Extradural haematoma in a patient following manual removal of the placenta under spinal anaesthesia: was the spinal to blame? (2023)

  • Research article

    Systematic review of the effectiveness of caudal epidural steroid injections in the treatment of chronic low back or radicular pain

    Interventional Pain Medicine, Volume 1, Issue 4, 2022, Article 100149

    Determine the efficacy, effectiveness, and safety of fluoroscopically- or ultrasound-guided caudal epidural steroid injections (ESIs) with or without catheter placement for the treatment of chronic low back (CLBP), radicular pain, and/or chronic post-surgical back pain (CPSBP).

    Systematic review.

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    Adults ≥18 years with CLBP, radicular pain, or CPSBP ≥3 months.

    Fluoroscopically- or ultrasound-guided caudal ESI with or without a catheter including epidural neuroplasty.

    Sham, placebo procedure, active standard care treatment, or none.

    The primary outcome was the proportion of individuals with reduction of pain by​≥​50%. Secondary outcomes included functional improvement, analgesic use, subsequent spinal surgery, healthcare utilization, and mean improvement in pain. Reported adverse events were also cataloged.

    Four reviewers independently assessed publications before January 2, 2022 in PubMed, Ovid MEDLINE, and Scopus. Quality of evidence was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework.

    Of 364 records screened, 23 publications met inclusion criteria. The success rates for the primary outcome could only be extrapolated from one study. Another study used a composite improvement scale that included pain and functional outcomes. The reported success rates in these two studies ranged from 40 to 58% at three months, 25%–67% at six months, and 58%–61% at one year. Data on secondary outcomes were limited; however, rates of functional improvement as measured by mean improvement in Oswestry Disability Index (ODI) ranged from 2% to 55%.

    There is moderate-quality evidence that caudal ESIs using an in-dwelling catheter for two days is an effective treatment for pain and dysfunction associated with disc herniation with radicular pain and for CPSBP at three, six, and 12 months. There is low-quality evidence supporting the effectiveness of other caudal ESI techniques for pain and dysfunction associated with central lumbar spinal stenosis with neurogenic claudication, discogenic CLBP, and CLBP without disc herniation or radiculitis.

  • Research article

    Criteria for determining if a treatment for pain works

    Interventional Pain Medicine, Volume 1, Supplement 2, 2022, Article 100125

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    Claims that a treatment works are hollow unless qualified in terms of: in what respects, by how much, how often, and for how long. Essential co-requisites for improvements in pain are improvements in function, psychological distress, and use of health care. Validated instruments are available for these outcome measures. Mean scores and p-values are not informative. Categorical data are required to reveal by how much a treatment works and how often. In order to provide a full picture, outcomes need to be followed until they plateau. Readers of studies should not rely on what authors claim. Instead, readers should demand comprehensive, transparent data on outcomes so that they can decide for themselves if a treatment works to their satisfaction.

  • Research article

    Adult Tethered Cord Syndrome Following Chiari Decompression

    World Neurosurgery, Volume 112, 2018, pp. 205-208

    Adult tethered cord syndrome is a rare neurologic disorder that classically presents with back or leg pain, weakness, and urinary dysfunction. Spinal cord tethering has been associated with acquired Chiari malformations. Whereas the effects of tethered cord release on Chiari malformation symptoms have been described previously, we report an unusual case of acquired tethered cord syndrome following Chiari decompression.

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    We report a 68-year-old man with a history of distant T12-level spinal cord injury and 2 weeks of progressive bilateral lower extremity weakness. The patient underwent a T12-L1 laminectomy in 1977, complicated by arachnoiditis and syringomyelia, with eventual placement of a syringopleural shunt. He remained neurologically stable until 2012, when he underwent a suboccipital craniectomy for Chiari decompression for new-onset headache and dysphagia. Ten days later, the patient noted progressive leg weakness and radiographic evidence of spinal cord tethering at the T11-T12 level. A T10-L1 laminectomy and medical facetectomy was undertaken for detethering with postoperative recovery of ambulatory function with assistance.

    Our patient exhibited an unusual acquisition of tethered cord syndrome. The tethering of the spinal cord may have been triggered by arachnoid adhesions from initial lumbar surgery 35 years before presentation and subsequently exacerbated by alterations of cerebrospinal fluid dynamics after Chiari decompression. Given the potentially devastating sequelae of tethered cord syndrome, investigation of cerebrospinal fluid flow dynamics may be beneficial before operative intervention in patients with risk factors for a tethered cord who exhibit adult-onset Chiari malformation.

