Dae Moo Shim

Comparison of Ultrasonography- and Fluoroscopy-Guided Facet Joint Block in the Lumbar Spine

Study Design Retrospective study. Purpose Facet joint block is performed for diagnostic or therapeutic purposes and generally carried out under computerd tomography (CT) or radiologic fluoroscopy guidance. Ultrasonography-guided facet block has recently been attempted. So, we compared the results of ultrasonography-guided facet joint block with the results of fluoroscopy-guided facet joint block. Overview of Literature Because fluoroscopic or CT guided facet joint block has been reported side effects, we performed spinal facet block using a fluoroscopy-guided method. Methods We selected 133 patients who had lumbar pain or referred pain. They were diagnosed as having spinal stenosis and hospitalized from January 2008 to June 2008. As the subjects, we selected 105 patients who had been follow-up for more than 6 months and carried out a prospective study. Twenty six subjects were male and 25 were female in the fluoroscopy group (group 1) and their mean age was 56.1 years (range, 45 to 79 years). Twenty one were male and 33 were female in the ultrasonography-guided group (group 2). Their mean age was 58.3 years (range, 47 to 83 years). We studied the average time of the procedures, complications, the difference of the therapeutic cost between the two groups. We also evaluated the visual analogue scale (VAS) score and the Oswestry disability index. Results The procedure in group 2 averaged 4 minutes and 25 seconds, and in group 1, 4 minutes and 7 seconds. The coast was an average of 38,000 won in group 2 and 25,000 won in group 1. The VAS score was improved from an average of 7.5 (range, 5 to 9) to 2.8 (range, 2 to 6) in group 2 and from 7.8 (range, 4 to 10) to 2.7 (range, 2 to 5) in group 1. The Oswestry disability index was improved from an average of 32.3 (range, 28 to 41) to 23.5 (range, 17 to 26) in group 2 and from 34.2 (range, 29 to 43) to 24.8 (range, 18 to 28) in group 1. As for complications, worsening of lumbar pain, paresthesia, headache and allergic reaction were detected in 5 cases of group 2 and in 3 of group 1. Those symptoms were improved within several hours. One case of superficial infection that developed in group 2 was improved within several days. Conclusions We should consider that ultrasonography-guided facet joint block is a minimal invasive procedure that is easily carried out without radiation exposure.

Intradural extramedullary tuberculoma mimicking en plaque meningioma.

A 24-year-old man with tuberculosis meningitis developed acute paraplegia and sensory disturbances 5 weeks after receiving conventional antituberculous therapy. Magnetic resonance imaging revealed an intradural extramedullary long segmental mass mimicking en plaque meningioma at the T2-T6 vertebrae levels. Prompt surgical decompression was performed. A histology examination of the mass revealed a tuberculoma. After surgery, the patient showed improved motor power and a normal bladder function. Intradural extramedullary tuberculoma of the spinal cord is rare complication of tuberculosis meningitis, which can occur as a response to conventional antituberculous therapy.

Is Complex Regional Pain Syndrome a Cause of Post-Operative Syndrome in the Lumbar Spine? - A Case Report -

Complex regional pain syndrome (CRPS) along with post-operative syndrome in the lumbar spine shows confusing and duplicated symptoms, and this makes it difficult to make a clear differential diagnosis. Therefore, the patient with post-operative syndrome in the lumbar spine suffers losses of time and money, and the surgeon who diagnoses and treats post-operative syndrome in the lumbar spine also agonize from the patients losses. It is necessary to provide these patients with a multidisciplinary approach to their disease and symptoms. We diagnosed herniation of an intervertebral disc of the lumbar spine (L4/5) and we performed discetomy twice in different hospitals. However, the symptoms did not improve, so we re-operated and performed discetomy along with monosegmental fixation using pedicular screws and interbody cages. There was improvement of pre-operation symptoms, but neurogenic symptoms occurred and then progressed after the surgery. Therefore, we report here on the case of CRPS that was diagnosed with the exclusion of the causes of post-operative syndrome in the lumbar spine, and the patient was finally effectively treated with spinal cord stimulation. Although differentiating post-operative syndrome in the lumbar spine from CRPS is difficult, we recommend suspecting CRPS as the cause of post-operative syndrome in the lumbar spine and taking CRPS as the main interest in order to diagnose and treat CRPS more effectively and accurately.