Significant Differences In Visual Analogue Scale Research Articles

Safety of Yamamoto New Scalp Acupuncture in Healthy Subjects and the Relationship Between Shoulder Stiffness, Diagnosis Points, and Stimulation Points

Yamamoto New Scalp Acupuncture (YNSA) has been used in clinical practice for pain symptoms worldwide. However, the safety of YNSA and the role of the diagnosis and stimulation points have never been investigated. This study aimed to investigate the safety of YNSA and the relationship between the diagnosis points, the stimulation points, and changes in shoulder stiffness. YNSA was performed at the shoulder point A, acupuncture at the non-shoulder point D, and no intervention as a control in 15 healthy participants three times with a washout period of 1 week. Adverse reactions (changes in blood pressure, changes in heart rate, or bleeding), objective evaluation of the pressure pain threshold (PPT) and muscle hardness (MH) scores at the shoulder, and subjective evaluation of shoulder stiffness with a visual analog scale (VAS) were recorded before, during, and 20 min after stimulation. In the safety evaluation, no adverse reactions such as hypotension, bradycardia, or bleeding/hematoma were observed. PPT and MH revealed no significant difference between the conditions. There was a significant difference in the VAS between all three conditions (p = 0.039). Post-hoc analysis showed a significant difference between controls and D-point stimulation (p = 0.034), but no significant difference between A- and D-point stimulation. VAS subanalysis and post-hoc analysis in right-LI4-positive subjects (n = 4) showed a significant difference in VAS between A-point stimulation and controls (p = 0.01, 0.015, respectively). Our pilot investigation exhibited the safety of YNSA. Diagnosis and stimulation points may relate to changes in shoulder stiffness; however, further comparative studies with YNSA are required.

Septuagenarians aged 75 years and older do benefit from arthroscopic rotator cuff repair: a propensity matched-pair analysis.

BackgroundNumerous studies show that patients who failed conservative management, benefit from open, mini open and arthroscopic rotator cuff repair (ARCR). However, there is a paucity of literature addressing ARCR and outcomes in patients older than the age of 75 years. The purpose of our study was to compare the outcomes of ARCR in patients older than 75 years and younger than 75 years of age.MethodsBetween January 2010 and December 2016, 397 patients underwent unilateral ARCR; of which, 23 patients were 75 years of age and older. Outcome measures recorded include the Constant Shoulder Score (CSS), University of California, Los Angeles Shoulder Score (UCLASS), Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain assessment.ResultsThere were no statistically significant differences in VAS, CSS, and UCLASS between the two groups at all time points of follow-up (all P > .05). At 2 years after surgery, the OSS was 2 ± 5 points better in the <75 group (P = .012). However, the improvement in OSS was comparable between both groups. The improvement in VAS, CSS, and UCLASS at 2 years after surgery compared with baseline was also similar between the two groups (all P < .05).ConclusionsThe improvement in VAS, CSS, and UCLASS was similar in both groups of patients. We conclude that septuagenarians with symptomatic cuff tears, who have failed conservative management, experience significant improvement in pain, and function after surgery and should not be excluded from the benefits of ARCR.

