Articles: low-back-pain.
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The superior and middle cluneal nerves are sources of low back, buttock, and leg pain. These nerves are cutaneous branches of the lateral branches of the dorsal rami of T11- S4. Pain arising from entrapment or dysfunction of one or more of these nerves is called "cluneal nerve syndrome." A clear understanding of the anatomy underlying cluneal nerve syndrome and its treatment has been hampered by the very small size of the cluneal nerves and their complex, varying anatomy. Because of differing methods and foci of investigation, the literature regarding cluneal nerves has been confusing and even contradictory. ⋯ Cluneal nerve syndrome is characterized by a triad of pain, tender points, and relief with local anesthetic injections. The pain is a deep, aching, poorly localized low back pain with variable involvement of the buttocks and/or legs. Tender points are localized at the iliac crest or caudal to the posterior superior iliac spine. Muscle weakness and dermatomal sensory changes are absent in cluneal nerve syndrome. If the pain returns after injections, neuroablation, nerve stimulation, or surgical release may be needed.
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Review Meta Analysis
Spinal Cord Stimulation in Failed Back Surgery Syndrome: An Integrative Review of Quantitative and Qualitative Studies.
Spinal cord stimulation (SCS) is an established therapy of failed back surgery syndrome (FBSS), although the effects on daily functioning, quality of life (QoL), and patients' expectations, experiences, and satisfaction remain elusive. The current integrative review aimed to summarize the overall effects of SCS in patients with FBSS on pain relief, health-related QoL, and daily activities. ⋯ SCS showed beneficial effects on different domains of life in patients with FBSS. The quantitative analyses suggest an overall improvement in most domains, although patients' experiences show that limitations in daily life and living with the SCS system persist. Multiple extensive preoperative counseling sessions and discussions with patients are deemed necessary to improve patient satisfaction and meet their expectations. Shared decision-making and provision of complete information are key factors for success.
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Randomized Controlled Trial
Bilateral ultrasound-guided erector spinae plane block for postoperative persistent low back pain in lumbar disc surgery.
Persistent low back pain is an important disability after lumbar disc surgery. Erector spinae plane block (ESPB) is highly effective in providing post-surgical pain control, but its effectiveness in long-term persistent low back pain has not been investigated. The aim of this randomized controlled trial was to investigate the effect of ESPB on the reduction of persistent low back pain after surgery. ⋯ ESPB, which has a low risk of complications and is simple to perform, has been found useful in the treatment of persistent low back pain after disc surgery.
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Randomized Controlled Trial
Local Anesthetic and Steroid Injection to Relieve the Distal Lumbosacral Pain in Osteoporotic Vertebral Compression Fractures of Patients Treated with Kyphoplasty.
Percutaneous kyphoplasty (PKP) is widely used in osteoporotic vertebral compression fractures (OVCF). But in some patients, distal lumbosacral pain (DLP) persists even after treatment and affects their quality of life. ⋯ Local anesthetic and steroid injection improved the short-term clinical outcome of PKP for OVCF, which will enhance the confidence of patients in performing out-of-bed activities and functional exercises early after the operation.
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Case Reports
Cauda Equina Syndrome after Unilateral Medial Branch Block of the Lower Right Lumbar Zygapophyseal Joints.
Medial branch blockade of the lumbar facet joints is widely performed and generally accepted as a safe intervention. We present a case of neurological damage following a medial branch blockade with local anesthetic and steroid. A patient suffering from chronic low back pain radiating to the buttocks and thighs underwent nine medial branch blockades over a few years. ⋯ Although the patient received nine sets of injections uneventfully during the previous 36 months, this procedure took place 3 months following spinal surgery. This rare, but catastrophic case of cauda equina syndrome occurred following L3-4 , L4-5 , and L5 -S1 medial branch blockades 3 months after spinal surgery, which is believed to be caused by accidental intra-arterial injection of particulate methylprednisolone, with consequent aggregates causing blockage and ensuing ischemia. Therefore we suggest particulate steroid preparations should not be used in axial spinal injection.