ABSTRACT
BACKGROUND: Low back pain and sciatica caused by herniated lumbar discs (HLDs) are common complaints among patients visiting pain clinics. Among the various therapeutic methods, intradiscal ozone injections have emerged as an effective alternative or additional treatment option for HLDs. OBJECTIVE: This meta-analysis aimed to investigate the effectiveness of intradiscal ozone injections in the treatment of HLDs. METHODS: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published until January 25, 2024. We included studies that investigated the efficacy of intradiscal ozone injections in patients with HLDs. We evaluated the methodological quality of individual studies using the Cochrane Collaboration tool. RESULTS: At ⩾ 6 months after treatment, the therapeutic effect of intradiscal ozone injections in patients with HLDs was greater than that of steroid injections (treatment success rate, 6 months: odds ratio = 3.95, 95% confidence interval [CI] [2.44, 6.39], P< 0.01) or conventional medications (changes in the Visual Analog Scale [VAS], 6 months: standardized mean difference [SMD] = 1.65, 95% CI [1.08, 2.22], P< 0.01; 12 months: SMD = 1.52, 95% CI [0.96, 2.08], P< 0.01) but similar to that of microdiscectomy (changes in VAS, 18 months: SMD =-0.05, 95% CI [-0.67, 0.57], P= 0.87). At < 6 months after treatment, the reduction in the VAS score after intradiscal ozone injections was higher than that after steroid injections (changes in VAS, 1 month: SMD = 2.53, 95% CI [1.84, 3.21], P< 0.01). CONCLUSION: Intradiscal ozone injections may be a useful therapeutic tool in patients with HLDs. Compared with other conventional treatment methods such as steroid injections and oral medications, intradiscal ozone injection has great long-term (⩾ 6 months) effectiveness.
ABSTRACT
Sonoelastography is a relatively new non-invasive imaging tool to assess the in vivo qualitative and quantitative biomechanical properties of various tissues. Two types of sonoelastography (SE) are commonly explored: strain and shear wave. Sonoelastography can be used in multiple medical subspecialties to assess pathological tissular changes by obtaining mechanical properties, shear wave speed, and strain ratio data. Although there are various radiological imaging methods, such as MRI or CT scan, to assess musculoskeletal structures (muscles, tendons, joint capsules), SE is more accessible since this approach is of low cost and does not involve radiation. As of 2018, SE has garnered promising data in multiple studies. Preliminary clinico-radiological correlations have been established to bridge tissue biomechanical findings with their respective clinical pathologies. Specifically, concerning the shoulder complex, recent findings have described mechanical tissue changes in shoulder capsulitis. The long head of the biceps and supraspinatus SE were among the recently studied structures with conditions regarding impingement, tendinosis, and tears. Since ultrasonography has established itself as an important tool in shoulder evaluation, it completes the history and physical examination skills of the clinicians. This study will provide an update on the most recent findings on SE of shoulder structures.
ABSTRACT
BACKGROUND: Glenohumeral idiopathic adhesive capsulitis is a common shoulder condition that hinders functionality. Addressing the pathology has been extensively researched. Ultrasound (US)-guided injections have shown their efficacy. However, no study has been conducted to compare anatomical accuracy between different approaches in targeting the coracohumeral ligament (CHL). OBJECTIVE: To investigate whether US-guided injection of the CHL can be performed accurately using either the rotator interval (RI) or the coracoidal (CO) approach. METHODS: An experimental cadaveric case series. SETTING: Anatomy laboratory. SPECIMENS: Both shoulders of 13 Thiel-embalmed cadavers. INTERVENTIONS: Three physiatrists each injected a 0.1 mL bolus of colored dye in both shoulders of each cadaver using either the RI or the CO approach under US guidance. Each cadaver received a total of six injections (three injections per shoulder). The accuracy of the injection was determined following shoulder dissection by an anatomist. MAIN OUTCOME MEASURE: The accuracy of the US-guided injection of the CHL. RESULTS: The RI approach yielded 36 accurate injections, giving it an accuracy of 100%. With the CO approach two injections were deemed inaccurate yielding an accuracy of 94%. There was no significant difference in accuracy between all operators. CONCLUSIONS: US-guided injection of the CHL can be performed accurately with both the RI and CO approaches. The RI approach was likely to be more accurate.