Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. A prospective study.

OBJECTIVES: The aim of this work was to assess the performance of facet joint and nerve root infiltrations under computed tomography guidance for the management of low back pain and to investigate the complications and patient tolerance. MATERIALS AND METHODS: The study was board-certified and informed consent was obtained from all patients. In 1 year, 86 consecutive patients (47 male, 39 female, age range 47-87 years, mean age 63) with low back pain for more than 2 years were included. All patients were clinically examined and had cross-sectional imaging performed before the procedure. Fifty-five facet joint infiltrations and 31 nerve blocks were performed under computed tomography guidance. All patients completed two valid pain questionnaires before and 3 months after the procedures. At the same time, they were clinically examined by the referring Orthopaedic Surgeon. The pain response was assessed by comparing the scores of the questionnaires. The improvement in clinical examination findings was assessed as well. RESULTS: In patients who underwent facet joint infiltrations, long-term pain improvement was achieved in 79% and in those with nerve blocks in 85%. Immediate pain relief was demonstrated in 83% of patients with nerve infiltrations. No complications were observed. All procedures were very well tolerated by patients. CONCLUSIONS: Facet joint and nerve infiltrations under computed tomography guidance constitute an accurate and safe method that could be used to relieve low back pain and minimize the risk of disability.

How reliable is intracorporeal laparoscopic knot tying?

BACKGROUND: Are knots tied laparoscopically as reliable as those tied in open surgery? The aim of our study was to try to answer this question. MATERIALS AND METHODS: Using a standardized technique, one senior laparoscopic surgeon tied 3 suture materials using 3 methods of knotting: hand, instrument, and laparoscopic (in a simulator). The tension in the knots was measured using a tension gauge at the time of knotting and 5 minutes later. The surgeon was blinded to the value. The experiment was repeated 4 times. The 36 sutures were then analyzed using a materials-testing machine. The force achieved prior to breakage, the extension, and the breaking points were recorded. The scientist performing the analysis was blinded as to the method of tying and tensions produced. RESULTS: There were no significant differences in tension at 5 minutes between suture materials or method of knot tying. The mean extension achieved prior to breakage for 33 sutures was 29.71 mm with a force of 16.09 N. In 3 sutures the knot slipped completely while tension was being increased, thus no measure of breakage force could be obtained. These 3 sutures were monofilament and tied laparoscopically. CONCLUSION: There were no significant changes in suture tension after 5 minutes regardless of material or method of knot tying. Three of the 12 knots tied laparoscopically came undone under strain testing. All 3 knots were monofilament suture. This may have important implications when choosing suture material. Further studies are planned to expand the analysis of different knotting techniques with different suture materials.