bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Profession-Oriented Syllabus of “Occupational Safety in the Field” on the Motivation of Future Primary School Teachers to Prepare for the Provision of Pupils’ Physical Activity
Authors:   Department of General technical subjects, technologies and public safety, Faculty of physics-technologies, Rivne State University of Humanities, Rivne, Ukraine., Hlinchuk Yuliia O.
Published: October 2019

The aim: The research of the influence of profession-oriented syllabus of future primary school teachers with regard to the subject “Occupational safety in the field” on their motivation to prepare for the provision of pupils’ physical activity. Research material: 90 students of the specialty “Primary education” of the Rivne State University of Humanities (gender – female; year – the 5th) have taken part in the research. All the respondents attended classes of “Occupational safety in the field”. Their participation in the study was anonymous and voluntary. The motives to prepare for the provision of pupils’ physical activity were researched. The B. Pashniev’s methodology “The Motives of Educational Activity” was used for diagnostics. Results: Profession-oriented syllabus of “Occupational safety in the field” has resulted in positive changes with regard to the motivation of the future primary school teachers’ preparation to the provision of pupils’ physical activity in the future professional practice. In particular, the motive of obligation and responsibility and the cognitive one have grown stronger; the motive of prestige and the one of orientation on the socially dependent conduct have weakened. Obviously, although not feasibly, the motive of external coercion and avoidance of trouble has weakened as well. Conclusions: Profession-oriented syllabus of the subject “Occupational safety in the field” positively influences the motivation of the future primary school teachers to prepare for the provision of the pupils’ physical activity.
Impact Resistance of Ternary Concrete using SCBA and Silica Fume as Partial Substitute of Cement in Concrete
Authors:   Assistant Professor & Research Scholar, Department of Civil Engineering, GITAM (Deemed to be University), kumar T. Santhosh , kvgd Dr. Balaji ,   Professor, Department of Civil Engineering, GITAM (Deemed to be University), Murthy P.Narasimha ,   PG student, Department of Civil Engineering, GITAM (Deemed to be University)
Published: October 2019

Concrete structures inevitably encounter dynamic loads throughout the planning lifetime of structure. Impact resistance is necessary factor for evaluate the dynamic concert of concrete. To fulfill the necessities of strength and toughness properties of concrete we have a tendency to use the industrial by-products likecoal bottom ash, silica fume, metakaolin, etc., as supplementary building material. During this research work the experimental investigation was investigation to gauge the Impact resistance of TBASF concrete mixby cement is partially substitute with silica fume 10% and also the SCBA 0%, 5%, 10%, 15%, 20% and 25%. The Impact resistance of TBASF concrete mix is additionally compared with normal concrete. This study is additionally conducting elaborated investigation of TBASF concrete for mineralogical properties by using Optical microscope and XRD keeping Impact resistance in view. The maximumpercentage of SCBA is obtained at 15% replacement of cement.
Efficacy of Adjuvant 10% Hypertonic Saline in
Transforaminal Epidural Steroid Injection: A
Retrospective Analysis
Authors: Koh Won Uk
Published: October 2019

Background: Chronic lower back pain with or without radiculopathy represents an important
medical, social, and economic problem. Many treatment modalities and techniques, including
surgery and epidural administration of steroids, have been used to manage this pain. Hypertonic
saline, which has been used as an adjunct to percutaneous epidural adhesiolysis, can also be
injected via a transforaminal approach in expectation of longer-lasting effects.
Objectives: This study aimed to determine the effect of adding hypertonic saline to
conventional transforaminal epidural steroid injections (TFEI) to provide pain relief for chronic
radiculopathy patients.
Study Design: A retrospective study.
Setting: Pain clinic of a university hospital.
Methods: Between January 2010 and December 2013, the medical records of 246 patients
(94 in the hypertonic group, 153 in the control group) who received transforaminal epidural
block were reviewed and analyzed. The hypertonic group received 10% sodium chloride
solution added to lidocaine, triamcinolone, and hyaluronidase. Outcomes on pain reduction
were measured using a numerical rating scale (NRS) and the responder rate at baseline, one, 3,
and 6 months after procedure.
Results: The estimated difference in NRS scores from baseline throughout a 6-month followup period in the hypertonic group were significantly higher (P = 0.0003). The proportion of
substantial responders (41.9% vs. 34.6% at one month, 40.9% vs. 26.8% at 3 months, and
33.3% vs. 14.4% at 6 months, respectively, P = 0.0058) and substantial/moderate responders
(71.0% vs. 58.8% at one month, 65.6% vs. 40.4% at 3 months, and 48.4% vs. 20.3% at
6 months, respectively, P < 0.0001) were significantly higher in the hypertonic group. The
Oswestry disability index (ODI) was not different between the groups (P = 0.2697).
Limitations: Retrospective design without a control group.
Conclusions: Hypertonic saline provides more superior and longer lasting pain relieving
effects when added to TFEIs.
Key words: Back pain, epidural injections, epidural steroids, hypertonic saline, lumbar,
radiculopathy, transforaminal
Multidisciplinary Care of Unruptured Brain
Arteriovenous Malformations to Improve
Symptomatic Headache and the Onset,
Progression, and Outcomes of Unruptured Brain
Arteriovenous Malformations
Authors: Chuan-Zhi Chuan-Zhi
Published: October 2019

