Fluoroscopy-guided triple hip block for patients with hip osteoarthritis: A new approach.

Hip osteoarthritis (OA) is found in approximately 10% of the population and often causes disability and social limitations in elderly patients. Intra-articular injections are among the most frequently applied interventional treatments for the hip joint. Femoral and obturator sensorial nerve blocks have also been reported to be effective for both diagnostic and therapeutic purposes. A single needle insertion was performed for the blockage of the hip joint and sensory branches. For the sensory branch of the femoral nerve, the needle is advanced at nearly a 45-degree angle toward below the anterior inferior iliac spine near the anterolateral edge of the hip joint. For the sensory branch of the obturator nerve, the needle is advanced at nearly an angle of 45 degrees toward the area below the junction of the pubis and ischium. Finally, for joint injection, the same needle was advanced toward the midline of the anterior femoral head-neck junction at a steeper angle, and blocks were applied. Three patients with hip osteoarthritis were injected with this method and well-being was achieved in a 3-month follow-up. We think that blockage of the hip joint and peripheral sensory branches with a single needle insertion is a fast and effective method. However, prospective controlled studies are needed to determine the efficacy and safety of the method.

Effects of epidural steroid injections on menstrual cycle in women: An observational study.

OBJECTIVES: The aim of this study was to investigate the effect of epidural steroid injections on the menstrual cycle of women and to identify risk factors in those with changes. METHODS: A total of 78 women who had epidural steroid injections between the ages of 18 and 55 years were retrospectively analyzed. The patients were called by phone and asked whether there was any change in their menstrual cycles after the epidural injections. Data including demographic and clinical characteristics, body height and weight, education status, alcohol and smoking habits, comorbidities, number of children, birth control method, history of cesarean section, miscarriage, and abortion were recorded. RESULTS: Changes in the menstrual cycle were seen in five of 12 patients who underwent cervical interlaminar epidural steroid injection, in 27 of 56 patients who underwent lumbar transforaminal epidural steroid injection, in one of two patients who underwent lumbar interlaminar epidural steroid injection, and in three of eight patients who underwent caudal epidural steroid injection. The number of patients with obesity was higher in the patients with changes than those without, indicating a statistically significant difference (41.7% vs. 14.3%, respectively; p=0.007). CONCLUSION: Our study suggests that epidural steroid injections are associated with changes in the menstrual cycle. Obesity is a risk factor for menstrual cycle changes after epidural steroid injections.

Comparison of Radiation Doses of Contralateral Oblique and Lateral View for Fluoroscopy-Guided Lumbar Interlaminar Epidural Steroid Injection.

BACKGROUND: Despite newly developing technologies and techniques, the use of fluoroscopic guidance in spinal interventional treatments remains popular. Therefore, it is essential to set reference standards and techniques for reducing radiation exposure in fluoroscopy-guided procedures. OBJECTIVE: The aim of this study was is to compare the radiation doses and procedure time of the contralateral oblique (CLO) view to  lateral view imaging during fluoroscopy-guided spinal procedures. STUDY DESIGN: A retrospective study. SETTING: Pain management unit of a tertiary care center. METHODS: An evaluation of patients who received epidural steroid injections between May 2021 and May 2023 in a university hospital interventional pain management center was performed. This observational study was conducted with 248 patients aged 18 and older who underwent lumbar interlaminar epidural injections (ILESI) confirmed by CLO or lateral oblique imaging. The primary outcomes were the comparison of radiation dose and procedure time between the 2 groups. The secondary outcome was the comparison of complication rates. RESULTS: There were no significant differences between the two groups in terms of age, gender, diagnosis, body mass index, procedure level, Numeric Rating Scale, and procedure time. Although the radiation dose was lower in the CLO group, there was no significant difference between the 2 groups. However, there was a significant difference between the 2 groups in terms of complications (P < 0.001). LIMITATIONS: The study was designed in a single center and performing all the procedures with the same fluoroscopy device makes it difficult to generalize our results. CONCLUSIONS: Although there was no difference in terms of radiation dose and duration of procedure between lumbar ILESI conducting using the CLO or lateral view fluoroscopy imaging, there was a significant difference in terms of complications. Therefore, conducting lumbar ILESI using a CLO view minimizes the complication rate.

The effect of lumbar multifidus cross-sectional areas on transforaminal epidural steroid injection: An observational clinical study.

