The interrelation between body mass index and post-dural puncture headache in parturient women.

BACKGROUND AND AIMS: Post-dural puncture headache is seen more frequently in pregnant women due to stress, dehydration, intra-abdominal pressure, and insufficient fluid replacement after delivery. Obesity protects against post-dural puncture headache in pregnant women; increased intra-abdominal fat tissue reduced cerebrospinal fluid leakage by increasing the pressure in the epidural space. Therefore, this study investigated the influence of body mass index on post-dural puncture headache in elective cesarean section patients in whom 27G spinal needles were used. MATERIAL AND METHODS: The study included 464 women who underwent elective cesarean section under spinal anesthesia. Dural puncture performed with a 27G Quincke spinal needle at the L3-4 or L4-5 intervertebral space and given 12.5 mg hyperbaric bupivacaine intrathecally. The patients were questioned regarding headache and low back pain 6, 12, 24, and 48 h after the procedure, and by phone calls on days 3 and 7. RESULTS: Post-dural puncture headache developed in 38 (8.2%) patients. Of the patients who developed post-dural puncture headache, 23 (60.5%) had a body mass index <30 and 15 (39.5%) had a body mass index ≥30. Of the patients who did not develop post-dural puncture headache, 258 (60, 6%) had a body mass index <30 and 168 (39, 4%) had a body mass index ≥30. CONCLUSION: This prospective study found the body mass index values did not affect post-dural puncture headache in the elective cesarean section performed under spinal anesthesia.

Evaluation of Increased Intracranial Pressure with the Optic Nerve Sheath Diameter by Ultrasound in Epiduroscopic Neural Laser Discectomy Procedures.

BACKGROUND: In order to clarify the camera image and open the adhesions mechanically during epiduroscopy, saline is injected continuously in the epidural area. As a result, an increase in intracranial pressure is to be expected in theory. Increased intracranial pressure can be evaluated by measuring by optic nerve sheath diameter. OBJECTIVES: This study was designed to evaluate the relationship between optic nerve sheath diameter measurements and intracranial pressure, after injecting fluid to the epidural area during epiduroscopy procedures performed in our clinic. STUDY DESIGN: Retrospective study. SETTING: Sakarya University Training and Research Hospital. METHODS: During the epiduroscopy procedure, pre and postoperative bilateral optic nerve sheath diameters were measured with an ultrasonography probe. With the patients' eyelids closed, the probe was placed on the orbita in the sagittal plane, measuring 3 mm posterior of the papilla. RESULTS: While there was a statistically significant difference between pre- and post-operative optic nerve sheath diameter measurements, there was no significant correlation with processing time, amount of fluid delivered, or fluid delivery rates. LIMITATIONS: One of the limitations of this study is the retrospective collection of data. A second limitation is that repetitive measurements were not performed, instead of a single postoperative measurement. CONCLUSION: We think more prospective randomized controlled studies are required to examine the increase in the diameter of the optic nerve sheath, which is an indirect indicator of increased intracranial pressure after epiduroscopy applications, in order to determine whether the pressure increase is associated with the rate of fluid delivery, the total fluid amount, or the processing time.

Evaluation of the Efficacy of Epiduroscopic Laser Neural Discectomy in Lumbar Disc Herniations: Retrospective Analysis of 163 Cases- Evaluation of the Efficacy of ELNP.

Background: Epiduroscopy, or spinal endoscopy, is the visualisation of the epidural space using a percutaneous and minimally invasive imaging fiberoptic device. Recently, as a result of some studies, it has been reported that laser therapy with epiduroscopic laser neural discectomy (ELND) was applied during multiple lesions. Methods: In this study, ELND performed between January 2012 and July 2016 at the Algology Clinic of the Department of Anesthesiology and Reanimation, Sakarya University Training and Research Hospital, was examined retrospectively. The Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores were recorded preoperatively, as well as after 2 weeks and 2, 6, and 12 months after the ELND. Results: According to the preoperative VAS and ODI scores, the decrease in postoperative 2nd week, 2nd, 6th, and 12th month VAS and ODI scores was significant (p=0.001). Similarly, according to the postoperative 2nd week VAS and ODI scores, decrease in postoperative 6th and 12th VAS and ODI scores was significant (p=0.001). Conclusions: As a result, ELND with Holmium: YAG laser, which is a new technique in patients with lumbar disc herniated low back and/or leg pain, can reduce VAS and ODI scores from 2 weeks without any complications that open surgery can bring with it. We believe that it is a useful and advanced technique in treatment of lumbar disc herniation and has low complication rates that provides maximum efficacy from the first year.

A Novel Combination Technique: Three Points of Epiduroscopic Laser Neural Decompression and Percutaneous Laser Disc Decompression With the Ho:YAG Laser in an MSU Classification 3AB Herniated Disc.

