcome from Iran

IntroductionNerve root block (NRB) and facet block (FB) are viable options for pain arising from facet and lumbar disc herniation (LDH) not responding to conservative therapy but still not suitable for surgery. Classically, they are performed under fluoroscopy and computed tomography (CT) guidance, which have the disadvantages of radiation exposure and limited accessibility. The aim of this study was to assess the effectiveness of US guided FB and NRB in patients suffering from facet arthropathy and LDH.Methods14 patients were involved in the study. After defining nerve root (for NRB) or facet joints (for FB) under a standard US investigation, real-time injection of methylprednisolone and bupivacaine was performed. Pain was measured before and after procedure by VAS.ResultsTen patients underwent FBs (8 bilateral and 2 unilateral) and 4 underwent NRBs (2 bilateral and 2 unilateral). 11/14 (79%) patients improved after the block (8 in FB, 3 in NRB) and the VAS had significantly decreased 1 week after procedure (mean [range] −1.7 [−6 to 0]). For the 11 patients that improved after FB or NRB, the effect lasted for a mean of 59 days (range: 30–130 days). Analysis showed that neither block procedure (NRB vs. FB) nor block level (L4L5 vs. L5S1) had an effect on result.ConclusionsResults of our preliminary study shows that in appropriately selected patients, nerve root and facet blocks can be effectively performed under ultrasonography guidance without notable complications, with effects lasting for a mean 2 months.     

New evidence for structural integration across the cartilage-vertebral endplate junction and its relation to herniation

BACKGROUND CONTEXT

The cartilaginous and bony material that can be present in herniated tissue suggests that failure can involve both cartilaginous and vertebral-endplates. How structural integration is achieved across the junction between these two distinct tissue regions via its fibril and mineral components is clearly relevant to the modes of endplate failure that occur.

Asymptomatic isolated partial hiatal herniation of the pancreas: MDCT evaluation and anatomical explanation: Case report and review of literature

Isolated herniation of the pancreas through a gastroesophageal hiatus is an extremely rare condition, and only one case has been reported in the world literature. We describe a MDCT diagnosis of isolated partial hiatal hernia containing the body of a normal pancreas in an asymptomatic patient, give an anatomical explanation and review the corresponding literature. Clin. Anat. 26:1008–1013, 2013. © 2013 Wiley Periodicals, Inc.     

A unique case of pure lateral spinal cord herniation

BackgroundSpinal cord herniation (SCH) remains a challenging diagnosis for neuroradiologists and may require treatment challenging for neurosurgeons. Most cord herniations are usually found at anterior thoracic levels.Clinical presentationA 28-year-old woman presented at our department with a 7-year history of progressive myelopathy. MR analysis showed a displacement of the spinal cord in a lateral thoracic dural defect. The herniated cord was released using a microscope and the patient significantly recovered 6 months after surgery.ConclusionWe present a unique case of pure lateral SCH. In the light of reviewed literature and operative findings, the underlying pathophysiological mechanisms are discussed.     

腰椎间盘突出症针灸治疗的相关进展

腰椎间盘突出症(LIDP)是临床上最为常见的一类脊柱退行性变基本,由于年龄或外力等因素导致腰椎间盘髓核、纤维环及软骨板有不同程度的退行性改变后突出于后方或椎管内,导致相邻脊神经根遭受刺激或压迫,从而产生腰部疼痛下肢麻木等临床症状。该病症临床上主要以物理康复、对症止痛或手术治疗等方法。祖国传统中医针灸对腰椎间盘突出症临床疗效亦较为确切,因此本文对腰椎间盘突出症针灸治疗的相关进展做一简要综述,以期为临床腰椎间盘治疗针灸治疗提供一定的参考。     

Cerebellar swelling after surgery for medulloblastoma with leptomeningeal dissemination in children. A case based-update

ObjectDespite the improvement in the overall management of medulloblastomas in recent years, certain phenomena and in particular postoperative cerebellar swelling remain an enigma. This rare complication, little described in the literature, is nonetheless life threatening for the patients.Case reportsWe report our experience about two children who developed severe cerebellar swelling with hydrocephalus and upward herniation soon after a gross total resection of a fourth ventricle medulloblastoma by a telo-velar approach. Despite rapid management of ventricular dilation and optimal medical intensive treatment of intracranial hypertension, both children died quickly after the surgery. Pathological examination analyses were in favour of anaplastic/large cell medulloblastoma.DiscussionDiffuse cerebellar swelling with upward herniation may occur postoperatively in young children with anaplastic/large cell medulloblastoma with leptomeningeal spread. In the literature, only 4 cases have been so far described with delayed onset of symptoms. Two children survived with an aggressive management (decompressive surgery and early radio-chemotherapy).ConclusionCerebellar swelling is an unrecognised and sudden complication of posterior fossa surgery for metastatic anaplastic medulloblastoma with leptomeningeal dissemination in young children. An initial less invasive surgical approach could be considered in such cases, in order to prevent this complication with potentially tragic issue, and which cannot be managed with a CSF shunt alone.     

