Percutaneous Laser Disc Decompression in the Treatment of Lumbar Radicular Pain

Lumbar radicular pain is defined as pain in the lumbar spine with propagation to the lower extremities. It is a major public health, social and economic problem in the modern society, and is one of the most common reasons for visits to the doctor. Lumbar radicular pain is often the reason for absenteeism and occupational disabilities. It is estimated that about 70-85% of the world’s population have experienced lumbar spine pain once in their lifetime. There are numerous modalities for the treatment of lumbar radicular pain, ranging from pharmacotherapy to surgery. In order to avoid systemic side effects of analgesics, anaesthesia and long-term and extensive surgery, minimally invasive procedures are increasingly used for treating lumbar radicular pain. Percutaneous laser disc decompression (PLDD) is one such procedure, first performed by Dr Choy and Dr Ascher in 1986. PLDD is an outpatient surgery performed under local anaesthesia, its success rate is high and the complication rate is low. This method therefore certainly attracts the attention of clinicians dealing with this issue. (Budrovac D, Radoš I, Tot OK, Haršanji Drenjančević I, Omrčen I. Percutaneous Laser Disc Decompression in the Treatment of Lumbar Radicular Pain. SEEMEDJ 2020; 4(2); 62-68

Lumbar disc herniation in children

Hernija diska lumbalne regije javlja se kod djece znatno rjeđe nego kod odraslih, a najčešće je zahvaćena razina L4-5. Naša bolesnica u dobi od 16 godina i 4 mjeseca hospitalizirana je zbog bolova u leđima i trnjenja u nogama unazad 2-3 godine. Pri neurološkom pregledu, tetivni refleksi su simetrični, a na nogama oslabljeni. Gruba mišićna snaga nogu je oslabljena. Lassequeov znak je obostrano pozitivan. Magnetskom rezonancom lumbosakralne kralježnice uočeno je suženje intvertebralnog prostora u segmentu L4-5, te fokalna dorzomedijalna protruzija intervertebralnog diska do 6 mm izvan koštanih okvira s kompresijom neuralnih struktura. Prisutan je i poremećaj senzibiliteta na nogama. Elektroneuromiografija pokazuje da se radi o kroničnoj neurogenoj leziji. Bolesnica je liječena konzervativno, uz djelomičnu regresiju tegoba. Hernija diska lumbalne kralježnice je entitet na koji je važno pomišljati i u dječjoj dobi, kako bi se pravovremeno provela odgovarajuća terapija i spriječile moguće komplikacije, te izbjegao invazivni način liječenja.Lumbar disc herniation occurs more likely in adults than in children, with the most common pathology site at L4-L5 lumbar level. Our patient was a 16 years and 4 months old girl with pain in her lumbar region and numbness in her legs that occurred two to three years ago. During the neurological examination, decreased, symmetrical tendon reflexes of the lower extremities were found. Muscle power in the legs was reduced with bilateral positive Lasseque’s sign. Magnetic resonance of lumbar spine showed narrowing of the intervertebral space at L4-L5 level with focal dorsomedial protrusion of the intervertebral disc within 6 mm outside of the bone frame and with neural structures compression. There was sensory impairment in the lower extremities. Electroneuromyography showed chronic neural lesion. The girl was treated conservatively, but with only partial response. Lumbar disc herniation is the entity that deserves more attention in children because early diagnosis provides adequate therapy and enables avoiding possible complications as well as invasive therapy

Perkutana laserska dekompresija diska zbog lumbalne radikularne boli: sistemski pregled PubMeda zadnjih pet godina

The most common causes of lumbar radicular pain are pathological changes in the intervertebral disc. Lumbar disc herniation (LDH) is the most common cause of lumbosacral radicular syndrome. It affects 1-2% of the general population, burdening health services and the economy worldwide. Excessive scar tissue after lumbar microdiscectomy can increase postoperative pain. Postoperative fibrosis is one of the most important causes of failed back surgery syndrome after lumbar disc surgery. Percutaneous laser disc decompression (PLDD) is a minimally invasive procedure in which thermal energy produced by a LASER probe is used to reduce the intervertebral disc herniation located within the annulus fibrosus. Evaporation of a small volume in a closed hydraulic space (nucleus pulposus) leads to decreased intradiscal pressure. It causes a thermal “shrinkage effect” with the retreat of the herniated disc and the decompression of the nerve root, which reduces lumbar radicular pain. Previous research has shown effective reduction of pain after PLDD and only a small number of complications of the procedure itself. PLDD is a safe and effective procedure in well-selected patients. Unfortunately, there is still a need for extensive, randomized prospective studies on PLDD in lumbar radicular pain in order to confirm or dispute the results obtained so far.Najčešći uzrok lumbalne radikularne boli su patološke promjene intervertebralnog diska. Lumbalna diskus hernija (LDH) je najčešći uzrok lumbosakralnog radikularnog sindroma i pogađa 1-2% opće populacije, stavljajući značajan teret na zdravstvene usluge i gospodarstvo u cijelom svijetu. Prekomjerna količina ožiljnog tkiva nakon lumbalne mikrodiscektomije može povećati postoperativnu bol. Postoperativna fibroza je jedan od najvažnijih uzroka sindroma neuspjele operacije leđa nakon operacije lumbalnog diska. Perkutana laserska dekompresija diska (PLDD) je vrsta minimalno invazivnog zahvata u kojem se toplinska energija proizvedena LASER sondom koristi za smanjenje hernije interverterbralnog diska koja se nalazi unutar fibroznog prstena. Isparavanje malog volumena u zatvorenom hidrauličkom prostoru (nucleus pulposus) dovodi do smanjenja intradiskalnog tlaka i implicira termički „učinak skupljanja“ sa povlačenjem hernije diska i dekompresiju živčanog korijena što ima za posljedicu smanjenja lumbalne radikularne boli. Dosadašnja istraživanja pokazala su učinkovito smanjenje boli poslije PLDD, te mali broj komplikacija samog zahvata. PLDD je siguran i djelotvoran zahvat kod dobro probranih bolesnika. Nažalost, ne postoje još velike, randomizirane prospektivne studije iz PLDD kod lumbalne radikularne boli, te su navedena istraživanja potrebna u budućnosti kako bi potvrdila ili osporila dosadašnje rezultate

