Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy.

OBJECTIVE: Lumbar facet joints (FJ) is a common source of low back pain and contributes approximmately on one third of chronic low back pain. Medial branch radiofrequency neurotomy is considered as a gold standard in the treatment of facet joint pain. Corticosteroid injections have also presented effect in FJ pain. As an interventional procedures, they carry not-negligible risk of possible complications including infection, damage to nerve root or medial branch structures. Shockwave therapy (SWT) is a non-invasive method for treatment of various musculoskeletal disorders. Its effect is based on transduction of mechanical energy, transferred to cascade of various biochemical processes in target tissue. Its efficacy was proved in the treatment of different painful conditions. The efficacy of SWT was not yet studied in FJ pain. Aim of our work was to compare the efficacy of SWT against interventional treatment procedures - radiofrequency neurotomy and corticosteroid FJ injections. METHODS: A retrospective study was done on 62 selected patients with unilateral chronic lumbar facet pain. There were 32 women and 30 men, divided into SWT group, corticosteroid injections group radiofrequency group. Nociceptive and neuropathic pain intensity and severity of pain were measured. RESULTS: Shockwave therapy had shown better longterm results compared to FJ injections group and little inferior efficacy compared to RMBN. We did not observe any adverse effects and complications in SWT group. Moreover, in SWT and RMBN groups, significant longterm improvement in daily activities limitation, was observed. CONCLUSIONS: SWT appears to be a safe and perspective option in the treatment of FJ pain with negligible side effects.

Quantification of Trunk Postural Stability Using Convex Polyhedron of the Time-Series Accelerometer Data.

Techniques to quantify postural stability usually rely on the evaluation of only two variables, that is, two coordinates of COP. However, by using three variables, that is, three components of acceleration vector, it is possible to describe human movement more precisely. For this purpose, a single three-axis accelerometer was used, making it possible to evaluate 3D movement by use of a novel method, convex polyhedron (CP), together with a traditional method, based on area of the confidence ellipse (ACE). Ten patients (Pts) with cerebellar ataxia and eleven healthy individuals of control group (CG) participated in the study. The results show a significant increase of volume of the CP (CPV) in Pts or CG standing on foam surface with eyes open (EO) and eyes closed (EC) after the EC phase. Significant difference between Pts and CG was found in all cases as well. Correlation coefficient indicates strong correlation between the CPV and ACE in most cases of patient examinations, thus confirming the possibility of quantification of postural instability by the introduced method of CPV.

Symptomatic arrhythmias due to syringomyelia-induced severe autonomic dysfunction.

UNLABELLED: Syringomyelia is characterized by cavity formation in the spinal cord, most often at C2-Th9 level. Clinical manifestation reflects extent and localization of the spinal cord injury. CASES: 20-year old woman was admitted for recurrent rest-related presyncopes with sudden manifestation. Paroxysms of sinus bradycardia with SA and AV blocks were repeatedly documented during symptoms. There was normal echocardiographic finding, (para) infectious etiology was not proved. Character of the ECG findings raised suspicion on neurogenic cause. Autonomic nervous system testing demonstrated abnormalities reflecting predominant sympathetic dysfunction. Suspicion on incipient myelopathy was subsequently confirmed by MRI, which discovered syringomyelia at Th5 level as the only pathology. A 52-year old man with hypotrophic quadruparesis resulting from perinatal brain injury was sent for 2-years lasting symptoms (sudden palpitation, sweating, muscle tightness, shaking) with progressive worsening. Symptoms occurred in association with sudden increase of sinus rhythm rate and blood pressure that were provoked by minimal physical activity. Presence of significant autonomic dysregulation with baroreflex hyperreactivity in orthostatic test and symptomatic postural orthostatic tachycardia with verticalization-associated hypertension were proved. MRI revealed syringomyelia at C7 and Th7 level affecting sympathetic centers at these levels. Sympathetic fibers dysfunction at C-Th spinal level may cause significant autonomic dysfunction with arrhythmic manifestation.