Background: Symptomatic headaches attributed to unruptured brain arteriovenous malformations
(ubAVMs) are very common and affect patients’ quality life, but multidisciplinary care of ubAVMs to
improve symptomatic headache remains unclear.
Objective: The objective is to identify the features of symptomatic headaches, and to obtain
headache outcomes following multidisciplinary care of ubAVMs, as well as provide background on
the natural history of ubAVMs.
Study Design: The features of symptomatic headaches and headache outcomes were analyzed in
a large cohort of cases after multidisciplinary care of ubAVMs. We have also provided information
on the natural history of ubAVMs
Setting: This study was conducted at the Department of Neurosurgery of Zhujiang Hospital where
336 patients from 1998 to 2014 were reviewed by a multidiscipline team. Only 124 patients were
eligible.
Methods: The demographics, clinical features, imaging features, and headache details of eligible
patients were reviewed. An 11-point pain scale score was used to assess symptomatic headaches
before, during, and after treatment. The headache outcomes, death or stroke, and adverse functional
outcomes (modified Rankin Scale score ≥ 2, mRS ≥ 2) were assessed following multidisciplinary care
of ubAVMs.
Results: Twenty-three (56.1%) of 41 patients had migraine-like headaches located in occipital
lobe (P < 0.001), while forty (63.5%) of 63 patients had tension-type-like headaches located in
frontotemporal lobe (P < 0.001). For patients with tension-type-like or all types of headache,
headache improvement differed between the multidisciplinary group and medical group (87.8% vs.
31.8%, P < 0.001; 85.7% vs. 40.7%, P < 0.001). The risk of death or stroke did not differ between
multidisciplinary group and medical group (P = 0.393), whereas the risk of adverse functional
outcome (mRS ≥ 2) differed significantly by long-time follow-up (23.0% vs.10.0%, P = 0.022).
Limitations: This study provides the initial experience to support multidisciplinary care for ubAVMs
to improve symptomatic headaches and patients’ quality life, but based on the retrospective study
with inherent limitations, larger samples and multi-center trials are needed on this interesting issue.
Conclusions: Occipital ubAVM is more likely to present with migraine-like headache, while
frontotemporal ubAVM tends to present with tension-type-like headache. The effectiveness of
multidisciplinary care for ubAVM to improve headache has been shown, but the natural history of
ubAVM patients with headache remains unclear.
Key Words: Unruptured brain arteriovenous malformations, headache, headache improvement,
natural history
High Frequency Spinal Cord Stimulation for
Complex Regional Pain Syndrome: A Case
Report
Authors: Kaye Alan D.
Published: October 2019

Complex regional pain syndrome (CRPS) is a chronic, debilitating, neuropathic pain condition
which is often misdiagnosed, difficult to manage, and lacks proven methods for remission. Most
available methods provide some relief to a small percentage of patients. Recent FDA approval
and superiority of the Nevro Senza 10-kHz high frequency (HF10) spinal cord stimulation (SCS)
therapy over traditional low-frequency spinal cord stimulation for treatment of chronic back
and leg pain may provide a new interventional therapeutic option for patients suffering from
CRPS. We provide a case report of a 53-year-old Caucasian woman who suffered with CRPS
in the right knee and thigh for over 7 years. Implantation of the HF10 device provided over
75% relief of pain, erythema, heat, swelling, and tissue necrosis to the entire region within 1
month of treatment. Because the HP10 therapy provides pain relief without paresthesia typical
of traditional low-frequency, this system may provide relief for patients suffering from chronic
pain.
Key words: Complex regional pain syndrome, spinal cord stimulation, Nevro Senza HF10,
erythema, knee, thigh
Evaluation of the Ototoxicity Potential of OnceDaily, Single-Entity Hydrocodone in Patients
with Chronic Pain: Results of Two Phase-3
Clinical Studies
Authors: He Ellie
Published: October 2019

Background: Use/misuse of the opioid combination hydrocodone-acetaminophen has been
associated with permanent hearing loss. Although reports have been rare, this potential effect
can have significant detrimental effect on patients’ overall quality of life. To date, the ototoxic
effect of hydrocodone alone has not been systematically investigated.
Objective: In this report, we aimed to evaluate the potential ototoxicity of a novel, singleentity, once-daily, extended-release hydrocodone tablet (Hysingla® ER; HYD).
Study Design: Clinical study.
Setting: Audiology clinics in US.
Methods: Results from 1207 patients in two phase 3 clinical studies were evaluated: A
placebo-controlled study with an enriched enrollment, randomized withdrawal design in
patients with chronic low back pain, and an open-label, long-term, safety study in patients
with chronic nonmalignant and non-neuropathic pain.
Comprehensive audiologic assessments (comprising pure-tone air-conduction audiometry
in the conventional [0.25-8 kHz] and ultra-high [10-16 kHz] frequencies, pure-tone boneconduction audiometry, tympanometry, speech reception thresholds, and word recognition)
were conducted at baseline and end-of-studies; air-conduction audiometry was conducted
periodically during the studies. All audiologic assessments were performed in audiology clinics
in the United States by licensed audiologists. The primary endpoint was changes from baseline
in pure-tone air-conduction thresholds in the conventional frequencies during the studies.
These trials are registered with ClinicalTrials.gov, identifiers NCT01400139 and NCT01452529
Results: During the studies, mean changes from baseline in air-conduction thresholds were
clinically unremarkable. Bidirectional variability across all test frequencies was observed; 82% of
patients did not experience significant threshold changes during the studies, 7% had potential
hearing decrement, and 10% experienced hearing sensitivity improvement. No notable
differences were observed between patients receiving HYD and placebo or between different
HYD doses.
Conclusion: No ototoxic signal was observed for single-entity hydrocodone tablets at the
dosages and treatment durations investigated.
Key words: Audiologic monitoring, clinical trials, hydrocodone, opioids, ototoxicity
monitoring, sensorineural hearing loss
Treatment Outcomes for Patients with Failed
Back Surgery
Authors: Cho Jae Hwan
Published: October 2019

