bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome of Transforaminal Epidural Steroid
Injection According to the Severity of Lumbar
Foraminal Spinal Stenosis
Authors: Chang Min Cheol Chang, MD
Published: October 2019

Background: Lumbar foraminal spinal stenosis (LFSS) is a common cause of radicular pain in
the lower extremities. Transforaminal epidural steroid injection (TFESI) is being used widely for
controlling radicular pain induced by LFSS. The efficacy of TFESI has been demonstrated in previous
studies. However, no study has evaluated the outcome of TFESI according to the severity of LFSS.
Objective: In this study, we evaluated the outcome of TFESI in patients with chronic lumbar
radicular pain due to LFSS according to the severity of LFSS by using magnetic resonance imaging
(MRI).
Study Design: A prospective observational study.
Setting: A university hospital.
Methods: Sixty patients with chronic lumbar radicular pain due to LFSS were included in this
prospective study and received TFESI at our university hospital. Three patients were lost to followup. On the basis of sagittal lumbar MRI findings, we assigned patients with mild to moderate LFSS
to group A (n = 31) and those with severe LFSS to group B (n = 26). Pain intensity was evaluated
using a numeric rating scale (NRS) before treatment and at 1, 2, and 3 months after treatment.
Results: Compared to pretreatment NRS scores, a significant decrease in NRS scores was observed
in patients in both groups at 1, 2, and 3 months after treatment (P = 0.000). However, reductions
in the NRS scores over time were significantly larger in group A (P = 0.023). Three months after
treatment, 27 patients (87.1%) in group A and 11 patients (42.3%) in group B reported successful
pain relief (pain relief of ≥ 50%).
Limitations: This study had a small number of patients.
Conclusions: After TFESI, chronic lumbar radicular pain was significantly reduced regardless of
the severity of LFSS, and the effects of TFESI were sustained for at least 3 months after treatment.
However, the outcome of TFESI was superior in the group with a mild to moderate degree of LFSS,
compared to the group with a severe degree of LFSS. We believe that our study provides useful
information for establishing a treatment plan for radicular pain due to LFSS.
Key words: Lumbar foraminal spinal stenosis, transforaminal epidural steroid injection, disease
severity, magnetic resonance imaging, numeric rating scale, corticosteroids
Dual Site Pudendal Nerve Infiltration: More
than Just a Diagnostic Test?
Authors: Kastler Adrian
Published: October 2019

Background: Pudendal neuralgia (PN) is a very painful and often disabling condition in which
pudendal nerve blocks play an important role in both the diagnosis and management of PN. Some
previous reports have advocated the use of pudendal nerve infiltration (PNI) as a diagnostic test
only.
Objective: We aim to assess the outcomes of patients with typical refractory PN who underwent
dual site computed tomography (CT)-guided pudendal nerve infiltration.
Study Design: A bicentric, retrospective cohort analysis.
Setting: An academic practice.
Methods: Between 2002 and 2016, 385 PNIs were performed in 195 patients in the 2 units.
Only patients suffering from typical clinical PN were included, and only the first infiltration in
each patient was considered for analysis. Therefore, 95 patients who underwent 155 procedures
were assessed. Pain was assessed using a visual analog scale (0–10) and self-reported estimated
improvement (SRI), expressed as a percentage. Efficacy of the procedure was assessed at 1, 3, and
6 months after procedure follow-up, and clinical success was defined as a 50% decrease of the
VAS score. All procedures were performed under CT guidance and on an outpatient basis. Dual
site infiltration was performed in each case at both the ischial spine and intra-Alcock’s canal sites
using a mixture of fast- and slow-acting anesthetic (1 mL lidocaine hydrochloride 1% and 2 mL
ropivacaine chlorhydrate) along with a half dose of 1.5 mL of cortivazol (3.75 mg).
Results: Clinical success at one month post-procedure was present in 63.2% of patients (60/95)
with a mean VAS score of 2.07 (P < 0.05) and a mean SRI of 71%. At 3 months follow-up, clinical
success was still present in 50.5% of patients (48/95) with a mean VAS score of 2.90/10 (P < 0.05)
and a mean SRI of 62.3%. At 6 months follow-up, the efficacy rate decreased to 25.2% with a
mean VAS score of 3.2/10 and SRI of 60%.
Limitations: The retrospective aspect of the study is a limitation, as well as the lack of a control
group.
Conclusion: Dual site PNI under CT guidance may offer significant mid-term pain relief to a
majority of patients suffering from typical refractory PN.
Key words: Pudendal nerve, neuralgia, block, Alcock, CT, guidance
Neural Correlates of Maladaptive Pain Behavior
in Chronic Neck Pain – A Single Case Control
fMRI Study
Authors: Beinert Konstantin
Published: October 2019