OBJECTIVES: Multifidus has an important role in spinal stability, and multifidus degeneration causes long-term disability and low back pain. This study aimed to investigate the effect of multifidus cross-sectional area on transforaminal epidural steroid injections (TFESI). METHODS: Patients with single-level disc herniation were included in the study. Total multifidus cross-sectional area (TM-CSA) and functional cross-sectional area (FM-CSA) were measured from axial T2 MRI of the patients, and FM-CSA/TM-CSA ratio was calculated for determination of muscle degeneration or fat infiltration. Numerical Rating Scale (NRS) scores at the pre-injection, 3rd week, and 3rd month visits were recorded. A decrease of 50% or more in the NRS score in the 3rd month was accepted as a treatment success (TS), and patients were divided into TS and treatment failure groups. RESULTS: A total of 120 patients were included in the study; 57 of the patients were female, and 63 of them were male. Of the patients included in the study, 68 had herniation at the L5-S1 disc level and 52 had herniation at the L4-L5 disc level. FM-CSA and FM-CSA/TM-CSA ratio were found to be significantly lower below the disc herniation level on the affected side (p<0.05). The affected side TM-CSA and FM-CSA were higher in the TS group and TM-CSA/FM-CSA ratios were equal in both groups. CONCLUSION: Multifidus CSA was found to be lower on the affected side. However, the effect of multifidus CSA on the success of TFESI has not been determined.

The Impact of Contrast Spread Patterns to Clinical Outcomes of Cervical Interlaminar Epidural Steroid Injection: An Observational Study.

AIM: To investigate the relationship between epidural contrast spread patterns, and the treatment success of cervical interlaminar epidural steroid injection (CIESI) for cervical radicular pain. MATERIAL AND METHODS: A total of 76 patients aged between 20 and 60 years who had neck and unilateral upper limb pain due to a single-level disc herniation at C5-C6 or C6-C7 were included. Severity of pain and disability were assessed with Numerical Rating Scale (NRS-11) and Neck Pain Disability Scale (NPDS) at baseline, three weeks, and three months after the treatment. Contrast dispersion prior to injection of the medication was graded in anteroposterior fluoroscopic view. Treatment success was defined as a ≥50% improvement at three months in the NRS-11 scores compared to baseline. RESULTS: A significant improvement in pain and disability scores was observed at three months compared to baseline (p < 0.001). Treatment success was observed in 57% of the patients. The multivariate binary logistic regression analysis revealed that high initial NPDS scores, severe foraminal and central stenosis, Grade 1 contrast spread pattern were negative predictors of response to CIESI. CONCLUSION: Lateral contrast spread toward the dorsal root ganglion (DRG) and spinal nerve root of the target level was associated with more favorable clinical responses. Clinicians performing CIESIs should exert effort to administer the injectate around the DRG and spinal nerve root at the target level.

Proximal femur diaphysis osteoid osteoma mimicking lumbar radiculopathy.

Osteoid osteoma is a benign bone tumor that commonly arises from the metaphyseal and diaphyseal regions of long bones. Pain is often the first symptom, and it can mimic many diseases. Herein, we report a 36-year-old male patient who presented with complaints of lower back pain radiating to the right extremity for a year. In the patient's history, physical therapy, platelet-rich plasma, pregabalin, and duloxetine were used, with the only benefit from indomethacin. An X-ray of the femur was requested, and the diagnosis of osteoid osteoma was confirmed by magnetic resonance imaging. Osteoid osteoma should be kept in mind as a differential diagnosis of persistent pain despite treatment.

Caudal epidural steroid injection versus transforaminal ESI for unilateral S1 radiculopathy: a prospective, randomized trial.

