Effect of Interlaminar Epidural Steroid Injection in Acute and Subacute Pain Due to Lumbar Disk Herniation: A Randomized Comparison of 2 Different Protocols

In order to assess the efficacy of epidural steroid injections (ESI) in acute and subacute pain due to lumbar spine disk herniation, we conducted a randomized trial, comparing 2 different protocols. Fourty patients with radicular pain due to L4-L5 and L5-S1 disc herniation were assigned to receive either 3 consecutive ESI every 24 hours through a spinal catheter (group A) or 3 consecutive ESI every 10 days with an epidural needle (group B). All patients had improved Oswestry Disabilty Index (ODI) and the Visual Analog Scale (VAS) for pain scores at 1 month of follow-up compared to baseline, while no significant differences were observed between the 2 groups. The scores for group B were statistically significant lower at 2 months of follow-up compared to those of group A. The improvement in the scores of group B was continuous since the mean scores at 2 months of follow up were lower compared to the respective scores at 1 month. Protocol B (3 consecutive ESI every 10 days) was found more effective in the treatment of subacute pain compared to Protocol A (3 consecutive ESI every 24 hours) with statistically significant differences in the ODI and VAS scores at 2 months of follow-up

Is TKA with computer-assisted navigation associated with less blood loss? A comparative study between computer-navigated and conventional method

The aim of this study is to evaluate whether computer-assisted navigated TKA reduces perioperative blood loss. Patients were randomly divided into 2 groups and underwent either a conventional TKA (n = 40) or a TKA with computer-assisted navigation (n = 40). Perioperative blood loss was evaluated by laboratory parameters, postoperative drain output and number of required transfusions. Change in hemoglobin concentration and in hematocrit levels was similar. Also, there was no statistically significant difference in drain output and in the number of transfused units. The results of this study showed that TKA with computer-assisted navigation is similar to the conventional TKA regarding perioperative hemorrhage. © 2020 Professor P K Surendran Memorial Education Foundatio

Prótese total articulada de joelho utilizada no tratamento de osteossarcoma apendicular em cão Total articulated prosthesis for treatment of apendicular osteosarcoma in a dog

O objetivo do trabalho foi reportar o planejamento cirúrgico, a técnica operatória, a instrumentação e os resultados da substituição completa do terço médio distal do fêmur, do platô tibial e da articulação do joelho por prótese em um cão acometido por osteossarcoma no fêmur esquerdo. A prótese foi confeccionada em aço, apresentando três componentes articulados, mantendo o movimento semelhante à articulação do joelho. As porções femorais e tibiais da prótese foram cimentadas aos respectivos ossos, após ostectomia do fêmur e do platô tibial. O animal foi submetido a seis sessões de quimioterapia, com doxorrubicina e carboplatina, intercaladas mensalmente, objetivando inibir o crescimento de possíveis metástases pulmonares. Durante os seis primeiros dias, o animal apresentou neuropraxia e impotência funcional do membro. Aos 10 dias, o cão iniciou leve apoio e aos 30 dias já utilizava o membro pélvico de forma mais efetiva, porém, o ângulo de extensão da articulação foi reduzido de 150&deg; a 100&deg; devido à contratura muscular e à fibrose na região da fossa poplítea. Após um ano de observação, não houve melhora do ângulo de extensão do joelho, porém, o animal fazia uso do membro com claudicação. Aos 425 dias de pós-operatório, o animal veio a óbito por insuficiência renal. Nesse tempo não ocorreram metástases pulmonares ou locais visíveis radiograficamente, mas o proprietário não permitiu a realização da necropsia do paciente, sendo impossível confirmar outros dados que pudessem esclarecer melhor a causa morte. Conclui-se que a substituição total do joelho de cão é uma cirurgia factível, que permite a preservação e a utilização do membro após ressecção da neoplasia, embora outras pesquisas devam ser conduzidas para obtenção de melhores resultados pós-cirúrgicos.<br>This report describes the surgical technique, instrumentation and results of complete substitution of portion distal of the femur and knee articulation to prosthesis, in a dog with bone tumor in distal left femur. The prosthesis was made of steel, and composed by three articulated components with the goal of maintaining range of motion as a normal knee movement. The femoral and tibial prosthesis portions were fixed to the respective bones during the surgery, after femural and tibial plato ostectomy. The patient received six doses of adjuvant chemotherapy, composed by doxorrubicin monthly alternated with carboplatin. At six days after surgery the dog developed neuropraxy and non-weight bearing lameness. At 10 days the dog started to mild use of the limb and at 30 days it was more effective, but the extension of the stifle range was reduced by 100&deg; because of the fibrosis and muscle contracture on the popliteal fossa. At one year, this angle didn't improve but the dog continued to bear weight on the limb. At 425 days, the dog had died by renal failure. At this time, there was no evidence of local recurrence or distant metastasis, but the necropsy was declined by the owner, impairing the collection of more data. In conclusion, the replacement of total knee and half of the femur in dogs is possible and viable, but further study is warranted in order to obtain better technique and specific instrumentation, to attain better surgical outcomes