Pain physician
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Percutaneous endoscopic lumbar discectomy (PELD) has become an increasingly popular minimally invasive spinal surgery. Due to the technical evolution of PELD, the focus of decompression has shifted from the central nucleus to the subannular-protruded disc herniation, which allows direct neural decompression. Surgical entry into the spinal canal leads to the greater possibility of bony structure obstruction, thus the location and direction of the working channel are crucial. The existing preoperative measuring methods mainly rely on 2-dimensional (2D) x-ray images or MRI cross-sections. Because the bony structure and the trajectory are 3-dimensional (3D), the relationship between the anatomical lumbar structure and the working channel cannot be precisely evaluated. ⋯ Lumbar disc herniation, percutaneous endoscopic lumbar discectomy (PELD), transforaminal, trajectory, 3D method, quantitative measurement, angulation, bony structure obstruction.
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Meta Analysis
Prevalence of Recurrent Herniation Following Percutaneous Endoscopic Lumbar Discectomy: A Meta-Analysis.
Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgery for the treatment of lumbar disc herniation (LDH) with a smaller incision, decreased damage to soft tissues, faster recovery, and fewer postoperative complications. However, the exactly epidemiological prevalence of recurrent herniation after PELD remains unclear. ⋯ Percutaneous endoscopic lumbar discectomy, prevalence, recurrent herniation, meta-analysis.
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Combination therapy with a gabapentinoid and an opioid improves the quality of life (QOL) of patients with chronic pain. However, the role of combination therapy in patients with spinal cord stimulation (SCS) has not been evaluated. ⋯ Combination, drug therapy, gabapentin, multimodal analgesia, opioid, pain, pregabalin, spinal cord stimulation.
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Several meta-analyses have been performed to compare unilateral percutaneous kyphoplasty (PKP) and bilateral PKP in the treatment of osteoporotic vertebral compression fractures (OVCFs), but inconsistencies in the results have led to questions as to which technique is preferable. ⋯ Osteoporotic vertebral compression fractures, percutaneous kyphoplasty, meta-analysis.
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Randomized Controlled Trial
Transforaminal vs Interlaminar Epidural Steroid Injection for Acute-Phase Shingles: A Randomized, Prospective Trial.
The acute phase of shingles is characterized by severe pain, and one of the complications of shingles known as postherpetic neuralgia (PHN) is associated with prolonged pain. Although factors predicting the development of PHN, as well as its preventative measures, have been investigated, there is no single treatment effective for PHN. Some studies showed effectiveness of epidural injection to alleviate pain associated with acute-phase shingles. In these studies, epidural injection was performed by interlaminar (IL) approach. However, transforaminal (TF) approach may be more effective as it enables injection of steroids and local anesthetics closer to the dorsal root ganglion where inflammation primarily occurs. There have not been any studies comparing the analgesic effects of epidural injection approaches for pain associated with acute-phase shingles. ⋯ Shingles epidural steroid injection interlaminar approach; transforaminal approach, fluoroscopic, postherpetic neuralgia, VAS, SF-36.