Serratus anterior plane blok za analgeziju kod mastektomije

The incidence of breast cancer in women is on the rise, but the survival rate has increased due to the progress of medicine, especially if the disease is detected early. One of the imperatives is the patient’s quality of life after treatment. Inadequately treated acute postoperative pain leads to a worse treatment outcome and the development of chronic pain. The incidence of chronic pain after surgical treatment of breast cancer is high and negatively affects the quality of life of patients in the long term. Serratus anterior plane block (SAPB) is a relatively new ultrasound-guided regional analgesia technique. SAPB represents an alternative to an epidural, and to paravertebral and intercostal blocks. This review aims to describe serratus anterior plane block for breast surgery and emphasize their short- and long-term benefit. For this review, we searched MEDLINE in November 2022 to identify metanalyses, randomized controlled trial systemic reviews, and reviews published in the last five years. The search for metanalyses yielded 4 results; 12 results were found for randomized controlled trials; 5 results for reviews; and 4 results for systematic reviews. When employing SAPB in patients after mastectomy, good analgesia is achieved in the early postoperative period and the incidence of chronic pain is reduced, thus improving quality of life.Incidencija karcinoma dojke kod žena je u porastu ali napretkom liječenja povećana je stopa preživljena naročito ako se bolest otkrije u ranom stadiju. Jedan od imperativa je kvaliteta života bolesnice nakon liječenja. Neadekvatno liječena akutna poslijeoperacijska bol dovodi do lošijeg ishoda liječenja i razvoja kronične boli. Incidencija kronične boli nakon operativnog liječenja karcinoma dojke je visoka i dugoročno negativno utječe na kvalitetu života bolesnica. Serratus anterior plane block (SAPB) je relativno nova ultrazvukom vođena tehnika regionalne analgezije a predstavlja alternativu epiduralnim, paravertebralnim i interkostalnim blokovima.Cilj ovog pregleda je opisati serratus anterior plane block za mastektomiju i naglasiti njegovu kratkoročnu i dugoročnu korist. Za potrebe ovog rada proveli smo pretragu MEDLINE baze do studenog 2022. kako bismo identificirali meta-analize, sistemske preglede, randomizirana kontrolirana ispitivanja i preglede objavljene u posljednjih pet godina. Pretraživanjem meta-analiza dobili smo 4 rezultata, za randomizirano kontrolirano ispitivanje 12 rezultata, za preglede 5 rezultata i za sustavni pregled 4 rezultata. Primjenom SAPB kod bolesnica nakon mastektomije postiže se dobra analgezija u ranom poslijeoperacijskom periodu te se smanjuje pojavnost kronične boli i na taj način poboljšava se kvaliteta života

The Influnce of Epidural Steroids Injections with Transforaminal and Interlaminal Approaches on Quality of Sleeping, Anxiety, and Depression in Patients With Chronic Lumbal Radicular Pain - Prospective, Randomized Research

Chronic lumbar radicular pain is connected with the anxiety, depression and sleep disorders. The aims of this study are to compare the effect of pain on sleep quality, anxiety and depression in patients receiving interlaminar and transforaminal epidural steroids injections. The study is an original scientific-research work, a prospective randomized controlled clinical trial that included 70 patients with lumbar radicular pain at the Clinical Hospital Centre Osijek. The selected patients were divided into two groups considering the approach of administration of epidural steroids, the interlaminar (IL) and transforaminal group (TF). The anxiety, depression and sleep disorders were evaluated with questionnaires "Hospital Anxiety and Depression Scale (HADS)" and "Questions for assessing sleep in chronic pain". In the end 64 patients completed the study, 41 women (64.1%) and 23 men (35.9%). Significantly lower values were recorded during the assessment of the sleep quality in the group with the interlaminar injection of steroids (ANOVA, p = 0.030), compared to the group with the transforaminal injection of steroids (ANOVA, p = 0.002), but there is no difference between the groups. In both groups, there is an improvement in anxiety and depression, but only in the sixth measurement a significantly lower evaluation value of the HADS questionnaire was obtained in transforaminal (TF) group (Mann Whitney test, p = 0.025). Within the TF group, the values of anxiety (Friedman\u27s test, p <0.001) and depression (Friedman\u27s test, p = 0.007) are significantly reduced. In patients who received epidural steroids injection with a transforaminal approach, lower levels of depression and anxiety were observed as there was a greater reduction in pain, compared to an interlaminar group. Sleep quality was higher in patients who received steroids via transforaminal compared to the interlaminar approach