Chronic neck pain patients display functional impairments like decreased range of motion,
decreased strength, and reduced sensorimotor function. In patients without structural damage,
the reason for the persistence of pain is not well understood. Therefore, it is assumed that in
chronic pain states, memory processes play an important role. We have now detected and tested
a patient that might help us to better understand the neural correlates of maladaptive pain
expectation/memory. This patient displays chronic neck pain and restricted unilateral motion
of the cervical spine to the left. However, when the patient is distracted, she can perform
head rotations without experiencing pain and without restricting her range of movement.
Based on this observation, we asked her to imagine movements shown in a video: conscious,
non-distracted head rotations (pain-provoking) versus distracted head rotations (pain-free)
and compared these results with an age and gender matched control volunteer. Functional
magnetic resonance imaging (fMRI) showed distinct brain activation patterns that depended
on the side of rotation (pain-free versus painful side) and the kind of movement (distracted
versus non-distracted head rotation). Interestingly, brain areas related to the processing of pain
such as primary somatosensory cortex, thalamus, insula, anterior cingulate cortex, primary
motor cortex, supplementary motor area, prefrontal cortex, and posterior cingulate cortex
were always more strongly activated in the non-distracted condition and when turning to the
left. The age and gender matched control volunteer displayed no comparable activation of
pain centers. In the patient, maladaptive pain behavior and the activity of pain-related brain
areas during imagined head rotations were task-specific, indicating that the activation and/
or recall of pain memories were context-dependent. These findings are important not only
to improve the understanding of the neural organization of maladaptive pain behavior but
also to reconsider clinical evaluation and treatment strategies. The current results therefore
suggest that treatment strategies have to take into account and exploit the context in which
the movement is performed.
Key words: Maladaptive pain behavior, pain memory, brain plasticity, motor control, neck
pain, fMRI, action observation, motor imagery
Reducing Radiation Exposure in Lumbar
Transforaminal Epidural Steroid Injections with
Pulsed Fluoroscopy: A Randomized, Doubleblind, Controlled Clinical Trial
Authors: Braun Edward
Published: October 2019

Background: Fluoroscopy-guided lumbar transforaminal epidural steroid injections (L-TFESI)
result in radiation exposure that carries risks to patients, physicians, and procedural staff.
Objective: We aim to evaluate the feasibility of using pulsed fluoroscopy to safely reduce
radiation exposure during L-TFESI.
Study Design: This is a prospective, double-blind, randomized controlled trial.
Setting: This study took place in a single-center, academic, outpatient interventional pain
management clinic.
Methods: Patients undergoing L-TFESI were randomly assigned to either continuous mode
fluoroscopy (high-dose), pulsed fluoroscopy with 8 pulses per second (medium-dose), or pulsed
fluoroscopy with one pulse per second (low-dose). Data on radiation doses and other clinical and
demographic factors were also collected.
Results: In total, 231 cases were analyzed in the high-dose group (n = 81), medium-dose group
(n = 72), and low-dose group (n = 78). Mean radiation effective dose (µSv) was 121 in the highdose group, 57.9 in the medium-dose group, and 34.8 in the low-dose group (P < 0.001). The
incidence of inadequate image quality in the pulsed groups was 6% (9/150). The body mass index
(BMI, mean ± SD) was significantly higher in patients with inadequate image quality (37.3 ± 7.2)
than with adequate quality (30.5 ± 7.2, P = 0.005).
Limitations: Radiation doses were measured using the meter on C-arm fluoroscopes rather than
by direct measurement.
Conclusions: The use of pulsed fluoroscopy during L-TFESI resulted in radiation dose reduction
of up to 72.1% without causing any significant adverse events. Pulsed fluoroscopy should be
considered as an initial fluoroscopic setting for L-TFESI to reduce radiation exposure.
Key words: Radiation, epidural, fluoroscopy, injection, exposure, pulse
Early Experience of Full-Endoscopic Interlaminar
Discectomy for Adolescent Lumbar Disc
Herniation with Sciatic Scoliosis
Authors: Wang Bing
Published: October 2019

Background: Full-endoscopic interlaminar discectomy (FEID) has achieved satisfactory outcome
in adolescent lumbar disc herniation (ALDH). Sciatic scoliosis is found to be a common presentation
in ALDH. However, few reports are focused on the influences of sciatic scoliosis on ALDH and the
prognosis of sciatic scoliosis after FEID.
Objective: This study aims to evaluate the clinical and radiological results of FEID in the treatment
of ALDH with sciatic scoliosis and to identify the effects of sciatic scoliosis on complication and
recurrence.
Study Design: A retrospective study.
Setting: An inpatient surgery center.
Methods: A series of cases of patients under age 20 with single-level ALDH that underwent
FEID between January 2010 and December 2014 were retrospectively analyzed. The patients were
divided into 2 groups according to if they had scoliosis or not. Clinical outcomes were evaluated
using a visual analog scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI) for
the functional assessment, and modified Macnab criteria for the patient satisfaction. Radiological
parameters of the scoliosis group such as Cobb angle, CVSL-max, and CVSL-C7 were statistically
analyzed.
Results: No significant differences were found between both groups in terms of the mean
operative time, the mean length of hospital stay, complications, and recurrences (P > 0.05). VAS
and ODI scores were significantly improved in both groups (P < 0.05). However, there were no
statistically significant differences between the 2 groups in VAS, ODI, and modified MacNab criteria
(P > 0.05). For the scoliosis group, significant improvements were observed in the postoperative
sagittal and coronal alignment parameters (P < 0.05).
Limitations: This was a retrospective study with a relatively small sample size. Additionally, the
length of follow-up was short.
Conclusions: The application of FEID in the treatment of ALDH could achieve satisfactory clinical
and radiological outcomes. Sciatic scoliosis was corrected spontaneously without increasing the
risk of complication and recurrence.
Key words: Adolescent lumbar disc herniation, full-endoscopic interlaminar discectomy, sciatic
scoliosis, recurrence
Evaluation of the Effect of Duration on the
Efficacy of Pulsed Radiofrequency in an Animal
Model of Neuropathic Pain
Authors: Khalil Khaled I.
Published: October 2019