OBJECTIVE: Epidural steroid injections are frequently performed to manage radicular symptoms. Most research investigating the effectiveness of different routes of epidural injections were conducted with non-homogeneous groups. In this study our aim was to investigate the efficacy of caudal versus transforaminal approaches in patients with unilateral S1 radiculopathy secondary to a paracentral L5-S1 disc herniation. STUDY DESIGN: Prospective, randomized clinical trial. SETTING: A university hospital pain management center. METHODS: The study was conducted between January 2022 and February 2023. Patients with unilateral S1 radiculopathy were randomly divided into two groups: the caudal epidural steroid injection (CESI) and the transforaminal epidural steroid injection (TFESI) group. Severity of pain and disability were assessed with Numeric Rating Scale (NRS-11) and Oswestry Disability Index (ODI) at baseline, 3 weeks, and 3 months after treatment. Fifty percent or more improvement in NRS-11 was defined as treatment success. Fluoroscopy time and doses of exposed radiation were also recorded. RESULTS: A total of 60 patients were included in the final analysis (n = 30 for each group). Significant improvement in pain and disability scores was observed at 3rd week and 3rd month compared to baseline (P < .001). Treatment success rate at 3rd month was 77% for the CESI group and 73% for the TFESI group without any significant difference between the groups (P = .766). CONCLUSIONS: CESI is equally effective as TFESI in the management of S1 radiculopathy due to a paracentral L5-S1 disc herniation. Both approaches can reduce pain and disability, while CESI requires shorter fluoroscopy time and less radiation exposure.

YouTube as a source of information on sacroiliac joint injection: A reliability and quality analysis.

Sacroiliac joint (SIJ) injection is recommended for both diagnosis and relief of SIJ pain. YouTube has become a widely used source for health professionals and patients to obtain information about various procedures but the quality of YouTube videos including medical content is questionable. Therefore, the aim of this study is to evaluate the quality of SIJ injection videos on YouTube. This cross-sectional study was conducted through March 2022 by searching the phrase "sacroiliac joint injection" on YouTube. After resetting search history top 100 videos were screened. Duration of videos, number of views, number of likes, number of comments, view ratio (number of views/d), time passed since upload date, guide used for injection, and source of videos were recorded. The DISCERN and the Global Quality Scale were used to assess the quality and reliability of the videos. Of the 100 videos screened 42 videos met the inclusion criteria. The videos (73.8%) were predominantly uploaded by physicians. Most frequently used guide for injections was ultrasound with 45.4%. According to the DISCERN classification, 35.7% of the videos were "very poor," 30.9% were "poor," 21.4% were "fair," 7.1% were "good" and 4.7% were "excellent." Physicians and patients should be aware of that many of the videos about SIJ injections are categorized as "poor" or "very poor," which means they may mislead trainees, resulting in inadequate treatments.

Follow-up of at least 3 years after ganglion impar block for control of chronic coccygodynia.

INTRODUCTION: Although it is well known that ganglion impar block (GIB) reduces pain in the short term in patients with chronic coccygodynia, there are insufficient data on long-term treatment outcomes. The aim of this study was to examine the long-term outcomes of patients who underwent GIB for chronic coccygodynia and possible factors that might affect these outcomes. METHODS: The pre-treatment, 1st-hour, and 3rd-week numeric rating scale (NRS) scores of patients who underwent GIB 36-119 (min-max) months ago (between November 2011 and October 2018) due to coccygodynia were obtained from the medical records. Final NRS scores and presence of factors that may affect success such as accompanying low back pain (LBP) were questioned via telephone interviews. Treatment success was defined as a 50% or more reduction in final NRS scores compared with pre-treatment NRS scores. RESULTS: Telephone interviews were made with 70 patients. Treatment success was achieved in 55.7% of the patients. The patients were divided into two groups as those who achieved treatment success (group A) and those who could not (group B) and were compared. The NRS scores at the 3rd week and the number of patients with LBP in the group B were significantly higher than the group A. No serious complications developed in any patients. CONCLUSION: In patients with chronic coccygodynia, GIB is an effective and safe treatment option for pain reduction in the long term. Accompanying LBP and high pain scores in the 3rd week after injection should be considered as parameters that negatively affect long-term treatment success.

Incidence and Disease Course of COVID-19 Infection Among Unvaccinated Patients Who Received Local Corticosteroid Injections.

OBJECTIVE: There are concerns that local corticosteroid injections may increase the risk of COVID-19 infection because of the immunosuppressive effect of corticosteroids. This study aimed to examine the relationship between local corticosteroid injections and the risk of COVID-19 infection. DESIGN: The date and type of procedure as well as the dose and type of corticosteroids used in patients who underwent local corticosteroid injections within 1 yr after the first COVID-19 case in the country were examined retrospectively and recorded. Patients who did not receive corticosteroids were included in the control group. Coronavirus disease 2019 infection histories of all patients were recorded. RESULTS: There was no significant difference between the patients who received local corticosteroids and the control group in terms of the incidence of COVID-19 infections, and the number of patients who needed hospitalization or intensive care treatment. In addition, it was found that the administration of two injections, the type of procedure performed, and the dose and type of steroids were not associated with the incidence or severity of COVID-19 infections. CONCLUSIONS: It has been shown that local corticosteroid injections are not associated with the incidence of COVID-19 infections and the number of patients who need hospitalization or intensive care treatment due to COVID-19.

