Pain physician
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Balloon-assisted kyphoplasty (BAK) is a well-accepted treatment for symptomatic vertebral compression fractures (VCF) secondary to osteoporosis. Some have raised a concern of an increased incidence of adjacent fractures due to alterations in spine biomechanics after cement augmentation. The incidence of subsequent VCFs following BAK is poorly understood. The aim of this study was to investigate the timing, location, and incidence of new VCFs following BAK and to identify risk factors associated specifically with the occurrence of new adjacent level fractures. ⋯ Symptomatic compression fractures after BAK are relatively uncommon and may occur long after the initial kyphoplasty procedure. Only half of subsequent fractures occur immediately adjacent to the initially treated level; the others occur remotely. Patients with a single symptomatic thoracic or lumbar fracture suffered from remote and adjacent level fractures equally. In contrast, all patients who suffered both a thoracic and lumbar fracture at the same time had a second fracture at an adjacent level. Specific risk factors for remote versus adjacent level fractures could not be determined. Key words: Balloon kyphoplasty, cement augmentation, osteoporosis, vertebral compression fracture, adjacent level fracture, vertebroplasty.
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Open lumbar microdiscectomy (OLM) has been considered the gold standard in the management of lumbar disc herniation (LDH) for its favorable outcomes in long-term follow-up. Nowadays, percutaneous endoscopic lumbar discectomy (PELD) is gaining recognition. However, greatest limitation of studies of PELD is the lack of long-term follow-up outcomes. ⋯ PELD has favorable long-term outcomes.Key words: Long-term, PELD, endoscopic lumbar discectomy, revision rate, disc height, instability.
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Randomized Controlled Trial
Transversus Abdominis Plane Block in the Management of Acute Postoperative Pain Syndrome after Caesarean Section: A Randomized Controlled Clinical Trial.
The international literature is unclear regarding the analgesic efficacy of the transversus abdominis plane block (TAPB) after a Caesarean section (CS). ⋯ These results could confirm the assumption that the correct performance of an USG-TAPB as part of a multimodal analgesic treatment could represent a viable alternative to common analgesic procedures performed for acute postoperative pain control after a CS.Key words: Bowel function, Caesarian section, incident pain, local anesthetics, multimodal analgesic treatment, postoperative recovery, rest pain, ultrasound-guided TAP block.
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Radiofrequency (RF) treatment is a minimally invasive procedure that has been used for more than 3 decades in treating various chronic pain syndromes. Conventional (continuous) RF treatment occasionally results in worsening or even initiating a new type of pain. The use of pulsed radiofrequency (PRF), which has a non- or minimally neurodestructive neuromodulatory effect, serves as an alternative to conventional RF therapy in many medical situations. ⋯ PRF to the medial calcaneal nerve is a safe and effective method for treatment of chronic plantar fasciitis pain. The onset of effective analgesia can be achieved more rapidly with PRF compared to TRF on the same nerve. Further randomized trials are needed to confirm the therapeutic effect and optimizing the dose of RF needed.Key words: Pulsed radiofrequency, thermal radiofrequency, medial calcaneal nerve, plantar fasciitis, plantar aponeurosis, visual analogue scale.
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Entrapment neuropathies of the fibular nerve and its branches are often underdiagnosed due to the lack of reliable diagnosis using clinical examination and electrophysiologic evaluation. Most fibular nerve compressions may be classified into 2 broad categories: (a) mechanical causes, which occur at fibrous or fibro-osseous tunnels, and (b) dynamic causes related to nerve injury during specific limb positioning. Foot drop resulting from weakness of the dorsiflexor muscles of the foot is a relatively uncommon presentation and closely related to L5 neuropathy caused by a disc herniation. ⋯ Knowledge of normal MRI anatomy of the nerves in the knee and leg is essential for the precise assessment of the presence of peripheral entrapment conditions that may produce painless or painful drop foot. In conclusion, we stress the importance of preoperative anatomic mapping of entrapment neuropathies to minimize neurological complications. Key words: Foot drop, fibular nerve, ganglion cyst, proximal tibiofibular jointFoot drop, fibular nerve, ganglion cyst, proximal tibiofibular joint.