Average VAS Research Articles

Anatomic reconstruction of anterior talofibular ligament with tibial tuberosity-patellar tendon autograft for chronic lateral ankle instability.

Anatomic repair of the anterior talofibular ligament (ATFL) is challenging when the local ligamentous tissue is severely attenuated. Anatomic reconstruction of the ATFL with tibial tuberosity-patellar tendon (TT-PT) autograft is a feasible choice that can avoid the complicated tendon-bone healing and restore ankle stability. From 2009 to 2015, 31 chronic lateral ankle instability (CLAI) patients (31 ankles), who had a serious injury on the ATFL only, were treated with anatomic reconstruction of ATFL with TT-PT. American orthopedic foot and ankle society ankle-hindfoot score (AHS), visual analog scale for pain score (VAS), Karlsson-Peterson score, Tegner activity level, and objective examination comprehending range of motion were used to evaluate the clinical outcomes before and after operation. Radiographically, talar tilt angles and anterior drawer were assessed in pre- and postoperative ankle stress views. Among the 31 ankles, 17 ankles with single-bundle ATFL and 14 ankles with double-bundle ATFL were found at operation. At a mean follow-up of 42 months (24-82 months), all patients were satisfied with the procedure. Mean AHS significantly increased from 60.5 ± 8.2 to 93.5 ± 4.8. Mean Karlsson-Peterson score significantly increased from 55.2 ± 11.0 preoperatively to 91.2 ± 6.9 at final follow-up. Average VAS significantly decreased from 5.9 ± 1.6 preoperatively to 1.4 ± 1.0 at the latest follow-up. Mean Tegner activity level was 3.7 ± 0.9 before operation, compared with 7.0 ± 0.8 after operation. On stress radiographs, mean talar tilt angle was 17.0 ± 3.4° before operation and 3.8 ± 2.1° at the latest follow-up. In addition, mean anterior tibiotalar translation was 7.5 ± 2.2 mm before operation and 1.8 ± 1.1 mm at the latest follow-up. Anatomic reconstruction of the ATFL using a TT-PT autograft allows bone-bone healing in talus and tendon-tendon/periosteum healing in fibula rather than requiring tendon-bone healing, which is an alternative choice for treating CLAI caused by single ATFL insufficiency.

EVALUATION OF THE PAIN MANAGEMENT EFFICIENCY AFTER PRIMARY HIP ARTHROPLASTY: RESULTS OF KVEST PROJECT

Introduction. Celecoxibum being one of high-selective COX-2 inhibitors is specifically inhibiting COX-2 in vivo not influencing protective effect of COX-1. Celecoxibum systemic administration after primary arthroplasty in combination with local infiltration anesthesia has a number of advantages. Purpose of the study. To evaluate the efficiency of postoperative pain relief by Celecoxibum in primary hip arthroplasty using standard and minimally invasive approaches as well as to analyze the pain syndrome dynamics by a method of local infiltration anesthesia (LIA).Material and methods. The study included 91 patients with hip arthritis of grade III-IV without severe anatomical alterations who underwent primary hip arthroplasty in the Vreden Research institute of traumatology and orthopaedics during 2017. Patients were randomized by type of surgical approach used (standard or minimally invasive), the authors compared monotherapy by Celecoxibum with a multimodal anesthesia which included systemic Celecoxibum administration in combination with LIA. Additional evaluation of two LIA methods was conducted in the group of patients with standard approach.Results. Pain syndrome dynamics was comparable in all groups — minimal intensity within first day after the surgery and almost complete absence of pain on day 7. However, on day 3 variance between the subgroups increased: the best outcome was observed in the group of minimally invasive approach combined with LIA VAS score was 1.0 (95% CI, 0–1); in the group with standard approach without LIA VAS score was 4.5 (95% CI, 2–7); in the group with standard approach with a single LIA VAS score was 2.6 (95%CI, 0–5); in the group with standard approach with threestage LIA VAS score was 2.4 (95%CI, 0–5); in the group with minimally invasive approach without LIA VAS score was 3,9 (95% CI, 0–2). On day 7 the parameters in all groups demonstrated no statistically significant variances with a minor elevation in cases when LIA was not performed and with average VAS score of 0.8 (95% CI, 0–4). By day 14 pain syndrome was absent or within a range of 1 point in all patients, by this treatment stage Celecoxibum medication was stopped in 37 out of 91 patients (40.7%).Conclusion. Administration of Celecoxibum per os (200 mg twice per 24 hours) in combination with LIA by Ropivacaine and dexamethasone solution in primary hip arthroplasty provides fast relief of pain facilitating early mobilization of patients and accelerated rehabilitation. Celecoxibum safety in therapeutic dose was also proven.

