Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptom...Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.展开更多
The lack of truly robust analgesics for chronic pain is owed,in part,to the lack of an animal model that reflects the clinical pain state and of a mechanismbased,objective neurological indicator of pain.The present st...The lack of truly robust analgesics for chronic pain is owed,in part,to the lack of an animal model that reflects the clinical pain state and of a mechanismbased,objective neurological indicator of pain.The present study examined stimulus-evo ked brain activation with functional magnetic resonance imaging in male and female cynomolgus macaques following unilateral L7 spinal nerve ligation and the effects of clinical analgesics pregabalin,duloxetine,and morphine on brain activation in these macaques.A modified straight leg raise test was used to assess pain severity in awake animals and to evo ke regional brain activation in anesthetized animals.The potential effects of clinical analgesics on both awake pain behavior and regional brain activation were examined.Following spinal nerve ligation,both male and female macaques showed significantly decreased ipsilateral straight leg raise thresholds,suggesting the presence of radicula rlike pain.Morphine treatment increased straight leg raise thresholds in both males and females whereas duloxetine and pregabalin did not.In male macaques,the ipsilateral straight leg raise activated contralateral insular and somatosensory cortex(Ins/SII),and thalamus.In female macaques,the ipsilateral leg raise activated cingulate cortex and contralateral insular and somatosensory cortex.Straight leg raises of the contralateral,unligated leg did not evoke brain activation.Morphine reduced activation in all brain regions in both male and female macaques.In males,neither pregabalin nor duloxetine decreased brain activation compared with vehicle treatment.In females,however,pregabalin and duloxetine decreased the activation of cingulate cortex compared with vehicle treatment.The current findings suggest a diffe rential activation of brain areas depending on sex following a peripheral nerve injury.Diffe rential brain activation observed in this study could underlie qualitative sexual dimorphism in clinical chronic pain perception and responses to analgesics.Future pain management approaches for neuropathic pain will need to consider potential sex differences in pain mechanism and treatment efficacy.展开更多
目的探讨影像引导下经椎间孔微电流刺激联合神经根封闭对腰椎间盘突出症临床疗效。方法选取收治的腰椎间盘突出症患者42例,随机分为神经根封闭组与神经根封闭联合微电流刺激组,通过对患者进行VAS和JOA评分对比2组治疗效果。结果治疗后...目的探讨影像引导下经椎间孔微电流刺激联合神经根封闭对腰椎间盘突出症临床疗效。方法选取收治的腰椎间盘突出症患者42例,随机分为神经根封闭组与神经根封闭联合微电流刺激组,通过对患者进行VAS和JOA评分对比2组治疗效果。结果治疗后各个时间点VAS评分低于术前,差异有统计学意义(P<0.05)。治疗后各个时间点JOA评分高于术前,差异有统计学意义(P<0.05)。术后3 d 2组VAS和JOA评分差异无统计学意义(P>0.05),术后1个月、3个月、6个月及12个月差异有统计学意义(P<0.05)。结论经椎间孔入路微电流刺激联合神经根封闭是治疗腰椎间盘突出症的有效方法。展开更多
文摘Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.
文摘The lack of truly robust analgesics for chronic pain is owed,in part,to the lack of an animal model that reflects the clinical pain state and of a mechanismbased,objective neurological indicator of pain.The present study examined stimulus-evo ked brain activation with functional magnetic resonance imaging in male and female cynomolgus macaques following unilateral L7 spinal nerve ligation and the effects of clinical analgesics pregabalin,duloxetine,and morphine on brain activation in these macaques.A modified straight leg raise test was used to assess pain severity in awake animals and to evo ke regional brain activation in anesthetized animals.The potential effects of clinical analgesics on both awake pain behavior and regional brain activation were examined.Following spinal nerve ligation,both male and female macaques showed significantly decreased ipsilateral straight leg raise thresholds,suggesting the presence of radicula rlike pain.Morphine treatment increased straight leg raise thresholds in both males and females whereas duloxetine and pregabalin did not.In male macaques,the ipsilateral straight leg raise activated contralateral insular and somatosensory cortex(Ins/SII),and thalamus.In female macaques,the ipsilateral leg raise activated cingulate cortex and contralateral insular and somatosensory cortex.Straight leg raises of the contralateral,unligated leg did not evoke brain activation.Morphine reduced activation in all brain regions in both male and female macaques.In males,neither pregabalin nor duloxetine decreased brain activation compared with vehicle treatment.In females,however,pregabalin and duloxetine decreased the activation of cingulate cortex compared with vehicle treatment.The current findings suggest a diffe rential activation of brain areas depending on sex following a peripheral nerve injury.Diffe rential brain activation observed in this study could underlie qualitative sexual dimorphism in clinical chronic pain perception and responses to analgesics.Future pain management approaches for neuropathic pain will need to consider potential sex differences in pain mechanism and treatment efficacy.
文摘目的探讨影像引导下经椎间孔微电流刺激联合神经根封闭对腰椎间盘突出症临床疗效。方法选取收治的腰椎间盘突出症患者42例,随机分为神经根封闭组与神经根封闭联合微电流刺激组,通过对患者进行VAS和JOA评分对比2组治疗效果。结果治疗后各个时间点VAS评分低于术前,差异有统计学意义(P<0.05)。治疗后各个时间点JOA评分高于术前,差异有统计学意义(P<0.05)。术后3 d 2组VAS和JOA评分差异无统计学意义(P>0.05),术后1个月、3个月、6个月及12个月差异有统计学意义(P<0.05)。结论经椎间孔入路微电流刺激联合神经根封闭是治疗腰椎间盘突出症的有效方法。
