Relationships between the Spinal Dural Pulsations and the Short-Term Efficacy of Lumbar Epidural Steroid Injection.

Background: Lumbar spinal stenosis (LSS) causes low back pain, leg pain, numbness in the leg, and neurogenic intermittent claudication. Epidural steroid injection (ESI) has been used for treating spinal stenosis symptoms. We hypothesized that dural pulsation was variable for lumbar spinal stenosis. In cases of the presence of dural pulsation, the pain relief after the ESI was better than in the absence of dural pulsation. This study aimed at investigating the relationships between the presence or absence of spinal dural pulsations and the efficacy of ESI. Methods: A total of 71 patients were enrolled in this prospective study. Prior to the ESI, the dural pulsation was measured using a 5-1 MHz array ultrasound transducer. The visual analogue scale (VAS) score was measured pre-ESI and 2 weeks post-ESI and 4 weeks post-ESI. At 4 weeks post-ESI, dural pulsation was rechecked. Results: The VAS scores improved after the ESI procedure regardless of the presence or absence of dural pulsation. There was a correlation between the pulsation of the dura and post-ESI VAS scores. However, VAS was not significantly different for different grades of stenosis. Conclusion: The ESI was effective in patients with spinal stenosis in short-term follow-up. Dural pulsation of the spinal cord was a positive predictive factor for the ESI effect, but the grade of spinal stenosis severity had no effect on the effectiveness of ESI.

Sesquiterpenes from Streptomyces qinglanensis and Their Cytotoxic Activity.

Nine sesquiterpenes, including eight pentalenenes (1-8) and one bolinane derivative (9), were isolated from the culture broth of a marine-derived actinobacterium Streptomyces qinglanensis 213DD-006. Among them, 1, 4, 7, and 9 were new compounds. Their planar structures were determined by spectroscopic methods (HRMS, 1D, and 2D NMR), and the absolute configuration was established by biosynthesis consideration and electronic-circular-dichroism (ECD) calculations. All the isolated compounds were screened for their cytotoxicity against six solid and seven blood cancer cell lines. Compounds 4-6 and 8 showed a moderate activity against all of the tested solid cell lines, with GI50 values ranging from 1.97 to 3.46 µM.

Uniportal full endoscopic spinous process-preserving laminectomy for bilateral decompression in cervical stenotic myelopathy: patient series.

BACKGROUND: Endoscopic decompression for cervical stenotic myelopathy has several advantages over conventional open surgery. However, sometimes performing bilateral decompression, especially contralateral decompression, can be dangerous. The cervical spine has specific characteristics, including a shallower lamina angle and thinner lamina than the lumbar or thoracic lamina. These characteristics may cause cord compression when instruments approach the contralateral side of the lamina. This article introduces a novel surgical technique that can overcome the specificities of the cervical spine and discusses the efficacy and safety of uniportal full endoscopy for cervical decompression. OBSERVATIONS: Fourteen patients underwent uniportal full endoscopic spinous process-preserving laminectomy (ESP-L) for bilateral decompression of multilevel cervical stenotic myelopathy. The mean follow-up period was 13.44 months (range: 4-17 months). The preoperative and postoperative cervical spine angle and cervical range of motion did not differ significantly. The Japanese Orthopaedic Association score significantly improved postoperatively. The numeric rating scale scores significantly improved postoperatively. The mean duration of postoperative hospitalization was 2.3 days. LESSONS: ESP-L is a new, safe, effective, and noninvasive technique that can achieve complete decompression of multilevel cervical stenotic myelopathy.

Five-year recurrence pattern of mature cystic teratoma according to operation type in young women.