Perineural Therapy in Treatment of Chronic DegenerativeLumbosacral Lesions

AbstractBackground: Low Back Pain (LBP) is the most frequenttype of musculoskeletal pain. “It is often recurrent and oftenhas important socio-economic consequences.Aim of Study: The aim of this study is to evaluate efficacy of perineural injection in treatment of chronic low back pain due to degenerative lumbosacral lesions among sample of Egyptian population.Patients and Methods: A prospective randomized casecontrolled study was performed on forty patients with subacuteand chronic low back pain; they were diagnosed clinicallyand radiologically as having degenerative disc lesion. Thepatients were randomly divided in two groups. In group 1,twenty patients received PNI sessions, the injection was doneonce weekly for 8 sessions with dextrose 5% (500ml) bufferedwith 2.4ml sodium bicarbonate (8.4% concentration). In eachsession; 5-10ml was injected subcutaneously with insulinsyringe with angle of introduction 30-40 degrees which targets:Pain located in thoraco-dorsal fascia, the fascia of the erectorspinae muscles along T10 to L2 dorsal rami, interspinoustenderness from medial branches of dorsal rami, superiorcluneal nerve at 7-8 cm from middle line cross the iliac crest& T10 cross over iliac crest at a distance 8-10cm. In group2, twenty patients received physical rehabilitation programTranscutaneous Electrical Nerve Stimulation (TENS), Ultra-sound (US), infrared light (IR) and massage if needed+ homeexercise) 3 days per week 1 day apart for 4 weeks.Results: Our forty cases were 17 males and 23 females;their mean age was 36.8±4.7. Significant improvement inROM post-treatment in the group 1 compared to group 2. Ahighly statistically significant difference in VAS (VisualAnalogue Scale) and Oswestry Disability Index (ODI) scorespost-treatment in group 1 compared to the group 2. PNI wassignificantly associated with higher improvements measuredby VAS, ROM and ODI when compared with group 2. Signif-icant positive correlation between age and disease durationin the 1st group. Significant positive correlations betweenROM & VAS. ODI change showed significant positive corre-lation with age and VAS change in group 1. In the 1st group;VAS change showed significant positive correlations witheach of flexion tips to floor change and lateral flexion. In the 2nd group; VAS change showed positive correlations withflexion change, flexion tips to floor change and lateral flexion.Group 1 showed more positive correlations regarding ROMdue to improvement of pain score.Conclusion: PNI with Dextrose 5% achieved short termimprovement in pain and functional abilities in patients withlow back pain secondary to degenerative lumbosacral disclesions at least for a short-term. The degree of improvementof pain and functional abilities was higher in the group thatreceived PNI compared to the group that received physicalrehabilitation program.

Anorectal application of 5% lidocaine cream reduces pain prior to periprostatic nerve block during transrectal ultrasound guided prostate biopsy: Randomized, prospective controlled study

Objectives Trans rectal ultrasound guided prostate biopsy with periprostatic nerve block (PPNB) is performed following probe insertion and manipulation leaving these initial maneuvers uncovered in terms of pain control. We evaluated whether topical analgesia reduces pain during early stages of the procedure. Patients and methods Seven group prospective, randomized controlled study: groups 1–3: nerve block with 5 ml 1% lidocaine bilaterally plus perianal topical application of 10 ml 5% lidocaine cream. Groups 4–6 as in 1–3 plus digital application of 10 ml 5% lidocaine cream internally on rectal walls. For each approach exposure times were 5 (groups 1 and 4), 10 (groups 2 and 5) and 20 (groups 3 and 6) min, respectively. The control group (7) received PPNB only. Patients filled a 0–10 visual analogue scale (VAS) at five points: after probe insertion, during probe manipulation, following PPNB, after prostate biopsies and a global pain estimation. Results Two hundred and fifty-two patients were enrolled. Significant differences in VAS between all study groups and controls were observed at the pre-biopsy stages of the procedure. In multivariate analysis adjusted for prostate specific antigen, diabetes mellitus status, spinal disease, abnormal digital rectal examination and non- benign prostate hyperplasia histology, significance remained for probe insertion and intra-rectal manipulation. For each exposure time no significant differences were observed between topical application and topical + intra-rectal application. After PPNB, differences between study and control groups disappeared. Conclusion Topical anesthesia significantly reduces pain during early stages of prostate biopsy. Perianal application sufficed whereas intra-rectal application of local anesthetics does not add to pain control. Perianal application for 10 min seems to be optimal.

Unilateral percutaneous vertebroplasty for osteoporotic lumbar compression fractures: a comparative study between transverse process root-pedicle approach and conventional transpedicular approach

PurposePercutaneous vertebroplasty (PVP) is a routine operation for the treatment of osteoporotic lumbar compression fractures (OLCFs). As is well known, unilateral puncture is a common method. However, with the conventional transpedicular approach (CTPA), the cement may be asymmetrically dispersed, so some surgeons use the transverse process root-pedicle approach (TPRPA). The objective of this study was to compare the clinical results and bone cement distribution of PVP for OLCF with unilateral TPRPA and CTPA to identify the advantages and disadvantages of the two surgical options.Patients and methodsFrom January 2016 to June 2019, seventy-two elderly patients who underwent unilateral PVP for single-level OLCF were retrospectively reviewed. Operation time, injection amount and type of bone cement distribution, and bone cement leakage and surgical complications were recorded. The visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were used to evaluate the clinical results. All patients were followed up for more than 12 months, and the assessment was based primarily on clinical and radiological outcomes.ResultsThere were significant differences in the surgical time and the volume and the type of bone cement distribution and the lost of operative vertebra height between the two groups. However, there was no significant difference in bone cement leakage. Moreover, there were no significant differences in VAS and ODI between the two groups at 2 days and 12 months after the operation.ConclusionsUnilateral TPRPA and CTPA are practical and feasible methods in PVP for the treatment of OLCF, and they have similar clinical effects. However, TPRPA has the advantages of a better distribution of bone cement and a shorter operation time and a better maintenance effect of injured vertebra height, without increasing the rate of bone cement leakage.

Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study

Purpose: The aim of the study was to assess radiological changes and clinical outcomes of patients with sequestered lumbar disc herniation (LDH) and evaluate the relationship between them. Methods: Patients diagnosed with sequestered LDH were followed up in 2 groups: operated (within the 1st month after diagnosis) and nonoperated. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores at baseline (V1) and 1st (V2), 3rd (V3), and 6th (V4) month visits were used for clinical evaluation. Radiological evaluation was performed by measuring the sequestered LDH level and herniation volume using magnetic resonance imaging (MRI) at V1 and V4. After the second MRI, patients in the nonoperated group were divided into 3 groups: nonregression (n = 6), partial regression (n = 22), and complete resolution (n = 27); patients were analyzed in 4 groups including the ones in the operated (n = 25) group. Results: Significant improvements were observed in VAS and ODI scores at V2 and V3 in all groups (p = 0.000) and at V4 in partial regression and complete resolution groups (p = 0.000). VAS and ODI score improvements at V2 and V3 were significantly higher in the operated group than in other groups (p = 0.000). At V4, there were no significant differences in VAS and ODI scores (p > 0.05) between the operated group and partial regression and complete resolution groups. Conclusion: Spontaneous regression was observed in the 6th month post-MRI in most of the nonoperated sequestered LDH patients with conservative treatment. Improvements in pain and disability scores were higher among the operated patients at the early stage, whereas they were not significantly different compared to patients with spontaneous regression at the 6th month.

Sacroiliac Joint Degeneration After Lumbopelvic Fixation.

Study Design:Retrospective Study.Objectives:Sacroiliac buttress screws (SBS) and S2 alar iliac screws (SAI) are used as distal screws in cases with long fusion to the pelvis. Distal fixation ends, whether exceeding the sacroiliac joint (SIJ), may affect postoperative degenerative changes in the SIJ. The aim of this study was to investigate SIJ degeneration after lumbosacral and lumbopelvic fixation, using SBS and SAI in degenerative spine diseases, respectively.Methods:This study included 70 patients aged ≥50 years with lumbosacral fusion (>3 levels). They were divided into 2 groups (SBS 20 and SAI 50 cases) based on the type of distal screws. Radiographical and clinical data were reviewed with a minimum 2-year follow-up. Radiographical SIJ degeneration was analyzed using computed tomography; clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ).Results:No significant differences were observed in patients’ preoperative characteristics between the 2 groups. The incidence of SIJ degeneration, including osteophyte formation (30.0% and 8.0%, p = 0.03), intraarticular air (75.0% and 16.0%, p < 0.001), and subchondral cyst (20.0% and 2.0%. p = 0.02) in SBS and SAI groups, respectively, at the follow-up, was significantly higher in the SBS group. Although SIJ degenerative changes were significantly different between the SBS and SAI groups, there was no significant difference in VAS and JOABPEQ scores between the groups at 2 years post-surgery.Conclusions:Lumbosacral fusion can cause SIJ degeneration, which is more frequent when SBS are used in fixation to the sacrum.

Efficacy and safety of paravertebral block versus intercostal nerve block in thoracic surgery and breast surgery: A systematic review and meta-analysis.

To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery. The PubMed, Web of Science, Embase and the Cochrane Library were searched up to February 2020 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of PVB compared with INB after thoracic surgery and breast surgery. For binary variables, odds ratio (OR) and 95% confidence interval (CI) was used. For continuous variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0 were used for performing the meta-analysis. A total of 9 trials including 440 patients (PVB block:222 patients; INB: 218 patients) met the inclusion criteria. In the primary outcome, there was no significant differences between the two groups with respect to postoperative visual analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P = 0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h (Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD = -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0. 33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h (Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary outcome, the analysis also showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27). There was significant difference in postoperative consumption of morphine (Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02). Compared with INB, PVB can provide better analgesia efficacy and cause lower consumption of morphine after thoracic surgery and breast surgery.