Background: Pulsed radiofrequency (PRF) is increasingly used in clinical practice, especially
in neuropathic pain disorders. Although PRF is not new to clinical use, there are significant
gaps in knowledge regarding its effectiveness.
Objectives: The current study was conducted to evaluate the effect of duration of
application of PRF on its analgesic efficacy in improvement of neuropathic pain. Study Design:
A randomized experimental trial.
Setting: An animal research facility at the College of Veterinary Medicine at Mansoura
University in Egypt.
Methods: Chronic constriction of the sciatic nerve of 36 male Sprague-Dawley rats
was performed to induce neuropathic pain. The rats were divided into 6 groups (6 rats
each) in which PRF was applied for 2, 4, 6, or 8 minutes or not at all. In one group, RF
cannula was applied without performing PRF intervention. The pain was assessed through
observation of resting paw posture (RPP) at 3, 10, and 21 days. Nerve damage was assessed
by histopathological evaluation of the sciatic nerve. Immunohistochemical localization of
proinflammatory cytokines (interleukin 6 [IL-6] and tumor necrosis factor alpha [TNF-α]) was
also done.
Results: RPP was improved in rats treated with PRF. This improvement was significant only
in rats treated for 8 minutes. Increased duration for PRF application was associated with a
significant decrease in IL-6 and TNF-α contents in all groups when compared with the control
group. Histopathological evaluation of the constricted sciatic nerve revealed no statistical
significance among the different study groups.
Limitations: The study was limited by the lack of measurement of other inflammatory
markers that may help elucidate other relevant mechanisms.
Conclusions: Increased duration of PRF application resulted in better analgesic efficacy
without any increase in tissue injury in an animal model of neuropathic pain. This effect may
be attributed to decreased production of pro-inflammatory cytokines.
Key words: Pulsed radiofrequency, analgesic, rats, sciatic nerve, duration, neuropathic pain
Detection of Intravascular Injection During
Cervical Transforaminal Epidural Injection: A
Comparison of Digital Subtraction Angiography
and Real Time Fluoroscopy
Authors: Kim Saeyoung
Published: October 2019

Background: Transforaminal epidural injection (TFEI) with local anesthetics and steroids are
effective in treating spinal radicular pain. However, inadvertent intravascular injection can lead to
severe neurologic complications. To reduce complications of intravascular injection, use of imaging
modality, such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA), has been
recommended. DSA is an imaging technique that can clearly visualize the blood vessels from
surrounding bones or dense soft tissues by subtracting the pre-contrast image from the image
after injecting contrast medium.
Objective: In this study, we investigated whether there is a difference between RTF and DSA in
the detection of intravascular injection during cervical TFEI.
Study Design: Clinical study.
Setting: Pain clinic in South Korea.
Methods: We prospectively examined 137 cervical TFEIs on 128 patients who have a radiating
pain from spinal stenosis and herniated nucleus pulposus. The needle position was confirmed
using biplanar fluoroscopy and 2 mL of nonionic contrast medium was injected at the rate of 0.5
mL/sec under RTF. Thirty seconds later, 2 mL of nonionic contrast medium was injected at the
rate of 0.5 mL/sec under DSA. Intravascular injection was defined as contrast medium spreading
throughout the vascular channel during injection of contrast medium under RTF and DSA. This
study is registered in the ClinicalTrials.gov (NCT03040648).
Results: The detection rate of intravascular injection in RTF was not statistically different compared
to that in DSA (30.7 % vs. 34.3%, P > 0.05).
Limitations: We injected 2 mL of contrast medium at the rate of 0.5 mL/sec. Further studies
about the ideal injection speed and volume of contrast medium for improvement of detection
of intravascular injection during TFEI are needed. This study was a single center study. Therefore,
multi-center studies are needed to obtain the high level of evidence. Additionally, the procedural
pain physician was not blinded to the type of imaging modality, such as RTF and DSA, to detect
intravascular injection. To minimize this confirmation bias and provide homogenous procedural
conditions for TFEI, the same procedural physician performed all 137 injections.
Conclusions: In this study, there is no significant difference in detection rate of intravascular
injection between RTF and DSA during cervical TFEI.
Key words: Analgesia, bleeding, clinical trials, complications, diagnostic equipment, epidural,
radiculopathy, spine
Pulsed Radiofrequency Ablation for the
Treatment of Glossopharyngeal Neuralgia
Secondary to Oropharyngeal Carcinoma
Authors: Bharti Neerja
Published: October 2019

Background: The management of glossopharyngeal neuralgia due to oropharyngeal carcinoma
is particularly difficult because of rich innervations of the area, erosive nature of neoplasm and
dynamic pain evoked by the functional movements like swallowing and chewing. Few case reports
have shown the efficacy of pulsed radiofrequency (PRF) treatment in primary and secondary
glossopharyngeal neuralgia in non-cancer patients. However, the efficacy of PRF ablation of the
glossopharyngeal nerve in oral cancer patients is not known.
Objectives: This study was conducted to evaluate the efficacy and safety of PRF ablation of the
glossopharyngeal nerve for the management of oropharyngeal cancer pain involving the base of
the tongue, tonsillar fossa, and oropharynx.
Study Design: Prospective interventional clinical trial.
Setting: Tertiary care hospital and medical education and research institute.
Methods: A total of 25 adult patients suffering from oropharyngeal carcinoma, complaining of
severe pain in the area mainly supplied by glossopharyngeal nerve, were included. The patients
underwent fluoroscopy-guided PRF ablation of the glossopharyngeal nerve of the affected site
3 times at 42°C temperature for 120 seconds with 22-gauge, 10 cm long, 5 mm active tip
radiofrequency needle. They were followed up for one year for pain relief, nausea-vomiting and
sleep disturbances. The treatment was considered effective if there was 50% reduction in pain
score at 2 weeks.
Results: There was significant reduction in the overall pain score including site specific pain,
odynophagia and ear pain after radiofrequency ablation (P < 0.0001) in all the patients. This was
associated with decreased opioid consumption (P < 0.001), lesser nausea/vomiting, and improved
sleep. The treatment was effective in 23 out of 25 patients (92%) for more than 3 months. No
major complication was observed in any patient. The average duration of effective pain relief was
5 to 9 months.
Limitations: Patients having bilateral glossopharyngeal neuralgia or an advanced stage of oral
cancer with large lymph nodes at the angle of mandible were not included. This study was a singlecenter observational clinical trial and further multi-center, randomized, controlled trails are needed
to obtain higher level of evidence.
Conclusion: Our results showed that PRF ablation can be used effectively and safely for the
treatment of glossopharyngeal neuralgia secondary to oropharyngeal carcinoma.
Key words: Glossopharyngeal neuralgia, ear pain, odynophagia, oral cancer pain, pulsed
radiofrequency ablation, side effects
Effect of Radiofrequency Thermocoagulation
of Thoracic Nerve Roots in Patients with Cancer
and Intractable Chest Wall Pain
Authors: Kim Dae Hyun
Published: October 2019

