Fluoroscopy-guided triple hip block for patients with hip osteoarthritis: A new approach.

Hip osteoarthritis (OA) is found in approximately 10% of the population and often causes disability and social limitations in elderly patients. Intra-articular injections are among the most frequently applied interventional treatments for the hip joint. Femoral and obturator sensorial nerve blocks have also been reported to be effective for both diagnostic and therapeutic purposes. A single needle insertion was performed for the blockage of the hip joint and sensory branches. For the sensory branch of the femoral nerve, the needle is advanced at nearly a 45-degree angle toward below the anterior inferior iliac spine near the anterolateral edge of the hip joint. For the sensory branch of the obturator nerve, the needle is advanced at nearly an angle of 45 degrees toward the area below the junction of the pubis and ischium. Finally, for joint injection, the same needle was advanced toward the midline of the anterior femoral head-neck junction at a steeper angle, and blocks were applied. Three patients with hip osteoarthritis were injected with this method and well-being was achieved in a 3-month follow-up. We think that blockage of the hip joint and peripheral sensory branches with a single needle insertion is a fast and effective method. However, prospective controlled studies are needed to determine the efficacy and safety of the method.

Comparison of the Use of Peripheral Nerve Stimulator and Quincke Needle for Lumbar Transforaminal Epidural Steroid Injections.

AIM: To compare the procedural features of transforaminal epidural steroid injection (TFESI) performed using two different needles (Stimuplex® and Quincke) in terms of procedure time, exposed radiation dose and adverse effects and complications, thus providing preliminary data to aid needle selection for TFESI. MATERIAL AND METHODS: Patients who received fluoroscopy-guided single-level lumbosacral TFESI between September 2020 and September 2021 were retrospectively included in this study. The patients were divided into two groups with respect to the needle type used for the procedure ? those treated with a Quincke needle were classified as Group Q and those treated with a Stimuplex® needle comprised Group S. Subsequently, the two groups were compared in terms of their demographic data, procedure time, radiation dose, amount of contrast use, first-hour numeric rating scale (NRS), intravascular flow and complication rates. RESULTS: The number of patients recruited for Groups Q and S was 65 and 61, respectively. No significant difference was observed between the groups regarding their demographic data, preprocedural NRS scores, procedure time, exposed radiation dose and the amount of contrast dye used. Notably, the first-hour NRS scores were found to be significantly lower in Group S (p=0.040) after the procedure. Moreover, the intravascular contrast spread was significantly different between the two groups (p < 0.05) ? it was encountered during four procedures in Group Q, but was altogether absent in Group S. CONCLUSION: The Stimuplex® needle may decrease the possibility of inadvertent intravascular leakages during TFESI and may also improve immediate pain scores after the procedure.

A case of transient hemiplegia after cervical transforaminal epidural injection with dexamethasone: What actually happened?

Cervical transforaminal epidural steroid injections (TESIs) have technical difficulties and a risk of complications due to the cervical spine anatomy. A 52-year-old female patient was admitted to our outpatient clinic with complaint of neuropathic pain radiating to her right arm. Right C7 TESI was planned for patient who did not respond to conservative treatment. Immediately after the procedure, flaccid paralysis was detected in the right side and, at the end of 24 h, the patient completely regained her former muscle strength. In conclusion, patient selection for the cervical TESI should be done carefully and kept in mind that transient spinal cord ischemia may develop.

Comparison of Radiation Doses of Contralateral Oblique and Lateral View for Fluoroscopy-Guided Lumbar Interlaminar Epidural Steroid Injection.

BACKGROUND: Despite newly developing technologies and techniques, the use of fluoroscopic guidance in spinal interventional treatments remains popular. Therefore, it is essential to set reference standards and techniques for reducing radiation exposure in fluoroscopy-guided procedures. OBJECTIVE: The aim of this study was is to compare the radiation doses and procedure time of the contralateral oblique (CLO) view to  lateral view imaging during fluoroscopy-guided spinal procedures. STUDY DESIGN: A retrospective study. SETTING: Pain management unit of a tertiary care center. METHODS: An evaluation of patients who received epidural steroid injections between May 2021 and May 2023 in a university hospital interventional pain management center was performed. This observational study was conducted with 248 patients aged 18 and older who underwent lumbar interlaminar epidural injections (ILESI) confirmed by CLO or lateral oblique imaging. The primary outcomes were the comparison of radiation dose and procedure time between the 2 groups. The secondary outcome was the comparison of complication rates. RESULTS: There were no significant differences between the two groups in terms of age, gender, diagnosis, body mass index, procedure level, Numeric Rating Scale, and procedure time. Although the radiation dose was lower in the CLO group, there was no significant difference between the 2 groups. However, there was a significant difference between the 2 groups in terms of complications (P < 0.001). LIMITATIONS: The study was designed in a single center and performing all the procedures with the same fluoroscopy device makes it difficult to generalize our results. CONCLUSIONS: Although there was no difference in terms of radiation dose and duration of procedure between lumbar ILESI conducting using the CLO or lateral view fluoroscopy imaging, there was a significant difference in terms of complications. Therefore, conducting lumbar ILESI using a CLO view minimizes the complication rate.