Effect of neural therapy versus extracorporeal shock wave therapy for the treatment of lateral epicondylitis: A randomized-controlled trial

IntroductionLateral epicondylitis is a common disease of the elbow joint. The main goal of therapy is to reduce pain and increase function. This study aimed to evaluate the effectiveness of neural therapy (NT) versus extracorporeal shock wave therapy (ESWT) in the treatment of lateral epicondylitis. MethodsBetween August 2018 and November 2018, 76 patients with lateral epicondylitis (26 males, 50 females; mean age: 44, 8 ± 9,5 years; range, 29–65 years) were randomly allocated to either NT or ESWT one session weekly for a total of three weeks. The subjective pain severity was evaluated using the Visual Analog Scale (VAS) and Duruoz Hand Index (DHI) was used to assess the functional disability before and after treatment and at 12 weeks. ResultsWhen the before and after treatment and 12 weeks variances of values were compared between ESWT and NT groups, there were no significant differences in the VAS and DHI scores between the groups(p > 0.05)(VAS score at 12 weeks (effect size = 0, 18, 95% confidence interval (CI): -0,358−1,619) or DHI score (effect size = 0, 13, 95 % CI: -7,627−4,390). However, within the groups, there were significant differences in VAS and DHI scores between before treatment and after treatment(P < 0.05), and between before treatment and at 12 weeks follow up (P < 0.05). No adverse events occured in this study. ConclusionThe results of this study show that both ESWT and NT have similar effects in reducing pain and hand function in patients with lateral epicondylitis. However neither of two the treatment modalities showed superiority.

155. Safer way for vertebroplasty under fluid mechanics theory

BACKGROUND CONTEXT Osteoporotic vertebral fractures (OVF) are a hallmark of osteoporosis and are the most prevalent fracture. PURPOSE Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of OVF. However, the matter of which surgical approach should be selected remains controversial. This study aimed to find a safer and better way for patients treated with cement augmentation technique through fluid dynamics theory to prevent cement leakage. STUDY DESIGN/SETTING Randomized controlled trials and biomechanics analysis PATIENT SAMPLE In vitro, 36 standardized osteoporotic porcine vertebrae body series (T10-L3) were developed. In vivo, from January 2015 to December 2018, 68 patients with OVF were randomly assigned to the unilateral puncture group (n=36) or the bilateral group (n=32). OUTCOME MEASURES In vitro, specimens were imaged with plain radiology, mounted on the testing apparatus, and histologic examination. In vivo, these patients underwent percutaneous injection of PMMA into posterior pedicle by the unilateral or bilateral puncture approach. Visual analogue scale (VAS) and the Quality of Life were recorded on presentation, at 1 week, 3, 6, and 12 months after operation. The cement leakage was measured by x-ray and computed tomography scan. METHODS Two different cement augmentation techniques were assessed with polymethyl methacrylate (PMMA) under unilateral vertebroplasty and bilateral vertebroplasty with continuous negative pressure to the contralateral side of the vertebral body. RESULTS The leakage rate was significantly lower in the continuous-negative pressure system than unilateral puncture approach. Excellent cross-filling of bone cement, better stress-resist power, better digitation of cement under histology examination were in negative pressure group. As for patient follow-up data showed there were no significant differences in VAS and QUALEFFO between two groups after PVP between two groups at 3, 6, and 12 months after operation. The cement leakage was higher in the unilateral puncture group than in the bilateral group. CONCLUSIONS Cement injection combined with continuous negative pressure system to the contralateral side of the vertebral body is a simple approach to minimize the risk for leakage. It offers surgeon a more secure and effective way to perform augmentation technique and reduces the likelihood of cement leakage and pulmonary embolism. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Sublaminar decompression and fusion versus transforaminal lumbar interbody fusion in management of lumbar degenerative disorders: a retrospective cohort study

