Pain physician
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In recent years, many extrapedicular puncture methods have been applied to percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCFs). However, these techniques were generally complex and had the risk of some puncture-related complications, which greatly limited the wide applications in PKP. Finding a safer and more feasible extrapedicular puncture method was rather important. ⋯ Modified unilateral extrapedicular PKP, in which the puncture trajectory was advanced through the bottom of Kambin's triangle to or across the midline of VB for proper bilateral cement distribution, greatly alleviated back pain and restored the morphology of fractured vertebrae. It seemed to be a safe and effective alternative applied to treat lumbar OVCFs with appropriate patient selection.
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Although several studies have examined the epidemiological features of vertebral compression fractures (VCF) among elderly patients, few studies have reported the epidemiology of VCF among younger individuals. ⋯ The mortality rate ratio and hazard ratio were significantly higher among younger patients with VCF, indicating the need for further research on VCF in younger age groups.
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Pulsed radiofrequency (PRF) treatment of the dorsal root ganglia (DRG) has recently been used as an important option for postherpetic neuralgia (PHN) patients who do not respond well to drugs. This procedure is commonly guided by computed tomography (CT) or fluoroscopy, but they cannot be performed in real time and are associated with radiation exposure. Ultrasound (US) is a potential alternative option, but no reliable method of US-guided DRG PRF treatment has been reported. ⋯ US-guided transforaminal DRG PRF is a safe and effective method for the treatment of cervical PHN. It is a reliable alternative option to the CT-guided procedure, demonstrating great advantages in reducing radiation exposure and the operation time.
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The erector spinae plane block (ESPB) is a less invasive, safer, and technically easier procedure compared to the conventional neuraxial technique. Although the ESPB is a favored and easy technique compared to neuraxial block, there is no study with a large number of patients describing the exact spread level of injected local anesthetics. ⋯ The ESPB 20 mL group showed a more extensive distribution of contrast medium than that of the ESPB 10 mL group. Inadvertent injections into the epidural space, psoas muscle, and intravascular system were observed. Among them, intravascular system injections were found to be the most common (12.9%).
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Trigeminal neuralgia (TN) is the most common excruciating cranial neuralgia in the elderly population. Radiofrequency thermocoagulation (RFT) of the trigeminal ganglion is an alternative treatment for medically intractable patients with TN. RFT cannula tip position is an important issue since it is related to treatment outcome and patient safety. ⋯ Nearly 70% of patients in V2 TN and all patients in V3 TN, the cannula tip was positioned below the clival line. RFT of the trigeminal ganglion showed a successful treatment outcome with BNI I or II in 83% of patients.