Terms Of Pain Relief Research Articles

Combination of Trochleoplasty and High Tibial Osteotomy in Patellofemoral Instability Yielding Good Short-Term Results in Terms of Pain Relief, Patella Stability and Knee Function

Combination of Trochleoplasty and High Tibial Osteotomy in Patellofemoral Instability Yielding Good Short-Term Results in Terms of Pain Relief, Patella Stability and Knee Function

Effectiveness of Proximal Fibular Osteotomy as an Alternative Treatment Modality for Pain Relief and Functional Improvement in Medial Compartment Knee Osteoarthritis

Introduction: Medial compartment knee Osteoarthritis (OA) is a painful and debilitating disease that hinders an individual’s day-to-day activities physically and psychologically. Therefore, amelioration of pain is of utmost importance, which can be achieved by decompressing the medial compartment by Proximal Fibular Osteotomy (PFO). PFO is a simple, novel surgical technique that leads to significant pain relief and functional improvement in patients with knee OA. Aim: To assess the effectiveness of PFO in patients with primary medial compartment OA of the knee joint in terms of pain relief and functional outcome. Materials and Methods: A prospective and interventional study was carried out in the Department of Orthopaedics at Indira Gandhi Government Medical College, Nagpur, Maharashtra, India, during the period from November 2017 to October 2020. A total of 58 patients with moderate to severe symptoms of medial compartment knee OA underwent PFO. Visual Analogue Score (VAS score), Knee Society Score (KSS), and Femoro-Tibial Angle (FTA) were assessed preoperatively, postoperatively, and during follow-up visits at 1, 3, 6, and 12 months. These parameters (VAS score and KSS) were also compared with groups based on Body Mass Index (BMI) and Kellgren-Lawrence (K-L) grading. Paired-t test was used. A p-value of <0.001 was considered statistically significant. Results: Remarkable pain relief was observed by the significant decline in mean VAS score from 8.04±0.68 to 2.65±1.14 at the final follow-up. Mean KSS at final follow-up was 69.82±3.03, which was significantly higher than the preoperative score of 43.38±2.39 (p-value <0.001). A change in mechanical alignment was seen with a decrease in mean FTA from 183.38±1.29° to 179.84±1.83° (p-value <0.001) at the final follow-up. Also, it was observed that results were much more encouraging and consistent in patients with BMI ≤24.99 and K-L grades 1 and 2. Conclusion: PFO is a simple, safe, reasonable, and effective surgical modality of treatment in patients with primary medial compartment knee OA that provides good pain relief and functional improvement. PFO can be an alternative treatment modality for pain relief in patients with medial compartment knee OA.

Review of Medical and Surgical Management of Chronic Anal Fissure

To determine which treatment modality has the best outcome for chronic anal fissures in terms of pain relief, fissure healing, and recurrence. The main symptoms are pain while the passage of stools is acute in primary fissures but often persists in case of longstanding fissures causing significant discomfort to the patient. The management of anal fissure has progressed immensely in the last decade due to a better understanding of its pathophysiology. The main aim of the treatment is to reduce the spasm of the internal anal sphincter, thereby reducing the anal canal pressure. The Conservative approach consists of topical nitrates, calcium channel blockers, and calcium channel blockers. It is often preferred over surgical alternatives as it is not invasive. Surgeries for chronic anal fissures include anal dilatation, posterior mid-line sphincterotomy, lateral internal sphincterotomy, fistulectomy, sphincterolysis, and advancement flap repair. This narrative review article aims to review all the existing and newer complex modalities available for the management of chronic anal fissures. Currently the initial management of fissures is pharmacological therapy with topical nitroglycerin or diltiazem or botulinum toxin A injection. The following line of treatment is surgical, which is lateral internal sphincterotomy. Non-surgical therapy often proves ineffective in providing relief and healing, frequently culminating in the recurrence of fissures. On the other hand, surgical therapy has postoperative drawbacks like intestinal incontinence, commonly gas, loose stool or rarely hard stool. There is inadequate data on the latest treatment modalities like fistulotomy, sphincterolysis, flap procedures, etc. They may be considered only when conventional therapy fails to provide relief.

Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty.

BACKGROUNDDevelopment of infrapatellar saphenous neuroma (ISN) is a well-recognized reason for knee pain following total knee arthroplasty (TKA). So far, very few studies have addressed the development of painful ISN after TKA and its impact on functional outcome and patient satisfaction.AIMTo present the results of surgical treatment for ISN after primary TKA, the level of pain relief, and the improvement of knee motion and function.METHODSFifteen patients (13 women, 2 men) with persistent medial pain for more than six months after primary TKA, due to osteoarthritis, underwent surgical excision of ISN. ISN diagnosis was confirmed with the presence of Tinel’s sign along the course of the infrapatellar branch of the saphenous nerve and with pain relief after selective nerve block using local anesthetic. Component loosening, malalignment, instability and infection were excluded systematically in all patients as a source of pain. Pain relief in terms of visual analog scale (VAS), active knee range of motion (ROM), and the Knee Society Score (KSS) for pain and function were evaluated preoperatively and at least six months postoperatively.RESULTSThe mean patients’ age was 71.3 ± 5.4 years old. The mean interval between TKA and neuroma excision was 10 mo (range, 6 to 14 mo), while the mean follow-up was 8 mo (range: 6 to 11 mo). All 15 patients experienced almost complete immediate pain relief and resolution of allodynia and hyperesthesia after surgery. Pain on the VAS scale improved from 8.6 ± 1.3 preoperatively to 0.8 ± 0.9 at the final follow-up (P = 0.001). KSS pain and function scores were improved from 49.3 ± 5.9 and 62.7 ± 12.8 before surgery to 91.8 ± 4.2 and 75.3 ± 11.3 after surgery, respectively (P = 0.001 and P = 0.015). Active knee ROM was also increased postoperatively from 96 ± 4 to 105 ± 6 degrees (P = 0.001). There were no complications and no further operations required.CONCLUSIONISN should be considered a potential cause of persistent pain following TKA. Neuroma excision not only provides immediate pain relief and resolution of symptoms but may also improve the knee range of motion.

A randomized controlled study of acupuncture for pain relief during first trimester surgical termination of pregnancy performed under local analgesia.

Acupuncture reduces pain levels in many painful conditions. This study compared pain levels during surgical termination of first trimester pregnancy by suction evacuation (SE) under local analgesia with and without the use of acupuncture. In all, 60 nulliparous women undergoing SE before 10 weeks of gestation were randomly assigned into one of the following three groups in a 1:1:1 ratio according to a computer-generated randomization list. In the control group, women received oral diazepam 5 mg and intramuscular (i.m.) injection of pethidine 30 and 15 min, respectively, prior to SE. In the acupuncture group, women received acupuncture 10 min before SE until the end of SE while oral diazepam 5 mg and i.m. injection of normal saline were given. In the combined group, women received acupuncture in addition to the drugs in the control group. Data from 52 participants were analysed. Pain scores during and after SE, post-operative side-effects and satisfaction levels were compared. The three groups had similar baseline characteristics. The median pain levels during SE differed significantly between the control, acupuncture, and combined groups (80, 50 and 66 mm, respectively, p = 0.03). Pain levels during SE in the acupuncture and combined groups were significantly lower than that of the control group. However, the anxiety scores did not differ between the three groups after SE (p = 0.86). Acupuncture can provide additional benefit in terms of pain relief in women undergoing first trimester termination of pregnancy by SE under local analgesia.

Non-steroidal anti-inflammatory drugs for acute gout.

Non-steroidal anti-inflammatory drugs for acute gout.

Comparison of patient controlled epidural infusion versus physician controlled epidural infusion for postoperative analgesia in patients undergoing major abdominal surgeries.