Anterior knee pain following BPTB graft harvest. Reality or overhyped

IntroductionThe patellar tendon graft has long been the gold standard for ACL reconstruction. Recently semitendinosus and gracilis tendons graft have been used increasingly. We hypothetise that the Bone-Patella Tendon-Bone graft is a good and economical graft for the Indian population with no adverse effects of anterior knee pain or patellar tendon shortening. We believe that the early squatting and cross-legged sitting causes early and constant stretching of the tendon in our patients. This is responsible for the lesser incidences of adverse effects in the Indian population. Material and MethodIn a retrospective study, the hospital database was scrutinized to shortlist patients who had undergone a bone-patella tendon-bone harvest for ACL or PCL reconstruction before 2013. Each patient was evaluated using the Lysholm score and the KOOS Score. VAS was also used, to evaluate for the amount of pain experienced by patients. The analysis of the quadriceps power along with the presence or absence of any extensor lag was made too. The modified Insall Salvati index was also calculated. ResultsForty-seven patients were shortlisted of which 25 patients were followed up with an average follow up of 94.5 months. Although some patients did complain of occasional pain with the average VAS score of 1.45; on analyzing the data it was evident that all our patients had excellent quadriceps power (5/5) with no extensor lag. The mean Lysholm score was 95.55, while the mean KOOS score was 94.17. The mean Insall index of 1.05 showed no significant patella baja in any of our patients. ConclusionIt is ascertained that no significant retro-patellar pain or shortening of the patellar tendon occurs following a bone patella tendon bone harvest. The bone patella bone tendon graft is a suitable graft for ligament reconstruction with good functional outcome, and no significant adverse effect of patella baja or anterior knee pain in the Indian patients. Level of EvidenceLevel IV.

Trans-sacral epiduroscopic laser decompression versus the microscopic open interlaminar approach for L5-S1 disc herniation

Context/Objective: Trans-sacral epiduroscopic laser decompression (SELD) is an alternative to microscopic open lumbar discectomy (OLD). SELD and OLD for L5-S1 lumbar disc herniation (LDH) have not been compared. We compared clinical results, including pain control, between SELD and OLD.Design: Retrospective analysis.Setting: Korean hospital.Participants: Eighty patients treated with SELD (n = 40) or microscopic OLD (n = 40) for L5-S1 LDH.Interventions: N/A.Outcome Measures: Clinical data were compared over 6 months. Functional status was evaluated using Oswestry Disability Index (ODI, 0–100%) and time to return to work. Preoperative and postoperative pain was measured using a visual analog scale (VAS, 0–10). Radiological assessment was performed preoperatively and postoperatively.Results: The ODI and VAS scores for leg and back pain significantly improved in both groups. At 6-months after the procedure, the average ODI decreased to 13.2 ± 11.2 from 54.5 ± 14.5 for SELD and 9.5 ± 10.4 from 57.5 ± 16.0 for OLD. The average leg VAS decreased to 1.9 ± 1.2 from 6.0 ± 1.4 for SELD and 2.3 ± 1.3 from 6.7 ± 1.6 for OLD. Back VAS reduced to 2.6 ± 1.3 from 7.2 ± 1.5 for OLD. Time to return to work was 1.1 ± 1.1 weeks for SELD and 5.4 ± 2.1 weeks for OLD. Clinical outcomes of SELD were non-inferior to those of OLD in terms of pain control.Conclusion: A scar-free procedure and early return to normal life are advantages of SELD.

