Jung Hoon Sul, Dana Hong, Joochul Yang, Tae Wan Kim, K. Park
Objective: A few cases of post-surgical spine syndrome (PSSS) are resistant to standard treatment. Intrathecal morphine (ITM) therapy can be used to achieve improved pain control with fewer side effects compared to systemic analgesics alone. ITM-associated complications may be associated with the intrathecal catheter, implanted pump, device management, and the drugs themselves.Methods: Twenty-six patients with PSSS were retrospectively evaluated. All patients had visual analog scale (VAS) scores of 7 or higher, which continued for more than 6 months, and all received a single dose of the ITM trial. If the VAS score was reduced by 50%, and there were no side effects from the trial, ITM pump (ITMP) implantation was performed for continuous morphine injection to control pain. Of the 26 patients, 19 underwent only the ITM trial, and 7 in whom the VAS decreased by more than 50% after the trial further underwent ITMP implantation. Patients who underwent only the trial were observed for an average of 5.4 days (range: 3–14 days), and those who underwent ITMP implantation were observed for an average of 55.9 months (range: 15–123 months). The occurrence of side effects following ITM injection and complications related to the ITM trial or ITMP implantation were analyzed. Results: The most common complications were drug side effects (n=11), followed by procedural (n=1) and equipment (n=1) side effects. The most common symptoms were urinary difficulty (n=8) and pruritus (n=3). Serious complications included a large lumbosacral subdural hematoma, intradural fibrotic tissues at the lumbar puncture site, and urinary retention (n=1). A case of mid-catheter occlusion caused by precipitated morphine crystals and skin infection on an implantable pulse generator was also reported (n=1). In another case, skin necrosis was observed in the surgical area (n=1). Conclusion: The most common drug-related side effect is urination difficulty, and patients generally recover within a few days after the ITM trial. Complications, such as procedure-related subdural bleeding or IT catheter blockage, may also occur. A better understanding of IT drugs, equipment, and meticulous procedural techniques, can allow a reduction of complications.
{"title":"Opioid-Related Side Effects and Complications After Intrathecal Morphine Trial or Pump Implantation","authors":"Jung Hoon Sul, Dana Hong, Joochul Yang, Tae Wan Kim, K. Park","doi":"10.35353/ajp.2022.00073","DOIUrl":"https://doi.org/10.35353/ajp.2022.00073","url":null,"abstract":"Objective: A few cases of post-surgical spine syndrome (PSSS) are resistant to standard treatment. Intrathecal morphine (ITM) therapy can be used to achieve improved pain control with fewer side effects compared to systemic analgesics alone. ITM-associated complications may be associated with the intrathecal catheter, implanted pump, device management, and the drugs themselves.Methods: Twenty-six patients with PSSS were retrospectively evaluated. All patients had visual analog scale (VAS) scores of 7 or higher, which continued for more than 6 months, and all received a single dose of the ITM trial. If the VAS score was reduced by 50%, and there were no side effects from the trial, ITM pump (ITMP) implantation was performed for continuous morphine injection to control pain. Of the 26 patients, 19 underwent only the ITM trial, and 7 in whom the VAS decreased by more than 50% after the trial further underwent ITMP implantation. Patients who underwent only the trial were observed for an average of 5.4 days (range: 3–14 days), and those who underwent ITMP implantation were observed for an average of 55.9 months (range: 15–123 months). The occurrence of side effects following ITM injection and complications related to the ITM trial or ITMP implantation were analyzed. Results: The most common complications were drug side effects (n=11), followed by procedural (n=1) and equipment (n=1) side effects. The most common symptoms were urinary difficulty (n=8) and pruritus (n=3). Serious complications included a large lumbosacral subdural hematoma, intradural fibrotic tissues at the lumbar puncture site, and urinary retention (n=1). A case of mid-catheter occlusion caused by precipitated morphine crystals and skin infection on an implantable pulse generator was also reported (n=1). In another case, skin necrosis was observed in the surgical area (n=1). Conclusion: The most common drug-related side effect is urination difficulty, and patients generally recover within a few days after the ITM trial. Complications, such as procedure-related subdural bleeding or IT catheter blockage, may also occur. A better understanding of IT drugs, equipment, and meticulous procedural techniques, can allow a reduction of complications.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129045255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Several recent studies have revealed that anterior cervical discectomy and fusion (ACDF) with i-factor, a bone substitute material, is safe and effective, with a superior fusion rate. Clinical studies with i-factor have thus far been shown favorable results, despite theoretical concerns; moreover, no adverse events related to i-factor after ACDF have been reported. Herein, we discuss two cases that presented unexpected bone formation after ACDF using polyetheretherketone (PEEK) cage with i-factor. A 60-year-old male patient underwent stand-alone ACDF surgery at the C4–5–6–7 level. The appropriate PEEK cage was selected, filled with an i-factor 2.5 mL divided into 1/3 that was intermixed with autologous bone chips, The patient developed mild dysphagia 1 month after surgery. A simple cervical spine radiograph showed unexpected bone formation in the anterior portion of the vertebral body at C6 and C7 levels. A 67-year-old male patient underwent stand-alone ACDF surgery at the C3–4 level. The appropriate PEEK cage was selected, filled with 1 mL of i-factor 1 mL that was intermixed with autologous bone chips. The patient developed mild dysphagia 3 months after surgery. Computed tomography (CT) scan revealed the presence of a bridging bone at the graft level, but showed unexpected bone formation in the anterior portion of the vertebral body. The unexpected bone formation causing dysphagia that we observed may be due to the high potent bone-inductive capacity of i-factor, but instead because there are no guidelines on proper dosage and usage. Further biomechanical studies are required to determine the optimal dose and usage instruction of i-factor.
