The diverse features of apophyseal fracture lead to various modalities of classifications and operation options. Prior to operation, the surgeons should carefully make a plan to consider decompressive scope, removal of apophyseal fragment or/and disc and fusion or not. Because of methodological shortcomings in publications, it is not possible to definitively conclude what treatment modality is the best for the treatment of PRAF. More high-quality clinical studies are needed to draw more confirmable conclusions.

Small-molecule vascular disrupting agents (VDAs) target the established tumor blood vessels, resulting in rapidly and selectively widespread ischemia and necrosis of central tumor; meanwhile, blood flow in normal tissues is relatively unaffected. Although VDAs therapy is considered an important option for treatment, its use is still limited. The tumor cells at the periphery are less sensitive to vascular shutdown than those at the center, and subsequently avoid a nutrient-deprived environment. This phenomenon is referred to as tumor resistance to VDAs treatment. The viable periphery rim of tumor cells contributes to tumor regeneration, metastasis, and ongoing progression. However, there is no systematic review of the plausible mechanisms of repopulation of the viable tumor cells following VDAs therapy. The purpose of this review is to provide insights into mechanisms of tumor surviving small-molecule VDAs therapy, and the synergetic treatment to the remaining viable tumor cells at the periphery.

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Introduction: The physical, socioeconomic and psychological burden of low back pain is enormous. The poor socioeconomic condition and geographical constrains confines people to limited health facilities. The objective of the study was to evaluate whether combination of caudal epidural steroids with local anaesthetics and gabapentin is effective for radicular low back pain in the rural Nepal setting. Methods: It was a prospective observational study including 300 patients with radicular low back pain done over a period of 6 months (13/4/2016 to 30/10/2016). All participants received caudal epidural steroid injection (6ml 2% Xylocaine with adrenaline plus Depomedroxy steroid 80mg plus 12 ml distilled water) and 200 mg gabapentin daily for three months. All patients were followed up for three months and were evaluated. Results: Mean age of presentation was 41.21 years (SD ± 11.02) with majority of farmers (42.31%). Mean Numerical Rating Scale at the baseline was 8.01(SD±1.00) and at the first follow up was 3.98 (SD±0.83) (p <0.001). Mean Oswestry Disability Index at baseline was7.85 (SD±0.98) and at the first follow up was 4.04 (SD±0.80) (p <0.001). Straight Leg Raising Test at baseline was less than 70° in 84.7% which improved to more than 70° in 87.9% of the patients (p-value <0.001). Conclusion: Caudal epidural steroids combined with gabapentin is safe, economical and technically less demanding. This treatment modality can be used with good outcomes in the rural areas with limited diagnostic and therapeutic facilities.