Therapeutic Effects of Low-Level Laser Therapy on Pain and Disability of Patients with Failed Back Surgery Syndrome.

Purpose: This study intended to evaluate the effects of Low-Level Laser Therapy (LLLT) on Failed Back Surgery Syndrome (FBSS). FBSS refers to symptoms and disabilities which remain or occur after lumbar spinal surgery. Prevalent treatments for FBSS are based mostly on conservative management while LLLT has gained significant interest in the treatment of a wide variety of musculoskeletal disorders. Methods: In the present study, the authors included 50 individuals with FBSS. Target points were determined by an ultrasonic study including bilateral L2-L3 through L5-S1 facet joints, sacroiliac joints, and the region immediately above bilateral supra crestal iliac bones representing cluneal nerves. LLLT was performed three times a week for 3 weeks. A near-infrared laser (wavelength 808 nm, power 500 mw) was used in continuous mode for laser therapy sessions. The Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were registered before treatment and after last treatment session, 1 month and 6 months later, respectively. Results: NRS and ODI were significantly improved after treatment, as well as therapeutic effects, after 1 month and 6 months were also evident and comparison of the NRS and ODI showed significant difference. Conclusion: LLLT has a positive impact on pain and disability in patients with FBSS.

Cerebral Oxygenation Under General Anesthesia Can Be Safely Preserved in Patients in Prone Position: A Prospective Observational Study.

BACKGROUND: The effects of prone position (PP) on cerebral tissue metabolism are not well known. The aim of this investigation was to evaluate regional cerebral oxygen desaturation in patients undergoing lumbar spine surgery in PP during routine anesthesia management. MATERIALS AND METHODS: Between July 2013 and October 2013, 50 consecutive patients undergoing lumbar spine surgery under general anesthesia in PP were enrolled. The anesthetic technique was standardized. Using near-infrared spectroscopy, bilateral regional cerebrovascular oxygen saturation was recorded during the surgery. RESULTS: After 30 and 60 minutes of prone repositioning, significant decreases in bilateral regional cerebral oxygen saturation were observed compared with the values in the supine position (from 76.24% to 73.18% at 30 min and 72.76% at 60 min on the right side and from 77.06% to 73.76% at 30 min and 72.92% at 60 min on the left side; P<0.05). These changes were not clinically important and returned to supine values after 90 minutes of prone positioning. Decreases in cerebral oxygen saturation were accompanied by reductions in heart rate and mean arterial pressure (P<0.05). Older age and higher perioperative risk had a significant effect on the reduction of cerebral oxygen values (P<0.05). CONCLUSIONS: The results of our study show that margin of safety against impaired cerebral oxygenation can be maintained in PP. Preventing bradycardia and arterial hypotension is crucial. Older patients and those at higher perioperative risk need more meticulous attention.

Unanticipated Disturbance in Somatosensory Evoked Potentials in a Patient in Park-Bench Position.

Perioperative neuropathy is a known complication of malpositioning during anaesthesia. Somatosensory evoked potentials are used for detecting such a complication in selected surgeries. Most reports of intraoperative nerve injuries due to malpositioning are limited to injuries to the peripheral nervous system, and there have been no previously reported cases of somatosensory evoked potential monitoring disturbance attributable to position-related cerebral ischemia in the park-bench position. We present the case of a patient with glioblastoma in the park-bench position whose somatosensory evoked potential waveforms disappeared after head and neck repositioning. A prompt diagnosis of this complication and elimination of the underlying cause led to the return of somatosensory evoked potential waveforms, and there was no relevant neurologic deficit at the end of the surgery.