{"title":"Unexpected Bone Formation after Stand-Alone Anterior Cervical Discectomy and Fusion Using Polyetheretherketone Cage with i-Factor","authors":"Seul-Kee Lee, Moon-Soo Han, B. Moon, Jung-Kil Lee","doi":"10.35353/ajp.2022.00066","DOIUrl":"https://doi.org/10.35353/ajp.2022.00066","url":null,"abstract":"Several recent studies have revealed that anterior cervical discectomy and fusion (ACDF) with i-factor, a bone substitute material, is safe and effective, with a superior fusion rate. Clinical studies with i-factor have thus far been shown favorable results, despite theoretical concerns; moreover, no adverse events related to i-factor after ACDF have been reported. Herein, we discuss two cases that presented unexpected bone formation after ACDF using polyetheretherketone (PEEK) cage with i-factor. A 60-year-old male patient underwent stand-alone ACDF surgery at the C4–5–6–7 level. The appropriate PEEK cage was selected, filled with an i-factor 2.5 mL divided into 1/3 that was intermixed with autologous bone chips, The patient developed mild dysphagia 1 month after surgery. A simple cervical spine radiograph showed unexpected bone formation in the anterior portion of the vertebral body at C6 and C7 levels. A 67-year-old male patient underwent stand-alone ACDF surgery at the C3–4 level. The appropriate PEEK cage was selected, filled with 1 mL of i-factor 1 mL that was intermixed with autologous bone chips. The patient developed mild dysphagia 3 months after surgery. Computed tomography (CT) scan revealed the presence of a bridging bone at the graft level, but showed unexpected bone formation in the anterior portion of the vertebral body. The unexpected bone formation causing dysphagia that we observed may be due to the high potent bone-inductive capacity of i-factor, but instead because there are no guidelines on proper dosage and usage. Further biomechanical studies are required to determine the optimal dose and usage instruction of i-factor.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114074259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seung-Jin Choi, Youn-Kwan Park, Joo-Han Kim, H. Moon, W. Kwon, C. H. Ham
Objective: Computed tomography (CT) is an often-used diagnostic imaging tool during the evaluation of the cervical spine pathology. CT scan can provide one’s bone density by measuring Hounsfield’s unit. In anterior cervical discectomy and fusion (ACDF) surgeries, bone density may play an important role as it may relate to non-union. Therefore, the evaluation and consideration of the Hounsfield’s unit of sub-axial cervical vertebral body is important, especially during multi-level ACDF.Methods: Patients who have taken cervical CT scan pre-operatively to multi-level (3 or 4 levels) anterior cervical discectomy and fusion with anterior plating between June 2010 and August 2018, at our department were retrospectively reviewed. The bone density was estimated by measuring Hounsfield Unit (HU) of sub-axial vertebrae - C3 to T1 - by using PiViewStar imaging software program. Radiological evaluation of fusion was done by assessing postoperative plain X-rays and CT scans of 4 months and 1-year follow-up. The difference in HU were evaluated between different segments of sub-axial vertebrae. Then the fusion rate of the ACDF ending at C6 were compared to C7. All grouped values were tested for normality using the Shapiro-Wilk test. Matched-ANOVA and Fisher’s exact test was used.Results: A total of eighty patients were who underwent 3 or 4 level ACDF with anterior plate fixation were retrospectively reviewed. Bone density estimated from Hounsfield unit (HU) measurement of the sub-axial vertebral bodies ranges from 112.2 to 594.9 with the mean of 280.91. When comparing C5 with 6, 6 with 7, and 7 with T1 they showed significantly decreasing HU value with p-value<0.01 with mean difference of 49.10, 30.98, and 31.25, respectively. ACDF ending at C7 showed significantly lower fusion rate than C6 at 4 months and 1-year follow-up, respectively.Conclusion: The HU show a decreasing trend towards lower sub-axial cervical vertebral body. Furthermore, multi-level ACDF ending at C7 showed higher non-union rate than ending at C6. Although, there is no direct evidence that lower bone density at lower sub-axial cervical vertebrae is causative for non-union, it should be considered for pre-operative planning.
