Percutaneous nucleoplasty and intradiscal electrothermal therapy in the management of lumbar discogenic pain: A retrospective comparative study.

Percutaneous lumbar nucleoplasty (PLN) and intradiscal electrothermal therapy (IDET) are effective treatment options for discogenic low back pain (D-LBP). We evaluated the effectiveness of PLN and IDET and the positive predictive factors associated with intradiscal procedures. We reviewed the medical records of 205 patients who underwent IDET or PLN in patients with D-LBP followed by positive provocation discography. A successful outcome was defined as ≥ 50% pain relief on the numerical rating scale (NRS) pain score at the 6-month follow-up visit. The relationship between the outcome of the intradiscal procedure and clinical variables was investigated using multivariate analyses. Of the 142 patients (89 with PLN and 53 with IDET), 86 (60.5%) experienced a successful outcome, which was more substantial in PLN (n = 61, 68.5%) than in IDET (n = 25, 47.2%; P = .010). The high-grade Modified Dallas Discogram Scale in provocation discography and a procedure at the L3/L4 spinal level were independent positive predictors of successful outcomes (P = .023 and .010, respectively). Coexisting psychiatric disorders, such as depression and anxiety, were negative predictors of successful treatment (P = .007). No serious complications related to the intradiscal procedures were reported during the 6-month follow-up period. PLN and IDET might be effective for managing low back pain (LBP) from internal disc disruption (IDD). The high-grade Modified Dallas Discogram, a procedure at the L3/4 spinal level, and the absence of neuropsychiatric disorders could be positive factors for the successful outcome of the intradiscal procedure.

The Warburg effect in patients with brain tumors: a comprehensive analysis of clinical significance.

PURPOSE: The Warburg Effect, referring to an elevation in serum lactate level attributable to increased tumor metabolism, is present in patients with brain tumors. This study comprehensively analyzes the Warburg effect in patients undergoing brain tumor resection. METHODS: We retrospectively analyzed the baseline intraoperative serum lactate levels of 2,053 patients who underwent craniotomies, including 415 with cerebral aneurysms and 1,638 with brain tumors. The brain tumor group was divided into subgroups based on the tumor pathology (extra-axial and intra-axial tumor) and the WHO tumor grade (high-grade and low-grade). RESULTS: Serum lactate level was significantly higher in the tumor group than in the aneurysm group (1.98 ± 0.97 vs. 1.09 ± 0.57 mmol/L, p < 0.001). The hyperlactatemia incidence (serum lactate level > 2.2 mmol/L) was higher in the tumor group (33.5 vs. 3.1%, p < 0.001). Severe hyperlactatemia (serum lactate level > 4.4 mmol/L) was found in 34 patients (2.1%) of only the tumor group. In patients with intra-axial tumors, serum lactate level was greater in high- than low-grade tumors (2.10 ± 1.05 vs. 1.88 ± 0.92 mmol/L, p = 0.006). Factors predictive of hyperlactatemia included supratentorial tumor location (odds ratio[95%CI] 2.926[2.127-4.025], p < 0.001) and a long tumor diameter (1.071[1.007-1.139], p = 0.028). In high-grade intra-axial brain tumor patients, there was a significant difference in overall survival between patients with hyperlactatemia than those without (p = 0.048). CONCLUSION: Our results show that brain tumor patients exhibit the Warburg effect and serum lactate may be a useful diagnostic and prognostic biomarker in patients with high-grade intra-axial brain tumors.