Background: Interventional pain management is essential for patients with cancer who
experience medically uncontrollable chest wall pain to help control their symptoms and improve
their quality of life. However, there is a lack of data on this topic, so there is an urgent need for
further research.
Objectives: To identify the effects of radiofrequency ablation (RFA) of the thoracic nerve roots on
pain outcomes in patients with cancer and intractable chest wall pain.
Study Design: Retrospective, observational cohort study.
Setting: National Cancer Center in Korea.
Methods: The medical records of patients with cancer who were referred to the pain clinic at our
National Cancer Center for intractable chest wall pain and who underwent thoracic nerve root RFA
between Jan. 1, 2011 and Dec. 31, 2015 were analyzed. The primary outcome was the change
in Numeric Rating Scale (NRS) scores between pre-procedure and one week, one month, and 6
months post-procedure. The secondary outcomes were the change in morphine equivalent daily
dose (MEDD) between pre-procedure and one week, one month, and 6 months post-procedure,
and whether the primary cancer type (lung vs. non-lung) or radiotherapy to the chest within one
month affected the outcomes of RFA. The Wilcoxon signed-rank test was used to compare RFA
data between pre and post-procedure and P values less than 0.05 were considered statistically
significant.
Results: One hundred patients were included in the final analysis. The median NRS score in
patients who underwent RFA decreased from 7 (range 3–10) pre-procedure to 4 (0–9) at one week
and one-month post-procedure (both P < 0.001) and 4 (1–8) at 6 months post-procedure (P <
0.001). The median MEDD value decreased from 200 (range 30–1800) mg pre-procedure to 180
(10–1600) mg at one week post-procedure (P < 0.001), but there was no statistically significant
change at one month (P = 0.699) or 6 months (P = 0.151) post-procedure. There was no difference
in RFA outcome according to type of primary cancer or radiotherapy to the chest within one
month.
Limitations: Retrospective design.
Conclusion: Radiofrequency thermocoagulation of the thoracic nerve roots achieved effective
short-term pain control in patients with cancer and intractable chest wall pain.
Key words: Radiofrequency ablation, thermocoagulation, thoracic nerve root, cancer, chest wall
pain, radiotherapy, pain relief
The Validity and Reliability of Provocation Tests
in the Diagnosis of Sacroiliac Joint Dysfunction
Authors: Telli Hilal
Published: October 2019

Background: Although sacroiliac joint dysfunction (SIJD) is generally regarded as a source of
lumbar pain, its anatomical position and the absence of a diagnostic ‘gold standard’ lead to
difficulties at examination and differential diagnosis. However, since sacroiliac (SI) joint blocks
only provide information about pathologies of joint origin and since SIJD developing secondary
to pathologies in structures around the joint can be missed. Provocation and palpation tests
also need to be used in diagnosis.
Objectives: The purpose of this study was to examine the reliability of clinical examination
and provocation tests used in the diagnosis of SIJD.
Study Design: Retrospective analysis of prospectively collected data.
Setting: Outpatient physical medicine and rehabilitation clinic.
Methods: One hundred and seventeen patients presenting with lumbar and/or leg pain and
diagnosed with SIJD through clinical evaluation were included in the study. Range of lumbar
joint movement, pain location and specific tests used in the diagnosis of SIJD were evaluated.
Positivity in 3 out of 6 provocation tests was adopted as the criterion.
Results: 75.2% of patients were female and 24.8% were male. Mean age was 46.41 ± 10.45
years. A higher level of females was determined in ender distribution. SIJD was determined
on the right in 52.6% of patients and on the left in 47.4%. When SI joint provocation tests
were analyzed individually, the highest positivity, in 91.4% patients diagnosed with SIJD, was
in the FABER test. The lowest positivity, in 56.4% of patients, was determined in the Ganslen
test. The same patients were assessed by the same clinician at 2 different times. In these data,
the simple consistence, kappa and PABAK coefficient values of all tests were close to 1 and
indicating good agreement. The thigh thrust (POSH) and sacral thrust tests exhibited very good
agreement with a kappa coefficient of 0.90 and a PABAK coefficient of 0.92, while the FABER
test exhibited good agreement with a kappa coefficient of 0.78 and a PABAK coefficient of
0.92.
Limitation: Agreement between different observers was not evaluated, and also no
comparison was performed with SI joint injection, regarded as a widely used diagnostic
technique.
Conclusion: The anatomical position of the SI joint and the lack of a diagnostic ‘gold
standard’ make the examination and diagnosis of SIJD difficult. Most SI joint clinical tests have
limited reliability and validity on their own, while a multitest regimen consisting of SI joint pain
provocation tests is a reliable method, and these tests can be used instead of unnecessary
invasive diagnostic SI joint procedures.
Key words: Dysfunction, lumbar, sacroiliac joint, provocation test, sacroiliac joint pain, pain
pattern
Patients with Impaired Descending Nociceptive
Inhibitory System Present Altered Cardiac
Vagal Control at Rest
Authors: Nogueira Leandro
Published: October 2019