The Impact of Contrast Spread Patterns to Clinical Outcomes of Cervical Interlaminar Epidural Steroid Injection: An Observational Study.

AIM: To investigate the relationship between epidural contrast spread patterns, and the treatment success of cervical interlaminar epidural steroid injection (CIESI) for cervical radicular pain. MATERIAL AND METHODS: A total of 76 patients aged between 20 and 60 years who had neck and unilateral upper limb pain due to a single-level disc herniation at C5-C6 or C6-C7 were included. Severity of pain and disability were assessed with Numerical Rating Scale (NRS-11) and Neck Pain Disability Scale (NPDS) at baseline, three weeks, and three months after the treatment. Contrast dispersion prior to injection of the medication was graded in anteroposterior fluoroscopic view. Treatment success was defined as a ≥50% improvement at three months in the NRS-11 scores compared to baseline. RESULTS: A significant improvement in pain and disability scores was observed at three months compared to baseline (p < 0.001). Treatment success was observed in 57% of the patients. The multivariate binary logistic regression analysis revealed that high initial NPDS scores, severe foraminal and central stenosis, Grade 1 contrast spread pattern were negative predictors of response to CIESI. CONCLUSION: Lateral contrast spread toward the dorsal root ganglion (DRG) and spinal nerve root of the target level was associated with more favorable clinical responses. Clinicians performing CIESIs should exert effort to administer the injectate around the DRG and spinal nerve root at the target level.

The effect of lumbar multifidus cross-sectional areas on transforaminal epidural steroid injection: An observational clinical study.

OBJECTIVES: Multifidus has an important role in spinal stability, and multifidus degeneration causes long-term disability and low back pain. This study aimed to investigate the effect of multifidus cross-sectional area on transforaminal epidural steroid injections (TFESI). METHODS: Patients with single-level disc herniation were included in the study. Total multifidus cross-sectional area (TM-CSA) and functional cross-sectional area (FM-CSA) were measured from axial T2 MRI of the patients, and FM-CSA/TM-CSA ratio was calculated for determination of muscle degeneration or fat infiltration. Numerical Rating Scale (NRS) scores at the pre-injection, 3rd week, and 3rd month visits were recorded. A decrease of 50% or more in the NRS score in the 3rd month was accepted as a treatment success (TS), and patients were divided into TS and treatment failure groups. RESULTS: A total of 120 patients were included in the study; 57 of the patients were female, and 63 of them were male. Of the patients included in the study, 68 had herniation at the L5-S1 disc level and 52 had herniation at the L4-L5 disc level. FM-CSA and FM-CSA/TM-CSA ratio were found to be significantly lower below the disc herniation level on the affected side (p<0.05). The affected side TM-CSA and FM-CSA were higher in the TS group and TM-CSA/FM-CSA ratios were equal in both groups. CONCLUSION: Multifidus CSA was found to be lower on the affected side. However, the effect of multifidus CSA on the success of TFESI has not been determined.

Frequency of fibromyalgia in a cohort of Turkish patients with lung cancer and its effect on pain, sleep quality, fatigue and quality of life.

This study aimed to examine the frequency of fibromyalgia (FM) in patients with lung cancer and evaluate its effect on patients' pain, sleep quality, fatigue, and quality of life parameters. The study was designed as a prospective cross-sectional and a total of 116 lung cancer patients were included. FM classification was made according to the 2016 ACR criteria. All patients were evaluated using a visual analog scale, fibromyalgia impact questionnaire, multidimensional assessment of fatigue, EuroQol 5D scale, Jenkins sleep scale, and Beck depression inventory. Patients were divided into FM-positive and negative groups according to the presence of FM. Demographic and clinical parameters were investigated between the groups. FM was detected in 14 (12.2%) patients. The mean age of the patients was 62.2 ±â€…8.4 years. There was a male predominance in 93 (80.2%) patients. No statistical difference was found between the groups in terms of body mass index, age, symptom duration, chemotherapy, and radiotherapy history. A statistically significant difference was found between FM positive and negative groups in FIQ, multidimensional assessment of fatigue, JSS, EQ-5D, visual analog scale, and Beck depression inventory scores. FM is seen more frequently in patients with lung cancer and has a negative effect on sleep, quality of life, fatigue, and mental functions. We think that physicians should not ignore the presence of FM when treating patients diagnosed with lung cancer.