An unusual obstacle to the thoracic interlaminar epidural injection for the treatment of post-herpetic neuralgia.

Interlaminar epidural steroid injections corresponding to dermatomes affected by post-herpetic neuralgia (PHN) were found effective in reducing pain. Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition that mainly occurs with calcification and ossification of spinal ligaments such as anterior and posterior longitudinal, interspinous, supraspinous ligament, and ligamentum flavum. In this case, it is presented that the failure of the access to the T7-T8 interlaminar space due to the supra/interspinous ligament calcification and ossification accompanied by thoracic DISH in a 73-year-old male for the treatment of PHN.

A case report of lumbosacral plexopathy in a patient with a history of sacral chordoma and radiotherapy: Will the detection of myokymia on the EMG help to solve the case?1.

BACKGROUND: When a patient with a prior history of malignancy and radiotherapy develops progressive weakness as a presentation of plexus involvement, the differential diagnosis usually rests between radiation-induced plexopathy and invasion from recurrent tumor. The presence of myokymic discharges is helpful in differentiating radiation-induced from neoplastic plexopathy. OBJECTIVE: To present a case report of a patient with chordoma, a locally aggressive tumor, who was diagnosed with recurrent tumor accompanied by the occurrence of myokymia in needle electromyographic examination. METHOD: A 55-year-old male patient with a history of chordoma and radiotherapy presented to our outpatient clinic with complaints of foot drop, and impaired walking for two months. His latest magnetic resonance imaging (MRI) which was performed three months earlier did not show recurrence. Upon electromyographic evaluation, myokymia, the pathognomic electromyography abnormal wave for radiation plexopathy was detected supporting a diagnosis of radiation plexitis rather than recurrent neoplastic invasion. One month later he presented with more severe pain and was re-evaluated by an MRI, on which a mass was detected indicating relapse. CONCLUSION: With this case report, we would like to emphasize that the behaviour of the tumor should be considered and imaging should be repeated when tumors display aggressive or recurrent behaviour.

Effect of sacralization on the success of lumbar transforaminal epidural steroid injection treatment: prospective clinical trial.

OBJECTIVE: The aim of this study was to invastigate the effect of the sacralization on the results of transforaminal epidural steroid injection for radicular low back pain. MATERIALS AND METHODS: The study included 64 patients diagnosed with radicular low back pain due to unilateral and single-level lumbar disk herniation. Patients were divided into 2 groups: patients with sacralization (Group S) and patients without lumbosacral transitional vertebrae (Group A). Injection was applied to the relevant level. Patients were evaluated with Numeric Rating Scale and Modified Oswestry Disability Index before, at week 3 and month 3 after the procedure. Sacralization presence was determined by MRI. Sacralization was categorized by anteroposterior lumbar radiography using Castellvi classification. Treatment success was considered as ≥ 50% reduction in NRS scores. RESULTS: Numeric Rating Scale and Modified Oswestry Disability Index scores decreased in both groups on both week 3 and month 3 (p < 0.05). Pain scores of Group S (median value 5 (3-6)) were significantly higher than Group A ((median value 3 (0-5)) in the third month follow-up (p = 0.026), but no significant difference was observed at other time points. There was no significant difference in Modified Oswestry Disability Index scores between the groups at all follow-ups (p > 0.05). Treatment success in the third month was 44.8% in Group S and 65.6% in Group A. CONCLUSION: Transforaminal epidural steroid injection is an effective and safe method for radicular low back pain. Sacralization presence should be evaluated before treatment considering that it may be a risk factor reducing treatment success.

Comparison of cutaneous silent period parameters in patients with primary Sjögren's syndrome with the healthy population and determination of its relationship with clinical parameters.