Background and Aims:For effective patient-controlled epidural analgesia (PCEA) without many systemic effects after major intra-abdominal surgeries, optimal analgesic solution, background infusion rates, and settings need to be determined. The primary aim was to compare the efficacy of PCEA versus physician-controlled epidural analgesia (PhCEA) in terms of pain relief after major intra-abdominal surgeries. The secondary aim was, to establish an acceptable PCEA regime, to compare the vitals, amount of drug used, acute pain service (APS) interventions, rescue analgesics, and side effects.Material and Methods:This prospective randomized study was conducted on consenting 102 adult patients undergoing major intra-abdominal surgeries. The study drug was levobupivacaine 0.125% with fentanyl 2 ug mL-1. Trained nursing staff assessed patients and data were collected at fixed intervals (0, 1, 2, 4, 8, 12, and 24 h) till 24 hours post-surgery. Chi-square test, independent ‘t’ test, and Mann–Whitney U test were used and P value < 0.05 was considered as significant.Results:Pain scores were comparable in between the groups. Patients in the PCEA group had significantly (P = 0.000) fewer APS interventions (2.2 vs. 1.4 times) and need for rescue analgesics (1.8 vs. 0.8 times). There was no incidence of deep sedation, pruritus, hypotension, numbness, or complete motor block in either group.Conclusion:PCEA with background infusion is better than PhCEA after major intra-abdominal surgeries as it requires lesser pain team interventions and rescue analgesics. Epidural administration of lower concentration of opioid and local anesthetic gives adequate pain relief without any untoward side effects.

The Potential Role of Green Tea and its Main Constituent (Epigallocatechin -3-Gallate) in Pain Relief: A Mechanistic Review.

Medicinal plants and dietary supplements may provide an effective and safe treatment for pain relief. Green tea is one of the most common beverages with many several pharmacological activities. The results of various studies have indicated that green tea possesses antinociceptive effects. Many of the protective effects of green tea in terms of pain relief are attributed to its antioxidant and anti-inflammatory properties. Epigallocatechin -3-gallate (EGCG), as one of the major phytochemical components in green tea, is effective in the management of pain through suppression of inflammation and oxidative stress. We have reviewed the effects of green tea on pain and also discussed mechanisms involved in pain relief. This review suggests that green tea can be a safe and often effective treatment for pain.

Advancing the Role of Palliative Proton Therapy Through Diagnostic Scan-Based Planning

Single-fraction palliative spine radiation is an attractive option for patients with poor prognosis because of its convenience and effectiveness in terms of pain relief. However, the associated large doses to normal tissues can lead to toxicities that negatively impact quality of life. Proton therapy offers a dosimetric solution to this problem but has not historically been used for palliative treatment because of inherent cost and time needed for planning. The purpose of this study was to assess a process for delivering cost-effective and efficient palliative proton therapy by using diagnostic scan-based planning (DSBP) and prefabricated treatment delivery devices.We designed and characterized a reusable proton aperture system capable of adjusting to multiple field sizes for spine treatment. Next, we retrospectively identified 10 patients treated with proton therapy for thoracic malignancies in 2019 who also had a diagnostic CT of the thorax within 4 months of simulation. For each case, one physician contoured T6-T9 as the target volume on both the diagnostic and simulation scans. Using the reusable proton aperture system, we generated passive-scatter proton plans on the diagnostic scans using a single PA beam with no custom range compensator to treat T6-T9 to 8 Gy x 1. The plans were then transferred to the simulation scans to compare target coverage and doses to normal tissues, followed by robustness analysis with 5mm X, Y, and Z shifts. Finally, we generated AP/PA photon plans on the simulation scans to compare doses to normal tissues between proton and photon plans. Results were compared using the Wilcoxon signed-rank test.Median D95% on the diagnostic scan plans was 101% (range, 100%-102%) of the prescription dose using the same 12L x 7W aperture for each case. Median Dmax was 107% (range, 105-108%). When transferred to simulation scans, coverage remained excellent and hot spots acceptable for all cases with a median D95% of 101% (range, 100%-102%) and a median Dmax of 106% (range, 105%-106%). Heart and esophagus mean and max doses did not vary significantly between the diagnostic scan and the simulation scan proton plans (P > 0.2 for all). Robustness analysis with 5mm X, Y, and Z shifts showed that coverage remained acceptable with D95% > 98% for all cases. Compared to the proton plans, mean heart dose was markedly higher for the AP/PA photon plans (median 4.7 Gy v. 0.4 Gy, P < 0.01), as was mean esophagus dose (median 7.1 Gy v. 4.9 Gy, P < 0.01). Heart and esophagus max doses were not significantly different between the proton and photon plans (P > 0.05).Palliative proton DSBP is technically feasible and robust with superior sparing of normal tissues compared to AP/PA photon plans. By eliminating the need for simulation and custom devices, the cost-benefit ratio for palliative proton therapy may become more acceptable, particularly in a bundled payment environment.

Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in Treatment of Knee Osteoarthritis (Systematic Review and Meta-analysis)

Abstract Background Although PRP is one of the options in the management of knee OA, its effectiveness and wide application is still controversial. Therefore, we conducted the present systematic review and meta-analysis to compare the safety and effectiveness of PRP versus HA injection for knee OA. Objective The purpose of this study is to compare between the efficacy of intra-articular injections of Platelet-Rich Plasma versus Hyaluronic Acid in treatment of knee osteoarthritis. Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results The overall effect favoured PRP over HA for WOMAC function score, WOMAC pain score, WOMAC stiffness score, and WOMAC total score; mostly 6 and 12 months after treatment. According VAS score, we found that the overall effect favoured PRP over HA at 12 months only. In contrary, the overall effect did not favour PRP over HA for VAS score at 3 and 6 months. PRP is superior to HA for IKDC scores at 6 and 12 months with similar results at 3 months. Conclusion Intra-articular PRP injection is more effective in terms of pain relief and function improvement at short-term follow-up in the treatment of knee OA than HA, and there is no significant difference in the risk of adverse events between PRP and HA. A randomized controlled trial with larger group sizes is necessary to find the predictors of the response to PRP and HA intra-articular injection.

The comparison of different medical treatment modalities in pes anserinus tendino-bursitis: a prospective clinical study

Background: Periarticular knee pain is a frequent and age-independent condition that affects patients during daily life. Lower-extremity pain caused by disability is one of the major interests of both orthopaedic and physical therapy departments. The aim of this study was to compare different medical treatment options and describe an effective treatment modality in pes anserinus tendino-bursitis, which has been an underestimated problem. This study was a prospective randomized clinical study of 45 patients who were clinically diagnosed with pes anserinus tendino-bursitis. Methods: Three study groups (n=15) were created, and each group underwent different treatment modalities by different physicians. The first group of patients was prescribed one intralesional corticosteroid injection. The second group of patients was prescribed a topical medical treatment regimen for 20 days in total. The third group of patients was prescribed nonsteroidal antiinflammatory drugs (NSAIDs) in addition to cold application for 3 wk. The patients were observed according to Knee injury and Osteoarthritis Outcome Scores (KOOS) and Visual Analog Scale (VAS) scores. Results: This study revealed significantly better results with a triple topical treatment combination when compared with other common medical treatment modalities in terms of pain relief and functional improvement of patients. Conclusions: Combined topical treatment was an effective treatment regimen for pes anserinus bursitis. With the support of daily functional modification, this treatment decreased the healing time and increased patient function during the treatment with better pain control. Level of Evidence: Level II.

Early Clinical Outcome of Comparative Study between Revision Operation and Radiofrequency Treatment for Management of Failed Back Surgery Syndrome