Introduction: Sublaminar decompression is a new technique that includes partial laminectomy and facetectomy providing a wide central, foraminal, and lateral recess decompression and leaving maximal bone posterior and posterolateral to allow adequate fusion. The aim of this study was to evaluate the efficacy and safety of sublaminar decompression in comparison to standard transforaminal lumbar interbody fusion (TLIF). Methods: Forty patients with degenerative lumbar disorders were managed with spinal fusion at the Zagazig University Hospital. The patients were divided into two groups. Group 1 included 20 patients managed with sublaminar decompression and instrumented fusion with a mean patient age of 47.7±10.4 yr. The patients in group 2 had a mean age of 45.3±10.3 yr and were managed with TLIF. The patients were assessed clinically and by radiographs, and using a visual analogue scale (VAS) of pain and Owestry Disability Index (ODI) as outcome measures. Statistically significant differences between preoperative and the final follow-up means were assessed using paired t-test test. P&lt;0.05 was statistically significant. Results: In comparing the two groups regarding correction rate for different radiographic and clinical parameters, this study found significant changes in anteroposterior thecal diameter (P=0.002) and right foraminal height (P=0.004) and highly significant differences in left foraminal height (P&lt;0.001) and thecal sac area (P&lt;0.001) in favor of the sublaminar group. There were no significant differences in VAS for leg (P=0.979) and back pain (P=0.119) or ODI (P=0.0.497). Conclusion: When compared to TLIF, sublaminar decompression and fusion is a safe and effective procedure in the treatment of stenotic degenerative spinal disorders. Level of Evidence: Level III.

Relationship between alterations of spine-pelvic sagittal parameters and clinical outcomes after oblique lumbar interbody fusion

To investigate the relationship between spine-pelvic sagittal parameters and clinical efficacy before and after oblique lumbar interbody fusion(OLIF). A retrospective analysis of clinical data of 65 patients with lumbar degenerative diseases treated with OLIF were performed from July 2017 to July 2018. There were 26 males and 39 females aged from 33 to 79 years old with an average of (62.72±10.23) years old. Oswestry Disability Index (ODI) and visual analogue scale (VAS) before and at the latest follow up were evaluated. Disc height (DH) and spine- pelvic sagittal parameters of the surgical segment were measured before and at the latest follow- up, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL). According to the difference of PI-LL, it was judged whether PI and LL match and the patients were grouped, PI-LL ranged from -9° to 9° was set as matching group, and PI-LL less than -9° or larger than 9° was set as mismatching group. The spine-pelvic sagittal parameters were analyzed before and at the latest follow-up of OLIF in patients with lumbar degenerative diseases, and the correlation between changes and clinical efficacy was compared. All patients were followed up from 8 to 20 months with an average of (14.20±3.68) months. Operation time was (91.54±25.97) min, intraoperative blood loss was (48.15±10.14) ml, and the hospitalization time ranged from 6 to 19 days with an average of (9.28± 2.50) days. Totally 84 surgical levels, 46 patients were single segment and 19 patients were double segments. VAS and ODI score were improved from (4.88±0.99) point, (67.60±13.73) % preoperatively to (2.85±1.30) points, (30.57±6.48) % at the latest follow-up. There were significant differences in VAS and ODI scores between before and at the latest follow-up. The sagittal parameters of LL, PT, SS, PI, PI -LL and the surgical level DH were (42.80 ±16.35)° , (23.22 ±10.91)° , (26.95 ± 13.30)°, (50.22±14.51)°, (7.53±16.13) °, (0.91±0.29) cm preoperatively and improved to the latest follow-up (49.95± 12.82) °, (17.94±9.24) °, (33.71±12.66) °, (51.65±10.26) °, (1.68±17.00) °, (1.20±0.40) cm;there were statistical differences in LL, PT, SS, PI-LL, DH before operation and at the latest follow up, while no difference in PI. LL of preoperative PI-LL in matched group was (48.76±11.09)° , and (38.00±18.37)° in PI-LL mismatch group, there was difference between two groups. There were no differences in VAS, ODI, PT, SS, PI and DH between two groups. At the latest follow-up, ODI between PI-LL matched group and PI-LL mismatched group were (29.40±5.93)% and (32.86±7.02)% respectively, and had difference in ODI between two groups;while there were no significant differences in VAS, LL, PT, SS, PI, and DH. Pearson correlation analysis showed preoperative PT-LL was positively correlated with VAS;PT was positively correlated with ODI at the latest follow-up. OLIF has a good surgical effect on lumbar degenerative diseases, and could change spine-pelvic sagittal parameters of patient to a certain extent, and further restoring the balance of the sagittal plane of lumbar spine.