  • Research article

    MnO2 decorated on carbon sphere intercalated graphene film for high-performance supercapacitor electrodes

    Carbon, Volume 107, 2016, pp. 426-432

    Free-standing two-dimensional MnO2/carbon sphere/graphene (MCG) films are rationally designed and used as efficient electrode materials for supercapacitor. Carbon sphere/graphene (CG) films are firstly constructed through a simple vacuum filtration method, then MCG electrodes are prepared by simply floating CGs on KMnO4 solution at room temperature. CG films act as the reducing agents as well as freestanding substrates. Birnessite-type MnO2 in situ grow on the surface of carbon spheres and graphene nanosheets. In the unique structure, carbon spheres spaced sandwich-like porous structures can provide plenty of paths for electrolyte-ion penetration. After decorating with high performance MnO2, MCG films can deliver a gravimetric capacitance of 319.3Fg−1 and a volumetric capacitance of 277.8Fcm−3, much higher than graphene and CG films. More importantly, the electrodes also exhibits high gravimetric and volumetric energy densities of 29.4Whkg−1 and 25.6WhL−1, respectively, as well as excellent cycling stability with 94.1% of its initial capacitance after 5000 charge-discharge cycles at a current density of 5Ag−1.

  • Research article

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    Foot Loading and Gait Analysis Evaluation of Nonarticular Tibial Pilon Fracture: A Comparison of Three Surgical Techniques

    The Journal of Foot and Ankle Surgery, Volume 57, Issue 5, 2018, pp. 894-898

    The aim of our study was to investigate which technique among hybrid external fixation, plate and screws, and intramedullary nailing produces better outcomes in foot loading when treating type 43.A1, 43.A2, and 43.A3 fractures, according to the AO classification. From November 2011 to December 2014, 34 patients, including 25 (73.5%) males and 9 (26.5%) females with an average age of 32.3 (range 16 to 67) years, with a type A tibia fracture were treated with intramedullary nailing, plate and screws, or hybrid external fixation. The patients were divided into 3 groups: 16 (47%) received hybrid external fixation, 10 (29.4%) received plate and screw fixation, and 8 (23.5%) received intramedullary nailing fixation. The follow-up protocol included clinical and radiologic evaluations performed at 15 days, 1 month, 3 months, 6 months, and 12 months after surgery. The selected outcome parameters for the 3 groups were as follows: visual analog scale for pain of the traumatized tibia, interval from surgery to weightbearing, average time required for fracture recovery, subjective and objective Ovadia–Beals scores, baropodometric examination at 12 months, walking recovery at 12 months, outcomes, and surgical complications. The endpoint assessment was set at 12 months. The results showed that incorrect reduction of a type A tibia fracture can lead to changes in the sagittal balance line for foot loading and pace training. In conclusion, these findings have shown that the experience of the surgeon in the reduction of the fracture and knowledge of the method of synthesis is essential.

  • Research article

    Characteristics of and Factors Contributing to Immediate Postoperative Pain After Ankle Fracture Surgery

    The Journal of Foot and Ankle Surgery, Volume 57, Issue 5, 2018, pp. 890-893

    To build an appropriate strategy of pain management after ankle fracture surgery, surgeons need to know the characteristics of postoperative ankle pain and its contributing factors. The aim of the present study was to investigate the maximum pain period after ankle fracture surgery and the factors affecting postoperative pain using a linear mixed model when patient-controlled analgesia (PCA) was used as a basic modality. A total of 219 adult patients (108 males and 111 females; mean age 51.2 ± 15.9 years) who had undergone operative treatment for ankle fractures were included. Data on fracture severity, causes of injury, interval between injury and surgery, anesthesia method, American Society of Anesthesiologists classification, and operative time were collected. Pain intensity was measured using an 11-point pain intensity numerical rating scale preoperatively and postoperatively every 8 hours. Intravenous PCA was prescribed to all patients. The chronologic pattern of postoperative pain and factors affecting it were statistically analyzed using a linear mixed model. Maximum postoperative pain was observed at 8 hours postoperatively, and the maximum pain numerical rating scale score was 3.92, measured at 8-hour intervals. The severity of fracture (p = .01) was the only significant factor contributing to postoperative pain after ankle fracture surgery on multivariate analysis. Clinicians should consider the chronologic pattern of postoperative pain after ankle fracture surgery during postoperative pain management. Interventions for pain control, in addition to PCA, might be needed at ~8 hours postoperatively, especially for those with severe ankle fractures.

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Copyright © 2002 Elsevier Science Ltd. All rights reserved.

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