Periradicular therapy (PRT) is a minimally invasive radiological procedurein patients with chronic lumbar pain.The aim of the study is to identify clinical and radiological predictive factors for treatment success after a single PRT treatment in patients with sciatica.The study includes a prospective follow-up of 166 patients treated with PRT. The pain intensity is determined according to the VAS scale and the degree of improvement is presented as excellent (over 75%), good (50-70%), moderate (25-49%), and weak (less than 25%). The follow up of the treated patients was done at 2 weeks, 3 and 6 months. In patients with pain duration up to 3 months, the improvement was excellent in n=32 (58.18%) after 2 weeks, after 3 months n=41 (74.55%) and after 6 months n=41 (74.55%). This stands in contrast to patients with pain over 1 year. The percentage of improvement after 6 months, post-intervention, was highest in patients without nerve root compression (86.25±19.2),and the highest improvement after 6 months was in patients with localization of pain at the L4-L5 level (69.69±29.7), the greatest improvement after six months was in patients with extraforaminal hernia (62.82±34.3), and the lowest in patients with central stenosis (40.21±30.7).Our study results suggest that the shorter a pain duration, low-grade root compression, injection level and type of herniation area predictor the more favourable response patients have to transforaminal epidural steroid injection in patients with sciatica.
Measurements of urinary calculi density in Hounsfield Unit, stone size, site by non-contrast computed tomography (NCCT), correlated with success rate by extracorporeal shock wave lithotripsy (ESWL) outcome in complete fragmentation, fragments less than 5 mm or incomplete fragmentation. Retrospective study comprising 40 patients with urinary calculus of 10-20 mm divided into two groups (10-15 mm and 16-20 mm), with defining stone location, site and attenuation measured in Hounsfield Unit (HU), divided into three groups:1-Soft stones <6500HU; 2-Medium stones 650-1200HU; 3-Hard stones >1200HU. All treated from 4000-4500 shock waves. Success in initial stone disintegration was defined with a plain film X-ray in 5-6 weeks.Completely disintegrated calculus was confirmed in 31 (77.5%), up to 5 mm fragments in 3 (7.5%) and unsuccessful in 6 (15.0%) patients. The percentage difference between complete disintegration versus up to 5 mm fragments or failed disintegration was extremely statistically significant for p<0.05 (Difference test, p=0.001). High percentage calculated after one treatment in 2-Medium stone group 650-1200HU in 15 (60%) patients, in 6 (24%) of the 1-Soft stone group, and in 3-Hard stone group in 4 (16%).Percentage difference between the 2-Medium stone group after one ESWL treatment versus the 1-Soft stone group and 3-Hard stone group was statistically significant for p<0.05 (Difference test, p=0. 0162). Study findings show that the attenuation value of stones can predict successful outcome of ESWL treatment for the upper urinary tract, and it has a greater impact on ESWL outcome than the stone size and site.
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