Background: Patients with chronic musculoskeletal pain have a higher chance of presenting
impairment in cardiovascular autonomic modulation, which may have implications for
cardiovascular events. The autonomic nervous system plays an important role in pain modulation.
However, it is unclear whether patients with inefficient descending nociceptive inhibition have
poorer cardiovascular autonomic modulation.
Objective: To compare the cardiovascular autonomic modulation of patients with musculoskeletal
pain who had normal versus impaired functioning of descending nociceptive inhibitory system
(DNIS).
Study Design: A cross-sectional study.
Setting: Physiotherapy outpatient service.
Methods: Fifty-six patients with musculoskeletal pain were included. Conditioned pain
modulation was assessed by the difference of algometric values held in the dorsal forearm and
tibialis anterior muscle, before and after a thermal pain stimulus was employed via the cold pressure
test (CPT). Patients with inefficient DNIS in both sites were classified as impaired responders (n =
14). The others were classified as normal responders (n = 42). Cardiac autonomic modulation was
monitored at rest by heart rate variability (HRV). The blood pressure response to the CPT was used
as a proxy of sympathetic responsiveness.
Results: Most of the patients were women (60%) and had chronic pain (75%). The groups had
similar demographic characteristics. Patients with impaired DNIS showed lower HRV [RMSSD (P =
0.020), SDRR (P = 0.009), HF (ms2
) (P = 0.027), LF (ms2
) (P = 0.004), and total power (P = 0.002)].
The blood pressure response to CPT was similar between groups (systolic pressure, P = 0.813;
diastolic pressure, P = 0.709).
Limitation: Physical activity level, emotional changes, and visceral pathologies can alter the
autonomic nervous system and may represent potential confounders. The low number of patients
may have biased the results.
Conclusion: Patients with impaired DNIS presented lower resting HRV, indicating an altered vagal
control of the heart. In contrast, the blood pressure response to a sympathoexcitatory stimulus was
preserved.
The study was approved by the Research Ethics Committee of Augusto Motta University Centre
(CAAE number: 46245215.9.0000.5235), and all patients signed the Informed Consent Form.
Key words: Musculoskeletal pain, autonomic nervous system, heart rate, chronic pain, diffuse
noxious inhibitory control, blood pressure, sympathetic nervous system, parasympathetic nervous
system
Comparison of the Efficacy of a Gabapentinoid
with an Opioid Versus an Opioid Alone in
Patients with Spinal Cord Stimulation
Authors: Lee Jae Jun
Published: October 2019

Background: Combination therapy with a gabapentinoid and an opioid improves the
quality of life (QOL) of patients with chronic pain. However, the role of combination therapy in
patients with spinal cord stimulation (SCS) has not been evaluated.
Objective: Our primary objective was to evaluate the clinical outcomes of combination
therapy consisting of a gabapentinoid and an opioid in patients undergoing SCS.
Study Design: Retrospective evaluation.
Setting: Veterans Health Service Medical Center, Seoul, Korea.
Methods: We retrospectively reviewed 100 military veteran patients who underwent SCS
implantation. Forty-eight of 100 patients had been maintained on SCS for 2 years. Patients
were divided into 2 groups by analgesic type: group A (opioid only, n = 20) and group B
(opioid + gabapentinoids, n = 28). Pre-implantation information included the numeric rating
scale (NRS) pain score, quality of life scale (QOLS) score, and oral morphine equivalents (OMEs).
Post-implantation data were obtained at 1, 6, 12, and 24 months.
Results: Group B had higher QOLS scores at 1, 6, 12, and 24 months than those of group A
(P < 0.05). There were no statistically significant differences in the NRS pain score or OMEs at
1, 6, 12, or 24 months between the 2 groups.
Limitation: Retrospective design, relatively short follow up period (2 years).
Conclusion: This study indicated that the addition of a gabapentinoid to an opioid
is superior to an opioid alone in terms of QOL in military veteran patients with SCS for 2
years. Combination therapy consisting of a gabapentinoid added to an opioid can be a good
modality to improve QOL in patients with SCS.
Key words: Combination, drug therapy, gabapentin, multimodal analgesia, opioid, pain,
pregabalin, spinal cord stimulation
Postoperative Longitudinal Outcomes in
Patients with Residual Disc Fragments after
Percutaneous Endoscopic Lumbar Discectomy
Authors: Kim Chi Heon
Published: October 2019