目的:计算机断层扫描(CT)是评估颈椎病理过程中常用的诊断成像工具。CT扫描可以通过测量亨斯菲尔德单位来提供一个人的骨密度。在前路颈椎椎间盘切除术和融合(ACDF)手术中，骨密度可能起重要作用，因为它可能与不愈合有关。因此，评估和考虑亚轴颈椎体的Hounsfield单位是很重要的，特别是在多级ACDF中。方法:回顾性分析2010年6月至2018年8月在我科行多节段(3、4节段)颈椎前路椎间盘切除术融合前路钢板术前颈椎CT扫描的患者。采用PiViewStar成像软件，测量C3 ~ T1亚轴椎体的Hounsfield Unit (HU)来估计骨密度。通过术后4个月和1年随访的平片和CT扫描来评估融合的放射学评价。评估不同亚轴椎节段间HU的差异。然后比较结束于C6的ACDF与C7的融合率。使用Shapiro-Wilk检验检验所有分组值的正态性。采用匹配方差分析和Fisher精确检验。结果:回顾性分析了80例行3、4节段ACDF并前路钢板固定的患者。亚轴椎体Hounsfield单位(HU)测量估计的骨密度范围为112.2 ~ 594.9，平均值为280.91。C5与6、6与7、7与T1比较，其HU值均显著降低，p值<0.01，平均差值分别为49.10、30.98、31.25。在4个月和1年的随访中，结束于C7的ACDF的融合率分别明显低于C6。结论:HU向下亚轴颈椎椎体呈下降趋势。此外，结束于C7的多级ACDF的不愈合率高于结束于C6的不愈合率。虽然没有直接证据表明下亚轴颈椎的低骨密度是导致骨不愈合的原因，但在术前计划时应考虑到这一点。
{"title":"Clinical Importance of Hounsfield Unit in Computed Tomography of Sub-Axial Cervical Vertebral Body.","authors":"Seung-Jin Choi, Youn-Kwan Park, Joo-Han Kim, H. Moon, W. Kwon, C. H. Ham","doi":"10.35353/ajp.2022.00059","DOIUrl":"https://doi.org/10.35353/ajp.2022.00059","url":null,"abstract":"Objective: Computed tomography (CT) is an often-used diagnostic imaging tool during the evaluation of the cervical spine pathology. CT scan can provide one’s bone density by measuring Hounsfield’s unit. In anterior cervical discectomy and fusion (ACDF) surgeries, bone density may play an important role as it may relate to non-union. Therefore, the evaluation and consideration of the Hounsfield’s unit of sub-axial cervical vertebral body is important, especially during multi-level ACDF.Methods: Patients who have taken cervical CT scan pre-operatively to multi-level (3 or 4 levels) anterior cervical discectomy and fusion with anterior plating between June 2010 and August 2018, at our department were retrospectively reviewed. The bone density was estimated by measuring Hounsfield Unit (HU) of sub-axial vertebrae - C3 to T1 - by using PiViewStar imaging software program. Radiological evaluation of fusion was done by assessing postoperative plain X-rays and CT scans of 4 months and 1-year follow-up. The difference in HU were evaluated between different segments of sub-axial vertebrae. Then the fusion rate of the ACDF ending at C6 were compared to C7. All grouped values were tested for normality using the Shapiro-Wilk test. Matched-ANOVA and Fisher’s exact test was used.Results: A total of eighty patients were who underwent 3 or 4 level ACDF with anterior plate fixation were retrospectively reviewed. Bone density estimated from Hounsfield unit (HU) measurement of the sub-axial vertebral bodies ranges from 112.2 to 594.9 with the mean of 280.91. When comparing C5 with 6, 6 with 7, and 7 with T1 they showed significantly decreasing HU value with p-value<0.01 with mean difference of 49.10, 30.98, and 31.25, respectively. ACDF ending at C7 showed significantly lower fusion rate than C6 at 4 months and 1-year follow-up, respectively.Conclusion: The HU show a decreasing trend towards lower sub-axial cervical vertebral body. Furthermore, multi-level ACDF ending at C7 showed higher non-union rate than ending at C6. Although, there is no direct evidence that lower bone density at lower sub-axial cervical vertebrae is causative for non-union, it should be considered for pre-operative planning.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129251343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seung-Jin Choi, C. H. Ham, H. Moon, Joo-Han Kim, Youn-Kwan Park, W. Kwon
We present a case of a L5/S1 extraforaminal stenosis (EFS), also known as far-out syndrome, in which ineffective multiple previous fusion surgeries were performed because of misdiagnosis. An 83-year-old man, complaining of back and left sided leg pain along the L5 dermatome for 5 years visited our institute claiming persistent pain even after 2 fusion surgeries at another hospital. A new magnetic resonance image (MRI) scan with a half coronal T1-weighted sequence revealed left L5/S1 EFS and resultant L5 nerve root compression. Because of the patient’s old age, history of angina and anti-platelet medications, a minimally invasive full-endoscopic decompression was performed. Afterwards the patient experienced immediate relief of the radicular pain, satisfied with the surgery. Diagnosis of L5/S1 EFS can be challenging especially when only routine sagittal/axial MRI scans are provided. Half coronal plane T1-weighted image MRI can be extremely helpful in diagnosis of this distinct pathology. Through this case report, we would like to emphasize the significance of half coronal MRI in diagnosis of L5/S1 EFS and also show a representative successful full-endoscopic decompression for the disease.