A Randomized Controlled Trial of FNB versus FICB for Patients with Femoral Neck Fractures Before Spinal Anesthesia.

Background and ObjectivesPatients with femoral neck fractures often suffer severe pain. This randomized controlled clinical study compared the effect of femoral nerve block (FNB) and fascia iliaca compartment block (FICB) in this population.Patients and MethodsForty-six patients were randomly assigned to one of the two groups: FNB group (femoral nerve block, n=23) or FICB group (fascia iliaca compartment block, n=23). Before positioning for spinal anesthesia, patients received FNB with 15 mL of 0.5% ropivacaine or FICB with 40 mL of 0.5% ropivacaine. Pain was evaluated using a visual analogue scale (VAS) at rest and during hip flexion after admission to the operation room; at 3, 5, 8, and 10 min after analgesia intervention; and during positioning for spinal anesthesia. Positioning was attempted after 10 min of analgesia intervention in each group. Time required to perform spinal anesthesia, quality of positioning, and patient satisfaction were documented.ResultsThe VAS scores in the FNB group were significantly lower than those in FICB group at 3 and 5 min after analgesia intervention (P=0.000). However, there were no significant differences in VAS between groups at 8 or 10 min or during positioning.ConclusionFNB and FICB produce similar analgesic effects in patients with femoral neck fractures, but FNB has a more rapid onset of pain relief.

Bee Venom Acupuncture for Shoulder Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

ObjectivesOur review aimed to summarize and evaluate evidence on the effectiveness of bee venom acupuncture (BVA) in the treatment of shoulder pain.MethodsRandomized controlled trials (RCTs) evaluating the effectiveness of BVA on shoulder pain were searched up to October 2019 in 11 electronic databases (Medline, Embase, CENTRAL, CiNii, CNKI, VIP, Wanfang, Kmbase, NDSL, RISS, OASIS). The methodological quality of the included RCTs were evaluated using Cochrane Risk of Bias tool and a meta-analysis was performed.ResultsSeven studies were included in the review, and four studies were included in the meta-analysis. Comparing BVA plus conventional therapy (CT) with saline injection plus CT, it showed an effect in favor of BVA plus CT in visual analog scale (VAS) and pain rating scale (PRS) (p = 0.02, p = 0.009, respectively). Comparing BVA plus physiotherapy (PT) with saline injection plus PT, it showed that there was no significant difference in VAS and verbal rating scale (VRS) between the two groups.ConclusionThis systematic review and meta-analysis suggest that BVA could be beneficial as an adjuvant treatment for shoulder pain.

Clinical Comparison of Full-Endoscopic and Microscopic Unilateral Laminotomy for Bilateral Decompression in the Treatment of Elderly Lumbar Spinal stenosis: A Retrospective Study with 12-Month Follow-Up.

PurposeAlthough lumbar spinal stenosis (LSS) is the most common spinal disease in the elderly, there is still a confusion about the appropriate surgical treatment strategy. The aim of this study was to compare the safety and efficacy of full-endoscopic and microscopic unilateral laminotomy for bilateral decompression (ULBD) for LSS in elderly patients.Patients and MethodsA retrospective analysis of 61 consecutive elderly patients with LSS who underwent either full-endoscopic (FE group) or microscopic (Micro group) unilateral laminotomy for bilateral decompression was performed. Clinical data were assessed before 2 weeks, 3 months, 6 months and 12 months after surgery using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) and the modified MacNab criteria.ResultsThere are no significant differences in VAS (back and leg) and ODI between the two groups. However, the VAS back pain in the FE group was significantly improved compared to the Micro group at 2 weeks. The rate of excellent or good outcomes was 87.88% and 85.71% in the FE and Micro group, respectively (P>0.05). The hospital stay and early ambulation in FE group were shorter than those in Micro group, but the operation time was longer (P<0.05). The complications between the FE group (18.18%) and the Micro group (17.86%) were minor (P>0.05).ConclusionBoth full-endoscopic and microscopic decompression have achieved favorable clinical results in treating elderly lumbar spinal stenosis, and the complications are minor. Full-endoscopic decompression has the advantages of small incision and rapid recovery, which can be used as an alternative for the treatment of lumbar spinal stenosis, especially the elderly with comorbidities.

