No abstract

BackgroundWe have developed an intradiscal pulsed radiofrequency (Disc PRF) technique, using Diskit II® needles (NeuroTherm, Wilmington, MA, USA), as a minimally invasive treatment option for chronic discogenic low back pain (LBP). The purpose of this study was to compare the representative outcomes of Disc PRF and Intradiscal Electrothermal Therapy (IDET) in terms of pain relief and reduction of disability.MethodsThirty-one patients with chronic discogenic LBP who underwent either Disc PRF (n = 15) or IDET (n = 16) were enrolled in the study. A Diskit II® needle (15-cm length, 20-gauge needle with a 20-mm active tip) was placed centrally in the disc. PRF was applied for 15 min at a setting of 5 × 50 ms/s and 60 V. The pain intensity score on a 0-10 numeric rating scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) were assessed pretreatment and at 1, 3, and 6 months post-treatment.ResultsThe mean NRS was significantly improved from 7.2 ± 0.6 pretreatment to 2.5 ± 0.9 in the Disc PRF group, and from 7.5 ± 1.0 to 1.7 ± 1.5 in the IDET group, at the 6-month follow-up. The mean RMDQ also showed significant improvement in both the Disc PRF group and the IDET group at the 6-month follow-up. There were no significant differences in the pretreatment NRS and RMDQ scores between the groups.ConclusionsDisc PRF appears to be an alternative to IDET as a safe, minimally invasive treatment option for patients with chronic discogenic LBP.

IDHP produced significant effects on patients with radicular pain, leading to the improvement of VAS and JOA. Although IDHP displayed slightly less efficacy than MED, IDHP appears to be an alternative as a nonoperative treatment for a lumbar intervertebral disc extrusion.

An investigation was conducted on the frequency of accidental extubations at Shizuoka Children's Hospital during the past 12 years. The study was performed on 150 randomly selected patients who received respiratory support for more than 24 hr. Fifteen accidental extubations occurred in 9 patients. Most of them (87%) occurred in the neonatal intensive care unit (NICU), and the rate was 1 per 54 days of intubation. The time at which these accidents happened varied, although they were more common during the day-time. The reasons of accidental extubation could not be specified in two-thirds of the cases. It became clear that more immature babies were more likely to suffer accidental extubation, perhaps reflecting the fact that most of the immature babies in the NICU were intubated orally, and that a larger proportion of them required a longer period of respiratory support. Therefore, early weaning from respiratory support is recommended if it is possible. In conclusion, increased surveillance and more secure methods of taping of endotracheal tubes are crucial for preventing life-threatening accidental extubations during respiratory support.

The intradiscal high-pressure injection of saline and lidocaine (IDHP) is a minimally invasive percutaneous procedure for a lumbar intervertebral disc extrusion. The purpose of this study was to investigate the clinical outcomes of IDHP in terms of pain relief, reduction of disability, and risk of complications. Thirty patients with primarily radicular pain due to an extrusion-type disc herniation who underwent IDHP were enrolled in the study. A visual analogue pain scale (VAS) and the Japanese Orthopedic Association (JOA) scoring system for the treatment of low back disorders were used at pre-treatment, 2 weeks post-treatment, and 3 months post-treatment. The mean VAS decreased significantly (p < 0.01) from 64.3 mm at pre-treatment to 26.3 mm at 2 weeks post-treatment and 15.5 at 3 months post-treatment. The mean JOA score improved significantly (p < 0.01) from 14.7 to 21.3 at 2 weeks post-treatment and 24.6 at 3 months post-treatment. IDHP appeared to produce significant effects in patients with radicular pain, leading to the improvement of VAS and JOA scores. IDHP appears to be a safe, minimally invasive treatment option for a lumbar intervertebral disc extrusion.