Pain physician
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There is paucity in the literature directly comparing the clinical results between the paramedian and the midline interlaminar cervical epidural injections. ⋯ The paramedian approach showed the better direct injectate transfer over the ventral epidural space and subsequently superior clinical efficacy for the patients suffering from axial neck and/or interscapular pain secondary to cervical spine problems.
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Paraspinal muscle spasm caused by pain from a lumbar degenerative disc is frequently investigated in patients with low back pain. Radiofrequency ablation (RFA) surgery could alleviate paraspinal muscle spasms. ⋯ Hypersensitive sinuvertebral and basivertebral nerves are strongly associated with epidural neovascularization with adhesion and the pathological pain pathway in degenerative disc disease. Epidural neovascularization with adhesion reflects aberrant neurological connections, which are associated with reflex inhibitory mechanisms of the multifidus muscle, which induces spasm. RFA treatment of the region of epidural neovascularization with adhesion effectively treated chronic discogenic back pain and could induce paraspinal muscle spasm release.
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Percutaneous endoscopic lumbar discectomy (PELD), as a representative minimally invasive spine surgery technique for lumbar disc herniation (LDH), has been standardized. In PELD, tissues such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate were exposed, removed, and decompressed. However, during PELD, whether there is pain or not in the tissues under endoscope in LDH patients has never been thoroughly discussed in the previous research. ⋯ Tissues, such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate, have different kinds of pain in PELD for LDH.
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The costal pain is common in thoracic osteoporotic fracture patients. It is unclear why vertebral fracture patients without any specific nerve impingement on magnetic resonance imaging (MRI) present with costal pain. ⋯ The incidence of costal pain is significantly and positively associated with the width of the fractured vertebra in patients with osteoporotic thoracic vertebrae fracture.