Effect of warming anesthetic on pain perception during dental injection: a split-mouth randomized clinical trial.

BackgroundThe purpose of this study is to determine the effectiveness of warming anesthesia on the control of the pain produced during the administration of dental anesthesia injection and to analyze the role of Transient Receptor Potential Vanilloid-1 nociceptor channels in this effect.Patients and methodsA double-blind, split-mouth randomized clinical trial was designed. Seventy-two volunteer students (22.1±2.45 years old; 51 men) from the School of Dentistry at the Universidad Austral de Chile (Valdivia, Chile) participated. They were each administered 0.9 mL of lidocaine HCl 2% with epinephrine 1:100,000 (Alphacaine®) using two injections in the buccal vestibule at the level of the upper lateral incisor teeth. Anesthesia was administered in a hemiarch at 42°C (107.6°F) and after 1 week, anesthesia was administered by randomized sequence on the contralateral side at room temperature (21°C–69.8°F) at a standardized speed. The intensity of pain perceived during the injection was compared using a 100 mm visual analog scale (VAS; Wilcoxon test p<0.05).ResultsThe use of anesthesia at room temperature produced an average VAS for pain of 35.3±16.71 mm and anesthesia at 42°C produced VAS for pain of 15±14.67 mm (p<0.001).ConclusionThe use of anesthesia at 42°C significantly reduced the pain during the injection of anesthesia compared to its use at room temperature during maxillary injections. The physiological mechanism of the temperature on pain reduction could be due to a synergic action on the permeabilization of the Transient Receptor Potential Vanilloid-1 channels, allowing the passage of anesthetic inside the nociceptors.

Laparoscopic intracorporeal rectus aponeuroplasty (LIRA technique): a step forward in minimally invasive abdominal wall reconstruction for ventral hernia repair (LVHR).

Closing the defect (CD) during laparoscopic ventral hernia repair began to be performed in order to decrease seroma, to improve the functionality of the abdominal wall, and to decrease the bulging effect. However, tension at the incision after CD in large defects is related to an increased rate of pain and recurrence. We present the preliminary results of a new technique for medium midline hernias as an alternative to conventional CD. A prospective controlled study was conducted from January 2015 to January 2017 to evaluate an elective new procedure (LIRA) performed on patients with midline ventral hernias (4-10cm width). The posterior rectus aponeurosis was opened lengthwise around the hernia defect using a laparoscopic approach to create two flaps and was then sutured. The size of the flaps was estimated using a mathematical formula. An on-lay mesh was placed intraperitoneal overlapping the fascia defect. The data analyzed included patient demographics, operative parameters, and complications. A computerized tomography was performed preoperatively and postoperatively (1month and 1year) to evaluate recurrence, distance between rectus and seroma. Twelve patients were included. Mean width of the defect was 5.5cm. Average VAS (24h) was 3.9, 1.1 (1month), and 0 (1year). Mean preoperative distance between rectus was 5.5cm; postoperative was 2.2cm (1year). Radiological seroma at first month was detected in 50%. Mean follow-up was 15months. The LIRA technique could be considered as an alternative to conventional CD or endoscopic component separation for medium defects under 10cm in width. This technique obtained a "no tension" effect that could be related to a lower rate of postoperative pain with no recurrence or bulging, being a safe, feasible, and reproducible technique.

Health Behavior and Health-related Quality of Life in Patients with a High Risk of Cardiovascular Disease.