Objective: Intractable back pain and radicular pain after lumbosacral spine surgery are challenges for surgeons because the pathophysiology of failed back surgery syndrome (FBSS) remains unknown. Various medications, exercise, reoperation, spinal cord stimulation, and various interventional treatments, such as epidural injection, and radiofrequency treatment, have been suggested as treatment options. However, the clinical outcomes for each treatment are unclear. Methods: We retrospectively evaluated clinical outcomes of consecutive FBSS patients who underwent revision operation or radiofrequency treatment from 2014 to 2017, who previously showed response to nerve block. Pain was analyzed preoperatively and 1 month, 6 months, and 12 months postoperatively using a visual analogue scale (VAS). Short Form 36 (SF-36) health survey and Oswestry Disability Index (ODI) scores were assessed preoperatively and 12 months postoperatively. Results: A total of 70 patients was included in the present study (33 males, 37 females). When comparing preoperative and postoperative 12-month results, back pain VAS score decreased from 5.5 to 4.2 for revision operation and from 5.1 to 4.7 for radiofrequency treatment. Leg pain VAS score decreased from 6.5 to 4.02 for revision operation and 6.2 to 4.3 for radiofrequency treatment. ODI score decreased from 70.9 to 36.1 for revision operation and 70.2 to 36.1 for radiofrequency treatment. SF-36 score increased from 28.9 to 64.1 for revision operation and from 29.6 to 59.6 for radiofrequency treatment. Differences between treatments were not statistically significant after 12 months (p&gt;0.05) but were at 1 month (p=0.01). Conclusion: Compared with revision operation, radiofrequency treatment is not inferior on early clinical outcome (up to 1 year following the treatment) in terms of pain relief, functional capacity, patient satisfaction, and quality of life in patients with FBSS. Radiofrequency treatment can be considered in patients who are not good candidates for surgical treatment based on imaging results or underlying diseases and who are responsive to diagnostic/therapeutic nerve blocks.

The Analgesic Effects of Oral Acetaminophen vs. Ibuprofen in Children with Supracondylar Fractures: A Triple-blind Randomized Clinical Trial

Introduction: A supracondylar fracture are common in children with the average age of is 5-8 years. It is especially important to pay attention to pain control in these children because of lots of pain. This study was design to compare the analgesic effect of oral ibuprofen vs acetaminophen in children with supracondylar fractures who undergoing non-surgical treatment.Material & Methods: This triple-blind clinical trial was conducted on children with supracondylar fracture referred to the Emergency Department of Emam Reza and Hosheminejad Hospital. Children’s pain were assessed 2, 4 and 12 hours after taking the drug by VAS (Visual Analog Scale) criteria, which was explained by researcher to their parents. Results: In this study, 64 children with a mean age of 5.7±1.7 years were studied. 31 children in the acetaminophen group and 33 children in the ibuprofen group were evaluated. The mean pain score reduction within 12 hours of drug administration showed no difference between the two groups (P = 0.710). After 12 hours of drug administration, 5 and 7 children being painless in the acetaminophen and ibuprofen, respectively, with no difference between the two groups.Conclusion: During the 12 hours after ibuprofen and acetaminophen, children had similar analgesia and there was no significant difference between the two drugs in terms of pain relief and side effects, and both drugs are safe and effective for pain-control in children.

Caudal Epidural Injections in Lumbar Spinal Stenosis: Comparison of Nonimage, Ultrasonography-, and Fluoroscopy-Guided Techniques. A Randomized Clinical Trial.

Caudal epidural injections (CEIs) are widely used in the treatment of lumbar spinal stenosis (LSS). Imaging modalities, such as fluoroscopy and ultrasonography, are frequently employed to confirm proper needle placement and to prevent possible complications. This is a prospective, randomized, study aiming to compare the efficacy of nonimage, ultrasonography-, and fluoroscopy-guided CEIs for the management of LSS. A total of 45 patients were included based on their clinical symptoms and their magnetic resonance images indicative of LSS. Patients were randomized and allocated into 3 equal groups, the nonimage, the ultrasonography-guided, and the fluoroscopy-guided group. All patients received 12 mg betamethasone and 4 mg ropivacaine dissolved in 20 mL normal saline. The injections were administered twice, with a 30-day interval. Visual Analogue Scale (VAS) and Oswestry Disability Index were recorded before the injections and 1 month after the second injection. The procedure times for each group were also compared. Visual Analogue Scale scores and Oswestry Disability Index values were improved in all the groups compared to the baseline values (p < 0.001). The intergroup difference in Visual Analogue Scale scores and Oswestry Disability Index values before and after CEIs was not statistically significant (p = 0.836 and p = 0.438, respectively). The mean procedure time was higher for the fluoroscopy-guided group, followed by ultrasonography-guided, but the differences were not statistically significant (p = 0.067). CEIs are an effective analgesic method for patients suffering from LSS. Nonimage, ultrasonography-, and fluoroscopy-guided CEIs are similarly effective in terms of pain relief and functional improvement.