Background: Residual disc fragments are observed on immediate postoperative
magnetic resonance imaging (MRI) in 2.8–15% of patients after percutaneous
endoscopic lumbar discectomy (PELD). Considering the known postoperative
longitudinal outcomes in patients with residual disc tissue, a ‘watchful waiting’
strategy may be preferable to immediate re-operation in patients with asymptomatic
residual disc material.
Objectives: The aim of the present study was to compare the longitudinal clinical
outcomes between PELD patients in whom the complete removal of disc fragments
was achieved (complete group) and those in whom residual disc fragments were
observed on postoperative MRI (residual group).
Study Design: Retrospective nested case-control study.
Methods: A total of 225 patients were included (complete group, n=187 and
residual group, n=38). Clinical assessments were performed using the visual analog
pain score for the leg (VAS-L, x/10) and back (VAS-B, x/10) and the Korean version of
the Oswestry Disability Index (K-ODI, x/45). A linear mixed-effects model was used
to analyze changes during the first 24 postoperative months.
Results: One month after surgery, significant improvements in the VAS-L, VAS-B and
K-ODI values were observed and were maintained during the first 24 postoperative
months. No differences in these changes were noted between the groups. Early reoperation (during the first 3 postoperative months) was performed in 3 patients in
the residual group (7.9%) and in 4 patients in the complete group (2.1%) (P = 0.10).
Limitations: First, the study design was retrospective. Moreover, the number of
patients was relatively small and therefore insufficient to achieve robust statistical
power. Second, we did not explore the radiological outcomes in patients with
asymptomatic residual disc material because follow-up MRI was only obtained to
document symptom recurrence.
Conclusion: When residual disc tissue is observed in asymptomatic patients, a
‘watchful waiting’ strategy may be preferable to immediate re-operation. However,
an increased early re-operation rate is expected for patients with residual disc tissue.
Key words: Discectomy, endoscopes, longitudinal studies, patient-reported
outcome, percutaneous, reoperation, spine, residual disc
Comparison of 3 Approaches to Percutaneous
Epidural Adhesiolysis and Neuroplasty in Post
Lumbar Surgery Syndrome
Authors: Salem Haitham Hamdy
Published: October 2019

Background: Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to
be safe and effective in treating different spine pathologies, in particular post lumbar surgery
syndrome (PLSS).
Objectives: The purpose of this study was to compare the efficacy and complication rates of the
3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to
treat PLSS.
Study Design: This study used a case control, blind study.
Setting: The research took place at the pain clinic and interventional pain practice room at Asyut
University Hospital, Assiut, Egypt.
Methods: Sixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal,
S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients
underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels
were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual
Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was
performed prior to the procedure to determine the patients’ baseline levels of pain severity. Followup assessments were performed 1-, 3-, and 6-months after the procedure.
Results: Results of the group pairwise analysis indicated that, relative to baseline, there were
significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by
patients’ satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between
group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across
the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications
between the 3 different groups.
Limitations: Our study was limited by the low number of patients and the short duration (6
months) of follow-up.
Conclusion: The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal)
result in the same outcome with regard to pain relief and complication rate.
Key words: Post lumber surgery syndrome, post laminectomy back pain, percutaneous
adhesiolysis, Racz catheter, percutaneous neuroplasty
A Network Meta-Analysis to Compare the
Efficacy of Steroid and Antiviral Medications
for Facial Paralysis from Bell´s Palsy
Authors: Yang Wei
Published: October 2019

Background: Background: Facial paralysis is the most common cranial nerve injury. Bell’s palsy
is the name commonly used to describe an acute peripheral facial paralysis of unknown origin.
The annual incidence of Bell’s palsy is 20-30 cases per 100,000 persons, regardless of age and
gender.
Objective: Our objective was to appraise the efficacy of steroid and antiviral treatments for
facial paralysis.
Study Design: We conducted a network meta-analysis of studies of steroid and antiviral
treatments for facial paralysis.
Setting: Second Hospital of Jilin University.
Methods: We performed a systematic search of PubMed and Embase databases to retrieve
relevant studies. The efficacy outcome was overall recovery, measured in terms of the odds ratio
(OR) and a corresponding 95% confidence interval (CI). The comprehensive ranking for each
treatment with respect to overall recovery is presented as the value of the surface under the
cumulative ranking curve (SUCRA).
Results: A total of 23 articles representing 4,623 patients were eligible for our study. In terms
of overall recovery, no significant differences were found in the pairwise meta-analysis. From the
results of the network meta-analysis, antiviral combined with steroid treatment was superior
to placebo treatment (OR = 3.25; 95% CI, 1.23-8.61), but neither steroid nor antiviral therapy
alone resulted in significant benefit compared with placebo. According to the SUCRA, antiviral
combined with steroid treatment was the most effective, with a SUCRA value of 0.96, and
the probability of ranking first was 90%. Only a small difference was observed between the
efficacies of steroid and antiviral treatments (SUCRA values of 0.55 and 0.36, respectively), and
they were both better than the placebo (SUCRA value of 0.134).
Limitations: The major limitation of our study is that, due to the limited number of related
studies in the last several years, we were not able to evaluate the safety of these therapies.
Conclusions: Antiviral combined with steroid therapy is significantly better than antiviral
or steroid therapy alone with respect to overall recovery, and the efficacies of single antiviral
medications or single steroid treatments are nearly equal. In addition, all 3 therapies are more
effective than placebo, according to the SUCRA values.
Key words: Facial paralysis, Bell´s palsy, steroids, antiviral drugs, efficacy, overall recovery,
network meta-analysis, SUCRA
The Effects of Radiofrequency Neurotomy
Using a Strip-Lesioning Device on Patients with
Sacroiliac Joint Pain: Results from a Single-Center,
Randomized, Sham-Controlled Trial
Authors: Mehta Vivek
Published: October 2019