BackgroundHealth-related quality of life (HRQoL) is measuring a patient’s experience of his health status and represents an outcome of medical interventions. Existing data proves that a healthy lifestyle is positively associated with HRQoL in all age groups. Patients with a high risk for cardiovascular disease typically led an unhealthy lifestyle combined with risk diseases. We aimed to analyse these characteristics and their reflection in HRQoL.MethodsA cross-sectional study in 36 family practices, stratified by location and size. Each practice invited 30 high-risk patients from the register. Data were obtained from medical records and patient questionnaire. The EQ-5D questionnaire and the VAS scale were used for measuring the patient’s HRQoL as an independent variable.Results871 patients (80.6% response rate) were included in the analysis. 60.0% had 3-4 uncontrolled risk factors for CVD. The average VAS scale was 63.2 (SD 19.4). The correlation of EQ-5D was found in the number of visits in the practice (r=-0.31, p<0.001), the socioeconomic status (r=-0.25, p=0.001), age (r=-0.27, p=0.001) and healthy diet (r=0.20, p=0.006). In a multivariate model, only physical activity among lifestyle characteristics was an independent predictor of HRQoL (p=0.001, t=3.3), along with the frequency of visits (p<0.001, t=-5.3) and age (p=0.025, t=-2.2).ConclusionThis study has been performed on a specific group of patients, not being “really sick”, but having less optimal lifestyle in many cases. Encouragement to improve or keep healthy lifestyle, especially physical activity, is important, not only to lower the risk for CVD, but also to improve HRQoL.

Health behavior and health-related quality of life in patients with a high risk of cardiovascular disease

AbstractBackgroundHealth-related quality of life (HRQoL) is measuring a patient’s experience of his health status and represents an outcome of medical interventions. Existing data proves that a healthy lifestyle is positively associated with HRQoL in all age groups. Patients with a high risk for cardiovascular disease typically led an unhealthy lifestyle combined with risk diseases. We aimed to analyse these characteristics and their reflection in HRQoL.MethodsA cross-sectional study in 36 family practices, stratified by location and size. Each practice invited 30 high-risk patients from the register. Data were obtained from medical records and patient questionnaire. The EQ-5D questionnaire and the VAS scale were used for measuring the patient’s HRQoL as an independent variable.Results871 patients (80.6% response rate) were included in the analysis. 60.0% had 3-4 uncontrolled risk factors for CVD. The average VAS scale was 63.2 (SD 19.4). The correlation of EQ-5D was found in the number of visits in the practice (r=-0.31, p&lt;0.001), the socioeconomic status (r=-0.25, p=0.001), age (r=-0.27, p=0.001) and healthy diet (r=0.20, p=0.006). In a multivariate model, only physical activity among lifestyle characteristics was an independent predictor of HRQoL (p=0.001, t=3.3), along with the frequency of visits (p&lt;0.001, t=-5.3) and age (p=0.025, t=-2.2).ConclusionThis study has been performed on a specific group of patients, not being “really sick”, but having less optimal lifestyle in many cases. Encouragement to improve or keep healthy lifestyle, especially physical activity, is important, not only to lower the risk for CVD, but also to improve HRQoL.

Mid-term results of fixation of coronoid fractures via modified anterior elbow neurovascular interval approach

