[Reflex sympathetic dystrophy secondary to piriformis syndrome: a case report.]

Agri. 2009 Apr; 21(2): 75-79Akçalı D, Taş A, Cizmeci P, Oktar S, Zinnuroğlu M, Arslan E, Köseoğlu H, Babacan APiriformis syndrome is a rare cause of hip and foot pain which may be due to sciatic nerve irritation because of anatomic abnormalities of sciatic nerve and piriformis muscle or herniated disc, facet syndrome, trochanteric bursit, sacroiliac joint dysfunction, endometriosis and other conditions where sciatic nerve is irritated. There has been no reflex sympathetic dystrophy (RSD) case presented due to piriformis syndrome before. A sixty-two-year-old female patient had right foot and hip pain (VNS: 8), redness and swelling in the foot since 15 days. Her history revealed long walks and travelling 3 weeks ago and sitting on the foot for a long time for a couple of days. Physical examination revealed painful hip movement, positive straight leg rise. Erythema and hyperalgesia was present in dorsum of the right foot. Right foot dorsiflexion was weak and hyperesthesia was found in right L4-5 dermatome. Medical treatment and ultrasound treatment to piriformis muscle was not effective. The patient was injected 40 mg triamcinolon and local anesthetic in right piriformis muscle under floroscopy by diagnosis of piriformis syndrome, neuropathic pain and RSD. Pain and hyperalgesia resolved and motor weakness was better. During follow-up right foot redness resolved and pain decreased (VNS: 1). In this case report, there was vascular, muscle and skeletal signs supporting RSD, which shows us the therapoetic effect of diagnostic piriformis injection. The patient history, physical examination and diagnostic tests were evaluated by a multidisciplinary team which contributed to the treatment.

Systematic review of percutaneous lumbar mechanical disc decompression utilizing Dekompressor.

Pain Physician. 2009 May-Jun; 12(3): 589-99Singh V, Benyamin RM, Datta S, Falco FJ, Helm S, Manchikanti LBACKGROUND: In recent years, a number of minimally invasive nuclear decompression techniques for lumbar disc prolapse, protrusion, and/or herniation have been introduced, including the Dekompressor a device utilizing an Archimedes screw. The primary goal of the surgical treatment of nerve root compression from a disc protrusion continues to be the relief of compression by removing the herniated nuclear material with open discectomy. However, poor results have been reported for contained disc herniations with open surgical interventions. The results with several alternative techniques including the Dekompressor, automated percutaneous discectomy, and laser discectomy have been described, but are not convincing. There is a paucity of evidence for all decompression techniques. STUDY DESIGN: A systematic review of the mechanical disc decompression with Dekompressor literature. OBJECTIVE: The objective of this systematic review is to evaluate the clinical effectiveness of the Dekompressor, a high rotation per minute device utilizing an Archimedes screw, used in mechanical lumbar disc decompression. METHODS: The literature search was conducted utilizing a comprehensive strategy for mechanical disc decompression utilizing the Dekompressor. A literature search was conducted using only English language literature in a comprehensive search of databases including PubMed, EMBASE, the Cochrane Library, along with systematic reviews, and cross-references from reviews, systematic reviews, and individual articles. The quality of the manuscripts included was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and for observational studies with the criteria developed by the Agency for Healthcare Research and Quality (AHRQ). The level of evidence developed by the United States Preventive Services Task Force (USPSTF) was utilized in this review. The evidence was classified as Level I, II, or III with 3 subcategories in Level II for a total of 5 levels of evidence. OUTCOME MEASURES: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas, long-term effectiveness was defined as greater than one year. RESULTS: Based on USPSTF criteria the indicated level of evidence for the mechanical high RPM device or Dekompressor is Level III for short- and long-term relief. LIMITATIONS: Lack of literature, both randomized and observational. CONCLUSION: This systematic review illustrates Level III evidence for mechanical percutaneous disc decompression procedures with the high RPM device or Dekompressor.

[Observation on therapeutic effect of moxibustion on temperature-sensitive points for lumbar disc herniation]

Zhongguo Zhen Jiu. 2009 May; 29(5): 382-4Tang FY, Huang CJ, Chen RX, Xu M, Liu BX, Liang ZOBJECTIVE: To compare therapeutic effects of traditional moxibustion and moxibustion on temperature-sensitive points for lumbar disc herniation. METHODS: One hundred and twenty cases were randomly divided into a temperature-sensitive point group and a traditional moxibustion group, 60 cases in each group. The temperature-sensitive point group was treated with moxibustion on the temperature-sensitive points in the temperature-sensitive high incidence area such as waist and lower limbs, once each day; the traditional moxibustion group was treated with warming moxibustion at Jiaji (EX-B 2), Ciliao (BL 32), Zhibian (BL 54), Huantiao (GB 30), Weizhong (BL 40), Yanglingquan (GB 34), Kunlun (BI. 60), once each day, 7 days constituting one course. The therapeutic effect and the recurrence rate were observed after one course treatment and six months later. RESULTS: After treatment for one course, the cured-markedly effective rate was 65.00% in the temperature-sensitive point group, superior to 50.0% in the traditional moxibustion group, with a significant difference between the two groups (P < 0.05); all effective cases were followed-up for six months, the cured-markedly effective rate and the recurrence rate were 62.3% and 26.4% in the temperature-sensitive point group, and 34.2% and 46.3% in the traditional moxibustion group, the therapeutic effect of the temperature-sensitive point group being superior to the traditional moxibustion group, and the recurrence rate was lower than the traditional moxibustion group (both P < 0.05). CONCLUSION: Moxibustion on temperature-sensitive points is a effective therapy for lumbar disc herniation, with stable therapeutic effect and low recurrence rate.

[Neurological complication after a vertical infraclavicular brachial plexus block : Case report of possible differential diagnoses of a neurological deficit.]

Anaesthesist. 2009 Jun 24; Ehrenberg R, Bucher M, Graf BA 72-year-old man with an obliteration of the brachial artery received a vertical infraclavicular block (VIP) for vascular surgery but 20 h after the operation a complete paresis of the affected extremity occurred. A new vascular obliteration could be excluded. During the diagnostic examination the patient noticed a snapping noise in the cervical column when moving his head and an abrupt recovery of the neurological deficits occurred. The radiological diagnostic provided no indication of cerebral ischemia or lesions of the brachial plexus. An additional diagnostic finding was a profound herniated vertebral disc with compression of the myelon. Fortunately, the neurological deficits completely returned to normal.