Background: Radiofrequency neurotomy (RFN) is a therapy aimed at providing lasting back pain
relief for sacroiliac joint (SIJ) pain. A recent advancement in RFN is a strip lesioning technique that
involves placement of a single curved electrode and a 3-pole design that facilitates the creation of 5
overlapping lesions. These lesions form one long strip lesion accessible through a single entry point,
without the need for multiple punctures. Although the early case series data looks promising, there
is lack of long-term, randomized, controlled study evaluating the strip-lesioning system for SIJ pain.
Objectives: The purpose of this study was to examine the safety and effectiveness of RFN using a
strip lesioning device for reduction of SIJ pain.
Study Design: Prospective, double-blind, randomized, sham-controlled trial with 6-month
follow-up
Setting: A tertiary care interventional pain management center in the UK
Methods: Patients with SIJ pain with positive diagnostic local anesthetic blocks were randomly
assigned (2:1) to either the sham (no RF lesions performed) or the active group (RF lesions performed).
The primary endpoint was improvement of pain using the Numeric Rating Scale (NRS-11) at 3 months.
Results were analyzed using nonparametric tests. Safety, secondary, and long-term outcome data
were also collected.
Results: Seventeen of 30 enrolled patients were randomly assigned to active treatment (n =
11) or sham treatment (n = 6). At 3 months, the mean NRS-11 score for the active group had
decreased significantly, from 8.1 (± 0.8) at baseline to 3.4 (± 2.0) (P < 0.001). The sham group did
not experience a statistically or clinically meaningful decrease in mean NRS-11 score from baseline
(7.3 ± 0.8) to 3 months (7.0 ± 1.7). On average, patients in the active group moved from borderline
anxiety at baseline (9.4 ± 5.9) to no anxiety (6.6 ± 6.3) at 3 months. Results were similar at 6 months.
Limitations: Recruitment was stopped at 30 enrolled patients, only 17 of whom were randomly
assigned to active or sham treatment, after the interim analysis indicated a statistically significant (P
< 0.001) difference in the pain outcome between the treatment and the sham groups.
Conclusions: This study demonstrated that radiofrequency neurotomy using a strip lesioning
device is an appropriate therapy to treat SIJ pain.
Key words: Radiofrequency, sacroiliac joint pain, low back pain, neurotomy, randomized controlled
trial, simplicity
A Novel Technique of Saddle Rhizotomy Using
Thermal Radiofrequency for Intractable Perineal
Pain in Pelvic Malignancy: A Pilot Study
Authors: Abbas Dina N
Published: October 2019

Background: The prevalence of pain in advanced pelvic cancer may reach up to 95%. Control
of such pain is often difficult owing to a variety of neuroanatomical and functional peculiarities.
Different modalities have been utilized to treat this pain including saddle chemical rhizolysis with
the potential for jeopardizing the neural control of the sphincters.
Objective: The aim of this pilot study is to determine the feasibility of using selective thermal
radiofrequency as an alternative to saddle chemical rhizolysis in patients with refractory perineal
pain associated with pelvic malignancies.
Study Design: Pilot study.
Setting: Pain Relief Department of the National Cancer Institute, Cairo University.
Methods: Forty patients, 18 years of age or older, who had pelvic malignancy and were complaining
of moderate or severe perineal pain not controlled with maximum tolerable doses of morphine
sulfate for at least 4 weeks were randomly allocated to receive selective saddle rhizotomy using
thermal radiofrequency ablation of S3 on one side and bilateral ablation of S4 and S5 (RF group, n
= 20) or conventional chemical rhizotomy using hyperbaric 6% phenol in glycerin (Phenol group, n
= 20). Patients were assessed for the intensity of pain, daily consumption of analgesics, functional
improvement, overall patient satisfaction, degree of disability and occurrence of procedure-related
side effects at 1,4, and 12 weeks.
Result: The results were comparable in both groups regarding the control of pain and functional
improvement. The incidence of specific procedure-related adverse outcomes was also equivalent
for both interventions, although per-patient incidence of major complications was significantly
higher in the phenol group.
Limitation: Small sample size to demonstrate statistical significance of the relatively small
frequency of events, and the patients could not be blinded to the intervention they received owing
to the technical uniqueness of either intervention.
Conclusion: Selective thermal radiofrequency ablation of the S3 root on one side, S4 root on
both sides, and S5 roots could serve as a feasible alternative to conventional saddle rhizotomy
using hyperbaric phenol.
Key Words: Perineal cancer pain, chemical rhizotomy, thermal radiofrequency
PIMPINAN MTI TABEK GADANG PADANG JAPANG DARI MASA KEMASA
Authors: Hariadi Hariadi
Published: October 2019

Tulisan ini menjelaskan para pimpinan MTI Tabek Gadang dari masa ke masa. Diantara alasan yang melatarinya adalah perjalanan panjang dan pergantian kepemimpinan yang telah silih berganti. Penelitian ini adalah penelitian kwalitatif dengan pendekatan penulisan biografi. Beberapa hasil yang terungkap pemimpin MTI Tabek Gadang semenjak berdiri sampai penelianini telah silih berganti beberapa orang pemimpin. Pemimpin terdiri dari keturunan dan alumni MTI Tabek Gadang.
MITOS JENIS KELAMIN BAYI PADA IBU HAMIL DI MASYARAKAT MINANGKABAU
Authors: Devi Silvia
Published: October 2019

Peristiwa kehamilan pada setiap perempuan berbeda pengalamannya. Bahkan dari satu ibu saja ketika hamil anak pertama akan mengalami perbedaan dengan kehamilan anak selanjutnya. Oleh karena itu banyak mitos tanda-tanda yang ditampilkan ibu hamil dan memiliki mitos sendiri bagi masyarakat Minangkabau dalam menebak jenis kelamin bayi.Tujuan penelitian ini adalah mengetahui mitos tandatanda dan usaha yang dilakukan oleh seorang ibu hamil guna mendapatkan anak dengan jenis kelamin tertentu.Penelitian ini menggunakan metode deskriptif dengan pendekatan kualitatif. Pengumpulan data dengan observasi dan wawancara dengan informan yakni tiga orang tukang urut dan lima orang perempuanyang pernah melakukan upaya mendapatkan anak berjenis kelamin tertentu. Hasil penelitian ini diketahui bahwa sebagian dari mitos tanda-tanda dan usaha yang dilakukan untuk mendapatkan anak dengan jenis kelamin tertentu diyakini kebenarannya. Namun sebagian lain tidak membuahkan hasil. Akan tetapi, hal ini tidak menyurutkan usaha dari seorang perempuan untuk mendapatkan keinginananak dengan jenis kelamin tertentu yang didambakannya.
STRUKTUR MASYARAKAT SEMENDE DI KABUPATEN OGAN KOMERING ULU SELATAN
Authors: Efrianto. A Efrianto. A
Published: October 2019