Percutaneous transforaminal endoscopic foraminoplasty for simple lumbar spinal lateral exit-zone stenosis

To evaluate the clinical effects of percutaneous endoscopic foraminoplasty for simple lumbar spinal lateral exit zone stenosis. A total of 36 patients with simple lumbar spinal lateral exit zone stenosis were admitted to our hospital from January 2013 to June 2018, and received selective nerve root canal radiography and radicular block. According to the symptoms and patients' personal wills, 22 cases underwent the one-stage percutaneous foraminal surgery(the one-stage operation group), and the other 14 patients were re-admitted to the hospital for operation(the delayed operation group) because of the recurrence of symptoms after discharge. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical effects before therapy, 1 day after the radicular block, and 1 day, 3 months and 6 months after the operation. VAS and ODI of all 36 cases were obviously improved (P<0.05) at various stages after the surgery and maintained well and showed a continuous downward trend. The VAS at 6 months after the operation was improved significantly compared with that at 1 day after the operation (P<0.05).When comparing the postoperative ODI between 1 day and 3 months after the surgery, 1 day and 6 months after the surgery, 3 months and 6 months after the surgery, the differences were statistically significant (P<0.05). The VAS and ODI of the one-stage operation group at 1 day after radicular block were better than those of delayed operation group. The VAS and ODI of delayed operation group before readmission were significantly higher than those at 1 day after radicular block. There were no significant differences in VAS and ODI at each stage after operation between two groups(P>0.05), but when compared with its own pretherapy andbefore readmission results, the difference was significant (P<0.05). There was no nerve injury in all cases. Only 2 cases were presented with the outlet root stimulation symptoms, and the symptoms relieved after short term conservative treatment. The clinical effects of radicular block may be unsustainable for patients with simple lumbar spinal lateral exit zone stenosis. Instead, percutaneous endoscopic foraminoplasty was simple, safe and effective.

Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis.

Study Design:Retrospective analysis.Objective:Lumbar disc herniation is one the most common condition responsible for low back and radicular pain. Although the symptoms are not proportional to the size of disc prolapse but massive disc herniation frequently needs surgical management. According to literature, the incidence of low back pain, recurrent disc herniation and segmental instability are more in discectomy whereas incidence of adjacent segment degeneration (ASD) is more after fusion surgery. There are very few studies that directly compare long-term functional outcome of both these procedures. We compared the functional outcome of both the procedures in this study.Methods:All patients of massive disc prolapse, operated at our center between 2011 to 2017, were contacted. All the patients underwent either discectomy or transforaminal lumbar interbody fusion (TLIF). Functional outcomes of all the patients were collected using visual analogue scale (VAS) (back), VAS (leg), modified Oswestry Disability Index (mODI), Sciatica Bothersomeness Index (SBI), and McNab’s criterion. Various complications were also analyzed.Results:There were 144 patients in the discectomy group and 123 patients in the TLIF group. Mean duration of follow-up was 55.07 months and 51.86 months, respectively. Both the groups show no significant difference in VAS. Significant difference was seen in mODI and SBI favoring discectomy. McNab’s criterion showed excellent result in 80% of patients of discectomy compared with 68% patients of TLIF. Overall complication rate in discectomy group was 11% whereas 13% in TLIF group.Conclusion:Both show good functional outcome but better in discectomy. Recurrent herniation and instability were noticed more with discectomy and ASD was more common after fusion surgeries. The choice of procedure should be individualized, and it also depends on surgical expertise, but in developing countries where resources are constrained, discectomy should be preferred.

Intravenous metoclopramide versus dexketoprofen trometamol versus metoclopramide+ dexketoprofen trometamol in acute migraine attack in the emergency department: A randomized double-blind controlled trial