OBJECTIVE: To find cumulative recurrence rate and risk factors for recurrence in young women with mature cystic teratoma (MCT). METHODS: Patients aged 10-29 years with MCT confirmed by their first ovarian surgery between 2000 and 2018 were included in the study. To rule out residual lesions, only patients with no MCT-suspected lesions on imaging within 1 year after surgery were included in the study. Patients who had not undergone imaging tests from 1 year after surgery or had other findings on biopsy were excluded. RESULTS: The present study included 372 (84.2%) patients with cystectomy and 70 (15.8%) patients with oophorectomy. The 5-year cumulative recurrence rates for each patient group were 11.2% and 20.3%, respectively. The hazard rate of recurrence was higher in the oophorectomy group than the cystectomy group within 5 years after surgery. Large tumor size (hazard ratio [HR] 2.59; 95% confidence interval [CI] 1.11-6.08) and bilaterality (HR 2.65; 95% CI 1.27-5.52) were significant predictors of recurrence in the cystectomy group. CONCLUSION: The 5-year cumulative recurrence rate after surgery in young women with ovarian MCT was 11.2% in the cystectomy group and 20.3% in the oophorectomy group. Risk factors for recurrence after cystectomy were large tumor size and bilaterality.

Gravity and magnetic anomalies of earthquake-prone areas in the southwestern Ulleung basin margin, East Sea (Sea of Japan).

Submarine earthquakes have increased in the southwestern Ulleung Basin adjacent to the Korean Peninsula. This study analyzed the gravitational and magnetic properties of the three earthquake-prone areas (Hupo Bank and offshore regions near Pohang and Ulsan) in the basin. The basin was affected by tensile and compressive stresses during the formation of the East Sea. The southern Hupo Bank and the Pohang offshore exhibited high gravity anomalies and strong magnetic anomalies. Hupo Bank was separated from the peninsula and earthquakes in this region have been influenced by crustal fractures that facilitated igneous activities during the formation of the basin. Dense volcanic rocks and seaward dipping reflectors along the Pohang coast and continental slope suggest magmatic activities during the formation of the East Sea. Comparatively, the Ulsan offshore, with a thick sedimentary layer, exhibited a slightly higher gravity anomaly than the surrounding area, but no significant differences in the magnetic anomaly. Sequential tensile and compressive stresses related to the creation of the basin produced complex tectonic structures in this region. The magnetic tilt derivative results suggest that earthquakes were located near magnetic source boundaries. The results show that it is important to monitor earthquake-prone areas with gravity and magnetic anomalies.

Comparison of Pain Reduction and Changes in Serum Cortisol and Glucose Levels to Different Doses of Lumbar Epidural Dexamethasone: A Prospective Study.

BACKGROUND: Lumbar epidural steroid injection (LESI) is an effective treatment for low back pain. However, it may result in increased blood glucose levels, decreased plasma cortisol concentrations, and suppression of the adrenocorticotropic hormone axis. OBJECTIVE: We investigated the effects of 4 mg and 8 mg of dexamethasone as an LESI on back pain and the resulting changes in serum cortisol and glucose levels. STUDY DESIGN: Prospective study. SETTING: Department of Anesthesiology and Pain Medicine, Neurosurgery at Daegu Wooridul Spine Hospital. METHODS: Sixty-three patients were randomized into 2 LESI groups: one received 4 mg of dexamethasone (n = 25) and the other received 8 mg of dexamethasone (n = 28). Visual analog scale (VAS) scores and the Oswestry Disability Index (ODI) were determined. In addition, serum cortisol and glucose concentrations were measured before treatment, at the second LESI (one month follow-up), and at 2 months. All patients received LESI. RESULTS: Blood glucose and serum cortisol concentrations were not significantly different within a group and between groups. There was no difference in serum cortisol and glucose levels, VAS, and ODI between the first LESI and second LESI in both groups. The VAS and ODI were reduced in both groups and the difference between groups was not statistically significant. LIMITATIONS: The dexamethasone dosage was not variable; hence, we could not use larger doses of dexamethasone. Secondly, the blood draw interval was longer in this study than in previous studies. CONCLUSION: After the first lumbar epidural injection of either 4 mg or 8 mg of  dexamethasone, there was a reduction in pain in both groups. There was no significant difference in serum cortisol and glucose levels before treatment and during follow-up. Therefore, 4 mg or 8 mg of dexamethasone can be considered a treatment for patients who have low back pain.

Effect of lumbar epidural steroid injection on neuropathic pain: a prospective observational study.