Semende merupakan nama salah satu suku bangsa di Kabupaten Ogan Komering Ulu Selatan (OKUS). Suku bangsa ini dikenal dengan adat dan budaya yang unik berbeda dengan suku lain yang ada di kawasan OKUS. Semende merupakan bagian dari suku Pasemah, namun dalam perkembangan selanjutnya mereka memilik tradisi dan aturan adat sendiri berbeda dengan suku bangsa Pasemah lainnya. Perbedaan ini berkaitan erat dengan proses pembentukan mereka menjadi sebuah suku bangsadan. struktur adat yang mereka miliki. Untuk menjelaskan hal tersebut dilakukan pendekatan kualitatif dengan mewawancarai beberapa tokoh masyarakat Semende di Muara Dua dan beberapa daerah Semende lainnya di Kabupaten OKUS. Sejarah dan struktur adat mengambarkan bahwa merekamerupakan kelompok komunal yang saling terkait dan berbeda denga rumpun Pasemah lainnya.
ZIARAH KUBRA DI PALEMBANG: ANTARA KESADARAN RELIGI DAN POTENSI EKONOMI
Authors: Marbun Firdaus
Published: October 2019

Bagi umat beragama di Indonesia, ziarah masih merupakan kegiatan penting yang hingga kini masih tetap dipertahankan. Berbagai motivasi yang menyertai seperti barokah dan perolehan biasanya menjadipendorong seseorang untuk melaksanakan kunjungan ke makam orang yang sudah meninggal. Bahkan tradisi ini kemudian berkembang untuk tujuan-tujuan yang lebih besar seperti mempertahankan identitasdan menjaga eksistensi keagamaan. Ziarah kubra adalah salah satu tradisi ziarah yang rutin dilaksanakan umat Islam di Palembang. Ziarah ini dilakukan setiap akhir bulan Sya’ban atau menjelang umat Islam berpuasa. Menariknya, tradisi ini diikuti ribuan peserta yang semuanya laki-laki dan tidak hanya dari dalam negeri, tapi juga dari luar negeri. Ziarah ini bahkan dijadikan sebagai even pariwisata yang masuk dalam kalender tahunan. Penelitian ini bertujuan mengungkap motivasi masyarakat Islam dalam mendorong perubahan ruahan menjadi ziarah kubra. Selain itu penelitian ini juga ingin mengungkap potensi ekonomi pasca penetapan ziarah kubra sebagai even pariwisata daerah yang rutin dilaksanakan.Dengan menggunakan metode kualitatif melalui observasi dan wawancara, penelitian ini menemukan bahwa selain memdapatkan barokah dan perolehan, emosi keagamaan berperan meningkatkan solidaritasmasyarakat muslim untuk mempertahankan makam dengan mengikuti ziarah rutin setiap tahun. Tradisi ini juga turut membantu ekonomi daerah dan berpotensi mendorong kesejahteraan masyarakat di masa yang akan datang khususnya dalam sektor pariwisata.
PENDIDIKAN KARAKTER MELALUI PERMAINAN TRADISIONAL SAMBA LAKON
Authors: Yulisman Yulisman
Published: October 2019

Samba lakon adalah permainan tradisional anak-anak minangkabau yang persebarannya dikenal hampir di seluruh Propinsi Sumatera Barat. Walaupun saat ini sudah jarang dimainkan namun permainan ini memiliki nilai-nilai dalam pembentukan karakter. Tulisan ini menggambarkan nilai-nilai permainan samba lakon dan eksistensinya pada saat ini. Penelitian dilakukan dengan pendekatan kualitatif dengan wawancara dan observasi sebagai alat pengumpul data. Hasil penelitian menunjukkan permainan ini sudah jarang dimainkan dan tidak banyak anak-anak yang mengetahuinya. Sedangkan nilai-nilai pada permainan ini yaitu nilai rekreatif dan pendidikan (disiplin, sportifitas, dan kejujuran).
PENGARUH EROPA TERHADAP ARSITEKTUR MASJID RAO RAO TANAH DATAR
Authors: Rahmat Syahrul
Published: October 2019

Masuknya Belanda ke pedalaman Minangkabau pada pertengahan abad IX M memberikan pengaruh terhadap tatanan kehidupan masyarakat, termasuk pengaruh dalam hal pola pikir. Pengaruh tersebut dapat dilihat dari ide-ide yang kemudian diwujudkan ke dalam bentuk benda atau bangunan, salahsatunya adalah masjid Rao Rao. Pada dasarnya masjid merupakan bangunan sakral bagi umat Islam, akan tetapi dalam perkembangannya masjid tersebut mendapat pengaruh kebudayaan asing dari segi arsitektur bangunan. Penelitian ini merupakan penelitian sejarah dengan menggunakan pendekatan teori akulturasi guna melihat perpaduan dua kebudayaan pada masjid yang dibangun pada awal abad XX M. Beberapa pengaruh Eropa yang berakulturasi dalam masjid ini meliputi penggunaan material bangunan, unsur-unsur bangunan serta ornamen bangunan masjid.