Natural changes of traumatic vertebral compression fractures during the first 6 months in patients visiting for disability certificates: A retrospective observational study.

ABSTRACT: To identify the natural changes of traumatic vertebral compression fractures during the first six months in patients visiting for disability certificates after conservative treatment.Data of patients who visited the rehabilitation medicine department of a university hospital for disability certificates concerning traumatic vertebral compression fractures from 2015 to 2018 were reviewed. Those who visited 180 to 210 days after injuries were included, and those who received invasive procedures for compression fractures were excluded. The anterior and posterior heights, local kyphotic angle of compression fractures, and upper and lower vertebrae on initial and follow-up images were measured and compared. Compression ratio was calculated by vertebral body compression ratio and anterior vertebral body compression percentage. Thoracic and lumbar traumatic fractures were also compared.Among 110 patients, 61 patients met the criteria. After six months, the anterior height of compression fractures decreased more than 4 mm, which implies the development of new compression fractures. The compression ratio and local kyphotic angle increased significantly without affecting the upper and lower vertebrae. Thoracic and lumbar compression fractures showed similar changes.Traumatic vertebral compression fractures change significantly during the first six months. This study could warrant 6 months of waiting for issuance of disability certificates for patients with traumatic vertebral compression fractures.

Short-term cane use in subacute stroke patients affects the nonparetic upper extremity nerves.

Overuse of the nonparetic upper extremity can lead to entrapment neuropathies in chronic stroke patients. However, little is known about the effects of cane use in subacute stage of stroke. The aim of this study was to investigate the short-term effects of cane use on the upper extremity nerves in subacute stroke patients recovering from a bedridden state. Thirty subacute hemiparetic stroke patients who were initially bedridden participated when they were able to walk with a cane. Symptoms and signs related to the median or ulnar nerves were checked, and nerve conduction studies were performed. The largest cross-sectional area (CSA) of these nerves from the wrist to elbow was measured with ultrasound. After 3 weeks of cane use, electrophysiologic and ultrasonographic reevaluation was performed. Nerve conduction studies and CSA of the nerves at the nonparetic upper extremity showed significant changes, whereas those of the hemiparetic upper extremity did not. Walking with a cane for a short period can induce the enlargement of the median and ulnar nerves at the nonparetic extremity of subacute hemiparetic stroke patients. Attention should be placed on correct cane usage from the beginning of rehabilitation.

Effects of multi-session intermittent theta burst stimulation on central neuropathic pain: A randomized controlled trial.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is one of the effective treatments for neuropathic pain. Little is known about the effects of multi-session theta burst stimulation, one of the new paradigms of rTMS. OBJECTIVE: The aim of this study was to investigate the effects of multi-session intermittent theta burst stimulation (iTBS) on central neuropathic pain, using evaluation tools specific to neuropathic pain. METHODS: Patients with central neuropathic pain diagnosed using Neuropathic Pain Special Interest Group guidelines were recruited. Thirty patients were randomly assigned to either a real or sham iTBS group. Each patient underwent 5 sessions of iTBS; before and after completion of the 5 sessions, participants were evaluated using the self-completed Leeds assessment of neuropathic symptoms and signs (S-LANSS), the numeric rating scale (NRS), the neuropathic pain symptom inventory (NPSI), and the neuropathic pain scale (NPS). RESULTS: S-LANSS, NRS, NPSI, and 3 of 4 NPS combination scores decreased significantly in the real iTBS group but not in the sham iTBS group. No adverse effects were reported during or after iTBS sessions. CONCLUSIONS: Multi-session iTBS was associated with a significant decrease in neuropathic pain, indicating its effectiveness as a treatment for patients with central neuropathic pain.

Late-Onset Post-radiation Lymphedema Provoked by Bee Venom Therapy: A Case Report.

Lymphedema is a common complication associated with cancer itself or with cancer treatment. Lymphedema infrequently occurs after drug therapy. Bee venom is one of the materials used in acupuncture, and it has been used in the treatment of a variety of inflammatory diseases including arthritis. We report a 74-year-old male patient with late-onset post-radiation lymphedema provoked by bee venom therapy. He was free of lymphedema for 5 years after the complete remission of prostate cancer which had been treated with transurethral resection and radiation therapy. The patient developed left leg swelling after undergoing bee venom therapy for left hip pain. Computed tomography and lymphoscintigraphy showed lymphedema without tumor recurrence or infection. The lymphatic system was suspected to be injured by bee venom therapy and lymphedema was provoked. Bee venom therapy should be used cautiously in patients prone to lymphedema.