Background: Low back pain (LBP) is caused by disc herniation, spinal stenosis, facet syndrome or etc. This LBP could be either nociceptive or neuropathic pain (NP). In addition, these neuropathic pain is a major contributor to chronic low back pain. It is already known that lumbar epidural steroid injection (ESI) is effective for low back pain, but no study has assessed both nociceptive and neuropathic pain separately. This study investigated whether neuropathic or nociceptive pain was better improved after an epidural steroid injection. Methods: This was a prospective study. Patients were classified according to the pre-procedure painDETECT questionnaire (PD-Q) score. If the PD-Q score was ≤12, it was considered as nociceptive pain, and it the PD-Q was ≥19, it was considered NP. The patients were given a transforaminal (TF) or interlaminar (IL) epidural steroid injection (ESI). The PD-Q was filled out by each patient prior to the ESI (baseline), and again at 4 weeks after the ESI. Outcomes was assessed using a numerical rating scale (NRS) score, short form McGill Pain Questionnaire (MPQ), and revised Oswestry Back Disability Index (ODI) at 1 month later. Results: A total of 114 patients were enrolled and of these, 54 patients with a PD-Q score of ≤12 were classified into the nociceptive pain, and 60 patients with a PD-Q score ≥19 were classified into the neuropathic pain group. At 1 month after treatment, both groups had significantly lower than improved their mean NRS score. Not withstanding these improvements and difference between NRS, the differences in MPQ and ODI after treatment between the groups (nociceptive vs. neuropathic) not significant. After the procedure (TF-ESI or IL-ESI), the patients in group 1 (PD-Q score ≤12, n = 54) had no change in their PD-Q score. Among the patients in group 2 (pre-treatment PD-Q score ≥19, n = 41), 13 patients moved to a PD-Q score <12 and 15 patients had a PD-Q score of 13-18. Conclusion: For the short-term relief of neuropathic pain, ESI was effective for both nociceptive and neuropathic pain, therefore ESI could be treat the try neuropathic pain component in patients with low back pain.

Reduction of Radiation Exposure by Modifying Imaging Manner and Fluoroscopic Settings during Percutaneous Pedicle Screw Insertion.

OBJECTIVE: Percutaneous pedicle screw (PPS) fixation is a needle based procedure that requires fluoroscopic image guidance. Consequently, radiation exposure is inevitable for patients, surgeons, and operation room staff. We hypothesize that reducing the production of radiation emission will result in reduced radiation exposure for everyone in the operation room. Research was performed to evaluate reduction of radiation exposure by modifying imaging manner and mode of radiation source. METHODS: A total of 170 patients (680 screws) who underwent fusion surgery with PPS fixation from September 2019 to March 2020 were analyzed in this study. Personal dosimeters (Polimaster Ltd.) were worn at the collar outside a lead apron to measure radiation exposure. Patients were assigned to four groups based on imaging manner of fluoroscopy and radiation modification (pulse mode with reduced dose) : continuous use without radiation modification (group 1, n=34), intermittent use without radiation modification (group 2, n=54), continuous use with radiation modification (group 3, n=26), and intermittent use with radiation modification (group 4, n=56). Post hoc Tukey Honest significant difference test was used for individual comparisons of radiation exposure/screw and fluoroscopic time/screw. RESULTS: The average radiation exposure/screw was 71.45±45.75 µSv/screw for group 1, 18.77±11.51 µSv/screw for group 2, 19.58±7.00 µSv/screw for group 3, and 4.26±2.89 µSv/screw for group 4. By changing imaging manner from continuous multiple shot to intermittent single shot, 73.7% radiation reduction was achieved in the no radiation modification groups (groups 1, 2), and 78.2% radiation reduction was achieved in the radiation modification groups (groups 3, 4). Radiation source modification from continuous mode with standard dose to pulse mode with reduced dose resulted in 72.6% radiation reduction in continuous imaging groups (groups 1, 3) and 77.3% radiation reduction in intermittent imaging groups (groups 2, 4). The average radiation exposure/screw was reduced 94.1% by changing imaging manner and modifying radiation source from continuous imaging with standard fluoroscopy setting (group 1) to intermittent imaging with modified fluoroscopy setting (group 4). A total of 680 screws were reviewed postoperatively, and 99.3% (675) were evaluated as pedicle breach grade 0 (<2 mm). CONCLUSION: The average radiation exposure/screw for a spinal surgeon can be reduced 94.1% by changing imaging manner and modifying radiation source from real-time imaging with standard dose to intermittent imaging with modified dose. These modifications can be instantly applied to any procedure using fluoroscopic guidance and may reduce the overall radiation exposure of spine surgeons.