{"title":"Full Endoscopic Decompression for a Misdiagnosed Far-Out Syndrome (L5/S1 Extraforaminal Stenosis) in an Elderly Patient with L5 Radiculopathy: Case Report","authors":"Seung-Jin Choi, C. H. Ham, H. Moon, Joo-Han Kim, Youn-Kwan Park, W. Kwon","doi":"10.35353/ajp.2022.00052","DOIUrl":"https://doi.org/10.35353/ajp.2022.00052","url":null,"abstract":"We present a case of a L5/S1 extraforaminal stenosis (EFS), also known as far-out syndrome, in which ineffective multiple previous fusion surgeries were performed because of misdiagnosis. An 83-year-old man, complaining of back and left sided leg pain along the L5 dermatome for 5 years visited our institute claiming persistent pain even after 2 fusion surgeries at another hospital. A new magnetic resonance image (MRI) scan with a half coronal T1-weighted sequence revealed left L5/S1 EFS and resultant L5 nerve root compression. Because of the patient’s old age, history of angina and anti-platelet medications, a minimally invasive full-endoscopic decompression was performed. Afterwards the patient experienced immediate relief of the radicular pain, satisfied with the surgery. Diagnosis of L5/S1 EFS can be challenging especially when only routine sagittal/axial MRI scans are provided. Half coronal plane T1-weighted image MRI can be extremely helpful in diagnosis of this distinct pathology. Through this case report, we would like to emphasize the significance of half coronal MRI in diagnosis of L5/S1 EFS and also show a representative successful full-endoscopic decompression for the disease.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128401536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lim-joon Yoon, B. Moon, In-Suk Bae, H. Kang, Jae Hoon Kim, D. Kim
Objective: This study aimed to determine the association between redundant nerve root and clinical outcome after fusion for lumbar spinal stenosis by comparing outcomes in patients with or without redundant nerve root.Methods: A total of 163 patients who underwent spinal fusion surgery between January 1, 2014, and December 31, 2018, were enrolled. Patients were divided into two groups: with a redundant nerve root (R group) and without a redundant nerve root (N group). The clinical outcome of the two groups was compared using VAS and claudication distance.Results: A total of 46 patients had a redundant nerve root, while the remaining 117 did not. Symptom duration was significantly different between the two groups (R=41.0±25.0, N=24.1±12.2, p<0.001). Changes in the VAS score for lower extremity pain between the two groups at 1 year after surgery showed that patients without a redundant nerve root had significantly better outcomes than those with a redundant nerve root (R: 4.2±1.3 vs. N: 5.5±1.4; p<0.001). Conclusion: Redundant nerve root on MRI is associated with clinical outcome after fusion for lumbar spinal stenosis. Patients with a redundant nerve root had poor outcomes after fusion surgery for lumbar spinal stenosis than those without a redundant nerve root.
