The Korean journal of pain
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The use of fluoroscopy guidance together with the loss of resistance technique during epidural injections has been advocated lately; moreover, epidural injections in the absence of fluoroscopic guidance have a high rate of inaccurate needle-tip placement during the injections. However, the approach to the lower cervical and upper thoracic epidural space may be challenging due to its obscure lateral fluoroscopic views from overlying normal tissue structures. In this case, we report an alternative oblique C-arm fluoroscopy guided view approach to supplement the standard anterior-posterior and lateral fluoroscopic views to facilitate successful needle placement and precise anatomical localization of the epidural space.
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Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. ⋯ For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst.
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The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB). ⋯ SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.
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Spinal cord stimulation has become a widely used and efficient alternative for the management of refractory chronic pain that is unresponsive to conservative therapies. Technological improvements have been considerable and the current neuromodulation devices are both extremely sophisticated and reliable in obtaining good results for various clinical situations of chronic pain, such as failed back surgery syndrome, complex regional pain syndrome, ischemic and coronary artery disease. This technique is likely to possess a savings in costs compared with alternative therapy strategies despite its high initial cost. Spinal cord stimulation continues to be a valuable tool in the treatment of chronic disabling pain.