Intradiscal Pulsed Radiofrequency Application Duration Effect on Lumbar Discogenic Low Back Pain.

BACKGROUND: Discogenic pain is recognized as the most important and most common cause of low back pain (LBP). Intradiscal pulsed radiofrequency (ID-PRF) is used for the treatment of chronic discogenic pain. OBJECTIVES: We investigated the effects of the duration of percutaneous monopolar ID-PRF application on chronic discogenic LBP. STUDY DESIGN: Retrospective study. SETTING: Department of Anesthesiology and Pain Medicine, Neurosurgery at Wooridul Spine Hospital. METHODS: Forty-five patients were included in this retrospective study. The patients were assigned into 2 groups according to the duration of the PRF procedure they underwent (7-minute group = 17 patients vs. 15-minute group = 28 patients). The main outcome measures tested were pain score, as determined by the Numeric Rating Scale (NRS-11) and the Oswestry Disability Index (ODI), at baseline, at 2-week, and 6-month follow-up visits. Success was defined as a reduction in NRS-11 of 50% or more or an ODI reduction of 40% or more. RESULTS: The mean posttreatment pain scores at 2 weeks and 6 months were significantly lower (P < 0.05) in both groups, but the differences between the groups were not significant. ODI scores were also significantly lower compared with the baseline, but the differences between the groups were not significant. At the 6-month follow-up, 12 patients (70.6%) in the 7-minute group and 20 patients (71.4%) in the 15-minute group reported more than 50% reduction in the pain score (P = 0.16), and there was no significant difference between the 2 groups in the number of patients with more than 40% reduction in ODI score (P = 0.23). LIMITATIONS: This study was performed with a small sample size and there was no control group. Additional well-designed and well-controlled studies that include parameters such as the stimulation duration, mode, and intensity of PRF are needed to fully assess the efficiency of ID-PRF. CONCLUSIONS: ID-PRF was shown to be effective for the treatment of discogenic LBP regardless of duration of ID-PRF application (7 vs. 15 minutes).

Feasibility of Posterior Cervical Foraminotomy for Adjacent Segmental Disease after Anterior Cervical Fusion.

OBJECTIVE: The aim of this study is to evaluate the feasibility of posterior cervical foraminotomy (PCF) for adjacent segmental disease (ASD) after anterior cervical fusion (ACF). As ACF is accepted as the standard treatment for cervical spondylosis, many studies have been conducted to evaluate the efficacy of various surgical techniques to overcome symptomatic ASD after the previous surgery. Herein, PCF was performed for the treatment of symptomatic ASD and the feasibility of the surgery was evaluated. METHODS: Forty nine patients who underwent PCF due to symptomatic ASD from August 2008 to November 2017 were identified. For demographic and perioperative data, the sex, age, types of previous surgery, ASD levels, operation times, and bleeding amount were recorded. The clinical outcome was assessed using the visual analogue scale for the neck and arm, the modified Odom's criteria as well as neck disability index. Radiologic evaluations were performed by measuring disc softness, disc height, the cervical 2-7 sagittal vertical axis, cervical cobb angle, and facet violation. RESULTS: Thirty-seven patients were enrolled in this study. The patients were divided into two groups based on the location of the pathology; paracentral (group P) or foramina (group F). Both groups showed significant clinical improvement (p<0.05). The proportion of calcified disc and facet violations was significantly larger in group F (p<0.05). The minimal disc height decrease with mild improvement on sagittal alignment and cervical lordosis was radiologically measured without statistical significance in both groups (p>0.05). CONCLUSION: PCF showed satisfactory clinical and radiologic outcomes for both paracentral and foraminal pathologies of ASD after ACF. Complications related to anterior revision were also avoided. PCF can be considered a feasible and safe surgical option for ASD after ACF.

A long-term ecological monitoring of subtidal macrozoobenthos around Dokdo waters, East Sea, Korea.

