Pulsed radiofrequency in the treatment of coccygodynia.

By London Spine
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Pulsed radiofrequency in the treatment of coccygodynia.

Agri. 2011 Jan;23(1):1-6

Authors: Atim A, Ergin A, Bilgiç S, Deniz S, Kurt E

Abstract
OBJECTIVES: Coccygodynia is a clinical condition characterized by pain and tenderness around the coccygeal region. Trauma is the most common etiologic factor. We aimed to investigate the effectiveness of pulsed radiofrequency (PRF) treatment in patients with coccygodynia that could not be relieved by classic treatment protocols, and we present our long-term results with caudal epidural PRF.
METHODS: The study included 21 patients who were treated for coccygodynia by caudal epidural PRF in our Pain Clinic. Sixteen patients (76%) had a history of trauma, three patients (14%) had previous surgery, and two patients (10%) had idiopathic coccygodynia with no identifiable cause. All patients had been previously treated with conservative methods, but none had pain relief. Pain level of the patients was assessed by visual analog scale (VAS) score. A questionnaire to evaluate subjective patient satisfaction was also used at the 3rd-week and the 6th-month follow-ups.
RESULTS: Median VAS score was 8 at baseline, decreased to 2 by the 3rd week and was 2 at the 6th month. VAS at the 3rd week and 6th month were significantly lower compared to baseline (p<0.001). At the 6th month, 12 patients (57%) had excellent results, 5 patients (24%) had good results and only 4 patients (19%) had poor results regarding the subjective patient satisfaction questionnaire.
CONCLUSION: Caudal epidural PRF may be an alternative to surgery for coccygodynia patients who are unresponsive to classic treatment methods.

PMID: 21341145 [PubMed – indexed for MEDLINE]

Severe headache following ozone therapy: Pneumocephalus.

By London Spine
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Severe headache following ozone therapy: Pneumocephalus.

Agri. 2017 Jul;29(3):132-136

Authors: Toman H, Özdemir U, Kiraz HA, Lüleci N

Abstract
Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.

PMID: 29039154 [PubMed – in process]