目的:本研究旨在通过比较有或无神经根冗余的患者的预后，确定腰椎管狭窄融合术后神经根冗余与临床预后的关系。方法:纳入2014年1月1日至2018年12月31日期间接受脊柱融合手术的163例患者。将患者分为有神经根冗余组(R组)和无神经根冗余组(N组)。采用VAS和跛行距离比较两组患者的临床疗效。结果:46例患者存在神经根冗余，117例患者无神经根冗余。两组患者症状持续时间差异有统计学意义(R=41.0±25.0,N=24.1±12.2,p<0.001)。两组术后1年下肢疼痛VAS评分的变化显示，无神经根冗余的患者预后明显优于有神经根冗余的患者(R: 4.2±1.3 vs. N: 5.5±1.4;p < 0.001)。结论:MRI显示的神经根冗余与腰椎管狭窄融合术后的临床预后有关。与无神经根冗余的患者相比，有神经根冗余的患者在腰椎管狭窄融合手术后的预后较差。
{"title":"Association between Redundant Nerve Root and Clinical Outcome after Fusion for Lumbar Spinal Stenosis","authors":"Lim-joon Yoon, B. Moon, In-Suk Bae, H. Kang, Jae Hoon Kim, D. Kim","doi":"10.35353/ajp.2021.00038","DOIUrl":"https://doi.org/10.35353/ajp.2021.00038","url":null,"abstract":"Objective: This study aimed to determine the association between redundant nerve root and clinical outcome after fusion for lumbar spinal stenosis by comparing outcomes in patients with or without redundant nerve root.Methods: A total of 163 patients who underwent spinal fusion surgery between January 1, 2014, and December 31, 2018, were enrolled. Patients were divided into two groups: with a redundant nerve root (R group) and without a redundant nerve root (N group). The clinical outcome of the two groups was compared using VAS and claudication distance.Results: A total of 46 patients had a redundant nerve root, while the remaining 117 did not. Symptom duration was significantly different between the two groups (R=41.0±25.0, N=24.1±12.2, p<0.001). Changes in the VAS score for lower extremity pain between the two groups at 1 year after surgery showed that patients without a redundant nerve root had significantly better outcomes than those with a redundant nerve root (R: 4.2±1.3 vs. N: 5.5±1.4; p<0.001). Conclusion: Redundant nerve root on MRI is associated with clinical outcome after fusion for lumbar spinal stenosis. Patients with a redundant nerve root had poor outcomes after fusion surgery for lumbar spinal stenosis than those without a redundant nerve root.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130811198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Se-Heum Park, Junseok W. Hur, Jang-Bo Lee, J. Park
Objective: Intractable back pain and radicular pain after lumbosacral spine surgery are challenges for surgeons because the pathophysiology of failed back surgery syndrome (FBSS) remains unknown. Various medications, exercise, reoperation, spinal cord stimulation, and various interventional treatments, such as epidural injection, and radiofrequency treatment, have been suggested as treatment options. However, the clinical outcomes for each treatment are unclear. Methods: We retrospectively evaluated clinical outcomes of consecutive FBSS patients who underwent revision operation or radiofrequency treatment from 2014 to 2017, who previously showed response to nerve block. Pain was analyzed preoperatively and 1 month, 6 months, and 12 months postoperatively using a visual analogue scale (VAS). Short Form 36 (SF-36) health survey and Oswestry Disability Index (ODI) scores were assessed preoperatively and 12 months postoperatively. Results: A total of 70 patients was included in the present study (33 males, 37 females). When comparing preoperative and postoperative 12-month results, back pain VAS score decreased from 5.5 to 4.2 for revision operation and from 5.1 to 4.7 for radiofrequency treatment. Leg pain VAS score decreased from 6.5 to 4.02 for revision operation and 6.2 to 4.3 for radiofrequency treatment. ODI score decreased from 70.9 to 36.1 for revision operation and 70.2 to 36.1 for radiofrequency treatment. SF-36 score increased from 28.9 to 64.1 for revision operation and from 29.6 to 59.6 for radiofrequency treatment. Differences between treatments were not statistically significant after 12 months (p>0.05) but were at 1 month (p=0.01). Conclusion: Compared with revision operation, radiofrequency treatment is not inferior on early clinical outcome (up to 1 year following the treatment) in terms of pain relief, functional capacity, patient satisfaction, and quality of life in patients with FBSS. Radiofrequency treatment can be considered in patients who are not good candidates for surgical treatment based on imaging results or underlying diseases and who are responsive to diagnostic/therapeutic nerve blocks.
