穴位注射配合整脊手法治疗神经根型颈椎病的临床观察

目的：观察穴位注射配合整脊手法治疗神经根型颈椎病的,临床疗效。方法：60例神经根型颈椎病病人接受穴位注射配合整脊手法治疗,观察周期为2个疗程,观察指标包括临床疗效的观察、McGill量表测评等。结果：60例神经根型颈椎病患者中,34例获得临床痊愈,22例获得好转,总有效率为95．88％。治疗后的PRI感觉分、PRI情绪分、PRI总分、VAS和PPI治疗前后的积分差值,与治疗前比较均有显著性差异（P〈0．01～0．05）。结论：穴位注射配合整脊手法治疗能够有效地干预神经根型颈椎病患者的临床症状、改善疼痛,促进其临床痊愈。     

Cervical posterolaterallaminoforaminotomy

Laminoforaminotomy is an effective treatment for cervical radiculopathy. We present our technique in conjunctionwith analysis of our long-term clinical results. The posterior approach in the surgical management of cervical radiculopathy is not only acceptable, but in certain cases is preferable to the anterior approach. When pathology is central, broad-based, and anterior, posterior procedures are unlikely to achieve decompression. However, with lateral or foraminal nerve root compression, the simpler posterior keyhole laminoforaminotomy is both safe and effective. Physicians advocating either the anterior or the posterior procedure exclusively are not providing, in our opinion, optimal care.     

下肢节段性神经根刺激H反射

探索理想的诊断腰骶神经根病的神经电生理技术。采用高压短脉冲电刺激技术直接刺激神经根，在比目鱼肌及半腱肌记录Ｈ反射，共检测正常人３０例，Ｓ１及Ｌ５神经根病２０例。（１）测定了比目鱼肌及半腱肌神经根刺激Ｈ反射正常值。（２）半腱肌和经目鱼肌ＮＲＳＨ在正常人可１００％记录到。９３）Ｌ５Ｓ１椎间隙及Ｓ１神经孔刺激，比目鱼肌及 半腱肌ＮＲＳＨ各参数相差均不显著。（４）单纯Ｓ１神经根病仅比目鱼肌ＮＲＳＨ异常，而     

Small keyhole transuncal foraminotomy for unilateral cervical radiculopathy

Summary Interbody fusion after anterior discectomy may lead to acceleration of degenerative changes at adjacent levels. Although the posterior approach preserves the motion segment, decompression of the nerve root is indirect if “hard disc prolaps” is the main cause. Recently, a technique of microsurgical anterior cervical foraminotomy for the treatment of radiculopathy with preservation of the segment mobility was published. In this study, we present this technique with several modifications. Thirteen patients – 5 men and 8 women with an average age of 49 years – with unilateral radiculopathy resistant to conservative treatment underwent microsurgical anterior foraminotomy via a small keyhole transuncal approach. The base of the uncinate process (UP) was directly drilled in the trajectory to the intervertebral foramen without destroying the disc tissue. The vertebral artery between the transverse process was not exposed. Furthermore, the functional anatomy of the uncovertebral joint remained largely intact. All patients experienced complete relief of radiating pain. A cervical collar was not used. Mean follow-up time was 19 months. The mobility of the operated segment was preserved in each patient. No instability of the cervical spine was seen. The microsurgical anterior foraminotomy via a small keyhole transuncal approach is safe, minimally invasive, and represents an effective method to treat unilateral cervical radiculopathy caused by disc prolaps and/or uncovertebral osteophytes. Additionally, the segment mobility is preserved and prevents the acceleration of degenerative changes at adjacent levels.     

Segmental overlap: foot drop in S1 radiculopathy

Summary Knowledge of segmental innervation of skeletal muscles is essential for diagnosing lumbar radiculopathy. Myotomes and dermatomes are traditionally thought to be innervated by a single spinal segment, but experimental studies have shown that this pattern of segmental innervation allows considerable overlap. This implies that muscles (or dermatomes) are innervated not only by axons of one spinal segment, but also partially by axons of adjacent spinal levels. We describe a patient in whom overlap in segmental innervation complicated adequate diagnosis of a recurrent lumbar hernia. Further, we present an outline of electrophysiological and anatomical studies on segmental innervation.     

Improvement of hip abductor muscle weakness after lumbar decompressive surgery

Abstract

Introduction. Degenerative lumbar spinal disorder is common in Japan, and the L5 nerve root is commonly involved in this disorder. The symptoms of L5 radiculopathy are irradiating lateral leg pain, and numbness and weakness of tibialis anterior and the hip abductor muscle. There has been only one report on the results of surgery for hip abductor muscle weakness caused by degenerative lumbar spinal disorder.

Patients and methods. In this study, we analyzed the strength of the hip abductor muscle before and after decompressive surgery in 26 cases and the relationship between the lumbar disc herniation (LDH) and lumbar spinal canal stenosis (LSCS) groups.

Results. Of the total 26 cases, muscle strength improved in 23 cases (88%), with complete recovery in 17 cases (65%). In the LDH group, the improvement rate was 92%. In the LSCS group, the improvement rate was 68%. Although the improvement rate for the LDH group was higher than that for the LSCS group, the difference was not significant (P = 0.054).

Discussion. Decompressive surgery may be an effective method to improve hip abductor muscle weakness in degenerative lumbar spinal disorder.     

Lenalidomide and thalidomide in the treatment of chronic pain

ABSTRACT

Introduction: Doxycycline is highly effective, inexpensive with a broad therapeutic spectrum and exceptional bioavailability. However these benefits have been overshadowed by its classification alongside the tetracyclines – class D drugs, contraindicated in pregnancy and in children under 8 years of age. Doxycycline-treatable diseases are emerging as leading causes of undifferentiated febrile illness in Southeast Asia. For example scrub typhus and murine typhus have an unusually severe impact on pregnancy outcomes, and current mortality rates for scrub typhus reach 12-13% in India and Thailand. The emerging evidence for these important doxycycline-treatable diseases prompted us to revisit doxycycline usage in pregnancy and childhood.

Areas Covered: A systematic review of the available literature on doxycycline use in pregnant women and children revealed a safety profile of doxycycline that differed significantly from that of tetracycline; no correlation between the use of doxycycline and teratogenic effects during pregnancy or dental staining in children was found.

Expert Opinion: The change of the US FDA pregnancy classification scheme to an evidence-based approach will enable adequate evaluation of doxycycline in common tropical illnesses and in vulnerable populations in clinical treatment trials, dosage-optimization pharmacokinetic studies and for the empirical treatment of undifferentiated febrile illnesses, especially in pregnant women and children.