Dokdo's high marine biodiversity has received worldwide attention recently. A total of 578 macrozoobenthos are recorded since the 1960s, but ecology of Dokdo's fauna is unknown. We monitored Dokdo's subtidal macrozoobenthos for 5 years in 2013-17, in the present study. Five stations representing three subtidal habitats were monitored; 1) oceanic plateau, 2) coastal terrace, and 3) island wharf. In total, 13,664 individuals belonging to 141 taxa were recorded during the survey. The number of species and density varied greatly among stations without distinct year-round variation. Faunal compositions significantly differed in time and space, reflecting varied faunal adaptations in a harsh environment. Whilst, temporal stability in faunal assemblages was evidenced for some dominant or cosmopolitan taxa. High spatial heterogeneity reflects site-specific oceanographic conditions. Meantime, sea-surface temperature and wave action were associated with year-round faunal compositions. Overall, the Dokdo's macrozoobenthos significantly contribute to marine biodiversity of the East Sea.

Influence of combined oral contraceptives on polycystic ovarian morphology-related parameters in Korean women with polycystic ovary syndrome.

OBJECTIVE: This study aimed to assess the effect of combined oral contraceptives (COCs) on polycystic ovarian morphology (PCOM) and serum anti-Müllerian hormone (AMH) levels in Korean women with polycystic ovary syndrome (PCOS). METHODS: This university hospital study enrolled 36 Korean women who were newly diagnosed with PCOS based on the Rotterdam criteria and were treated with COCs for at least 1 year. We retrospectively evaluated the ovarian volume and number of antral follicles using ultrasonography and assessed serum AMH levels at baseline and after 1 year of COC treatment. RESULTS: Significant decreases in ovarian volume and antral follicle count were observed after 1 year of COC treatment. Compared to baseline, serum AMH levels were significantly decreased after 1 year. CONCLUSION: COC treatment significantly affects ultrasound-assessed PCOM and serum AMH levels of patients with PCOS.

Endoscope-Assisted Minimally Invasive Interlaminar Lumbar Decompression for Spinal Stenosis.

BACKGROUND: Lumbar stenosis is characterized by a narrowing of the spinal canal in association with progressive degenerative changes in the lumbar spine and surrounding structures, including hypertrophy of the ligamentum flavum (LF). OBJECTIVES: The aim of this study was to examine the usefulness of endoscope-assisted interlaminar lumbar decompression (EILD) for patients with lumbar stenosis and hypertrophy of the LF. STUDY DESIGN: Retrospective study. SETTING: Department of Anesthesiology and Pain Medicine, Neurosurgery at Wooridul Spine Hospital. METHODS: A total of 51 patients were enrolled in this study. Outcomes were evaluated at baseline and at 2 weeks and 6 months postprocedure via the Numeric Rating Scale, Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ). RESULTS: Mean posttreatment pain scores at 2 weeks and 6 months were significantly lower, and ODI scores were significantly decreased compared with baseline. ZCQ scores were also significantly decreased compared with pretreatment surveys. Two patients required reoperation within one month. At postprocedure 6 months, a>/= 50% reduction in pain score was recorded in 26 (80%) of 51 patients, and there was >/= 40% reduction in ODI score in 82% of patients. No serious complications including epidural bleeding, dural or neural injuries, or infection were recorded. LIMITATIONS: This study lacked secondary outcome substantiation. In addition, the follow-up period was short (< 6 months), and no patients had postprocedure magnetic resonance imaging. The number of patients was also small. CONCLUSIONS: EILD provided good outcomes and may be a reasonable treatment option for carefully selected patients with hypertrophy of the LF. KEY WORDS: Spinal stenosis, ligamentum flavus, hypertrophy, decompression, endoxcope, minimally.

WITHDRAWN:Comparison of the Efficacy of Epidural Balloon Neuroplasty Versus Percutaneous Epidural Neuroplasty Using a Catheter for Lumbar Central Spinal Stenosis.

This article was withdrawn by the Neurospine editorial board's decision due to the author's ethical problem.

Efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain.