Proximal femur diaphysis osteoid osteoma mimicking lumbar radiculopathy.

Osteoid osteoma is a benign bone tumor that commonly arises from the metaphyseal and diaphyseal regions of long bones. Pain is often the first symptom, and it can mimic many diseases. Herein, we report a 36-year-old male patient who presented with complaints of lower back pain radiating to the right extremity for a year. In the patient's history, physical therapy, platelet-rich plasma, pregabalin, and duloxetine were used, with the only benefit from indomethacin. An X-ray of the femur was requested, and the diagnosis of osteoid osteoma was confirmed by magnetic resonance imaging. Osteoid osteoma should be kept in mind as a differential diagnosis of persistent pain despite treatment.

Caudal epidural steroid injection versus transforaminal ESI for unilateral S1 radiculopathy: a prospective, randomized trial.

OBJECTIVE: Epidural steroid injections are frequently performed to manage radicular symptoms. Most research investigating the effectiveness of different routes of epidural injections were conducted with non-homogeneous groups. In this study our aim was to investigate the efficacy of caudal versus transforaminal approaches in patients with unilateral S1 radiculopathy secondary to a paracentral L5-S1 disc herniation. STUDY DESIGN: Prospective, randomized clinical trial. SETTING: A university hospital pain management center. METHODS: The study was conducted between January 2022 and February 2023. Patients with unilateral S1 radiculopathy were randomly divided into two groups: the caudal epidural steroid injection (CESI) and the transforaminal epidural steroid injection (TFESI) group. Severity of pain and disability were assessed with Numeric Rating Scale (NRS-11) and Oswestry Disability Index (ODI) at baseline, 3 weeks, and 3 months after treatment. Fifty percent or more improvement in NRS-11 was defined as treatment success. Fluoroscopy time and doses of exposed radiation were also recorded. RESULTS: A total of 60 patients were included in the final analysis (n = 30 for each group). Significant improvement in pain and disability scores was observed at 3rd week and 3rd month compared to baseline (P < .001). Treatment success rate at 3rd month was 77% for the CESI group and 73% for the TFESI group without any significant difference between the groups (P = .766). CONCLUSIONS: CESI is equally effective as TFESI in the management of S1 radiculopathy due to a paracentral L5-S1 disc herniation. Both approaches can reduce pain and disability, while CESI requires shorter fluoroscopy time and less radiation exposure.

YouTube as a source of information on sacroiliac joint injection: A reliability and quality analysis.

Sacroiliac joint (SIJ) injection is recommended for both diagnosis and relief of SIJ pain. YouTube has become a widely used source for health professionals and patients to obtain information about various procedures but the quality of YouTube videos including medical content is questionable. Therefore, the aim of this study is to evaluate the quality of SIJ injection videos on YouTube. This cross-sectional study was conducted through March 2022 by searching the phrase "sacroiliac joint injection" on YouTube. After resetting search history top 100 videos were screened. Duration of videos, number of views, number of likes, number of comments, view ratio (number of views/d), time passed since upload date, guide used for injection, and source of videos were recorded. The DISCERN and the Global Quality Scale were used to assess the quality and reliability of the videos. Of the 100 videos screened 42 videos met the inclusion criteria. The videos (73.8%) were predominantly uploaded by physicians. Most frequently used guide for injections was ultrasound with 45.4%. According to the DISCERN classification, 35.7% of the videos were "very poor," 30.9% were "poor," 21.4% were "fair," 7.1% were "good" and 4.7% were "excellent." Physicians and patients should be aware of that many of the videos about SIJ injections are categorized as "poor" or "very poor," which means they may mislead trainees, resulting in inadequate treatments.

The Effect of Central Sensitization on Interlaminar Epidural Steroid Injection Treatment Outcomes in Patients with Cervical Disc Herniation: An Observational Study.