Background: Failed back surgery syndrome (FBSS) is a frequently encountered
disease entity following lumbar spinal surgery. Although many plausible reasons have
been investigated, the exact pathophysiology remains unknown. Various medications,
reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural
injection, exercise therapy, and psychotherapy have been suggested treatment options.
However, the evidence of the clinical outcome for each treatment has not been clearly
determined.
Objectives: To evaluate the outcomes of each treatment modality and to present
treatment guidelines for patients with FBSS.
Study Design: A systematic review of each treatment regimen in patients with FBSS.
Methods: The available literature regarding each modality for the treatment of refractory
back pain or radiating pain for FBSS was reviewed. The quality assessment and the level of
evidence were analyzed using the “Methodology Checklist” of SIGN (Scottish Intercollegiate
Guidelines Network). Data sources included relevant English language literature identified
through searches of Pubmed, EMBASE, and Cochrane library from 1980 to Feb 2016.
The primary outcome measure was pain relief of back pain or radiating pain for at least
3 months. Secondary outcome measures were improvement of the patient’s functional
status, health-related quality of life, return to work, and reduction of opioid use.
Results: Twenty-three articles were finally identified and reviewed. Based on our analysis,
epidural adhesiolysis showed a short-term (6 to 24 months) effect (grade A) and spinal cord
stimulation showed a mid-term (2 or 3 years) effect (grade B). Epidural injections showed a
short-term (up to 2 years) effect (grade C). However, other treatments were recommended
as grade D or inconclusive.
Limitations: The limitations of this systematic review included the rarity of relevant
literature.
Conclusions: Epidural adhesiolysis or spinal cord stimulation can be effective in order to
control chronic back pain or leg pain due to FBSS, and its recommendation grades are A
and B, respectively. Other treatments showed poor or inconclusive evidence.
Key words: Failed back surgery syndrome, post spinal surgery syndrome, chronic low
back pain, post lumbar surgery syndrome, epidural adhesiolysis, spinal cord stimulation,
epidural injection, revision
Incidence of Spontaneous Resorption of
Lumbar Disc Herniation: A Meta-Analysis
Authors: Jiang Hong
Published: October 2019

Background: Lumbar disc herniation (LDH), a common disease, is often treated conservatively,
frequently resulting in spontaneous resorption of the herniated disc. The incidence of this
phenomenon, however, remains unknown.
Objective: To analyze the incidence of spontaneous resorption after conservative treatment
of LDH using computed tomography and magnetic resonance imaging.
Study Design: Meta-analysis and systematic review of cohort studies.
Setting: The work was performed at The Suzhou Hospital of Traditional Chinese Medicine,
Shanghai University of Traditional Chinese Medicine.
Methods: We initiated a search for the period from January 1990 to December 2015 using
PubMed, Embase, and the Cochrane Library. Two independent reviewers examined the relevant
reports. The references from these reports were also searched for additional trials using the
criteria established in the PRISMA statement.
Results: Our results represent the pooled results from 11 cohort studies. The overall incidence
of spontaneous resorption after LDH was 66.66% (95% CI 51% – 69%). The incidence in
the United Kingdom was 82.94% (95% CI 63.77% – 102.11%). The incidence in Japan was
62.58% (95% CI 55.71% – 69.46%).
Limitations: Our study was limited because there were few sources from which to extract
data, either in abstracts or published studies. There were no randomized, controlled trials that
met our criteria.
Conclusions: The phenomenon of LDH reabsorption is well recognized. Because its overall
incidence is now 66.66% according to our results, conservative treatment may become the first
choice of treatment for LDH. More large-scale, double-blinded, randomized, controlled trials
are necessary to study the phenomenon of spontaneous resorption of LDH.
Key words: Lumbar, disc herniation, spontaneous resorption, conservative treatment,
incidence, country, meta-analysis, systematic review, observational studies, study designs
Effect of Concomitant Pain Medications on
Response to Pregabalin in Patients with
Postherpetic Neuralgia or Spinal Cord InjuryRelated Neuropathic Pain
Authors: Schug Stephan A.
Published: October 2019

