Multilevel Direct Repair Surgery for Three-Level Lumbar Spondylolysis

A 45-year-old man presented to our clinic requesting evaluation for surgical treatment of chronic low back pain of more than 20 years duration. He was diagnosed with 3-level lumbar spondylolysis at L3–5. Direct repair using the pedicle screw and hook-rod system was conducted for all three levels. After the surgery, his low back pain completely disappeared. Six months later, he felt discomfort and heard a metallic sound as he twisted his trunk. Computed tomography and radiography indicated that the hook head for L3 and the screw head for L4 were interfering with each other, causing the sound. We confirmed bony union at L3 and removed the L3 system. Surgeons should be aware of such complications if direct repair using a pedicle screw and hook-rod system is conducted for multilevel spondylolysis

Stellate ganglion block as an early intervention in sympathetically maintained headache and orofacial pain Caused by Temporal Arteritis

Introduction We report a case of temporal arteritis with a sympathetic component in the orofacial region, which responded to stellate ganglion blocks (SGBs). Case An 81-year-old woman with limited mouth opening and pain upon chewing was referred to the Orofacial Pain Clinic at Nihon University Dental Hospital. The patient also presented with blurred vision and a burning sensation on the right side of her face. On clinical examination, the temporal artery was tender to palpation, and there was increased sensitivity in the temporal region bilaterally. The patient reported jaw pain and limited mouth opening. Laboratory examination showed elevations in erythrocyte sedimentation rate and C-reactive protein. The burning sensation was due to a sympathetic component, and SGBs substantially reduced both the burning sensation and right temporal pain. Blocking the sympathetic chain on the ipsilateral side also improved jaw movement. The patient was referred to a rheumatologist, after which she was admitted to hospital with a tentative diagnosis of temporal arteritis. Treatment with oral prednisone 30 mg daily was initiated, and the dose was tapered as her symptoms resolved. Discussion The reason for the gradual pain relief after SGB is unclear, but we believe it was effective for ischemia in temporal arteritis because it led to dilation of affected arteries or suppression of inflammation/edema of the vascular wall. Conclusion This case demonstrates that SGB may relieve pain related to temporal arteritis and sympathetically maintained headache and orofacial pain by reducing noxious stimulation peripherally and decreasing central pain transmission centrally

Efficacy of distortion correction on diffusion imaging: comparison of FSL eddy and eddy_correct using 30 and 60 directions diffusion encoding.

Diffusion imaging is a unique noninvasive tool to detect brain white matter trajectory and integrity in vivo. However, this technique suffers from spatial distortion and signal pileup or dropout originating from local susceptibility gradients and eddy currents. Although there are several methods to mitigate these problems, most techniques can be applicable either to susceptibility or eddy-current induced distortion alone with a few exceptions. The present study compared the correction efficiency of FSL tools, "eddy_correct" and the combination of "eddy" and "topup" in terms of diffusion-derived fractional anisotropy (FA). The brain diffusion images were acquired from 10 healthy subjects using 30 and 60 directions encoding schemes based on the electrostatic repulsive forces. For the 30 directions encoding, 2 sets of diffusion images were acquired with the same parameters, except for the phase-encode blips which had opposing polarities along the anteroposterior direction. For the 60 directions encoding, non-diffusion-weighted and diffusion-weighted images were obtained with forward phase-encoding blips and non-diffusion-weighted images with the same parameter, except for the phase-encode blips, which had opposing polarities. FA images without and with distortion correction were compared in a voxel-wise manner with tract-based spatial statistics. We showed that images corrected with eddy and topup possessed higher FA values than images uncorrected and corrected with eddy_correct with trilinear (FSL default setting) or spline interpolation in most white matter skeletons, using both encoding schemes. Furthermore, the 60 directions encoding scheme was superior as measured by increased FA values to the 30 directions encoding scheme, despite comparable acquisition time. This study supports the combination of eddy and topup as a superior correction tool in diffusion imaging rather than the eddy_correct tool, especially with trilinear interpolation, using 60 directions encoding scheme

Representative diffusion-weighted images with the 60 directions encoding scheme.

<p>The images were from the same subject and slice location. The NC60 with forward phase-encoding blips had an artifactual signal pileup around the temporal base of the skull, which was not corrected in EC60, but corrected in ET60. Again, the EC30 with trilinear were blurred, compared with EC30 with spline interpolation.</p

Efficiency of correction schemes acquired with 60 directions diffusion encoding.

<p>Tripled paired group comparisons with TBSS were conducted between NC60 and EC60 with spline interpolation in the upper, NC60 and ET60 in the middle, and EC60 with spline and ET60 in the lower row. The FA values for ET60 were significantly higher than those for NC60 or EC60 in most of the white matter skeleton (blue/lightblue). In contrast, white matter skeleton with significantly higher (blue/lightblue) and lower (red/yellow) FA values for EC60 with spline interpolation than those for NC60 were observed in various areas. These data were overlaid onto the MNI152_T1 template, and the mean FA skeleton is shown in green. The significance level was set at a <i>P</i> value of <0.05 with FWE correction.</p

Comparison of ET30 and ET60 images.

<p>The FA values for ET60 were significantly higher than those for ET30 in most of the white matter, with slight left hemisphere predominance. These data were overlaid onto the MNI152_T1 template, and the mean FA skeleton is shown in green. The significance level was set at a <i>P</i> value of <0.05 with FWE correction.</p

Representative diffusion-weighted images with the 30 directions encoding scheme.

<p>The images were from the same subject and slice location, with forward phase-encoding blips (left panel), and with reversed phase-encoding blips (right panel). NC30 had an artifactual signal pileup around the frontal base of the skull, which was corrected not in EC30 with trilinear or spline but in ET30. The EC30 with trilinear interpolation were blurred, compared with EC30 with spline interpolation.</p