AIM: The aim of this study was to examine the effects of simultaneous epiduroscopic laser neural disc decompression (ELND) and percutaneous laser disc decompression (PLDD) applications using a holmium:yttrium-aluminum-garnet (Ho:YAG) laser in Michigan State University (MSU) classification 3AB herniated discs on VAS and Oswestry Disability Index (ODI) scores. METHODS: In this prospective observational study, ELND and PLDD procedures performed between January 2016 and December 2017 were examined. Preoperative, postoperative week 2, postoperative month 2, and postoperative month 6 ODI and VAS scores were obtained from patient files, and postoperative month 12 ODI and VAS scores were obtained from face-to-face interviews with patients and recorded. RESULTS: The data of 41 patients treated with simultaneous ELND and PLDD using a Ho:YAG laser were included in this study. Postoperative VAS scores of the patients were compared with preoperative values, and it was found that postoperative week 2, postoperative month 2, postoperative month 6, and postoperative month 12 VAS and ODI scores were significantly different compared to preoperative scores (P = 0.001; P < 0.01). 17.1% (n = 7) of the patients had a history of postoperative open surgery. Although dural puncture occurred in 7 patients (17%), only 1 patient had headache. CONCLUSION: We believe that the new combined technique of ELND and PLDD using a Ho:YAG laser is a reliable method in patients with MSU classification 3AB herniated discs, with an acceptable success rate and a low complication rate within 12 months after treatment. We think that randomized controlled studies are required for this method to be included in treatment algorithms.

The Effects of the Amount of Fluid Used in Epiduroscopic Laser Neural Discectomy Procedures on Intraocular Pressure and an Evaluation of the Ocular Findings.

INTRODUCTION: During epiduroscopic laser neural discectomy (ELNP) procedures, the amount of fluid used in the epidural area may cause increased intracranial pressure. This study aimed to investigate the effect of increased epidural pressure on intraocular pressure and other ocular findings due to the amount of fluid delivered to the epidural area and the rate of delivery of the fluid. MATERIAL AND METHODS: After obtaining approval from the Ethics Committee of Sakarya University Faculty of Medicine, patients who underwent ELNP in the Department of Anesthesiology and Reanimation Department, Algology Clinic, between January 2017 and May 2017 were included in this retrospective study. To evaluate the ocular findings after the operation, measurements obtained using an optical coherence tomography device were retrieved from the patient files and evaluated. RESULTS: Data from the medical files of 52 patients from the hospital system were evaluated. There was no significant difference between preoperative and postoperative retinal nerve fiber layer (RNFL) thickness, mean central macular thickness, optic disk area, and vertical cup-to-disk ratio (P > 0.05). CONCLUSIONS: Epiduroscopy procedures include intermittent or continuous infusion of saline into the epidural area. Currently, the volume of fluid that should be given to the epidural area in epiduroscopy procedures is very controversial. As a result of this study, we concluded that the amount of fluid used during ELNP, at 107.25 mL and 8.33 mL/min, had no effect on the intraocular pressure, optic disk diameter, macular thickness, or peripapillary RNFL thickness; thus, it was safe for ELNP.

Long-term Clinical Effects of DiscoGel for Cervical Disc Herniation.

BACKGROUND: Radiopaque gelified ethanol (RGE; DiscoGel, Gelscom SAS, France) is used as a chemonucleolysis substance in treating intradiscal herniation, showing good results without complications. It has also been used in cervical disc herniations (CDHs), demonstrating the potential efficacy of this substance. OBJECTIVE: The aim of the study is to investigate the long-term effectiveness and safety of DiscoGel in patients with CDH and chronic neck pain. STUDY DESIGN: This is a cross-sectional, single-center study. SETTING: The study was conducted from November 2013 to May 2016 on patients visiting Sakarya University Training and Research Hospital's pain clinic . METHODS: Each patient was evaluated before the procedure (baseline) and at 1, 3, 6, and 12 months after the procedure, using the visual analog scale (VAS) score for pain, the Oswestry Disability Index score to measure degree of disability, and estimate quality of life for those with pain; this coincides with scores on the Neuropathic Pain Questionnaire (DN4) for differential diagnoses. RESULTS: Thirty-three patients with CDH underwent the same treatment with DiscoGel between November 2013 and May 2016. Significant pain relief was noted, as opposed to preoperative pain, at 1, 3, 6, and 12 months after the procedure according to each patient's self-evaluation (P = 0.01). Differences in VAS, ODI, and DN4 scores between 1, 3, 6, and 12 months with the same variables were not statistically significant. There were no complications with the procedure. LIMITATIONS: Our study was conducted retrospectively, which led to problems with long-term follow-up data. In addition, this study was performed with a small group of patients. CONCLUSIONS: RGE is a potential alternative to surgery for patients with pain at the cervical level. However, we concluded that more studies with longer follow-up intervals with RGE will be necessary for assessment of the technique's efficiency. KEY WORDS: Cervical pain, herniation, neuropathic pain, injection, DiscoGel, chemonucleolysis.

Combined Use of High Radiofrequency Disk Ablation, Annulus Modulation, and Manual Nucleotomy in a Patient with Extruded Disk Herniation.

UNLABELLED: Different minimally invasive procedures are used to treat lumbar disk herniation. It is important to differentiate these techniques due to their specific effects and the disparate technical issues associated with each. This report describes a successful case involving the use of mechanical decompression in conjunction with radiofrequency ablation to treat a patient with pain and neurological deficits due to an extruded disk hernia. CASE REPORT: A 43-year-old male had magnetic resonance imaging (MRI) demonstrating an extruded disk herniation in the left foraminal region, compression at the left spinal nerve root, and obliteration of the left foraminal entrance of the L5-S1 distribution. In the operating room, sufficient disk material was removed using grasping forceps, and then, the Disc-FX system with a Trigger-Flex probe (Elliquence, Baldwin, NY, U.S.A.) was inserted. Modulation of the annulus was performed in bipolar hemo mode, and nucleus ablation was conducted in bipolar turbo mode within a 1.7-MHz frequency range. Among the available minimally invasive techniques, newly developed technologies may become important treatment options if they enable faster rehabilitation, lower rates of recurrence, shorter hospital stays, and reduced medical costs.