Study objectiveThe objective of this study was to determine the analgesic efficacy and safety of intravenous, single-dose metoclopramide versus dexketoprofen trometamol versus metoclopramide+ dexketoprofen trometamol in patients presenting with acute migraine attack to the emergency department (ED). MethodsThis single-center, randomized, double-blind study was conducted in a tertiary care ED. Eligible patients met the migraine criteria of the International Headache Society were randomized to receive 10 mg intravenous metoclopramide, 50 mg intravenous dexketoprofen trometamol, or 50 mg dexketoprofen trometamol +10 mg metoclopramide. Visual analogue scale (VAS) was used for pain measurement at baseline, after 15 and 30 min. The primary outcome measure was the changes in the VAS scores at the 15th and 30th minutes of treatment. The secondary outcome measures were the presence of adverse effects and the requirement of rescue medicine. ResultsPatients (n = 150) were randomized into 3 groups with similar VAS scores at baseline. While there was no significant difference between metoclopramide and dexketoprofen trometamol in reducing pain at the 15th and 30th minute (p = 0.618 and p = 0.862, respectively) and between metoclopramide and metoclopramide + dexketoprofen trometamol at the 15th minute (p = 0.074), metoclopramide + dexketoprofen trometamol was superior to both metoclopramide [mean difference: −13.2 mm (95% CI −23.1 to −3.3)] and dexketoprofen trometamol [mean difference: −11.02 mm (95% CI −20.9 to −1.1)] at the 30th min (p = 0.006 and p = 0.025 respectively). The rescue drug was required by 3 patients (6%) were in metoclopramide group, 4 patients (8%) in dexketoprofen trometamol group and one patient (2%) in the metoclopramide + dexketoprofen trometamol group. No side effects were observed in subjects in three treatment groups. ConclusionNo significant difference in VAS was found between three treatment groups at the 15th minute, but metoclopramide + dexketoprofen trometamol was superior to both metoclopramide and dexketoprofen trometamol at the 30th min.

A comparative study of carpal tunnel release through three kinds of small incision for the treatment of carpal tunnel syndrome

Objective To compare the clinical efficacy and complications of small transverse and longitudinal incision of the wrist, and the small longitudinal incision of the palm in the treatment of carpal tunnel syndrome (CTS). Methods From June 2015 to June 2018, 150 patients with CTS were diagnosed and treated. There were 50 cases of wrist small transverse incision, 50 cases of wrist small longitudinal incision and 50 cases of longitudinal incision at the root of the palm for carpal tunnel release. The visual analogue scale (VAS), BCTQ score, Kelly's evaluation of clinical efficacy, postoperative complications, neuro-electrophysiological parameters, two-point discrimination and basic operation conditions were compared in three groups at 1, 3 and 6 months after operation. Results There was no significant difference in VAS, BCTQ score and Kelly's evaluation of clinical efficacy and excellent rate between the three groups (P>0.05); the incidence of postoperative scar pain and overall complications in the wrist longitudinal incision group was significantly higher than that in the wrist transverse incision group and the longitudinal incision at the root of the palm (P 0.05). Conclusion The results of three kinds of small incision carpal tunnel release surgery are similar in the treatment of CTS, but the complications of longitudinal incision at the root of the palm and wrist small transverse incision for carpal tunnel release surgery are less. Key words: Carpal tunnel syndrome; Treatment outcome; Small incision; Release

Comparison of therapeutic effects of continuous epidural nerve block combined with drugs on postherpetic neuralgia

Purpose To compare the therapeutic effects of continuous epidural block combined with drugs and oral drugs alone on postherpetic neuralgia (PHN). Methods Ninety-six PHN patients meeting the standard were selected and divided into group A and group B. Patients in group A had epidural block combined with oral administration of gabapentin and oxycodone-acetaminophen, and patients in group B received oral gabapentin and oxycodone-acetaminophen. Visual analogue scale (VAS) and Wisconsin brief pain inventory scores were used to evaluate the patients in group A and group B for 6 times (before treatment, 1 d, 3 d, 7 d, 15 d and 30 d after treatment) respectively, and the complications and adverse reactions of the two treatment methods, as well as the number of cases requiring remedial measures were observed. Results There were significant differences in VAS and Wisconsin brief pain inventory scores at 1 d, 3 d, 7 d, 15 d and 30 d after treatment between the two groups (p < 0.05). Moreover, the scores before and after treatment decreased with the time of treatment, and there was a significant difference between the two groups at different time points (p < 0.05). No significant adverse reactions were observed in group A except for 1 patient with catheter detachment. Compared with group A, the adverse reactions of group B were more varied and obvious. Conclusion Both treatments have certain effects on PHN, but epidural block combined with drug therapy is more effective, especially for patients with severe pain, early use can quickly relieve pain.