Background: Patients with neuropathic pain (NeP) often receive combination therapy with
multiple agents in the hopes of improving both pain and any comorbidities that may be present.
While pregabalin is often recommended as a first-line treatment of NeP, few studies have examined
the effects of concomitant medications on the efficacy of pregabalin.
Objective: To examine the effects of concomitant medications on the efficacy and safety of
pregabalin for the treatment of NeP.
Study Design: Data were derived from 7 randomized placebo-controlled trials of pregabalin
(150, 300, 600, and flexible 150 – 600 mg/d) for the treatment of postherpetic neuralgia (PHN)
and 2 randomized placebo-controlled trials for the treatment of NeP due to spinal cord injury (SCINeP). On each day, patients rated the severity of their pain and pain-related sleep interference
(PRSI) over the previous 24 hours on a scale from 0 to 10, with higher scores indicating greater
severity. Patients were also continually monitored for the occurrence of adverse events.
Setting: A pooled retrospective analyses of data from randomized clinical trials.
Methods: Changes from baseline in mean weekly pain and PRSI scores were compared between
patients who received concomitant NeP medications and patients who did not receive concomitant
NeP medications. Results of these comparisons are presented separately for the PHN (through 4,
8, and 12 weeks) and SCI-NeP (through 12 weeks) cohorts. Common adverse events are also
presented for each treatment group.
Results: Pregabalin significantly improved both pain and PRSI scores relative to placebo at most
dose levels and time points examined. Notably, little difference was observed in the extent of
therapeutic response to pregabalin between patients who received concomitant NeP medications
and patients who did not receive concomitant NeP medications. Additionally, the profile of
treatment-emergent adverse events appeared to be largely unaffected by the use of concomitant
NeP medications in the pooled patient population.
Limitations: Our analysis is limited in that the original trials of pregabalin were not powered to
examine the effects of concomitant NeP medications.
Conclusions: The data presented here demonstrate that therapeutic response to pregabalin and
the occurrence of adverse events in patients with NeP are generally unaffected by the concurrent
use of other NeP medications.
Trial Registration numbers: NCT00159666; NCT00301223; NCT00407745
Key words: Pregabalin, neuropathic pain, pain-related sleep interference, concomitant
medications, postherpetic neuralgia, spinal cord injury, efficacy, safety
Fusion or Not for Degenerative Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review
Authors: Hao Jie
Published: October 2019

Background: Degenerative lumbar spinal stenosis (DLSS) is the main cause for chronic low back
pain in the elderly. When refractory to conservative treatment, symptomatic patients commonly
undergo surgery. However, whether or not fusion is a relatively better surgical option still remains
unclear.
Objective: The purpose of the present study was to systematically review the clinical outcomes
of spinal decompression with or without spinal fusion for DLSS.
Study Design: A systematic review of the therapeutic effect for DLSS with or without fusion.
Methods: A literature search of 5 electronic databases was performed including PubMed,
EMBASE, MEDLINE, Cochrane Library, and CENTRAL from inception to August 2016. Only
randomized controlled trials (RCTs) assessing the comparison between decompression and fusion
surgery for DLSS were included.
Results: A total of 5 RCTs involving 438 patients met the inclusion criteria. Low-quality evidence
of the meta-analysis was performed for the heterogeneity of the included studies. Pooled
analysis showed no significant differences between decompression alone and fusion groups for
the Oswestry Disability Index (ODI) scores at the baseline (P = 0.50) and 2 years follow-up (P =
0.71), and the satisfaction rate of operations was also similar for the groups (P = 0.53). However,
operation time (P = 0.002), blood loss (P < 0.00001), and length of hospital stay (P = 0.007) were
remarkably higher in the fusion group. Furthermore, there was no difference in the reoperation
rate between these 2 groups at the latest follow-up (P = 0.49).
Limitation: The methodological criteria and sample sizes were highly variable. The studies were
heterogeneous.
Conclusion: The present meta-analysis is the first to compare the efficacy of decompression
alone and spinal fusion for the treatment of DLSS, including 5 RCTs. Our results demonstrate that
additional fusion surgery seems unlikely to result in better outcomes for patients with DLSS, but it
may increase additional risks and costs. High-quality homogeneous research is required to provide
further evidence about surgical procedures for patients with DLSS.
Key words: Decompression, fusion, lumbar spinal stenosis, meta-analysis
Efficacy of Pain Relief in Different Postherpetic
Neuralgia Therapies: A Network Meta-Analysis
Authors: Wei Yulian
Published: October 2019

Background: Postherpetic neuralgia (PHN) is a nerve pain disease usually controlled
by different therapies, i.e., topical therapies, antiepileptics, analgesics, antipsychotics,
antidepressants, anti-dementia drugs, antivirals, amitriptyline, fluphenazine, and
magnesium sulfate. It is believed that different therapies may lead to different levels of
pain relief.
Objectives: We proposed this study to compare the efficacy of PHN treatments.
Study Design: We conducted a systematic review of the current literature. All relevant
studies were retrieved from online databases. The standardized mean difference (SMD)
was used for pain relief measurement in different PHN therapies.
Setting: A conventional meta-analysis and a network meta-analysis (NMA) were carried
out together with the surface under the cumulative ranking curve (SUCRA) for each
therapy calculated regarding their efficacy.
Results: A pairwise meta-analysis suggested that 4 treatment classes, including topical
therapies, antiepileptics, analgesics, and antidepressants, exhibited better pain relief
results than placebo. Likewise, a NMA suggested that patients with 4 treatment classes
exhibited significant improvements in pain scores compared to those with placebo.
Limitations: There is a lack of direct head-to-head comparisons of some treatments,
especially for antivirals, anti-dementia drugs, and magnesium sulfate. Secondly, the
specific agents belonging to the same class of therapies might exhibit different effects
(gabapentin and carisbamate) with different mechanisms (opioids and ketamine) on
reducing pain, and some agents were hard to find in literatures and were not involved in
our study, which may influence our results.
Conclusions: Analgesics were preferable to other treatments with respect to pain relief
for PHN, while antivirals appeared to be less effective than other therapies.
Key words: Postherpetic neuralgia, topical agents, antiepileptics, analgesics,
antipsychotics, antidepressants
Buprenorphine Formulations: Clinical Best Practice Strategies Recommendations for Perioperative Management of Patients Undergoing Surgical or Interventional Pain Procedures
Authors: Urman Richard
Published: October 2019

