European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The combined recordings of epidural-(D wave) and muscle motor evoked potentials (m-MEPs) have been proposed in many studies in intramedullary spinal cord tumour (IMSCT) surgery, although not all agree. Furthermore, the usefulness of the intraoperative monitoring of motor systems using these methods in other types of spine surgery has not yet been clearly confirmed. The aim of this study is to test the impact of intraoperative D wave on the monitorability and motor outcome in spine surgery. ⋯ Not only is intraoperative D wave recording to be considered mandatory in IMSCT surgery but it should also be attempted in other types of spine/spinal cord surgeries.
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Comparative Study
Elevated IL-1β and IL-6 levels in lumbar herniated discs in patients with sciatic pain.
Previous experimental models have shown that proinflammatory cytokines modulate peripheral and central nociception. However, the direct correlation between inflammation and pain in patients remains unclear. Our aim is to correlate the levels of inflammation in the spine with pre- and postoperative pain scores after discectomy. ⋯ These findings support the idea that LDH is accompanied by a local inflammatory process. Yet, the lack of correlation between IL-1β or IL-6 expression and the severity pain suggests that these cytokines may not play a leading role in maintaining a pain generating network.
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Randomized Controlled Trial Multicenter Study
Limaprost alfadex and nonsteroidal anti-inflammatory drugs for sciatica due to lumbar spinal stenosis.
Limaprost, a prostaglandin E1 analog, has vasodilatory properties and increases blood flow of the nerve root. However, it has not been clarified whether limaprost affects pain sensation associated with radiculopathy due to lumbar spinal stenosis (LSS). The aim of this study was to compare the efficacy of oral limaprost with nonsteroidal anti-inflammatory drugs (NSAIDs) for radiculopathy. ⋯ These obtained findings suggest that the effects of limaprost seem to be limited to radicular pain, not for LBP. Overall, a combination treatment might be more effective in the management of radiculopathy induced by LSS than monotherapy with either agent.
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The objective of this prospective innovative treatment is to section the pain pathways carried by sympathetic lumbar rami communicantes to achieve lasting pain relief of refractory low back pain. ⋯ Section the pain pathways carried by sympathetic lumbar rami communicantes for refractory low back pain improved 22 % of patients at the last follow-up of 29 months.
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Comparative Study
Disk degeneration of the upper lumbar disks is associated with hip pain.
A possible cause of hip pain is the presence of radiating pain from the higher lumbar spine. Identification of factors associated with hip pain arising from the lumbar spine would aid the physician. The first step in identifying possible factors is to look at the association between hip pain and osteoarthritis of the lumbar spine. ⋯ Our data provide evidence for an association between hip pain and disk space narrowing at disk level L1/L2 and L2/L3. In case of uncertainty of the cause of hip pain, evaluation of lumbar radiographs may help to identify those hip pain patients who might have pain arising from the lumbar spine.