加减肾附丸治疗腰椎间盘突出症肾虚寒凝证的疗效观察

目的 观察加减肾附丸治疗腰椎间盘突出症肾虚寒凝证的近远期疗效。方法 100例患者被随机分为对照组和观察组，各50例。对照组口服美洛昔康片，每次7.5 mg，每日1次；观察组口服加减肾附丸，每次300 mL，每日2次，疗程均为3个月。治疗前后分别观察两组简化McGill疼痛积分量表（SF-MPQ），Oswestry腰背及下肢功能障碍指数（ODI），中医证候评分；检测全血黏度（高切、中切、低切），血清炎性因子［肿瘤坏死因子-α（TNF-α），白细胞介素-1β（IL-1β），白细胞介素-6（IL-6）］，疼痛介质［内皮素-1（ET-1），前列腺素E₂（PGE₂），环氧化酶-2（COX-2）］。观察两组临床疗效，随访12，24个月的复发率。记录研究期间两组患者出现的不良反应类型及时间。结果 治疗后，观察组患者总有效率98.0%（49/50），高于对照组的82.0%（41/50）（P<0.05）。随访12个月，观察组复发率23.9%（11/46）低于对照组的52.5%（21/40）（χ²＝5.193，P<0.05）。随访24个月，观察组复发率43.9%（18/41），低于对照组的80.6%（29/36）（P<0.05）。与对照组治疗后比较，观察组SF-MPQ，ODI，中医证候，全血黏度，IL-6，TNF-α，IL-1β，ET-1，PGE₂，COX-2明显降低（P<0.05）。观察组不良反应发生率2.0%（1/50），低于对照组的52.0%（26/50）（χ²＝6.264，P<0.05）。结论 加减肾附丸可明显改善腰椎间盘突出症肾虚寒凝证的患者的近远期临床疗效，不良反应发生率低。     

螺旋CT在腰椎间盘突出症的临床应用价值分析

目的:探讨螺旋CT应用在腰椎间盘突出症中的临床价值。方法:筛选经临床手术证实为腰椎间盘突出患者120例,作为研究对象。采用螺旋CT扫描及X线平片对所有患者腰椎间盘进行检查,比较两种检查手段诊断的正确率及病情评价情况。结果:螺旋CT诊断正确率为113例(94.17%),X线平片诊断正确率为93例(77.50%),二者比较,差异有统计学意义(P<0.05);螺旋CT对软组织病变、神经根及硬膜囊损伤评价结果较X线平片具有显著优势(P>0.05)。结论:应用螺旋CT检查腰椎间盘突出症具有诊断准确,可对腰椎神经根等病理性损伤做出准确评价,可指导临床治疗方案的选择。     

五步复位法治疗气滞血瘀型腰椎间盘突出症的临床疗效

目的 评价五步复位法治疗气滞血瘀型腰椎间盘突出症的临床疗效。方法 将2018年8月至2019年12月入组的70例气滞血瘀型腰椎间盘突出症患者随机分为两组,每组各35例。治疗组采用五步复位法治疗,对照组采用传统推拿法治疗,分别比较两组患者疗效及治疗前后疼痛评分、ODI功能障碍指数。结果 治疗1个疗程后,治疗组临床总有效率为91.43%,明显高于对照组的85.72%,差异有统计学意义(P0.05),治疗组临床疗效明显优于对照组,差异有统计学意义(P0.05)。治疗后两组VAS疼痛评分及ODI功能障碍指数均较治疗前降低,差异有统计学意义(P0.01),且治疗后治疗组ODI指数较对照组降低更为显著,差异有统计学意义(P0.01)。结论 五步复位法能明显提高气滞血瘀型腰椎间盘突出症临床疗效,更好改善腰椎功能,且方法简便验廉,值得临床推广应用。