Clinical Efficacy of Epidural Injections of Local Anesthetic Alone or Combined with Steroid for Neck Pain: A Systematic Review and Meta-Analysis.

Aims: To compare the effectiveness of cervical epidural injections of local anesthetic with vs. without a steroid. Methods: Three databases (PubMed, Embase, and Cochrane library) were used to search and assess all clinical randomized controlled trials regarding the clinical efficacy of epidural injections from January 01, 2009, to October 31, 2020. Cochrane review criteria and the Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment instrument were used to evaluate the methodologic quality of the included studies. Qualitative and quantitative analyses were performed according to best evidence synthesis principles and by single-arm meta-analysis, respectively. Results: Based on the search criteria, 4 RCTs were qualitatively and quantitatively analyzed in the single-arm meta-analysis. Treatment with lidocaine alone or with the steroid resulted in decreases of 4.46 and 4.29 points, respectively, in pain scores and of 15.8 and 14.46 points, respectively, in functional scores at 6 months. Similar trends were observed at the 1-year follow-up: pain scores decreased by 4.27 and 4.14 points, while functional scores decreased by 15.94 and 14.44 points in patients with neck pain who received lidocaine without or with the steroid, respectively. In the 3 studies that reported 2-year follow-up data, patients with neck pain treated with lidocaine or lidocaine + steroid showed 4.2- and 4.14-point decreases, in pain score and 15.92- and 14.89-point decreases, respectively, in functional scores. Conclusions: The studies showed level I (strong) evidence for short- and long-term improvements in pain relief and functionality with cervical epidural injections of local anesthetic alone or with a steroid in the management of neck pain.

Effectiveness of Extracorporeal Shock Wave Therapy Reduces Leg Cramps in Patients of Lumbar Degenerative Disorders: A Retrospective Study.

BACKGROUND: The extracorporeal shock wave therapy (ESWT) has been fully utilized in orthopedics, but there are few studies in the treatment of lower limb spasm and pain caused by lumbar degenerative disorders (LDD). This study assesses the influence of ESWT in patients with LDD. METHODS: From October 2017 to June 2019, 126 patients with LDD were enrolled. All patients received shock wave therapy, once every two days for four weeks in total. Each treatment consisted of 2,000 shocks with a frequency of 8-10 shocks per second. To analyze the therapeutic progress, the following tests were performed (before and after therapy; 1- and 3-month follow-up) to assess pain and functional efficiency: (1) Visual Analog Scale (VAS), (2) the frequency and duration of muscle cramps, and (3) Fugl-Meyer (LL). RESULTS: Mean BMI of the participants was 26.1 ± 3.0 kg/m2. There was no statistically significant difference in terms of age or BMI between the groups (p > 0.05). Although all scoring parameters improved in both groups, the improvement in the ESWT group was more pronounced in pain (p < 0.001 and p < 0.001, respectively). A review of the LMA scores of our patients demonstrated moderate functional limitations before treatment and increased functional status after treatment in all patients, while overall functional status was fully improved in patients of the ESWT group (p < 0.001). CONCLUSION: The ESWT is particularly effective effect for patients with LDD. The use of ESWT has a significant long-term influence on the reduction of pain, leg cramps, and the improvement of the general functional state in relation to the conventional motor improvement program.

Hub Genes and Key Pathways of Intervertebral Disc Degeneration: Bioinformatics Analysis and Validation.

OBJECTIVE: To identify significant pathways and genes in intervertebral disc degeneration (IDD) based on bioinformatics analysis. DESIGN: The GEO database was used to download the GSE124272 dataset. Differentially expressed genes (DEGs) were analyzed using Limma package in R language. Then, gene ontologies (GO), Kyoto encyclopedia of genes and genomes (KEGG), and protein-protein interaction (PPI) networks were used to further identify hub genes. The mRNA expression levels of top six hub genes were verified. RESULTS: We found 563 DEGs, of which 214 were upregulated and 349 were downregulated. The top 5 GO terms and pathways were shown including immune response, cell cycle, and p53 pathway. Based on the PPI analysis, we verified the mRNA expression levels of 6 hub genes. The mRNA levels of CHEK1, CDCA2, SKA3, and KIF20A were upregulated in degenerative NP tissue than in healthy NP tissue. However, the mRNA level of BUB1 and SPC25 was downregulated. CONCLUSIONS: This study may provide new biomarkers for the IDD and treatments to repair IDD related to CHEK1, CDCA2, SKA3, BUB1, KIF20A, and SPC25.