Background: Starting with approval for clinical use in the treatment of opioid dependence in
October 2002 by the Food and Drug Administration (FDA), buprenorphine has become an integral
treatment option and in recent years, in chronic pain management. Buprenorphine possesses a
unique pharmacodynamic and pharmacokinetic profile that can potentially make perioperative
analgesia challenging.
Objectives: To date no unified guidelines or recommendations are available for buprenorphine
product management during the perioperative period. The present investigation aims to review the
literature and provide recommendations when encountering a patient on buprenorphine therapy
who is scheduled for a surgical or interventional pain procedure.
Methods: Clinical studies and reviews were searched using the PubMed National Center for
Biotechnology Information database using MeSH terms buprenorphine, buprenorphine and
naloxone, suboxone, perioperative, and postoperative pain.
Results: PubMed National Center for Biotechnology Information database search resulted in one
randomized control trial, one prospective case matched cohort, one retrospective cohort, 0 case
series, 4 case reports, and 6 review articles. Key literature is reviewed and summarized.
Limitations: Only 12 articles were included, which permits only limited recommendations drawn
from this review.
Conclusions: The perioperative management of buprenorphine and buprenorphine/naloxone
are dependent on several key factors. The nature of the surgery, namely the postoperative
opioid requirement, elective versus emergency surgery, patient characteristics, formulation of
buprenorphine, and indication for buprenorphine or buprenorphine/naloxone therapy must be
considered when devising a plan. Several options exist when formulating a plan for the perioperative
management, including continuing buprenorphine therapy or holding buprenorphine therapy for a
defined period of time with or without bridging to alternative opioids. Additionally, social support
people and patient motivation should be addressed and optimized, as well as nonopioid adjuvant
therapy should be maximized as applicable to each patient undergoing a surgical or interventional
pain procedure.
Key words: Buprenorphine, naloxone, surgery, pain management, anesthesia, suboxone, opioid
abuse
The Effect of Caudal Epidural Pulsed
Radiofrequency Stimulation in Patients
with Refractory Chronic Idiopathic Axonal
Polyneuropathy
Authors: Chang Min Cheol
Published: October 2019

Background: Many patients with chronic idiopathic axonal polyneuropathy (CIAP) suffer from
neuropathic pain, which is managed using several oral medications and modalities. However,
despite these treatments, pain persists in some patients.
Objective: In the clinical field, clinicians frequently meet patients with neuropathic pain caused
by CIAP. The authors investigated the effect of caudal epidural pulsed radiofrequency (PRF) for the
management of CIAP-induced refractory neuropathic pain.
Study Design: This is a prospective study.
Setting: The outpatient clinic of a single academic medical center in Korea
Methods: Twenty patients with neuropathic pain and a diagnosis of refractory CIAP were recruited.
For PRF stimulation, a 22-gauge cannula was inserted into the epidural space through the sacral hiatus
under fluoroscopic guidance. PRF stimulation was administered once at 5 Hz with a 5-ms pulse width
for 600 seconds at 55 V. The effect of stimulation was evaluated using a numeric rating scale (NRS) at
2 weeks and 1, 2, and 3 months after the procedure. Successful pain relief was defined as a reduction
in the NRS score of ≥ 50% as compared with the score prior to treatment. In addition, at 3 months
after treatment, patient satisfaction levels were examined; patients that reported “very good” (score
= 7) or “good” (score = 6) results were considered to be satisfied with the procedure.
Results: Neuropathic pain was significantly reduced at 2 weeks and at 1, 2, and 3 months followup after PRF (P < 0.001, repeated measures one-factor analysis). In addition, at 3 months post-PRF,
half of the patients achieved a successful response (≥ 50% pain reduction) and were satisfied with
treatment results.
Limitations: A small number of patients were recruited, and we did not perform long-term
follow-up.
Conclusion: Caudal epidural PRF may be a good treatment option for managing neuropathic pain
induced by CIAP, especially when pain is unresponsive to oral medications.
Key words: Pulsed radiofrequency, chronic idiopathic axonal neuropathy, caudal epidural
stimulation, neuropathic pain chronic pain, refractory pain
Long-term Clinical Effects of DiscoGel for
Cervical Disc Herniation
Authors: Beyaz Serbülent Gökhan
Published: October 2019

Background: Radiopaque gelified ethanol (RGE; DiscoGel®, Gelscom SAS, France) is used as
a chemonucleolysis substance in treating intradiscal herniation, showing good results without
complications. It has also been used in cervical disc herniations (CDHs), demonstrating the potential
efficacy of this substance.
Objective: The aim of the study is to investigate the long-term effectiveness and safety of
DiscoGel® in patients with CDH and chronic neck pain.
Study Design: This is a cross-sectional, single-center study.
Setting: The study was conducted from November 2013 to May 2016 on patients visiting Sakarya
University Training and Research Hospital’s pain clinic .
Methods: Each patient was evaluated before the procedure (baseline) and at 1, 3, 6, and 12
months after the procedure, using the visual analog scale (VAS) score for pain, the Oswestry
Disability Index score to measure degree of disability, and estimate quality of life for those with pain;
this coincides with scores on the Neuropathic Pain Questionnaire (DN4) for differential diagnoses.
Results: Thirty-three patients with CDH underwent the same treatment with DiscoGel® between
November 2013 and May 2016. Significant pain relief was noted, as opposed to preoperative pain,
at 1, 3, 6, and 12 months after the procedure according to each patient’s self-evaluation (P = 0.01).
Differences in VAS, ODI, and DN4 scores between 1, 3, 6, and 12 months with the same variables
were not statistically significant. There were no complications with the procedure.
Limitations: Our study was conducted retrospectively, which led to problems with long-term
follow-up data. In addition, this study was performed with a small group of patients.
Conclusions: RGE is a potential alternative to surgery for patients with pain at the cervical
level. However, we concluded that more studies with longer follow-up intervals with RGE will be
necessary for assessment of the technique’s efficiency.
Key words: Cervical pain, herniation, neuropathic pain, injection, DiscoGel®, chemonucleolysis
Neuropathic Pain in Acute and Subacute
Neuropathies: A Systematic Review
Authors: Artemiadis Artemios K.
Published: October 2019