BACKGROUND: Central sensitization (CS) is a hyperexcitability that is manifested by the increased response of the central nervous system to sensory stimuli. It has been shown that the presence of CS may have a negative effect on the clinical picture in some musculoskeletal diseases and also have a negative effect on spinal procedures. OBJECTIVES: To investigate the effect of CS on interlaminar epidural steroid injection (ILESI) treatment outcomes in patients with cervical disc herniation (CDH). STUDY DESIGN: An observational study. SETTING: A university hospital pain management center. METHODS: Patients, who underwent ILESI between 2020-2021 due to CDH, were included in the study. The Numeric Rating Scale (NRS-11), Neck Pain and Disability Scale (NPDS), Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), and Short Form-12 (SF-12) were used for evaluation of patients. Patients were assessed before the procedure, at the first hour, and 3 months after the procedure. The presence of CS was investigated by the Central Sensitization Inventory (CSI). RESULTS: A total of 51 patients were included in the study. Twenty-three of the patients had CS, as assessed by the CSI. Although, patients who underwent ESI, had significantly lower NRS-11, S-LANSS, and NPDS scores, and higher SF-12 scores at all follow-up points. The first and third months, NRS-11, S-LANSS, and NPDS were significantly higher, and SF-12 scores were lower in the CS group compared to patients without CS. LIMITATIONS: The short follow-up period and relatively low number of patients can be considered as a limitation. The fact that CS is not evaluated with a more objective method, such as Quantitative Sensory Testing (QST), can be considered as another limitation. Since most clinicians use CSI, so from a "real world" perspective the lack of QST may be observed as a strength of the study. The third limitation is that we did not evaluate the patients' pre- and posttreatment analgesic consumption. Finally, we did not include patients with a history of psychiatric illness, but not evaluating the current psychiatric conditions of the patients could be considered a limitation. Nevertheless, the main strengths of this study are its prospective design and, to our knowledge, it is the first study to explore the effects of CS on cervical ESI treatment. CONCLUSIONS: The presence of CS has a negative effect on pain scores, disability, and quality of life in patients undergoing cervical ESI due to CDH.

Reliability and validity of Turkish versions of Sciatica Bothersomeness and Sciatica Frequency Index.

BACKGROUND: The Sciatica Frequency Index (SFI) and Sciatica Bothersomeness Index (SBI) are two separate indices scored for both the bothersomeness and frequency of radiating symptoms. There is no Turkish scale used specifically for sciatica. OBJECTIVE: We aimed to translate SBI and SBI in Turkish and investigate the reliability and validity of these indices. METHODS: A total of 80 patients with lumbar disc herniation (LDH) were prospectively included. Construct validity was assessed by comparing the SBI and SFI with subscales of Short Form 36 (SF-36), back and leg Numeric Rating Scale (NRS) and Roland Morris Disability Questionnaire (RMDQ). Reliability was assessed by internal consistency (Cronbach's alpha) and test-retest reliability. RESULTS: A weak correlation was found between SBI/SFI, back NRS and SF-36 subgroups while a moderate correlation was found between SBI/SFI, RMDQ and leg NRS. The SBI and SFI had high internal consistency measured by Cronbach's alpha (0.76 and 0.73). Test-retest reliability of the SBI and SFI were 0.95 (95% CI: 0.92-0.97) and 0.95 (95% CI: 0.92-0.97) respectively, indicating excellent reliability. CONCLUSION: The Turkish versions of the SFI/SBI are a valid and reliable tool supporting their usability in patients with LDH-induced sciatica.

Radiation Doses for Different Approaches of Fluoroscopy-Guided Epidural Injections: An Observational Clinical Study.