Small fiber neuropathy (SFN) is one of the main neurological manifestations in primary Sjögren's Syndrome (pSS). For the detection of SFN, cutaneous silent period (CSP) measurement is gaining popularity recently due to its non-invasiveness and practical application. Evaluating SFN involvement in patients with pSS using CSP and evaluating its relationship with clinical parameters. Patients with a diagnosis of pSS and healthy volunteers demographically homogeneous with the patient group were included in the study. The CSP responses were recorded over the abductor pollicis brevis muscle. The latency and duration values of the responses were obtained. In patient group, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Hospital Anxiety and Depression Scale (HADS), Short Form-36 (SF-36) questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Central Sensitization Inventory (CSI) were applied for the evaluation of symptom severity, mood, quality of life, presence of neuropathic pain and central sensitization, respectively. The mean CSP latency was significantly longer in patient group compared to control group (p < 0.001). Mean CSP duration was also significantly shorter in patient group (p < 0.001). There were no significant differences in CSP parameters according to patients' neuropathic pain or central sensitization profile. There were significant correlations of CSP parameters (latency and duration, respectively) with ESSPRI dryness (ρ = 0.469, p = 0.004; ρ = -0.553, p < 0.001), fatigue (ρ = 0.42, p = 0.011; ρ = -0.505, p = 0.002), pain (ρ = 0.428, p = 0.009; ρ = -0.57, p < 0.001) subscores and mean ESSPRI score (ρ = 0.631, p < 0.001; ρ = -0.749, p < 0.001). When SF-36 subscores and CSP parameters were investigated, a significant correlation was found only between "bodily pain" subscore and CSP duration (ρ = -0.395, p = 0.017). In HADS, LANSS and CSI evaluations, a significant correlation was found only between HADS anxiety score and the CSP duration (ρ = 0.364, p = 0.02). As indicated by CSP measurement, SFN is more prominent in patients with pSS than in the healthy population. It is important to investigate the presence of SFN because of its correlation with the leading symptoms in the clinical spectrum of pSS.

Comparison of the Use of Peripheral Nerve Stimulator and Quincke Needle for Lumbar Transforaminal Epidural Steroid Injections.

AIM: Transforaminal epidural steroid injection (TFESI) is a frequently performed, minimally invasive procedure for addressing lumbosacral radicular pain that often uses Quincke and Stimuplex (peripheral nerve stimulator) needles for injection. This study aimed to compare the procedural features of TFESI performed using these two different needles (Stimuplex® and Quincke) in terms of procedure time, exposed radiation dose and adverse effects and complications, thus providing preliminary data to aid needle selection for TFESI. MATERIAL AND METHODS: Patients who received fluoroscopy-guided single-level lumbosacral TFESI between September 2020 and September 2021 were retrospectively included in this study. The patients were divided into two groups with respect to the needle type used for the procedure, those treated with a Quincke needle were classified as Group Q and those treated with a Stimuplex® needle comprised Group S. Subsequently, the two groups were compared in terms of their demographic data, procedure time, radiation dose, amount of contrast use, first-hour numeric rating scale (NRS), intravascular flow and complication rates. RESULTS: The number of patients recruited for Groups Q and S was 65 and 61, respectively. No significant difference was observed between the groups regarding their demographic data, preprocedural NRS scores, procedure time, exposed radiation dose and the amount of contrast dye used. Notably, the first-hour NRS scores were found to be significantly lower in Group S (p = 0.040) after the procedure. Moreover, the intravascular contrast spread was significantly different between the two groups (p 0.05), it was encountered during four procedures in Group Q, but was altogether absent in Group S. CONCLUSION: The Stimuplex needle may decrease the possibility of inadvertent intravascular leakages during TFESI and may also improve immediate pain scores after the procedure.

The Effect of Central Sensitization on Interlaminar Epidural Steroid Injection Treatment Outcomes in Patients with Cervical Disc Herniation: An Observational Study.

