This study is to compare advantages, safety and mid-term effects of fluoroscopy (FL)-guided transforaminal (TF) to caudal (CA) epidural steroid injection (ESI) for chronic pain after spinal surgery (CPSS) by assessing pain relief and improvement of functionality. Methods: Patients with radicular pain in CPSS who received FL-guided CA (n = 21) or TF (n = 28) ESI were included in this retrospective study. Complication frequencies, adverse events, treatment effects, and functional improvements for each procedure were compared at 1, 3, and 6 months following the last injection. Results: Both the Oswestry Disability Index (ODI) and verbal numeric pain scale scores (VNS) demonstrated improvement in both groups at all 1, 3, and 6 months following the last injection, without meaningful difference between groups (p < 0.05). Moreover, no meaningful difference was present between groups in terms of treatment success rate at every time point. The amount of time used for the injection procedure was shorter in CA group than in TF group (410.32 ± 25.73 seconds vs 640.65 ± 18.03 seconds, p < 0.05). Within 2 weeks of the injection treatment, the patient satisfactory scores were evaluated, with excellent being rated 85.7% (n = 18) among CA-ESI patients and 55.7% (n = 16) among TF-ESI patients (p < 0.05). Logistic regression analysis revealed that variables such as method of injection (CA or TF approach), sex, use of analgesics, pain duration, number of injections, and age were not significant variables for successful treatment results. There were no adverse complications after the procedure in both groups. Conclusion:The outcomes of FL-guided CA-ESI and TF-ESI for CPSS are similar in terms of pain reduction and functional improvements. CA-ESI is associated with lesser procedure time. In addition, compared with the TF-ESI, the patient experiences less discomfort during the injection, and the satisfaction with the injection treatment is confirmed to be better. Accordingly, both methods are effective; however, in the CA approach, patient satisfaction is higher and the procedure time is shorter.
Objective: To assess the accuracy of recently commercialized wearable devices in heart rate (HR) measurement during cardiopulmonary exercise test (CPX) under gradual increase in exercise intensity, while wearable devices with HR monitors are reported to be less accurate in different exercise intensities.Methods: CPX was performed for patients with coronary artery disease (CAD). Twelve lead electrocardiograph (ECG) was the gold standard and Apple watch 7 (AW7), Galaxy watch 4 (GW4) and Bio Patch Mobicare 200 (MC200) were applied for comparison. Paired absolute difference (PAD), mean absolute percentage error (MAPE) and intraclass correlation coefficient (ICC) were evaluated for each device.Results: Forty-four participants with CAD were included. All the devices showed MAPE under 2% and ICC above 0.9 in rest, exercise and recovery phases (MC200=0.999, GW4=0.997, AW7=0.998). When comparing exercise and recovery phase, PAD of MC200 and AW7 in recovery phase were significantly bigger than PAD of exercise phase (p<0.05). Although not significant, PAD of GW4 tended to be bigger in recovery phase, too. Also, when stratified by HR 20, ICC of all the devices were highest under HR of 100, and ICC decreased as HR increased. However, except for ICC of GW4 at HR above 160 (=0.867), all ICCs exceeded 0.9 indicating excellent accuracy.Conclusion: The HR measurement of the devices validated in this study shows a high concordance with the ECG device, so CAD patients may benefit from the devices during high-intensity exercise under conditions where HR is measured reliably.
The facet joints are a common source of chronic spinal pain. Blocks of the nerves supplying the facet joints are validated tools in the diagnosis and treatment for facet joint pain. These interventions are typically performed with fluoroscopic guidance. However, the target, which is the nerve, is radiolucent and cannot be identified with fluoroscopy. Recently, several ultrasound guided techniques in the domain of spinal pain have been emerging because ultrasound is useful in visualization of the inner structures, is portable, and is not associated with the radiation exposure. This paper reviews a variety of techniques for ultrasound guided interventions for the medial branch block which has been reported in treating axial pain originating from the facet joint.
Median nerve damage caused by trauma is rare, especially after the massage therapy. There have been no reports of median neuropathy in the distal forearm following massage therapy. A 61-year-old man developed paresthesia and numbness in the right hand after two sessions of massage therapy. Electrophysiologic studies, ultrasound, and magnetic resonance imaging were used to localize and confirm the median nerve lesion in the distal forearm. Ultrasound-guided perineural steroid injection and oral pregabalin were administered. At the 1-month follow-up, more than 80% of the sensory symptoms had resolved, and the results of the sensory nerve conduction study and ultrasound showed improvement. Although massage-induced mononeuropathy is uncommon, massage therapy should be performed carefully to avoid complications.
Objective To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community.Methods We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home.Results No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO<sub>2max</sub>) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO<sub>2max</sub> at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years.Conclusion Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.
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