Objective To explore the efficacy and complication prevention of operative fixation of coronoid fractures via neurovascular interval of anterior elbow approach. Methods From March 2006 to September 2009, data of 21 patients with coronoid process fractures associated with complex elbow dislocation who were treated via neurovascular interval of anterior elbow approach in my ward were retrospectively analyzed. There were 14 males and 7 females. The mean age of the patients was 31.6 years (range, 18-52 years). Injury was caused by walk falling in 10 cases, falling from standing-height in 3 cases and sports events in 8 cases; 7 patients were left side and 14 patients were right side, including 16 prominent sides and 5 non-prominent sides. There were 3 type Ia, 3 type IIa, 8 type IIb, 4 type IIc, 3 type IIIa coronoid process fractures according to the O'Driscoll's classification. Pre-operative 3D-CT scans were conducted to clarify if there were subluxations or sign of instabilities in elbows. Operative fixation of coronoid process fractures with cannulated screws and/or mini plates and/or suture anchors were carried out via the anterior interval between humeral vessels and median nerve, and then lateral collateral ligaments were repaired if instability still existed. Results The average operation time was 72 min, and the follow-up time was 52-74 months. Only 1 case of type Ia fracture got nonunion because of early postoperative activities from the first day after the operation and the elbow was fixed at 0 degree of extension with brace. At the latest follow-up, in suture anchor fixation group (3 cases), the average VAS was 1.8±0.5, Broberg-Morrey score 90.2±6.6, extension deficiency 11.2°±3.6°, flexion 133.4°±8.8°, and the excellent-good-rate was 66.7% (2 cases excellent and 1 fair). In the screw-fixation group (10 cases), the average VAS was 1.6±0.8, Broberg-Morrey score 89.2±6.6, extension deficiency 15.2°±4.6°, flexion 130.8°±10.8°, and the excellent-good-rate was 90% (6 cases excellent, 3 good, and 1 fair). In the mini plate fixation group (8 cases), the average VAS score was 1.6±0.7, Broberg-Morrey score 88.6±6.7, extension deficiency 11.8°±5.6°, flexion 134.2°±8.6°, and the excellent-good-rate was 87.5% (4 cases excellent, 3 good, and 1 fair). In the lateral ligament repaired group (14 cases), the average VAS was 1.3±0.9, Broberg-Morrey score 91.5±6.3, extension deficiency 10.2°±3.4°, flexion 135.2°±4.2°, and the excellent-good-rate was 100% (8 cases excellent, 6 good). In the lateral ligament non-repaired group (7 cases), the average VAS was 2.2±1.6, Broberg-Morrey score 80.2±13.8, extension deficiency 13.6°±4.4°, flexion 126.6°±4.0°, and the excellent-good-rate was 71.4% (3 cases excellent, 2 good, 1 fair). There were 5 cases which had early osteoarthritis changes in the elbow joint in 3 years’ follow-up, with the incidence rate 23.8% (5/21), and the incidence of mid-term osteoarthritis in the 5 and 7 years after operation was 4.8% (1/21). Conclusion Operative fixation of coronoid fractures with suture anchor and/or cannulated screw and/or mini plate via neurovascular interval of anterior elbow approach was confirmed to be efficient and safe. Lateral collateral ligaments should be repaired if the elbow is unstable. Key words: Elbow joint; Dislocations; Joint instability; Ulna fractures

Full-endoscopic lumbar discectomy for high canal compromised disc at upper lumbar level: A technical review

Objective: In this study, we have described the technique to overcome difficulty faced during trans-foraminal endoscopic discectomy for the treatment of lumbar radiculopathy in patients who have herniated discs at the upper lumbar level & thoracolumbar junction. Method: After institutional review board approval, A retrospective analysis of 27 patients operated between March 2013- September 2017, by a single specialist for disc herniation at upper lumbar levels D12-L1, L1-2, L2-3 with or without high canal compromise by outside in technique (using rigid endoscope, sequential reamers) along with detailed description of our technique is the focus of this study. Results: Out of 27 patients there were 11 cases for L1-2 & 16 cases of L2-3 disc herniation respectively. There were 21 cases of broad-based, high canal compromised disc herniation with significant neurological deficit & only 6 cases were of focal herniation type. The average preoperative VAS score of 8.5 (range 6-10) reduced to 4 (range 2-7) immediate postoperatively & it further reduced to 2 (range 0-4) at one month follow up. The average preoperative ODI score of 65 (range 28- 88) reduced to 27 (range 12-40) immediate postoperatively & it further reduced to 10 (range 3- 18) at one month follow up. Post-operative MRI showed that the ruptured disc had been successfully removed. Conclusion: An anatomically modified surgical technique promote a more successful outcome after percutaneous endoscopic discectomy for upper lumbar disc herniation. Foraminotomy is recommended for all intra-canalicular herniation. Transforaminal endoscopic discectomy and foraminotomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of an upper lumbar disc herniation.

