Pain physician
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Although percutaneous endoscopic lumbar discectomy (PELD) is an effective treatment for herniated discs, its application in a disc with extensive migration is still challenging. As such, epiduroscopic laser neural decompression (ELND) provides a new view of the epidural space as well as an alternative treatment for a herniated disc and epidural fibrosis. In this paper the authors introduce the novel combination of PELD and ELND for high grade down-migrated disc herniation. ⋯ The patient reported significant reduction of pain after surgery. Postoperative magnetic resonance imaging (MRI) showed complete removal of the ruptured disc fragment. A combination of PELD and ELND may be an option of treatments for down-migrated disc herniation.
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Observational Study
Evaluation of Depression in Subacute Low Back Pain: A Case Control Study.
Low back pain (LBP) is the most common musculoskeletal disorder affecting the general population and it is believed to be associated with depression. ⋯ People with SLBP also have a significant increase in depression based on BDI scores, regardless of gender.
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Accurate puncture during percutaneous transforaminal endoscopic discectomy at the L5/S1 level in cases with high iliac crest and narrow foramen were difficult, even though the difficulties of foraminoplasty could be overcome by advanced instruments like reamers. ⋯ The novel isocentric navigation technique with a definite pathway is practical and effective in reducing puncture times among difficult puncture cases at the L5/S1 level, which may contribute to the capacity of PETD at the L5/S1 level.
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Improved intrathecal (IT) pump technology is increasing the accuracy of IT opioid bolus dosing and promising advances in pain therapy. Opioid bolus dosing can be used with a minimal continuous infusion or it can function as the sole therapy. Bolus-only dosing is characterized by minimal use of opioid (often less than 1 mg of IT morphine). ⋯ With new bolus dosing possibilities, IT pumps can be used earlier in the treatment algorithm instead of being a late-stage treatment for patients who responded poorly to conservative treatments. We hypothesize that morphine bolus-only IT dosing will have comparable adverse effect rates, and possibly increased safety as compared to the more conservative continuous delivery method. We further predict that bolus-only delivery will provide better therapy satisfaction, improved functional scores, lower 24 hour opioid dose, and less dose escalation.