Background: Neuropathic pain (NP) is a common symptom caused by lesions or diseases of the
somatosensory nervous system. Acute/subacute peripheral neuropathies (APN) are rare, however
can be particularly painful.
Objectives: The aim of this systematic review was to estimate the incidence of NP in APN and
overview the various etiologies of such neuropathies.
Study Design: Systematic review.
Setting: Medline search.
Methods: We hand-searched Medline for observational studies published between 1995 and
2017.
Results: Our search strategy identified 1,400 papers. Of these, 70 met our inclusion criteria and
were included in this review. Out of a total of 2,341 patients, 1,139 patients were diagnosed
with NP (pooled incidence of NP 48.7%). In Guillain-Barré syndrome (GBS), the commonest cause
of APN, the pooled estimate of NP was 34.8%. Other causes of painful APN include immunemediated, vasculitic, metabolic, nutritional, toxic, paraneoplastic, and infectious.
Limitations: An important limitation was that GBS accounted for the majority of patients with
APN, as such the calculated incidence reflected mainly this disease entity. Another important
limitation was that very few studies targeted primarily NP. Thus, it is highly likely that observational
studies reporting NP were missed. Finally there could always be a publication bias due to
underreporting and gray literature.
Conclusions: NP is a cardinal manifestation of APN. The use of validated diagnostic tools and
accepted diagnostic criteria of NP is recommended for both clinical and research purposes.
Key words: Neuropathic, pain, acute, subacute, neuropathy, polyneuropathy, frequency,
incidence
Pulsed Radiofrequency Treatment for Chronic
Post-Surgical Orchialgia: A Double-Blind,
Sham-Controlled, Randomized Trial: ThreeMonth Results
Authors: Hetta Diab Fuad
Published: October 2019

Background: Chronic post-surgical pain in the groin region represents a challenge for the
managing physician and is a burden on the quality of life of the patient. None of the existing
interventions or medical treatment is satisfactory.
Objectives: We aim to evaluate the analgesic efficacy of pulsed radiofrequency (PRF) applied to
the ilioinguinal nerve and the genital branch of the genitofemoral nerve for patients suffering from
chronic post-surgical orchialgia.
Study Design: A prospective randomized, controlled clinical trial.
Settings: An interventional pain unit in a tertiary center at a university hospital in Egypt.
Methods: Seventy patients complaining of chronic post-surgical orchialgia were randomized into
2 groups: PRF group (n = 35), received pulsed radiofrequency on the ilioinguinal nerve and genital
branch of the genitofemoral nerve, or sham group (n = 35). The percentage of patients that
showed > 50 % reduction of their visual analog scale (VAS) pain score as well as the percentage of
patients that did not require additional analgesic drugs was assessed. The VAS pain score and the
global perceived effect (GPE) were reported during the 3-month follow-up period.
Results: The percentage of patients that showed > 50% reduction of their VAS pain score was
80% (24/30) in the PRF group versus 23.33% (7/30) in the sham group. The percentage of patients
that did not require analgesic drugs was 50% (15/30) in the PRF group versus 3.3% (1/30) in the
sham group. There was a significant reduction of the mean post-procedural VAS pain score at 2,
4, 6, 8, and 12 weeks (P = 0.001) in the PRF group in comparison to the sham group. Likewise,
there was a significant improvement of the GPE in the PRF group in comparison to the sham group
(P = 0.00).
Limitations: The study’s follow-up period was limited to 3 months only.
Conclusions: For patients suffering from chronic post-surgical orchialgia, PRF applied to the
ilioinguinal nerve and the genital branch of the genitofemoral nerve is an effective treatment
modality. It provides long-lasting pain relief and decreases the demand for pain medications.
Key words: Orchialgia, groin pain, radiofrequency, ilioinguinal nerve, genitofemoral nerve
Transforaminal Endoscopic Discectomy for
Treatment of Central Disc Herniation: Surgical
Techniques and Clinical Outcome
Authors: Zhang Wei
Published: October 2019