Intense Therapeutic Ultrasound for Chronic Lateral Epicondylitis Pain Reduction

Introduction: Intense therapeutic ultrasound (ITU) is a newly established ultrasound-based, non-invasive therapy in which sound waves are concentrated and focused on musculoskeletal tissue for the purpose of pain reduction. This technology produces selective thermal coagulative changes over a small controlled area while leaving the surrounding tissue unaffected and without impacting the integrity of the dermis.Methods: A clinical study evaluating 29 patients (Age: 39 – 60, Male: 59%, Female 41%) for the effectiveness, safety and patient tolerance of Intense Therapeutic Ultrasound (ITU) for treatment of chronic (average length of symptoms prior to treatment: 12.9 months), subcutaneous lateral Epicondylitis musculoskeletal tissue pain reduction was conducted. All patients enrolled in this IRB approved study had been previously diagnosed with Chronic Lateral Epicondylitis and had failed previous Standard-of-Care treatment regimen. Two ITU treatments were administered four weeks apart. Self-reported lateral elbow Universal Visual Analog pain scores and Patient-Rated Tennis Elbow Evaluation pain scores while performing normal daily tasks, were recorded pre-treatment (baseline measurement) and again at each follow-up time point - 4, 8, 12, and 26 weeks - after initial treatment. The goal for all subjects was to reduce overall pain and pain while performing everyday tasks by at least 25% on the average and more than 25% individually. While arbitrary, such criteria appear to be rigorous to reduce standard error and individual selfassessment variability.Results: Successful reduction of overall pain scores at 12 and 26 weeks following the first treatment are 88% and 82% of patients meeting the pain reduction criteria respectively. Also, at the same follow-up time points, patients reported an average VAS Pain Score reduction of 59% (Week 12) and 57% (Week 26) from a pre-treatment average of 5.08 down to an average of 2.2 at week 26. Additionally, patients reported an average pain reduction while performing everyday tasks of 58% and 61% respectively. Patient satisfaction remained over 80% for all follow-up dates.Conclusion: ITU is a promising non-invasive pain relief treatment for cases of chronic lateral epicondylitis.

Knowledge, Motivation Behavior and Level of Physical Activity for Medical Students

Introduction: Intense therapeutic ultrasound (ITU) is a newly established ultrasound-based, non-invasive therapy in which sound waves are concentrated and focused on musculoskeletal tissue for the purpose of pain reduction. This technology produces selective thermal coagulative changes over a small controlled area while leaving the surrounding tissue unaffected and without impacting the integrity of the dermis.Methods: A clinical study evaluating 29 patients (Age: 39 – 60, Male: 59%, Female 41%) for the effectiveness, safety and patient tolerance of Intense Therapeutic Ultrasound (ITU) for treatment of chronic (average length of symptoms prior to treatment: 12.9 Months), subcutaneous lateral Epicondylitis musculoskeletal tissue pain reduction was conducted. All patients enrolled in this IRB approved study had been previously diagnosed with Chronic Lateral Epicondylitis and had failed previous Standard-of-Care treatment regimen. Two ITU treatments were administered four weeks apart. Self-reported lateral elbow Universal Visual Analog pain scores and Patient-Rated Tennis Elbow Evaluation pain scores while performing normal daily tasks, were recorded pre-treatment (baseline measurement) and again at each follow-up time point - 4, 8, 12, and 26 weeks - after initial treatment. The goal for all subjects was to reduce overall pain and pain while performing everyday tasks by at least 25% on the average and more than 25% individually. While arbitrary, such criteria appear to be rigorous to reduce standard error and individual selfassessment variability.Results: Successful reduction of overall pain scores at 12 and 26 weeks following the first treatment are 88% and 82% of patients meeting the pain reduction criteria respectively. Also, at the same follow-up time points, patients reported an average VAS Pain Score reduction of 59% (Week 12) and 57% (Week 26) from a pre-treatment average of 5.08 down to an average of 2.2 at week 26. Additionally, patients reported an average pain reduction while performing everyday tasks of 58% and 61% respectively. Patient satisfaction remained over 80% for all follow-up dates.Conclusion: ITU is a promising non-invasive pain relief treatment for cases of chronic lateral epicondylitis.

Outcomes of Implant-Arthrodesis as Limb Salvage for Failed Total Knee Arthroplasties with Significant Bone Loss: Case Series.