{"title":"Early Clinical Outcome of Comparative Study between Revision Operation and Radiofrequency Treatment for Management of Failed Back Surgery Syndrome","authors":"Se-Heum Park, Junseok W. Hur, Jang-Bo Lee, J. Park","doi":"10.35353/ajp.2021.00017","DOIUrl":"https://doi.org/10.35353/ajp.2021.00017","url":null,"abstract":"Objective: Intractable back pain and radicular pain after lumbosacral spine surgery are challenges for surgeons because the pathophysiology of failed back surgery syndrome (FBSS) remains unknown. Various medications, exercise, reoperation, spinal cord stimulation, and various interventional treatments, such as epidural injection, and radiofrequency treatment, have been suggested as treatment options. However, the clinical outcomes for each treatment are unclear. Methods: We retrospectively evaluated clinical outcomes of consecutive FBSS patients who underwent revision operation or radiofrequency treatment from 2014 to 2017, who previously showed response to nerve block. Pain was analyzed preoperatively and 1 month, 6 months, and 12 months postoperatively using a visual analogue scale (VAS). Short Form 36 (SF-36) health survey and Oswestry Disability Index (ODI) scores were assessed preoperatively and 12 months postoperatively. Results: A total of 70 patients was included in the present study (33 males, 37 females). When comparing preoperative and postoperative 12-month results, back pain VAS score decreased from 5.5 to 4.2 for revision operation and from 5.1 to 4.7 for radiofrequency treatment. Leg pain VAS score decreased from 6.5 to 4.02 for revision operation and 6.2 to 4.3 for radiofrequency treatment. ODI score decreased from 70.9 to 36.1 for revision operation and 70.2 to 36.1 for radiofrequency treatment. SF-36 score increased from 28.9 to 64.1 for revision operation and from 29.6 to 59.6 for radiofrequency treatment. Differences between treatments were not statistically significant after 12 months (p>0.05) but were at 1 month (p=0.01). Conclusion: Compared with revision operation, radiofrequency treatment is not inferior on early clinical outcome (up to 1 year following the treatment) in terms of pain relief, functional capacity, patient satisfaction, and quality of life in patients with FBSS. Radiofrequency treatment can be considered in patients who are not good candidates for surgical treatment based on imaging results or underlying diseases and who are responsive to diagnostic/therapeutic nerve blocks.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127219140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Herniated nucleus pulposus is a common disease of the lumbar spine. Recurrence of disc herniation and subsequent disc degeneration are the most common problems following discectomy. Many first-time lumbar discectomy patients experience favorable outcomes; however, same-level recurrent discectomy can occasionally induce unfavorable results. Therefore, in this study, we retrospectively analyzed the risk factors for recurrence of lumbar disc herniation after discectomy.Methods: From January 2013 to December 2015, 226 patients underwent one-level discectomy in our department. We excluded patients with less than two years of follow-up, a previous spine deformity with a compression fracture, foraminal or extraforaminal discs, or a history of previous lumbar operation history, leaving 71 selected patients. Patients were divided into recurrent and non-recurrent groups and various factors were retrospectively compared between the groups.Results: Patients with preoperative disc space narrowing experienced recurrence less commonly; however, this was not statistically significant (10.0% and 25.5%, respectively; p=0.150). A disc height decrease of more than 20% during the follow-up period was a statistically significant risk factor for recurrence (36.4% and 14.3%, respectively; p=0.035), and grades 3 and 4, compared to grades 1 and 2, facet joint degeneration were also statistically significant risk factors for recurrence of disc herniation (41.2% and 14.8%, respectively; p=0.020).Conclusion: Patients who underwent more than a moderate degree of preoperative facet joint degeneration on the operated side and for whom the progression of disc space height decreased during the follow-up period may require closer observation for recurrence of disc herniation.
{"title":"Risk Factors for Recurrence of Disc Herniation After Single-Level Lumbar Discectomy","authors":"Yong Guk Kim, Joochul Yang, Tae Wan Kim","doi":"10.35353/AJP.2021.00003","DOIUrl":"https://doi.org/10.35353/AJP.2021.00003","url":null,"abstract":"Objective: Herniated nucleus pulposus is a common disease of the lumbar spine. Recurrence of disc herniation and subsequent disc degeneration are the most common problems following discectomy. Many first-time lumbar discectomy patients experience favorable outcomes; however, same-level recurrent discectomy can occasionally induce unfavorable results. Therefore, in this study, we retrospectively analyzed the risk factors for recurrence of lumbar disc herniation after discectomy.Methods: From January 2013 to December 2015, 226 patients underwent one-level discectomy in our department. We excluded patients with less than two years of follow-up, a previous spine deformity with a compression fracture, foraminal or extraforaminal discs, or a history of previous lumbar operation history, leaving 71 selected patients. Patients were divided into recurrent and non-recurrent groups and various factors were retrospectively compared between the groups.Results: Patients with preoperative disc space narrowing experienced recurrence less commonly; however, this was not statistically significant (10.0% and 25.5%, respectively; p=0.150). A disc height decrease of more than 20% during the follow-up period was a statistically significant risk factor for recurrence (36.4% and 14.3%, respectively; p=0.035), and grades 3 and 4, compared to grades 1 and 2, facet joint degeneration were also statistically significant risk factors for recurrence of disc herniation (41.2% and 14.8%, respectively; p=0.020).Conclusion: Patients who underwent more than a moderate degree of preoperative facet joint degeneration on the operated side and for whom the progression of disc space height decreased during the follow-up period may require closer observation for recurrence of disc herniation.