BACKGROUND: Discogenic pain is a common cause of disability and is assumed to be a major cause of nonspecific low back pain. Various treatment methods have been used for the treatment of discogenic pain. This study was conducted to compare the therapeutic success of radiofrequency (an intradiscal procedure) and laser annuloplasty (both an intradiscal and extradiscal procedure). METHODS: This single-center study included 80 patients and followed them for 6 months. Transforaminal laser annuloplasty (TFLA, 37 patients) or intradiscal radiofrequency annuloplasty (IDRA, 43 patients) was performed. The main outcomes included pain scores, determined by the numeric rating scale (NRS), and Oswestry disability index (ODI), at pre-treatment and at post-treatment months 1 and 6. RESULTS: The patients were grouped according to procedure. In all procedures, NRS and ODI scores were significantly decreased over time. Mean post-treatment pain scores at months 1 and 6 were significantly lower (P < 0.01) in both groups, and between-group differences were not significant. The ODI score was also significantly decreased compared with baseline. Among patients undergoing TFLA, 70.3% (n = 26) reported pain relief (NRS scores < 50% of baseline) at post-treatment 6 months, vs. 58.1% (n = 25) of those undergoing IDRA. There were no statistically significant differences between the groups in ODI reduction of > 40%. CONCLUSIONS: Our results indicate that annuloplasty is a reasonable treatment option for carefully selected patients with lower back and radicular pain of discogenic origin, and TFLA might be superior to IDRA in patients with discogenic low back pain.

Risk Factors for Early Recurrence After Transforaminal Endoscopic Lumbar Disc Decompression.

BACKGROUND: Transforaminal endoscopic lumbar disc decompression (TELD) has emerged as a treatment alternative to open lumbar discectomy, but rates of herniated lumbar disc (HLD) recurrence after TELD are higher by comparison. OBJECTIVES: We conducted this study to identify factors correlating with early HLD recurrence after TELD. STUDY DESIGN: Retrospective study. SETTING: The Department of Anesthesiology and Pain Medicine, Neurosurgery at Spine Health Wooridul Hospital. METHODS: As a retrospective review, we examined all patients undergoing TELD between 2012 and 2017, analyzing the following in terms of time to recurrence: age, gender, body mass index (BMI), comorbid conditions (diabetes mellitus [DM], hypertension [HTN]), smoking status, nature of disc herniation (central, paramedian, or foraminal), Modic changes, migration grade (rostral vs. caudal track + degree), herniated disc height (Dht) and base size (Dbase), and the presence of spondylolisthesis on magnetic resonance imaging. RESULTS: During the 5-year study period, 1,900 patients underwent TELD procedures, resulting in 209 recurrences (11.0%). In 27 of these patients (12.9%), herniation recurred within 24 hours after surgery. Recurrences most often developed within 2-30 days (n = 76). The smaller the size of a herniated disc, the earlier it recurred. Recurrences were unrelated to gender, BMI, DM or HTN, smoking status, migration grade, nature (Dht or Dbase of herniated disc), or the presence of spondylolisthesis. LIMITATIONS: In addition to variables assessed herein, other clinical and radiologic parameters that may be important in recurrent disc herniation should be included. Furthermore, only univariate analyses were performed, making no adjustments for potential confounders, therefore, independent risk factors could not be assessed. A prospective study would likely generate more precise results, especially in terms of standardized sampling and data classification. Finally, multiple causes for primary discectomy failures may have rendered our patient groups nonhomogeneous, and inequalities in surgical options or physician-dictated surgical choices may have had an effect. CONCLUSIONS: In patients undergoing TELD procedures, smaller-sized herniated discs are linked to early recurrences. KEY WORDS: Disc herniation, lumbar, endoscopic, recurrence, early.

The Outcome of Pulsed Radiofrequency Treatment According to Electodiagnosis in Patients with Intractable Lumbosacral Radicular Pain.