Background: Though transforaminal endoscopic discectomy has achieved a satisfactory clinical
outcome in the treatment of paracentral disc herniation, it has a high failure rate for treating
central disc herniation.
Objective: To explore the surgical techniques of transforaminal endoscopic discectomy in treating
central disc herniation and the clinical outcome based on 2-year follow-up.
Study Design: A retrospective study.
Setting: The Department of Spinal Surgery at the Third Hospital of Hebei Medical University in
China.
Methods: Sixty-nine consecutive patients (male:female = 14:9, mean age 38.8 ± 10.5 years)
were enrolled in the study, all of whom underwent transforaminal endoscopic discectomy due to
central disc herniation. The rod adjustment technique, apex technique, and posterior longitudinal
ligament detection technique were adopted for intraoperative individualization. All of the patients
were followed up for 24 months to assess the visual analog scale (VAS), Japanese Orthopaedic
Association (JOA), and Oswestry Disability Index (ODI) scores. The postoperative segmental
instability and recurrence were observed during the follow-up period as well. MacNab criteria
scores were recorded both intraoperatively and at the final follow-up; postoperative complications
and the surgical outcome and safety were also evaluated.
Results: The herniated disc tissues were successfully removed for all patients, without revision by
open surgery. Twenty-one cases (30.43%) were rated excellent, 44 (63.77%) good, 4 (5.80%) fair,
and 0 (0.00%) poor upon the final follow-up, with an overall excellent-to-good rate of 86.96%.
The VAS scores of low back and leg pain were all significantly lower at 3, 6, 12, and 24 months
postoperatively compared to preoperatively (all P < 0.05). The JOA scores at the 3-month and
24-month postoperative follow-ups were significantly higher than the preoperative values (all P
< 0.05). The ODI evaluation was significantly lower at 3 and 24 months postoperatively than
preoperatively (all P < 0.05).
Limitations: The retrospective nature of this study is a limitation, as well as the small sample size
and short observation time.
Conclusion: The application of novel surgical techniques can help improve the safety and
efficacy of transforaminal endoscopic discectomy in treating central disc herniations. Intraoperative
individualized application of rod adjustment technique, apex technique, or posterior longitudinal
ligament detection technique is the key to satisfactory clinical outcome.
Key words: Central disc herniation, rod adjustment technique, transforaminal endoscopy,
minimal invasion, complication
The Morphology and Possible Clinical
Significance of the Intraforaminal Ligaments in
the Entrance Zones of the L1-L5 Levels
Authors: Huang Wenhua
Published: October 2019

Background: The extraforaminal ligaments between the L1-L5 lumbar spinal nerves and the
tissues surrounding the intervertebral foramina (IVF) have been well studied. However, little
research has been performed to describe the local anatomy of the entrance zones at the L1-L5
level. Detailed anatomic studies of the intraforaminal ligaments (IFLs) in the entrance zones at
the L1-L5 levels have not been performed.
Objectives: The objective of this study is to identify and describe the IFLs in the entrance
zones of the L1-L5 IVF and to determine their possible clinical significance.
Study Design: A dissection-based study of 10 fresh-frozen human cadavers.
Setting: Guangdong Provincial Key Laboratory of Medical Biomechanics in Anatomy
Department of Southern Medical University.
Methods: Eighty L1-L5 IVF from 10 fresh cadavers were studied, and the IFLs in the
entrance zones were identified. The quantities, morphologies, origins, insertions, and spatial
orientations of the IFLs in the entrance zones of the L1-L5 IVF were observed. The lengths,
widths, diameters, and thicknesses of the ligaments were measured using a vernier caliper. Ten
intraforaminal radiating ligaments were removed for histological examination.
Results: A total of 197 ligaments were identified in the entrance zones of the 80 L1-L5
IVF, including 191 (96.95%) radiating ligaments and 6 (3.05%) transforaminal ligaments. The
thickest ligaments were observed at the L3-L4 IVF. The lengths of the ligaments varied from
0.59 to 11.92 mm. There were 66 (33.50%) ligaments in the superior aspect of the entrance
zone of the IVF, 58 (29.44%) ligaments at the anterior aspect, 43 (21.83%) ligaments at the
posterior aspect, and 30 (15.23%) ligaments at the inferior aspect. The morphologies of the
IFLs were divided into 2 types: the strap type and the trabs type. Histological examination of
the meningovertebral ligaments revealed fibrous connective tissue.
Limitations: The major limitation of this study is the lack of actual clinical data from live
patients. In addition, future medical biomechanics experiments are expected to contribute
more objective data on the strength of the IFLs.
Conclusions: In the lumbar spine, IFLs are common structures in the entrance zones of the
L1-L5 IVF, and radiating ligaments are more likely to be present.
Key words: Clinical Anatomy, microdissection, intraforaminal ligament, the entrance zone,
L1-L5 intervertebral foramen, endoscopic spinal adhesiolysis, sacral hiatus, cerebrospinal fluid
leakage, dural laceration
The Effect of Bipolar Pulsed Radiofrequency
Treatment on Chronic Lumbosacral Radicular
Pain Refractory to Monopolar Pulsed
Radiofrequency Treatment
Authors: Chang Min Cheol
Published: October 2019