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"75 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125998167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Ahn, Seu-ryang Jang, Sang-Bok Lee, Young-Woo Kim, Tae-Kyu Lee
Post-zoster neuralgia is an intractable pain by medical treatment. However, practice guidelines for invasive procedures of medically intractable post-zoster neuralgia are unclear, and it is not clear to apply to individual cases. In our study, the effect of spinal cord stimulation (SCS) for patients with post-zoster neuralgia was described in old patients with episodic pain with constant pain, which have been poorly controlled with oral and invasive treatments. We used an SCS device (Synergy2 IPG, model 7427; Medtronic Inc, Minneapolis, MN) equipped with an electrode (1×8 standard Lead model 977A290; Medtronic Inc, Minneapolis, MN). One lead was placed in the left lower margin of the T12 vertebral body (pulse width 60 ms, pulse rate 20 Hz, amplitude 2.5 V) and it covered on the distribution to left 10, 11, 12 thoracic dermatomes. VAS decreased to 3-4 after SCS compared with baseline VAS and was sustained by 3-4 for 1 week and by 3-4 at 1 month. After 6 months, the pain remained at 4-5. In morphine consumption, the baseline doses were 200 mg/day that significantly reduced to 120 mg/day and 90 mg/day after 1-month and 6-months post-procedure. The dose of gabapentin (1,800 mg/day) before treatment. The dose of gabapentin in the first month did not significantly decrease in taking gabapentin (1,200 mg/day ) compared with the baseline dose (1,200 mg/day). Consumption after 6 months was also significantly reduced by 900 mg/day.
{"title":"Effect of Spinal Cord Stimulation for Patients with Post-Zoster Neuralgia on the Trunk: A Case Report","authors":"J. Ahn, Seu-ryang Jang, Sang-Bok Lee, Young-Woo Kim, Tae-Kyu Lee","doi":"10.35353/ajp.5.1.17","DOIUrl":"https://doi.org/10.35353/ajp.5.1.17","url":null,"abstract":"Post-zoster neuralgia is an intractable pain by medical treatment. However, practice guidelines for invasive procedures of medically intractable post-zoster neuralgia are unclear, and it is not clear to apply to individual cases. In our study, the effect of spinal cord stimulation (SCS) for patients with post-zoster neuralgia was described in old patients with episodic pain with constant pain, which have been poorly controlled with oral and invasive treatments. We used an SCS device (Synergy2 IPG, model 7427; Medtronic Inc, Minneapolis, MN) equipped with an electrode (1×8 standard Lead model 977A290; Medtronic Inc, Minneapolis, MN). One lead was placed in the left lower margin of the T12 vertebral body (pulse width 60 ms, pulse rate 20 Hz, amplitude 2.5 V) and it covered on the distribution to left 10, 11, 12 thoracic dermatomes. VAS decreased to 3-4 after SCS compared with baseline VAS and was sustained by 3-4 for 1 week and by 3-4 at 1 month. After 6 months, the pain remained at 4-5. In morphine consumption, the baseline doses were 200 mg/day that significantly reduced to 120 mg/day and 90 mg/day after 1-month and 6-months post-procedure. The dose of gabapentin (1,800 mg/day) before treatment. The dose of gabapentin in the first month did not significantly decrease in taking gabapentin (1,200 mg/day ) compared with the baseline dose (1,200 mg/day). Consumption after 6 months was also significantly reduced by 900 mg/day.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"199 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122558060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tae Shin Kim, Junseok W. Hur, S. Ko, Juno Shin, J. Park
Objective: Patients with lumbar spinal stenosis experience a variety of symptoms, including back pain, and neurogenic claudication. However, these symptoms appear only after walking for a certain distance. Therefore, it is difficult to make an accurate diagnosis using conventional methods, which involve tests performed under resting conditions. Therefore, infrared thermography could be a helpful diagnostic tool. Methods: Eight patients, who had neurogenic claudication after walking a certain distance, were enrolled in this study. These patients underwent infrared thermography at least twice after they walked a certain distance (about 50 meters after walking for 10 minutes). Four other patients, who only had back pain but no claudication, were enrolled as the comparison groups. Results: Seven patients in the patient group showed a decrease of 0.6 to 2.3 degrees in body temperature, depending on the body regions evaluated, after walking a certain distance. However, in the comparison groups, only 1 patient had decreased body temperature after walking. Conclusion: Neurogenic claudication symptoms are present in spinal stenosis patients because of venous congestion, which causes neurogenic claudication and decreases surface temperature. Therefore, infrared thermography can be performed in patients not only in resting conditions but also in symptom-expression conditions. Hence, infrared thermography can help in the accurate diagnosis of lumbar spinal stenosis.