Functional outcome of displaced mid shaft clavicular fractures treated by plate fixation: a prospective observational study

&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Background:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; Clavicle fractures are one of the commonest injuries to the shoulder girdle. Traditionally these fractures are treated conservatively. This study was to assess the functional outcome of displaced mid shaft clavicular fractures treated with plate fixation.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Methods:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; This was a single center prospective observational study conducted at department of orthopaedics M.E.S medical college Perinthalmanna between the period January 2018 to December 2018 in patients with displaced mid shaft clavicle fractures treated by plate fixation. Out of 51 patients 35 patients were males and 16 were females with mean age of 37.7 years (range 19-59). All patients included in this study were included under Allman group 1. All Patients were treated with plate fixation. Post op follow done at 1 1/2 ,3 and 6 months. During follow up clinical and radiological union were checked. Final functional outcome was assessed at 6 months follow up by Constant-Murley Score.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Results:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; Out of 51 patients with displaced mid shaft clavicle fractures treated with plate fixation 43 patients (84.3%) showed excellent functional outcome 8 patients (15.7%) showed good functional outcome. None of the patients showed moderate or poor outcome. The radiological union was attained at 9.35 weeks. No complications in 83.4% of patients.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Conclusions: &lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt;Mid shaft clavicle fractures are more common in young males sustaining high energy trauma, and those fractures treated with plate fixation has a better functional outcome in terms of pain relief, activities of daily living and range of motion.&lt;/span&gt;&lt;/p&gt;

Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

BackgroundTotal knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA).MethodsA single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization.ResultsData from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes.ConclusionsPost-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications.Trial registrationThis trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

Outcomes of periarterial sympathectomy in patients with digital ischemia.

Digital ischemia with subsequent severe pain and tissue loss is often difficult to treat, with no obvious guidelines or strong evidence in the literature to support a specific treatment modality. Patients who fail medical treatment remain with very limited surgical options due to the difficulty of any intervention in this "no man's land" area of the hand, as described since 1918. Extended distal periarterial sympathectomy is reported as an effective treatment option since the eighties of last century. The procedure entails large incisions and major technical difficulties. In this study, we describe a less invasive approach with very promising results and equally high success rates. This was a prospective study. All patients with severe digital ischemia manifesting with bluish discoloration, ulceration, and/or dry gangrene who failed medical treatment underwent distal periarterial sympathectomy for the radial and ulnar arteries, with added digital sympathectomy in very severe cases. Primary endpoints were ulcer healing and improvement in pain scores assessed by Visual Analog Scale pain scoring system. Secondary endpoints included complications and amputation rates. This study recruited 17 patients between January 2019 and January 2020. The mean follow-up was 14.6months. The mean age was 33.71 (±SD 13.14)years. 41% were males. 59% suffered from vasculitis, 35% of patients had dry gangrene, and 71% had ulcers. Periarterial radial and ulnar sympathectomy was performed for all cases, with digital sympathectomy for 12 fingers. We had 50% complete ulcer healing within 1month (p = 0.031), and 100% were completely healed at 6months (p < 0.001). Pain scores showed significant reductions at 1 (p = 0.001) and 6 months (p < 0.001) of follow-up. Distal periarterial sympathectomy demonstrates high success rates in terms of pain relief and ulcer healing in severe digital ischemia.

Surgical treatment of solitary intradural extramedullary spinal cord metastases from solid cancers of non-neurogenic origin. A multicenter study.