BACKGROUND: Central sensitization (CS) is a hyperexcitability that is manifested by the increased response of the central nervous system to sensory stimuli. It has been shown that the presence of CS may have a negative effect on the clinical picture in some musculoskeletal diseases and also have a negative effect on spinal procedures. OBJECTIVES: To investigate the effect of CS on interlaminar epidural steroid injection (ILESI) treatment outcomes in patients with cervical disc herniation (CDH). STUDY DESIGN: An observational study. SETTING: A university hospital pain management center. METHODS: Patients, who underwent ILESI between 2020-2021 due to CDH, were included in the study. The Numeric Rating Scale (NRS-11), Neck Pain and Disability Scale (NPDS), Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), and Short Form-12 (SF-12) were used for evaluation of patients. Patients were assessed before the procedure, at the first hour, and 3 months after the procedure. The presence of CS was investigated by the Central Sensitization Inventory (CSI). RESULTS: A total of 51 patients were included in the study. Twenty-three of the patients had CS, as assessed by the CSI. Although, patients who underwent ESI, had significantly lower NRS-11, S-LANSS, and NPDS scores, and higher SF-12 scores at all follow-up points. The first and third months, NRS-11, S-LANSS, and NPDS were significantly higher, and SF-12 scores were lower in the CS group compared to patients without CS. LIMITATIONS: The short follow-up period and relatively low number of patients can be considered as a limitation. The fact that CS is not evaluated with a more objective method, such as Quantitative Sensory Testing (QST), can be considered as another limitation. Since most clinicians use CSI, so from a "real world" perspective the lack of QST may be observed as a strength of the study. The third limitation is that we did not evaluate the patients' pre- and posttreatment analgesic consumption. Finally, we did not include patients with a history of psychiatric illness, but not evaluating the current psychiatric conditions of the patients could be considered a limitation. Nevertheless, the main strengths of this study are its prospective design and, to our knowledge, it is the first study to explore the effects of CS on cervical ESI treatment. CONCLUSIONS: The presence of CS has a negative effect on pain scores, disability, and quality of life in patients undergoing cervical ESI due to CDH.

Assessment of the relationship between rectus femoris cross-sectional area and knee extension strength in the prosthesis users with transtibial amputation: A case-control study.

Objectives: This study aims to investigate cross-sectional area of the amputated-limb rectus femoris compared to the intact-limb and controls and to determine its correlation with functional strength and walking tests in prosthesis users with transtibial amputation. Patients and methods: Between October 2018 and April 2019, a total of 14 prosthesis users (12 males, 2 females; mean age: 47.1±16.2 years; range, 26 to 73 years) who met the inclusion criteria, and 14 age-, sex-, and dominancy-matched able-bodied controls (12 males, 2 females; mean age: 47.1±16.2 years; range, 26 to 73 years) were included in this case-control study. Cross-sectional area of rectus femoris (CSA-RF) was evaluated bilaterally by two independent examiners. Knee extension strength was measured bilaterally by using a handheld dynamometer. Functional strength and walking were assessed by Step-Up-Over and Walk-Across tests of the NeuroCom Balance Master® device. Results: The CSA-RF was found to be reduced in amputated-limb compared to the intact-limb and able-bodied controls (p<0.01). In the prosthesis users, the cross-sectional area difference between both limbs rectus femoris muscles was shown to be correlated with actual and functional knee extension strength, step length, and walking speed (p<0.05). Intra- and inter-observer reliability of CSA-RF on both sides were found to be good to excellent (intraclass correlation coefficient: 0.856-0.936). Conclusion: Ultrasonographic measurement of CSA-RF is a valid and reliable tool to assess the functional strength and walking in the prosthesis users with unilateral transtibial amputation.

Reliability and validity of Turkish versions of Sciatica Bothersomeness and Sciatica Frequency Index.

BACKGROUND: The Sciatica Frequency Index (SFI) and Sciatica Bothersomeness Index (SBI) are two separate indices scored for both the bothersomeness and frequency of radiating symptoms. There is no Turkish scale used specifically for sciatica. OBJECTIVE: We aimed to translate SBI and SBI in Turkish and investigate the reliability and validity of these indices. METHODS: A total of 80 patients with lumbar disc herniation (LDH) were prospectively included. Construct validity was assessed by comparing the SBI and SFI with subscales of Short Form 36 (SF-36), back and leg Numeric Rating Scale (NRS) and Roland Morris Disability Questionnaire (RMDQ). Reliability was assessed by internal consistency (Cronbach's alpha) and test-retest reliability. RESULTS: A weak correlation was found between SBI/SFI, back NRS and SF-36 subgroups while a moderate correlation was found between SBI/SFI, RMDQ and leg NRS. The SBI and SFI had high internal consistency measured by Cronbach's alpha (0.76 and 0.73). Test-retest reliability of the SBI and SFI were 0.95 (95% CI: 0.92-0.97) and 0.95 (95% CI: 0.92-0.97) respectively, indicating excellent reliability. CONCLUSION: The Turkish versions of the SFI/SBI are a valid and reliable tool supporting their usability in patients with LDH-induced sciatica.

Comparison of Caudal Versus Transforaminal Epidural Steroid Injection in Post Lumbar Surgery Syndrome After Single-level Discectomy: A Prospective, Randomized Trial.