The impact of the COVID-19 pandemic on the length of management of polytraumatized patients in the emergency department

INTRODUCTION: The personal protective equipment used by healthcare workers and special institutional protocols during the COVID-19 pandemic could potentially slow down the usual management of trauma patients. OBJECTIVE: To examine the difference in the length of management of polytraumatized patients in the emergency department (ED) before and during the COVID-19 pandemic. MATERIAL AND METHODS: The study was designed as a case-control study and included 52 polytraumatized patients who were admitted to the intensive care unit (ICU) after being managed in the ED of Osijek University Hospital. Data were collected from the hospital information system and included patients from March 2019 to February 2020 (pre-pandemic group) and from March 2020 to February 2021 (COVID-19 pandemic group). RESULTS: Differences in the duration of diagnostics in the ED, the duration of surgery, and the time required for admission to the ICU before and during the COVID-19 pandemic were examined. The duration of diagnostics of polytraumatized patients in the ED before vs during the pandemic was 98 (76–120) and 92 (68–167) minutes, p = 0.79, respectively. 16 (64%) patients in the pre-pandemic and 18 (67%) in the pandemic group needed emergency surgery. The time required for admission to the ICU from the beginning of management in the ED, after accounting for the duration of surgery was 128 (91.5–208.5) and 145 (110–755) minutes, p = 0.09, in pre-pandemic vs pandemic group, respectively. CONCLUSIONS: The COVID-19 pandemic did not have a significant impact on the length of management for polytraumatized patients admitted to the ICU

Utjecaj različitih minimalno invazivnih metoda na ishod liječenja lumbalne radikularne boli

Lumbar radicular pain is a major public health, social and economic problem and is often the cause of professional disability. The aim of this study was to compare pain intensity, disability and neuropatic pain depending on the method of treatment (epidural steroid injection or percutaneous laser disc decompression) in the treatment of lumbar radicular pain caused by intervertebral disc herniation with or without discoradicular contact. Data were collected from 28 patients at 3 measurement points (before the procedure and at examinations on the 15th and 30th day after the procedure) using the Numeric Rating Scale (NRS), Oswestry Disabilitiy Indeks (ODI) and Pain Detect. The reduction of the pain after the procedure was statistically significant only in the group of patients with discoradicular contact in whom PLDD was performed (P=0.04). From the obtained results, it can be concluded that percutaneous laser disc decompression (PLDD) led to a greater reduction in disability (P=0.009) in patients with discorradicular contact, whereas lumbar transforaminal epidural steroid injection (ESI TF) led to greater reduction in patients without discorradicular contact (P=0.02). The results indicate that there was a significant (P=0.01) reduction in neuropathic pain in patients without discorradicular contact who were treated with ESI TF and in patients with discoradicular contact who were treated with PLDD (P=0.04).Lumbalna radikularna bol je veliki javnozdravstveni, društveni i ekonomski problem i često je uzrok profesionalne nesposobnosti. Cilj ovog istraživanja bio je usporediti intenzitet boli, onesposobljenost i neuropatsku bol ovisno o načinu liječenja (epiduralna injekcija steroida ili perkutana laserska dekompresija diska) u liječenju lumbalne radikularne boli uzrokovane hernijom intervertebralnog diska sa ili bez diskoradikularnog kontakta. Podaci su prikupljeni od 28 pacijenata u 3 točke mjerenja (prije zahvata i na pregledima 15. i 30. dana nakon zahvata) pomoću Numeric Rating Scale (NRS), Oswestry Disabilitiy Indeks (ODI) i Pain Detect. Smanjenje boli nakon zahvata bilo je statistički značajno samo u skupini bolesnika s diskoradikularnim kontaktom kod kojih je učinjen PLDD (p = 0,04). Iz dobivenih rezultata može se zaključiti da je PLDD doveo do većeg smanjenja onesposobljenosti (p = 0,009 ) u bolesnika s diskoradikularnim kontaktom a ESI u bolesnika bez diskoradikularnog kontakta (p = 0,02 ). Rezultati pokazuju da je došlo do značajnog (p = 0,01) smanjenja neuropatske boli u bolesnika bez diskoradikularnog kontakta koji su liječeni ESI i u bolesnika s diskoradikularnim kontaktom koji su liječeni PLDD (p = 0,04)