Pain physician
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Vertebral hemangiomas are benign tumors with a rich vasculature. Symptoms may vary from simple vertebral pain, sometimes resistant to conservative medical treatment, to progressive neurological deficit. Surgery or radiotherapy have been the treatment of choice for several years, but they were worsened by intraoperative and postoperative hemorrhagic complications related to the rich vascularization that characterize these kinds of lesions, often preceded by a preoperative embolization in the acute setting. Recently, a percutaneous, minimally invasive technique of vertebroplasty has been introduced into clinical practice as an alternative to traditional surgical and radiotherapy treatment of symptomatic vertebral hemangiomas with or without features of aggressiveness at imaging studies. ⋯ PVP is an effective technique to treat symptomatic vertebral hemangioma, which is a valuable, minimally invasive, and quick method that allows a complete and lasting resolution of painful vertebral symptoms.
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Degenerative spondylolisthesis is one of the major causes for low back pain. Morphological abnormalities of the zygapophysial joints are a predisposing factor in the development of degenerative spondylolisthesis. Therefore, radiofrequency neurotomy seems to be a rational therapy. ⋯ Zygapophysial joints are a possible source of pain in patients with spondylolisthesis. Radiofrequency neurotomy is a rational, specific nonoperative therapy in addition to other nonoperative therapy methods with a success rate of 65%. This is the first study to determine the effect of radiofrequency neurotomy in patients with minor degenerative spondylolisthesis.
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Effective early antiviral treatments reduce both acute zoster pain and the risk of postherpetic neuralgia. The authors hypothesized that the direct neuraxial administration of acyclovir could provide superior drug application to the spinal neural structures with a higher viral burden and have various advantages over the other routes of drug administration in terms of required doses, side effects, and efficacy. ⋯ There was no evidence of neurological and histopathological abnormalities following intrathecal acyclovir injection.