Interscalene brachial plexus block for scapular and upper chest pain due to cervical radiculopathy: a randomized controlled clinical trial.

BACKGROUND: Animal experiments have shown that one of the pathways for pain originating from the cervical spine is the sympathetic trunk. However, there have been few reports regarding the cervical pain pathway and efficacy of interscalene brachial plexus block for upper limb, scapular and chest pain originating in the cervical spine in clinical cases. The purpose of the present study was to clarify the efficacy of interscalene brachial plexus block for upper limb, scapular and chest pain. METHODS: Patients (137 men and 223 women) who had cervical radicular pain were studied. The intensity of upper limb, scapular and chest pain was measured by using a VAS before injection and at 5 min and 7 days after injection. To evaluate the efficacy of interscalene brachial plexus block, patients with cervical radicular pain who had received NSAIDs for at least 2 weeks were randomized to interscalene brachial plexus block or control block groups. VAS scores were compared to assess the effects of injection and the pain pathway. RESULTS: The average VAS score for upper limb pain with or without scapular and chest pain was significantly reduced by interscalene brachial plexus block compared with control block at 5 min and 7 days after injection. After interscalene brachial plexus block, 89 patients reported symptoms of stellate ganglion block versus no patients after control block. Scapular and chest pain was significantly reduced in the patients with stellate ganglion block compared to those without stellate ganglion block. CONCLUSIONS: Interscalene brachial plexus block is useful for upper limb, scapular and chest pain due to disorders of the cervical spine. The scapular and chest pain pathway is more likely to be interrupted by an interscalene brachial plexus block that causes a stellate ganglion block compared to an interscalene brachial plexus block without stellate ganglion block.

L5 Radiculopathy due to Foraminal Stenosis Accompanied With Vacuum Phenomena of the L5/S Disc on Radiography Images in Extension Position.

STUDY DESIGN: Retrospective study for L5 radiculopathy due to foraminal stenosis with vacuum phenomena (VP) at the L5/S disc. OBJECTIVE: To investigate the influence of the L5/S VP on L5 radiculopathy, due to L5/S foraminal stenosis. SUMMARY OF BACKGROUND DATA: Foraminal stenosis has often been detected via images. However, although this condition is well known, it is occasionally overlooked during diagnosis, because spinal nerve compression is not always visible on stationary images. METHODS: Patients who underwent lumbar spine surgery were examined to determine the presence of foraminal stenosis (n = 194). The presence of VP and the range of motion of the L5/S disc were assessed on radiography with the lumbar spine in the extended and flexed positions. The shapes of the L5/S foramina were confirmed using sagittal magnetic resonance imaging. Patients who showed VP were divided into 2 groups: patients with (group A) and without (group B) symptomatic foraminal stenosis. The relationship between the VP and symptomatic foraminal stenosis was examined. RESULTS: In total, 35 cases of VP at the L5/S disc were noted on lateral radiography. L5 radiculopathy due to L5/S foraminal stenosis was identified in 14 of these 35 cases. The ranges of L5/S angles were 10°â€Š±â€Š4° and 5°â€Š±â€Š3° in groups A and B, respectively, and these values were significantly different (P < 0.01). 11 (48%) of 23 L5/S foramina that showed VP of the L5/S disc and were completely occupied by a disc below the caudal edge of the vertebra had symptomatic foraminal stenosis. CONCLUSION: Our results indicated that VP, which showed a large range of motion angle between flexion and extension, triggered symptoms of foraminal stenosis at the L5/S disc. The dynamic motion of the VP should thus be considered for the diagnosis of L5/S foraminal stenosis. LEVEL OF EVIDENCE: 3.

Reduction of caudal traction force using dural sac opening rather than spinal cord detethering for tethered cord syndrome caused by lipomyelomeningocele: a case report.

BACKGROUND CONTEXT: A few reports have addressed tethered cord syndrome. Detethering surgery has been performed in these cases because abnormal tension on the spinal cord causes neurologic and urologic symptoms. PURPOSE: To discuss the surgical treatment of tethered cord syndrome with the belief that the tension on the cord can be decreased by shifting tethered cord to the dorsal side. STUDY DESIGN: A patient with tethered cord syndrome was surgically treated by shifting the tethered cord to the dorsal side by harnessing the lumbar lordosis instead of detethering. METHODS: We performed surgery to shift the tethered cord to the dorsal side by harnessing the lumbar lordosis to decrease the tension on the spinal cord. RESULTS: The tethered cord that was pressed to the ventral side because of a lipoma was shifted dorsally by laminectomy and opening of the dural sac. Pain and numbness were alleviated immediately after surgery. CONCLUSIONS: The method used in the present case, that is, shifting the tethered cord and lipoma to the dorsal side by harnessing the lumbar lordosis instead of detethering, is a viable treatment option for tethered cord syndrome.

Clinical outcome of percutaneous drainage for spondylodiscitis.

BACKGROUND: Although vertebral debridement with interbody fusion is a useful procedure for the treatment of spondylodiscitis, anterior interbody fusion (AIF) is risky to perform on patients in a poor condition since it is highly invasive. Percutaneous nucleotomy and drainage (PND) is less invasive than AIF, but there only have been few reports regarding the outcome. The purpose of this study was to test the efficacy of PND for spondylodiscitis. PATIENTS AND METHODS: To analyze the effectiveness of different surgical treatments, 111 patients with spondylodiscitis were studied retrospectively. The average durations from the start of treatment until the C-reactive protein fell below 1.0 mg/dL or below the baseline value, which was defined as "recovery time" in the present study, were compared among PND, AIF, and posterior decompression. RESULTS: PND was performed when conservative treatment has been done for average 2.0 ± 0.9 months. Of the 18 PND patients, 15 (83%) showed recovery; 63 (97%) of the 65 patients who had AIF showed recovery. There was no significant difference of the mean recovery time after PND and AIF. All 10 patients whithout methicillin-resistant Staphylococcus aureus (MRSA) recovered after PND, whereas 3 of 8 patients with MRSA did not recover after PND. Of the 3 unsuccessful PND cases, 1 later had AIF, and 1 repeated PND. One patient could not undergo additional surgery because of a poor general condition. CONCLUSIONS: Although the results of PND were inferior to AIF, PND is a useful next step after conservative treatment for patients in a poor condition. PND can be the initial procedure for spondylodiscitis before AIF if its limitations are understood.