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Objective Deep brain stimulation (DBS) surgery has increasingly been performed for the treatment of movement disorders and is associated with a wide array of complications. We aimed to present our experience and discuss strategies to minimize adverse events in light of this contemporary series and others in the literature. Methods A retrospective chart review was conducted to collect data on age, sex, indication, operation date, surgical technique, and perioperative and late complications. Results A total of 181 patients (113 males, 68 females) underwent DBS implantation surgery (359 leads) in the past six years. Indications and targets were as follows: Parkinson's disease (STN) (n=159), dystonia (GPi) (n=13), and essential tremor (Vim) (n=9). Mean age was 55.2 ± 11.7 (range 9–74) years. Mean follow-up duration was 3.4 ± 1.6 years. No mortality or permanent morbidity was observed. Major perioperative complications were confusion (6.6%), intracerebral hemorrhage (2.2%), stroke (1.1%), and seizures (1.1%). Long-term adverse events included wound (7.2%), mostly infection, and hardware-related (5.5%) complications. Among several factors, only surgical experience was found to be related with overall complication rates (early period: 31% versus late period: 10%; p=0.001). Conclusion The rates of both early and late complications of DBS surgery are acceptably low and decrease significantly with cumulative experience.

Many patients may suffer from neuropathic pain in the early post-surgical period after lumbar discectomy. Gabapentin and pregabalin are anticonvulsant agents that may decrease perioperative central sensitization and early post-surgical neuropathic pain. Gabapentin and pregabalin effectively relieved neuropathic pain and prevented the conversion of acute pain to chronic pain at the 1-year follow-up after lumbar discectomy.

ABSTRACTimaging (USI). The use of these imaging methods increases the rate of success and decreases complications. Ultrasound is a good alternative to fluoroscopy, which has proven side effects (particularly radiation emission), is expensive and requires an additional technical team. Furthermore, in recent years, USI has been widely used in chronic pain cases as an effective and reliable imaging method (16).In the present study, we compared the results of ultrasoundand fluoroscopy-guided caudal epidural steroid injections in lumbar postlaminectomy patients in terms of efficacy, ease of administration, patient satisfaction, and complications. █ mATERIAl and mEThODSThis study was a prospective, randomized, and controlled single-blinded study. The study protocol was approved by █ INTRODUCTION L ow back pain (lumbago) is an important clinical problem in post-laminectomy patients. Unless treated early, it can attain a chronic neuropathic course, which requires a more complex therapy. For years, various epidural interventions (interlaminary, transforaminal, caudal) have been used for pain therapy in post-lumbar laminectomy (7). Caudal epidural blockade procures successful results in acute pain (in pediatric and adult inguinal and pelvic operations) as well as in chronic pain conditions (particularly in low back pain, pelvic pain, etc.) (13). For many years, caudal blockade had been administered utilizing the landmark technique. Since this technique does not provide adequate anesthesia and also causes some complications (dural perforation, hemorrhage, intraosseous injection, etc.), caudal blockade is currently performed under the guidance of fluoroscopy and ultrasound AIm:To compare the results of ultrasound and fluoroscopy guided caudal epidural steroid injections in postlaminectomy patients. mATERIAl and mEThODS: Thirty postlaminectomy patients were randomly divided into two groups, Group I (n=15) received ultrasound-guided and Group II (n=15) received fluoroscopy-guided caudal epidural local anesthetic and steroid injection. Time of block for each patient was recorded. The patients' visual analogue scale (VAS), Oswestry Disability Index (ODI), and satisfaction with the therapy during the 3-month follow-up were evaluated. RESUlTS:The caudal block performed with both methods resulted in similar improvement in low back pain and functions. Time of block was shorter in Group I than in Group II (6.06 ±0.88 minutes versus 11.2±1.14 minutes). CONClUSION:Caudal epidural steroid injection is an effective analgesic method for postlaminectomy patients. Ultrasound-guided caudal block can be as effective as fluoroscopy-guided block and even more comfortable.

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