{"title":"Thermographic Findings in Patients with Lumbar Spinal Stenosis Before and After Walking","authors":"Tae Shin Kim, Junseok W. Hur, S. Ko, Juno Shin, J. Park","doi":"10.35353/AJP.4.2.25","DOIUrl":"https://doi.org/10.35353/AJP.4.2.25","url":null,"abstract":"Objective: Patients with lumbar spinal stenosis experience a variety of symptoms, including back pain, and neurogenic claudication. However, these symptoms appear only after walking for a certain distance. Therefore, it is difficult to make an accurate diagnosis using conventional methods, which involve tests performed under resting conditions. Therefore, infrared thermography could be a helpful diagnostic tool. Methods: Eight patients, who had neurogenic claudication after walking a certain distance, were enrolled in this study. These patients underwent infrared thermography at least twice after they walked a certain distance (about 50 meters after walking for 10 minutes). Four other patients, who only had back pain but no claudication, were enrolled as the comparison groups. Results: Seven patients in the patient group showed a decrease of 0.6 to 2.3 degrees in body temperature, depending on the body regions evaluated, after walking a certain distance. However, in the comparison groups, only 1 patient had decreased body temperature after walking. Conclusion: Neurogenic claudication symptoms are present in spinal stenosis patients because of venous congestion, which causes neurogenic claudication and decreases surface temperature. Therefore, infrared thermography can be performed in patients not only in resting conditions but also in symptom-expression conditions. Hence, infrared thermography can help in the accurate diagnosis of lumbar spinal stenosis.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123631593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Myungseok Lee, D. Kang, Young Suk Lee, Dong Hyun Chun, Ja Myeong Lee
Sacral insufficiency fracture occurs with normal stress on abnormal bone. Sacral fractures after posterior multilevel lumbosacral fusion are uncommon complications. Only a few case series and case reports have been published so far. Here we describe five patients who have sacral fracture after multilevel fusion surgery. We retrospectively reviewed all patients treated at our institution by the author (Pf. K) for sacral fractures following an instrumented spinal arthrodesis with extension to S1 during the period of 2008 to 2015 (Total 158 cases). We describe these five patients’ characteristics, risk factors, symptom after surgery, and treatment plan. There was delay in diagnosis because it was difficult to find it in plain radiography. Computed tomography and MRI can detect most such fractures. Thus, they should probably be performed routinely when patients complain of renewed buttock pain after lumbosacral fusion. There are mainly three optional treatments for sacral fracture: conservative treatment, sacroplasty, and revision operation. Three patients who underwent revision surgery explained that their back pain and leg pain were improved dramatically. Early surgery can be considered because it can help patients relieve pain and ambulation earlier. Even though treatment of choice for sacral fracture is conservative management, surgery should be considered as one of good options for sacral fracture.
{"title":"Risk Factor and Diagnosis of Sacral Insufficient Fracture after Multilevel Fusion: A Case Report and Literature Review","authors":"Myungseok Lee, D. Kang, Young Suk Lee, Dong Hyun Chun, Ja Myeong Lee","doi":"10.35353/AJP.4.2.38","DOIUrl":"https://doi.org/10.35353/AJP.4.2.38","url":null,"abstract":"Sacral insufficiency fracture occurs with normal stress on abnormal bone. Sacral fractures after posterior multilevel lumbosacral fusion are uncommon complications. Only a few case series and case reports have been published so far. Here we describe five patients who have sacral fracture after multilevel fusion surgery. We retrospectively reviewed all patients treated at our institution by the author (Pf. K) for sacral fractures following an instrumented spinal arthrodesis with extension to S1 during the period of 2008 to 2015 (Total 158 cases). We describe these five patients’ characteristics, risk factors, symptom after surgery, and treatment plan. There was delay in diagnosis because it was difficult to find it in plain radiography. Computed tomography and MRI can detect most such fractures. Thus, they should probably be performed routinely when patients complain of renewed buttock pain after lumbosacral fusion. There are mainly three optional treatments for sacral fracture: conservative treatment, sacroplasty, and revision operation. Three patients who underwent revision surgery explained that their back pain and leg pain were improved dramatically. Early surgery can be considered because it can help patients relieve pain and ambulation earlier. Even though treatment of choice for sacral fracture is conservative management, surgery should be considered as one of good options for sacral fracture.","PeriodicalId":219852,"journal":{"name":"Asian Journal of Pain","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121708433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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