We sought to evaluate our consecutive series of knee-implant arthrodesis patients for failed total knee arthroplasties with medium term clinical and radiographic outcomes. We conducted a retrospective review of a consecutive series of 4 patients (average age, 75 years; range, 69-79) with failed knee arthroplasties and deficient extensor mechanism who underwent implant arthrodesis with a minimum 2-year follow-up. The primary outcome measure was the patient's reported outcome measures (Short-Form 12) and visual analogue scale for knee pain at final follow-up. All patients had multiple medical comorbidities, multiple previous knee surgeries with failed nonfunctional knee arthroplasties. Three patients had chronic infections and one had chronic pain and instability, and all had deficient extensor mechanism. Average follow-up was 5.5 years (range, 2-8), and the primary goal of surgery was achieved in all four patients. The average VAS score for knee pain was 3 of 10, and SF-12 was 36.16 (physical score) and 55.70 (mental score), indicating satisfactory outcomes. Satisfactory clinical and patient-reported outcomes can be achieved with implant arthrodesis as limb salvage for failed total knee arthroplasties with significant bone loss at medium-term follow-up.

Percutaneous endoscopic interlaminar lumbar discectomy for high-grade inferiorly migrated L5-S1 disc: A case report with technical review

L5-S1 disc has always been a difficult disc to target by rigid endoscope because of anatomical limitations. In this study, we have described the technique to overcome difficulty faced during endoscopic disc decompression of high-grade inferior migrated disc at L5-S1. We performed percutaneous endoscopic inter-laminar lumbar discectomy (PEILD) for removal of high grade inferiorly migrated disc and preserved the functional structures. After institutional review board approval, details of the patient with high-grade inferior migration at L5-S1 disc were reviewed. The patient was operated by a single specialist with use of the percutaneous endoscopic inter-laminar technique for high-grade inferior migrated extruded disc. Description of our technique & result is the focus of this study. The average VAS score was reduced from 9 pre-operatively to 3 post-operatively & to 1-2 within 2 weeks. Post-operative plantar flexion of foot improved from 2 to 4 immediately and up to 5 within 2 weeks. Ankle jerk reflex improved from 1+ to 2+. The pain severity score on BPI reduced from 9 to 3 postoperatively. Post-operative MRI showed that the high grade inferiorly ruptured disc had been successfully removed. We obtained excellent results in treating inferior extruded disc at L5-S1 using endoscopic inter-laminar approach. Inter-laminar endoscopic discectomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of a high grade inferior migrated lumbar disc herniation.

Acupuncture for neuropathic pain in adults.

Acupuncture for neuropathic pain in adults.

RESULTS OF TOTAL LUMBAR INTERVERTEBRAL DISK REPLACEMENT WITH M6-L: A MULTICENTER STUDY

ABSTRACT Objective: In this paper we report the clinical and radiological results of lumbar intervertebral disk (IVD) replacement with M6-L for the treatment of patients with IVD degeneration. Methods: One hundred and fifty-six patients with IVD degeneration were operated with the one level implantation of an M6-L prosthesis at three neurosurgical departments, in Irkutsk, Krasnoyarsk and Vladivostok. We assessed pain intensity (VAS), the Oswestry disability index (ODI) and outcomes by the Macnab scale up to 36 months after surgery. Instrumental data were used to assess range of motion in the operated segment and heterotopic ossification by the McAfee-Suchomel classification. Results: The average VAS before surgery was 6.9 ± 1.6 cm. After surgery, this value reduced significantly, to an average of 1.3 ± 1.2 cm (p&lt;0.001). The average ODI before surgery was 40.2 ± 6.9%, and after IVD arthroplasty, this indictor improved to 12.3 ± 6.1% (p &lt;0.001). Range of motion in the operated segment at baseline averaged 36.8 ± 2.6o, and within 36 months after the operation, this had increased to 41.2 ± 2.9o. During the entire follow-up period, signs of severe (13.4%, n = 21) or moderate (10.2%, n = 16) heterotopic ossification were observed. Conclusions: The use of M6-L prosthesis can significantly reduce the level of pain, improve quality of life and maintain the physiological range of motion in the operated spinal segment in patients with degenerative lesions IVD at a low level of adverse outcomes. [249 Words].