BACKGROUND: Radicular pain is related to lesions that either directly compromise the dorsal root ganglion (DRG) or indirectly compromise the spinal nerve and its roots by causing ischemia or inflammation of the axons. OBJECTIVE: Our study aimed to assess the outcomes of pulsed readiofrequency treatment (PRF) according to electrodiagnosis results in patients with chronic intractable lumbosacral radicular pain. METHODS: A total of 82 failed back surgery syndrome (FBSS) patients were included in this study. All of them underwent electromyography/nerve conduction studies before pulsed radiofrequency (PRF) treatment at the DRG, and they were classified according to the electrodiagnostic results as: group 1, no definite finding (normal); group 2, radiculopathy; and group 3, neuropathy. Pain intensity was assessed according to a numeric rating scale score and the Oswestry Disability Index (ODI) before treatment and at one, three, six, and 12 months after treatment, and successful treatment was defined as a pain score reduction of ≥50% at 12 months, as compared with the pretreatment score. RESULTS: Pretreatment electrodiagnosis identified 28 patients with no definite findings, 31 patients with radiculopathy, and 23 patients with neuropathy. The patients with neuropathy had less pain relief after treatment than those with no definite findings and those with radiculopathy. The prevalence of pain reduction of at least 50% was lower in the neuropathy group than in the other groups. There was no statistically significant difference in ODI between group. CONCLUSION: Outcomes after PRF at the DRG did not show strong differences according to electrodiagnostic findings in FBSS patients with chronic intractable lumbosacral radicular pain.

Posterior cervical foraminotomy for cervical radiculopathy: should cervical alignment be considered?

BACKGROUND: Concerning of progression of deformity, it is reluctant to utilize a posterior approach if preoperative sagittal alignment is kyphotic or straight. The purpose of this study was to determine interval changes in cervical segmental angles after posterior cervical foraminotomy (PCF) and analyzing factors affecting cervical sagittal re-alignment in the postoperative period. METHODS: Within 2 days and 6 months after PCF, postoperative plain radiograph was obtained to compare the cervical sagittal alignment with preoperative alignment in 286 consecutive patients. Sagittal angle between C2 and C7 formed by lines drawn at the base of axis and the superior endplate of the C7 vertebral body on lateral radiograph. To evaluate clinical outcomes, patients were routinely asked to gauge levels of pain they feeling at that point in time by visual analogue scale (VAS) on admission, prior to postoperative radiographs and 6 months after operation follow-up in outpatient. RESULTS: More than two-third of the patients presenting with kyphotic or straight curvature improved short-term following operation. On follow-up plain radiographs after 6 months, the improvement of sagittal alignment was well maintained, but rather more prominent (P<0.05). Improvement in sagittal alignment was dominant when radiculopathy was due to softened discs, rather than stenosis (P<0.05, ß=3.279), and with shorter symptom duration (P<0.05, ß=-0.042). Age had no significant impact on outcomes (P=0.614) and count of affected levels also did not (P=0.366). In patients with higher preoperative VAS score, Cobb's angle was significantly lower (P<0.05, ß=-0.460), and as perioperative VAS score declined, sagittal alignment improved significantly (P<0.05, ß=-0.508). CONCLUSIONS: Particularly in acute onset radiculopathies from softened discs, PCF is a valid surgical option, despite preoperative loss of normal lordotic sagittal alignment.

Cerebral Thromboembolic Events During Anterior Cervical Spine Surgery: Retrospective Case Series Study With Diffusion-Weighted Magnetic Resonance Imaging Follow-up in the Immediate Postoperative Period.

OBJECTIVE: We evaluated the efficacy of diffusion-weighted magnetic resonance imaging (DW-MRI) in detecting perioperative cerebral thromboembolic events after anterior cervical discectomy and fusion (ACDF). METHODS: This retrospective case series included 51 consecutive patients that underwent ACDF. To assess baseline presence of plaque or stenosis, all patients were assessed for risk factors of cerebrovascular events and underwent carotid ultrasound preoperatively and cerebral DW-MRI was performed in all patients postoperatively, with areas of high signal intensity interpreted as a cerebral thromboembolic event. RESULTS: One male patient who underwent a C4/5 ACDF had a focal diffusion abnormality on DW-MRI concerning for cerebral thromboembolic events in the right posterior cerebral artery territory. He remained asymptomatic and did not display related neurological symptoms, such as visual deficits. CONCLUSION: Asymptomatic cerebral thromboembolic events can be detected by DW-MRI after ACDF. The incidence of such events remains very rare despite the direct manipulation and associated alteration of common carotid artery flow dynamics.