BACKGROUND: Although fluoroscopy-guided interventional therapies have declined in recent years, radiation exposure remains a critical issue for both patients and medical staff. Radiation exposure varies according to the physicians' experience, procedure time, patients' body mass index (BMI), imaging techniques, and the type of procedure performed. OBJECTIVE: The purpose of this study is to report procedure times and calculate the radiation doses for 4 different approaches of fluoroscopy-guided epidural injections per procedure and BMI to provide radiations doses for potential use in future dose reduction strategies. STUDY DESIGN: Retrospective, observational study. SETTING: A university hospital, pain management center. METHODS: A retrospective evaluation was performed of patients who received epidural steroid injections between January 2015 and December 2020 in a university hospital interventional pain management center. This observational study was conducted with patients aged >= 18 who underwent 3,711 epidural injections including cervical interlaminar, lumbar interlaminar, lumbar transforaminal, and caudal approaches. If more than one level or bilateral injections were performed, total dose and times were divided by the number of sites injected to attain procedure time and mean dose per injection. Provided doses for each patient were also divided by patients' BMI to obtain dose per BMI. RESULTS: The highest radiation dose per procedure was found in caudal epidural injection with 0.218 mGy·m2, and the lowest dose was found in cervical interlaminar epidural injection with 0.057 mGy·m2. The radiation dose per procedure was 0.123 mGy·m2 for lumbar transforaminal and 0.191 mGy·m2 for lumbar interlaminar epidural injection. The shortest procedure time was determined in transforaminal (37.3 seconds) injections, and the longest was in lumbar interlaminar (46.7 seconds) injections. Caudal epidural injection also had the highest radiation dose per BMI which was 0.00749, and cervical interlaminar epidural injection had the lowest radiation dose per BMI, which was 0.00214. LIMITATIONS: Firstly, injections were performed by first- or second-year fellows in pain medicine. Moreover, patient-related factors (previous surgery, scoliosis, etc.) affecting radiation exposure were ignored. CONCLUSIONS: Radiation dose levels and procedure times of 4 approaches of epidural injections were obtained from 3,711 procedures performed in a university hospital pain medicine clinic. BMI of patients was taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels, which will guide pain physicians to self-assess their own levels of radiation exposure.

The Immediate Adverse Events of Lumbar Interventional Pain Procedures in 4,209 Patients: An Observational Clinical Study.

OBJECTIVE: Lumbar interventional pain procedures (LIPPs) are frequently used in low back pain and have shown an increasing trend in recent years. LIPPs are highly effective when performed by properly trained physicians. However, some adverse events are seen during interventional procedures. Our aim in this study is to determine the immediate adverse event rates of LIPPs and to inform our colleagues about possible adverse events. STUDY DESIGN: Retrospective, observational study. SETTING: A university hospital pain management center. METHODS: After approval by the institutional ethics committee, a retrospective evaluation of patients who received fluoroscopy-guided LIPPs between January 2015 and December 2020 was performed. This observational study was conducted with 4,209 patients who underwent LIPPs, including epidural steroid injection, sacroiliac and facet joint injection, medial branch block or radiofrequency ablation, application of pulsed radiofrequency to the dorsal root ganglion, epidural catheter placement, or spinal cord stimulator application. RESULTS: No major adverse events were detected during the procedures. Minor adverse events were detected in 60 patients, and the adverse events rate was found to be 1.4% (95% confidence interval: 1.0-1.8%). Minor adverse events rates varied between 0.7% and 2.3% according to the procedure type. The most common adverse events were determined to be vasovagal reactions (26/60). Facial numbness, cramps, and seizures were detected as rare adverse events. CONCLUSION: No major adverse events were seen in 4,209 patients. The rate of minor adverse events was 1.4%, with no sequelae in any of the events. When evidence-based guidelines are followed, interventional pain procedures can be performed safely.

Cervical Radiculopathy Impact Scale: Translation, cross-cultural adaptation, reliability and validity of the Turkish version.

Objectives: The aim of this study was to translate and cross-culturally adapt the English version of the Cervical Radiculopathy Impact Scale (CRIS) and to investigate the validity and reliability of the Turkish version of the CRIS. Patients and methods: Between October 2021 and February 2022, a total of 105 patients (48 males, 57 females; mean age: 45.4±11.8 years; range, 36.5 to 55.5 years) who were diagnosed with cervical radiculopathy due to disc herniation were included. Disability and quality of life were evaluated with the Neck Disability Index (NDI), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Short Form-12 (SF-12). Pain severity was evaluated using the Numerical Rating Scale (NRS) in three subscales (neck pain, pain radiating to the arm, and numbness in the finger, hand, or arm). The internal consistency for CRIS was assessed using the Cronbach alpha and test-retest reliability by intraclass correlation coefficients (ICCs). Explanatory factor analyses were performed for construct validity. To examine the content validity, the correlations among the three subgroup scores of CRIS and the other scale scores were analyzed. Results: The internal consistency of CRIS was found to be high (α=0.937). A high reliability was obtained for test-retest reliability for the three subscales of CRIS (Symptoms, Energy and postures, Actions and activities) (ICC: 0.950, 0.941, 0.962, respectively; p<0.001). All three subscale scores of CRIS were correlated with the NDI, QuickDASH, SF-12 (physical and mental) and NRS scores (r=0.358-0.713, p<0.001). Factor analysis showed that the scale had five factors. Conclusion: The CRIS is a valid and reliable instrument for Turkish patients with cervical radiculopathy due to disc herniation.