Inhaled nitrous oxide can reduce the pain perception in post Caldwell-Luc operation patients\u2013a randomised trial

To assess the efficiency of inhaled nitrous oxide (N2O) for the reduce the perception pain in extraction of iodoform gauze packing strips in post Caldwell-Luc operation patients. This randomized single blind trial included a total of 47 patients, aged between 14–82 years, in which undergoing radical maxillary sinusotomy. Based on the randomization procedure, patients were treated with (experimental) or without (control) inhaled N2O. The visual analogue scale scores (VAS scores) of the pain perception and the headache duration time were comparatively studied. The average VAS score for pain perception was 3.92 in the N2O group and 7.87 in the control group. The average headache duration time was 0.12 hour in the N2O group and 13.09 hours in the control group. Both VAS scores for pain perception during the treatment and the average headache duration time were significantly reduced in the inhaled N2O group (P < 0.01). Reduced pain perception and headache duration time indicated that, the inhaled N2O method might be viable in extraction of iodoform gauze packing strips in post Caldwell-Luc operation patients.

Relevant Anatomy, Morphology, and Implantation Techniques of the Dorsal Root Ganglia at the Lumbar Levels

While dorsal root ganglion (DRG) stimulation has been available in Europe and Australia for the past five years and in the United States for the past year, there are no published details concerning the optimal procedures for DRG lead implantation. We describe several techniques that can be applied to implant cylindrical leads over the DRG, highlighting some tips and tricks according to our experiences. Focus is mainly shifted toward implantations in the lumbar area. We furthermore give some insights in the results we experienced in Spain as well as some worldwide numbers. A 14-gauge needle is placed using a "2-Level Technique (2-LT)" or exceptionally a "1-Level Technique (1-LT)" or a "Primary- or Secondary Technique" at the level of L5. The delivery sheath, loaded with the lead, is advanced toward the targeted neural foramen. The lead is placed over the dorsal aspect of the DRG. A strain relief loop is created in the epidural space. Sheath and needle are retracted and the lead is secured using an anchor or anchorless technique. In Spain, 87.2% (N = 78) of the selected patients have been successfully implanted. Seven (8.9%) had a negative trial and three (4.2%) were explanted. Average VAS score decreased from 8.8 to 3.3 and on average 94.5% of the pain area was covered. In our center's subjects (N = 47 patients, 60.3% of all implanted patients in Spain), VAS scores decreased from an average of 8.8-1.7 and pain coverage averaged 96.4%. We used an average of 1.8 electrodes. Worldwide more than 4000 permanent cases have been successfully performed. We present implantation techniques whereby a percutaneous lead is placed over the DRG through the use of a special designed delivery sheath. Further investigation of the safety, efficacy, and sustainability of clinical outcomes using these devices is warranted.

Tantalum in type IV and V Paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery.

Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures. We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months. Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6-18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points. Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.

Study of the pattern and management of blunt chest injuries in rural setup

Background: Trauma is recognized as a serious public health problem. In fact, it is the leading cause of death and disability in the first four decades of life and is the third most common cause of death overall. Trauma may lead to short or long-term disability. Objective was to study the pattern of chest injuries with resultant underlying damage, in rural set up.Methods: The present study was carried out among 500 cases of age group 15 to 75 years, all religions and both sexes. All patients received in the Emergency Room (ER/Casualty) were immediately attended and history, primary survey and resuscitation were done simultaneously. X ray chest-erect position was taken and subsequent management either operative or non-operative was done according to clinic-radiological findings. After discharge, patients were followed on OPD basis till the time they return to the normal activity.Results: Majority of patients (31%) were from 55 to 65 years of age group and were male (64.2%). Vehicular accident was the commonest (56.8 %) cause of injury. Vehicular accidents were the most common cause of chest injuries. In vehicular accidents two-wheeler riders were the common victims (55.28%). Assault was 2nd most common mode of injury. Among those patients who sustained chest trauma had average VAS 6 (49.2%) followed by 4 (45%). Majority of patient were treated conservatively (93.6%).Conclusions: The most active age group and males were affected with commonly vehicular accidents. They mainly suffered chest injuries.