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ObjectiveThe objectives of this study were to clarify the short-term effects of transforaminal epidural steroid injection (TFESI) for degenerative lumbar scoliosis combined with spinal stenosis (DLSS), and to extrapolate factors relating to the prognosis of treatment.MethodThirty-six patients with lumbar radicular pain from DLSS were enrolled. Subjects were randomly assigned to one of two groups (steroid or lidocaine group). We compared the effect of pain suppression at 2, 4 and 12 weeks after the procedure between the two groups. Radiographic analysis included measurement of the Cobb's angle, the upper endplate obliquities of L3 and L4, and maximal lateral olisthy between two adjacent lumbar vertebrae. Sagittal plane measurement included lumbar lordosis, and thoracolumbar kyphosis. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two.ResultsThere were no significant differences in the demographic data, initial visual analogue scale (VAS) or Oswestry disability index (ODI) between the steroid group (n=17) and the lidocaine group (n=19). Two, 4, and 12 weeks after injection VAS, ODI showed a significantly greater improvement in the steroid group compared to the lidocaine group (p<0.05). The radiographic and clinical parameters were not significantly correlated with treatment outcome.ConclusionOur findings suggest that fluoroscopic transforaminal epidural steroid injections appear to be an effective non-surgical treatment option for patients with degenerative lumbar scoliosis combined with spinal stenosis (DLSS) and radicular pain.

These findings strongly suggest that patients who suffer head trauma should be routinely tested for anterior pituitary hormone deficiency.

Objectives Sonographically guided injections show more accuracy than blind injections, but there are no reports comparing sonographically guided intra‐articular injection approaches. This study examined the accuracy of sonographically guided intra‐articular injections at 3 different sites of the knee using medial, midlateral, and superolateral portals. Methods Sonographically guided intra‐articular injections and radiology evaluations were performed on 126 knees with osteoarthritis (Kellgren‐Lawrence grade 2 or 3). Six milliliters of mixed material containing 1% lidocaine (1 mL), 20 mg of triamcinolone (1 mL), and a nonionic contrast agent (4 mL) was injected into the intra‐articular space of the knee through the medial, midlateral, and superolateral portals. After the sonographically guided intra‐articular injection into the knee joint, a radiographic image was taken to determine whether the injected material had reached the intra‐articular space or infiltrated into the soft tissue. Results Sonographically guided intra‐articular injections in the midlateral portal (95%; P < .05) and superolateral portal (100%; P < .05) showed significantly higher accuracy than injections in the medial portal (75%). Conclusions Sonographically guided intra‐articular injections in the midlateral or superolateral portal may increase the accuracy of knee joint injections.

ObjectiveTo investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure.MethodsThis retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months' duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score.ResultsODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point.ConclusionOur study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary.

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ObjectiveTo compare the short-term effects and advantages of transforaminal epidural steroid injection (TFESI) performed using the conventional (CL) and posterolateral (PL) approaches.MethodFifty patients with lumbar radicular pain from lumbar spinal stenosis and herniated lumbar disc were enrolled. Subjects were randomly assigned to one of two groups (CL or PL group). All procedures were performed using a C-arm (KMC 950, KOMED, Kwangju, Kyunggi, Korea). We compared the frequency of complications during the procedure and the effects of the pain block between the two groups at 2, 4, and 12 weeks after the procedure.ResultsThere were no significant differences in the demographic data, initial VNS (Visual numeric scale), or ODI (Oswestry disability index) between the CL group (n=26) and the PL group (n=24). There was no statistically significant difference in the outcome measures (VNS and ODI) between the groups at 2, 4, or 12 weeks. Symptoms of nerve root irritation occurred in 1 case of the CL group and in 7 cases of the PL group (p<0.05). Pricking of spinal nerve during the procedure and transient weakness after the procedure occurred in 6 cases and 3 cases, respectively in the CL group, but did not occur in the PL group.ConclusionOur findings suggest that the posterolateral approach represents an alternative TFESI method in cases with difficult needle tip positioning in the anterior epidural space, and could lower the risk of target nerve root irritation and nerve penetration.

ObjectiveTo investigate associations between angiotensin-converting enzyme (ACE) polymorphisms and muscle fatigability in 65-year-old Koreans.MethodThe study participants were 49 Koreans aged 65 years. ACE insertion/deletion (I/D) polymorphisms were determined by polymerase chain reaction and serum ACE activity, by spectrophotometry. Body mass index (BMI), body fat mass (BFM), and lean body mass (LBM) were determined. To evaluate muscle fatigability, dynamic Electromyography was used to measure maximum voluntary isometric contractions (MVICs) of ankle plantar flexor muscles. Patients were seated with their hips flexed at 90°, knees fully extended, and ankles at 0°. Continuous submaximal VICs (40% MVIC) were then performed, and contraction duration and EMG frequency changes during the initial 2 min were measured. A self-reported physical activity questionnaire was used to evaluate effects of ACE activity levels on muscle fatigability.ResultsAmong the 49 volunteers, 15 showed II genotype; 22, ID genotype; and 12, DD genotype. Serum ACE activity levels were significantly higher in DD genotype subjects than in II genotype subjects (p<0.05). Furthermore, the duration of submaximal isometric contractions was longer in II and ID genotype subjects than in DD genotype subjects (p<0.05). Dynamic EMG showed significantly lower mean frequency changes in II genotype subjects than in DD genotype subjects (p<0.05). However, LBM, BFM, and BMI were independent of ACE genotypes.ConclusionACE II genotype subjects showed significantly higher resistant to muscle fatigue than that by DD genotype subjects. However, body composition and BMI showed no correlations with ACE I/D polymorphisms.