We investigated factors associated with improvement in pain and disability in patients with a spinal disease under a conservative pain treatment. We analyzed 185 patients who visited the Interdisciplinary Pain Center of Keio University Hospital from July 2018 to December 2019. We collected patients' demographic and therapeutic data, and assessed the Brief Pain Inventory (BPI) and Pain Disability Assessment Scale (PDAS) at the first visit and at 3 months. Improvements in pain and disability were defined as a ≥50％ and ≥30％ reduction in the BPI and PDAS, respectively. Shorter duration of pain and treatment with nerve blocks were significantly associated with a greater reduction in the BPI. Younger age, shorter duration of pain, and no history of spinal surgery were significantly associated with a greater reduction in the PDAS. We concluded that the duration of pain, age, nerve blocks, and history of spinal surgery are important factors associated with improvement in pain and disability in patients with a spinal disease.
At present, computed tomography (CT) myelography, magnetic resonance myelography, and radioisotope cisternography (RIC) are the main diagnostic imaging techniques for cerebrospinal fluid leakage. RIC is used in our hospital, although only a few cases can be diagnosed with RIC alone. We encountered three cases in whom a definitive diagnosis was possible using RIC combined with single photon emission CT (SPECT/CT). SPECT/CT is a three-dimensional imaging technique that measures the administered radiation distribution and superimposes it onto the CT image. SPECT/CT clearly showed the anatomical position of the leakage site, could accurately determine the leakage direction, and led to leakage site healing following treatment with an effective epidural blood patch. If CT myelography cannot be performed because of a contrast agent allergy, or if a clear diagnosis cannot be made on the basis of existing imaging criteria, combining RIC with SPECT/CT may provide a sensitive diagnostic option for cerebrospinal fluid leakage.
A 46-year-old woman, 157 cm 58 kg, underwent left total hip arthroplasty after lumbar plexus block and sciatic nerve block via the parasacral approach. Postoperative X-ray revealed 20-mm leg extension. After surgery, both legs had movement disorder and sensory disturbance, which improved within a few hours. Lumbar plexus block was considered to be an epidural block. Thereafter, sensory and motor disorders slightly improved, but recovery of dorsiflexion movement of the left ankle joint was delayed and mild peroneal neuropathy at the level of the peroneal head was diagnosed by electromyography 28 days after surgery. Thirty-two days after surgery, the patient was discharged with stable walking using a cane. The neurological symptoms were suspected to be caused by physical factors, such as hyperextension of the peroneal nerve, because the neuropathy was at the level of the peroneum. We also cannot exclude the possibility that this nerve block affected paralysis.
Background: Pain after scoliosis correction surgery is severe. Pain management is difficult, especially in children. Case: An 11-year-old female underwent scoliosis correction surgery. In addition to postoperative wound pain, numbness and pain in the right chest and axilla suggested neuropathic pain. She received fentanyl intravenous patient-controlled analgesia (IVPCA) for pain management. On the 5th postoperative day, she refused to discontinue IVPCA. Due to fear, she refrained from touching and washing her hair. Therefore, although it was an off-label use for children, we administered pregabalin in order to discontinue IVPCA. Afterwards, she was able to change her posture and begin rehabilitation. Discussion: In Japan, only a few oral analgesic types are considered usable for children, and opioids are contraindicated. Postoperative pain after spinal surgery is a mixture of nociceptive and neuropathic pain. Thus, pregabalin is effective for managing postoperative pain associated with scoliosis in children.