The relationship between traction spurs, Modic change, vacuum phenomenon, and segmental instability of the lumbar spine.

A thorough understanding of lumbar segmental motion is valuable to treat patients with degenerative lumbar disease, but kinematics associated with indicators of lumbar intervertebral instability [traction spur, Modic changes (MCs) and vacuum phenomenon (VP)] in the lumbar spine have not been well understood. The purpose of this study is to evaluate the relationships between traction spur, MCs and VP to radiographic measurements in the lumbar spine. A total of 525 lumbar discs from L1-2 to L5-S1 of 105 patients were evaluated. The sagittal translation (ST) and sagittal angulation were measured from the radiographs taken flexion-extension. The anterior disc height (ADH) was measured from the lateral radiographs, and ΔADH was measured as the difference from supine to sitting position. Logistic regression analyses were used to detect the association between the existence of traction spur, MCs and VP and related factors. Multivariate analysis showed that the traction spur was significantly related to translational motion (ST > 2 mm, OR 4.74) and the VP was significantly related to vertical motion (ΔADH > 3 mm, OR 1.94). These results suggest that the segments with traction spur and VP should be evaluated carefully because these may be a sign of lumbar intervertebral instability.

Transoral Mandibular Tongue-Splitting Approach in Upper Cervical Epidural Abscess: A Case Report and Review of the Literature.

INTRODUCTION: The transoral mandibular tongue-splitting approach is typically performed for the treatment of upper cervical tumor and instability but has not been performed for the treatment of upper cervical epidural abscess (UCEA). We report the first case of UCEA successfully treated with a transoral mandibular tongue-splitting approach. TECHNICAL NOTE: A 62-year-old man who had medical histories of tracheotomy with intubation and dermatopathy due to radiation therapy for the treatment of nasopharyngeal carcinoma presented with neck pain and limb weakness. The imaging examination revealed bone erosion of C2-C4 vertebrae and abscess at the level of C2-C4, supporting a diagnosis of UCEA. The transcervical approach could not be used for treatment; therefore, the transoral mandibular tongue-splitting approach was used successfully to perform decompression, debridement, and iliac bone grafting. Subsequently, we reviewed the literature pertaining to the use of the transoral mandibular tongue-splitting approach. The approach can be invasive and cause some complications. However, no fatal complications have been reported, and all patients demonstrated a favorable neurological outcome with reduced neurological deficits. CONCLUSIONS: This case and subsequent literature review suggest that the transoral mandibular tongue-splitting approach may be effective for the improvement of neurological outcomes without fatal complications in patients with UCEA. There may be an increasing number of patients with UCEA requiring the transoral mandibular tongue-splitting approach due to the increasing prevalence of immunocompromized status and the aging population.

Risk Factors of Neuropathic Pain after Total Hip Arthroplasty.

PURPOSE: Pain caused by osteoarthritis is primarily nociceptive pain; however, it is considered that a component of this pain is due to neuropathic pain (NP). We investigated the effects of total hip arthroplasty (THA) in patients with NP diagnosed by the PainDETECT questionnaire. MATERIALS AND METHODS: One hundred sixty-three hips (161 patients) were evaluated. All patients were asked to complete the PainDETECT questionnaire based on their experience with NP, and clinical scores were evaluated using the Japanese Orthopaedic Association (JOA) Hip Score before and after THA. RESULTS: The patients of 24.5% reported NP before THA; 5.5% reported NP 2 months after THA. Prior to THA, there was no significant correlation between the PainDETECT score and the radiographic severity; however, there was a significant correlation between the PainDETECT score and JOA score. NP at 2 months after THA was not significantly correlated with pain scores at 1 week after THA; however, a significant correlation was observed between the preoperative pain score and NP at 2 months after THA. CONCLUSION: THA was useful for relieving nociceptive pain and for relieving NP in patients with hip osteoarthritis. Preoperative pain was a risk factor for NP after THA. Controlling preoperative pain may be effective for reducing postoperative NP.

Subcutaneous single injection digital block with epinephrine.

The aim of this study was to investigate the anesthetic effect and risk of epinephrine for subcutaneous single injection digital block. Either 3.0 mL 1.0% Lidocaine or a 3.0 mL 1.0% Lidocaine with (1 : 100,000) epinephrine was injected into the subcutaneous space at the middle point of the palmar digital crease of the 18 middle fingers of 9 healthy volunteers. The SpO(2) of the fingers decreased to a maximum of 97. No subjects showed any symptoms of ischemic injury. The time to anesthesia for the fingers was significantly shorter (P < 0.05), and the duration of anesthesia was significantly longer (P < 0.01) for the fingers in the epinephrine group. In conclusion, a subcutaneous single injection digital blocks with 3.0 mL of 1.0% Lidocaine and (1 : 100,000) epinephrine were safe, reducing the time to the onset of anesthesia, while also markedly prolonging the anesthesia.