The effect of spinopelvic parameters on transforaminal epidural steroid injection treatment success in lumbar disc herniation.

BACKGROUND: Spinopelvic parameters (SPP) is closely associated with diseases such as lumbar disc herniation (LDH), disc degeneration and spondylolisthesis. Although there exist many known clinical and radiological factors affecting the success of the transforaminal epidural steroid injection (TFESI) treatment, the effect of SPP has not yet been investigated. This study aims to examine the effects of SPP on treatment success in patients who undergo TFESI because of lumbar disc herniation and to investigate the correlation among multifidus cross-sectional area (MFCSA). METHODS: This was a prospective, observational study. Patients with low back and/or leg pain, unilateral nerve root compression were applied TFESI. Outcome measures included the numerical rating scale (NRS), Oswestry Disability Index (ODI) and Beck Depression Inventory (BDI). The patients were evaluated at the first hour, third week and third month. The SPP and MFCSA measurements were made on direct radiographs and MRIs. RESULTS: A total of 58 patients, 24 women and 34 men, with an average age of 42.0 ± 9.5 were included. NRS, ODI and BDI scores improved significantly up to three months follow-up (P < .001). Moderately positive correlations were found between leg NRS and PT/PI scores immediately after treatment (r: 0.307 and r: 0.334) and a weak positive correlation was found between BDI and PT at third week (r: 0.269). The MFCSA/vertebral sectional area (VSA) and MFCSA/total multifidus cross-sectional area (TMFCSA) of the affected side was found to be significantly low (P < .001). CONCLUSIONS: Subjects with high PI and PT reported less improvement in leg pain immediately after treatment and patients with high PT had fewer BDI improvements. MFCSA had no correlations with SPPs in patients who underwent TFESI.

The Impact of Vitamin D Deficiency to Treatment Success of Transforaminal Epidural Steroid Injection.

BACKGROUND: Transforaminal epidural steroid injection (TFESI) is an interventional technique used to relieve disc herniation related back and radicular pain. Although few studies have investigated the factors predicting positive outcomes after TFESI, there is no data concerning the possible relationship between pre-procedure serum 25-hydroxyvitamin D (25(OH)D) levels and the response to TFESI. OBJECTIVES: To investigate the effect of vitamin D deficiency to treatment success of fluoroscopy-guided transforaminal epidural steroid injection. STUDY DESIGN: A retrospective assessment. SETTING: A university hospital interventional pain management center. METHODS: Nine hundred forty-eight patients received lumbosacral TFESI between January 2018 and December 2019 in a university hospital pain management center and were examined retrospectively for eligibility. Clinical and demographic data; magnetic resonance imaging (MRI); pre-procedure laboratory tests, including serum 25(OH)D; pain scores at baseline, third week, and third month follow-ups were collected. RESULTS: A total of 83 patients were recruited and divided into 2 groups with respect to vitamin D status. The number of patients with serum 25(OH)D level below 20 ng/mL was 57 and the number of patients with serum 25(OH)D level above 20 ng/mL was 26. Treatment success rates were significantly lower in vitamin D deficient group at third week and third month (P: 0.006, P: 0.01). LIMITATIONS: Retrospective nature and the absence of functional outcomes. CONCLUSION: Vitamin D deficiency is associated with a lower probability of meaningful pain relief following TFESI. It may worth assessing serum vitamin D level prior to this intervention, although prospective investigation is necessary.

Duruöz Hand Index: Is it valid and reliable in children with unilateral cerebral palsy?

PURPOSE: To investigate the validity and reliability of the Duruöz Hand Index (DHI) in patients with unilateral cerebral palsy (CP). METHODS: Assessments of patients (n = 23) were performed using the Modified Ashworth Scale (MAS), the Manual Ability Classification System (MACS), the grip and pinch strength tests, and DHI. Following the data collection, retest of DHI was administered telephonically within a 2-week period. RESULTS: Test-retest reliability and internal consistency of DHI were found to be excellent with a Cronbach's alpha value of 0.93 and an intraclass correlation coefficient value of 0.94. The correlation between the DHI and MACS was detected significantly high (r = 0.840, p = < 0.010). The DHI also correlated with grip and pinch strength in the affected side (r = -0.459, p = < 0.050; r = -0.509, p = < 0.050). CONCLUSIONS: DHI is a valid and reliable questionnaire for patients with unilateral CP.