Intradural extramedullary spinal metastases (IESM) represent an extremely rare manifestation of systemic cancer. We evaluated the surgical indications, complications and outcome in a series of 43 patients with solitary intradural extramedullary metastases originating from solid cancer of non-neurogenic origin. Patients' age, histopathological diagnoses of primary cancer, tumor size, spinal location, and extramedullary tumor dissemination were collected. Preoperative functional status, pre- and post-operative neurological status, extent of the tumor resection were also analyzed. The majority of IEMS occurred in the thoracic area, with the most common presenting symptoms ranging from motor (76.7%) to sensory (72%) deficits. Gross total resection was achieved in 55.8% of cases, while In 44.2% of patients a subtotal resection was performed due to strong adherence between the tumor and neural tissue. After surgery, 72.1% of patients exhibited improvement of symptoms in terms of pain relief and partial recovery of motor and/or sensory deficits, while neurologic functional status was severely affected postoperatively in 3 patients. Although there was no statistical significance between the different parameters and overall survival, KPS and the presence of other metastases were the strongest prognostic factors for overall survival and postoperative neurologic outcome.

Lumbosacral Transitional Vertebrae in Adolescents: Effects on the Short-Term Outcomes of Percutaneous Endoscopic Lumbar Discectomy.

Objective To investigate whether lumbosacral transitional vertebrae (LSTV) affects the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) in adolescent patients with lumbar disc herniation (LDH). Methods This was a retrospective study with two groups. Group A was made up of 22 adolescent LDH patients with LSTV (18 males and 4 females). Group B was made up of 44 adolescent LDH patients without LSTV (36 males and 4 females), who were matched to group A for age, sex, and body mass index. All patients underwent PELD at the L4/5 or L5/S1 single level and were followed up at 18 months after surgery. We identified LSTV on radiographs and computed tomography and assessed the imaging characteristics of all patients. Outcomes were evaluated through a numerical rating scale (NRS), the Oswestry Disability Index (ODI), the modified MacNab grading system, and the incidence of additional lumbar surgery. Results At 18 months after PELD, both groups had significant improvements in the mean NRS scores of low back pain (LBP) or leg pain and the ODI scores. In terms of the MacNab criteria, 90.9% in group A and 93.2% in group B showed excellent or good outcomes. The mean NRS scores of LBP or leg pain, ODI score, and MacNab grade after surgery were not significantly different between the 2 groups. Two patients (one patient had a recurrence; one patient had a new lumbar disc herniation) in group A and 3 patients (one patient had a recurrence; two patients had new lumbar disc herniations) in group B underwent additional lumbar surgery. Conclusions Our study suggests that in terms of pain relief, life function improvement, and the incidence of additional lumbar surgery, LSTV has no effect on the short-term clinical outcomes of PELD in adolescents. A new lumbar disc herniation is an important reason for additional surgery in adolescents, regardless of the LSTV status.

Relaxation exercise therapy improves pain, muscle strength, and kinesiophobia following total knee arthroplasty in the short term: a randomized controlled trial.

This study aimed to compare progressive muscle relaxation (PMR) + standard physiotherapy (PT) to standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of post-operative outcomes. The hypothesis was that PMR + standard PT would lead to better pain, function, and neuromuscular outcomes than standard PT. A total of 106 patients were randomly allocated into PMR or standard rehabilitation (SR) groups. Both groups received standard PT during their hospital stay. PMR group additionally performed PMR exercise on post-operative days 1, 2, and 3. Patients were evaluated regarding pain intensity, functional outcomes, muscle strength, active range of motion, knee edema, anxiety, depression, and kinesiophobia. There were no differences between groups at baseline (n.s.). During the inpatient period and at discharge, the PMR group had better results in terms of pain relief (p < 0.05), quadriceps strength (p = 0.001), kinesiophobia level (p = 0.011) compared to the SR group. No difference was detected between groups regarding other evaluation parameters during the inpatient period, at discharge, and third post-operative month (n.s.). The within-group analysis showed statistically significant differences over time in both groups in each variable (p < 0.05). Our findings support that PMR therapy offers beneficial results in subjective and objective measures of TKA patients during the inpatient period. Therefore, PMR therapy could be implemented into the rehabilitation program of TKA patients to enhance their early recovery from various symptoms following TKA. II.