BACKGROUND: Epidural fibrosis (EF) is one of the leading causes of post lumbar surgery syndrome (PLSS). Although there are studies in the literature suggesting that lumbar epidural steroid injections are an effective method in the pain management of PLSS caused by EF, no study is available comparing the effectiveness and safety of caudal and transforaminal approaches. OBJECTIVES: To investigate the efficacy of caudal epidural steroid injection (CESI) versus transforaminal epidural steroid injection (TFESI) in patients with PLSS. STUDY DESIGN: A prospective, randomized, assessor-blind study. SETTING: Interventional pain management center at a tertiary care center. METHODS: Patients with low back and radicular pain related to EF following single-level lumbar discectomy were included. The patients were randomly divided into 2 groups: a CESI group and a TFESI group. All patients were assessed before the procedure (baseline) and at one hour, 3 weeks, and 3 months after the procedure using the Numeric Rating Scale (NRS-11) and at baseline, 3 weeks, and 3 months using the modified Oswestry Disability Index (mODI). Treatment success was defined as a >= 50% decrease in the NRS-11 scores compared to baseline. RESULTS: A total of 56 patients (n = 26 CESI group; n = 30 TFESI group) were included. NRS-11 and mODI scores showed a significant decline in both groups at all follow-ups (P < 0.001). At 3 weeks, the improvement in the mODI scores was significantly higher in the TFESI group (P = 0.020). In all follow-ups, the NRS-11 scores were similar between the groups. At 3 weeks, the rates of patients with a >= 50% decrease in NRS-11 scores were 53.8% and 60% in the CESI group and TFESI group, respectively, while these rates were 30% and 26.7%, respectively, at 3 months. LIMITATIONS: This study had no placebo-control group and a relatively short follow-up. CONCLUSION: Both CESI and TFESI are effective and safe methods in the treatment of PLSS caused by EF following lumbar discectomy. These methods can reduce pain and disability. Although both methods have similar treatment success rates, TFESI seems to be a more effective treatment method in reducing disability at 3-week follow-up.

Radiation Doses for Different Approaches of Fluoroscopy-Guided Epidural Injections: An Observational Clinical Study.

BACKGROUND: Although fluoroscopy-guided interventional therapies have declined in recent years, radiation exposure remains a critical issue for both patients and medical staff. Radiation exposure varies according to the physicians' experience, procedure time, patients' body mass index (BMI), imaging techniques, and the type of procedure performed. OBJECTIVE: The purpose of this study is to report procedure times and calculate the radiation doses for 4 different approaches of fluoroscopy-guided epidural injections per procedure and BMI to provide radiations doses for potential use in future dose reduction strategies. STUDY DESIGN: Retrospective, observational study. SETTING: A university hospital, pain management center. METHODS: A retrospective evaluation was performed of patients who received epidural steroid injections between January 2015 and December 2020 in a university hospital interventional pain management center. This observational study was conducted with patients aged >= 18 who underwent 3,711 epidural injections including cervical interlaminar, lumbar interlaminar, lumbar transforaminal, and caudal approaches. If more than one level or bilateral injections were performed, total dose and times were divided by the number of sites injected to attain procedure time and mean dose per injection. Provided doses for each patient were also divided by patients' BMI to obtain dose per BMI. RESULTS: The highest radiation dose per procedure was found in caudal epidural injection with 0.218 mGy·m2, and the lowest dose was found in cervical interlaminar epidural injection with 0.057 mGy·m2. The radiation dose per procedure was 0.123 mGy·m2 for lumbar transforaminal and 0.191 mGy·m2 for lumbar interlaminar epidural injection. The shortest procedure time was determined in transforaminal (37.3 seconds) injections, and the longest was in lumbar interlaminar (46.7 seconds) injections. Caudal epidural injection also had the highest radiation dose per BMI which was 0.00749, and cervical interlaminar epidural injection had the lowest radiation dose per BMI, which was 0.00214. LIMITATIONS: Firstly, injections were performed by first- or second-year fellows in pain medicine. Moreover, patient-related factors (previous surgery, scoliosis, etc.) affecting radiation exposure were ignored. CONCLUSIONS: Radiation dose levels and procedure times of 4 approaches of epidural injections were obtained from 3,711 procedures performed in a university hospital pain medicine clinic. BMI of patients was taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels, which will guide pain physicians to self-assess their own levels of radiation exposure.