Background: Patients with lumbosacral radicular pain may complain of persisting pain after
monopolar pulsed radiofrequency (PRF) treatment.
Objective: We evaluated the effect of bipolar PRF stimulation of the dorsal root ganglion (DRG)
in patients with chronic lumbosacral radicular pain who were unresponsive to both monopolar PRF
stimulation of the DRG and transforaminal epidural steroid injection (TFESI).
Study Design: This is a prospective observational study.
Setting: The outpatient clinic of a single academic medical center in Korea.
Methods: We retrospectively reviewed data from 102 patients who had received monopolar PRF to
the DRG for management of lumbosacral radiculopathy. Of these, 32 patients had persistent radicular
pain that was scored at least 5 on a numeric rating scale (NRS). Twenty-three of them were included in
this study and underwent bipolar PRF of the DRG. The outcomes after the procedure were evaluated
using the NRS for radicular pain before treatment and 1, 2, and 3 months after treatment. Successful
pain relief was defined as ≥ 50% reduction in the NRS score compared with the score prior to treatment.
Furthermore, at 3 months after treatment, patient satisfaction levels were examined. Patients reporting
very good (score = 7) or good results (score = 6) were considered to be satisfied with the procedure.
Results: The NRS scores changed significantly over time. At 1, 2, and 3 months after bipolar PRF,
the NRS scores were significantly reduced compared with the scores before the treatment. Twelve
(52.2%) of the 23 patients reported successful pain relief and were satisfied with treatment results
3 months after bipolar PRF. No serious adverse effects were recorded.
Limitations: A small number of patients were recruited and we did not perform long-term
follow-up.
Conclusion: We believe the use of bipolar PRF of the DRG can be an effective and safe
interventional technique for chronic refractory lumbosacral radiculopathy. It appears to be a
potential option that can be tried before proceeding to spinal surgery.
Key words: Bipolar, pulsed radiofrequency, lumbosacral radicular pain, chronic pain, dorsal root
ganglion, spinal stenosis, herniated disc
The Role of Unilateral Balloon Kyphoplasty
for the Treatment of Patients with OVCFS: A
Systematic Review and Meta-Analysis
Authors: Ke Chen Rong
Published: October 2019

Background: An increasing number of studies have been conducted to apply unilateral balloon
kyphoplasty in the treatment of ostroporotic vertebral compression fractures (OVCFs). However,
the efficacy and safety of unilateral kyphoplasty and whether a unilateral or a bilateral approach
is superior is controversial.
Objectives: The purpose of this study was to evaluate the role of unilateral balloon kyphoplasty
and use meta-analysis to compare the efficacy and safety of unilateral and bilateral kyphoplasty in
patients with OVCFs.
Study Design: A systematic literature search was conducted from 1970 to April 2017 using
Medline database and the Cochrane Central Register of Controlled Trials. Articles were limited to
those published in English. Randomized controlled trials and nonrandomized comparative studies
were also included.
Setting: The following search terms were used: “osteoporotic vertebral compression fractures,”
or “OVCF,” and “unilateral kyphoplasty,” or “unipedicular approach,” or “single balloon
kyphoplasty,” or “one balloon kyphoplasty.” A comprehensive search of reference lists of retrieved
articles and previous published reviews was also performed to ensure inclusion of all possible
studies.
Methods: All potential articles were independently reviewed by 2 investigators for inclusion into
the final analysis. MINORS score was used for nonrandomized studies, and Detsky quality index
was applied for prospective randomized controlled trials. Systematic review and meta-analysis was
performed for the included studies.
Results: After unilateral balloon kyphoplasty the mean postoperative visual analog score (VAS) was
from 1.74 to 4.77, mean postoperative kyphotic angle was from 5.9º to 11.22º, and complications
involving cement leaks was from 6.8 to 21.9% or adjacent level fractures was from 0 to 5.6%).
Unilateral kyphoplasty had significantly lower operative time, and less bone cement volume;
however, the postoperative VAS, Oswestry Disability Index (ODI), vertebral height restoration rate,
and cement leakage and adjacent vertebral fracture rate, were similar to bilateral kyphoplasty.
Limitations: Only 6 randomized controlled trials and 3 retrospective comparative studies
were selected for analysis. Heterogeneity was detected among the studies when we pooled the
outcomes.
Conclusions: Based on the available evidence, the clinical and radiological results of unilateral
balloon kyphoplasty were as good as those of bilateral balloon kyphoplasty for the treatment of
OVCFs. And unilateral kyphoplasty had advantages in terms of operation time, radiation exposure,
and cost.
Key words: Unilateral balloon kyphoplasty, bilateral balloon kyphoplasty, osteoporotic vertebral
compression fractures, complications of balloon kyphoplasty, meta-analysis
Stem Cells for the Treatment of Knee
Osteoarthritis: A Comprehensive Review
Authors: Abd-Elsayed Alaa
Published: October 2019

Background: Knee osteoarthritis (KOA) is a very challenging condition to treat and can be
resistant to medications, procedures, and even surgery. Surgery may not be an option for some
patients due to obesity or comorbidities. Regenerative medicine utilizing stem cells, platelet
rich plasma (PRP), amniotic fluid, and cytokine modulation is very promising in the treatment
of KOA.
Objective: This is a review article to evaluate the current evidence about regenerative medicine
therapies in the treatment of KOA.
Study Design: A review article.
Setting: A review of literature.
Methods: An online search of PubMed and Cochrane Library databases between January
2006 and December 2016 was performed to search related articles using the keywords of
“treatment, stem cell, knee osteoarthritis,” limited to the English language. The articles were
then screened to make sure only articles fitting our inclusion criteria were included.
Results: Our search obtained a total of 268 articles, but only 18 articles met the inclusion
criteria and were included in the current study.
Limitations: There is still limited evidence in literature about the efficacy of regenerative
medicine in treating KOA. More large clinical trials are needed to confirm the evidence.
Conclusion: The present investigation demonstrates that regenerative medicine technologies
provide good evidence in the treatment of osteoarthritis (OA) of the knee, but greater in-depth
study to explore a more ideal way to overcome present difficulties, including standardization of
sources of cells, is warranted.
Key words: Knee osteoarthritis, stem cell, treatment, platelet rich plasma, amniotic fluid,
articular cartilage defect