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Zhai J, Gao B, Huang T, Zhang L. Reoperation of postoperative discal pseudocyst occurring after unilateral biprotal endoscopic surgery for HIVD: A rare case report. Asian J Surg 2024; 47:1811-1812. [PMID: 38160141 DOI: 10.1016/j.asjsur.2023.12.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Jinshuai Zhai
- The Department of Orthopedics,Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
| | - Bo Gao
- The Department of Orthopedics,Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
| | - Teng Huang
- The Department of Orthopedics,Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
| | - Long Zhang
- The Department of Orthopedics,Hebei General Hospital, Shijiazhuang, 050051, Hebei, China.
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Park JW, Park JY, Seo HW, Shin YD, Park SH. Successful treatment of facet joint synovial cyst through percutaneous rupture: a case report. Am J Transl Res 2023; 15:6299-6303. [PMID: 37969182 PMCID: PMC10641361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023]
Abstract
Facet joint synovial cysts can cause significant back pain and radiculopathy. Treatment options for symptomatic facet joint synovial cysts include surgical excision, facet joint steroid injections, and cyst aspiration. Herein, we report our experience of successfully rupturing a lumbar facet joint synovial cyst through a percutaneous approach with two needles using forceful pressure under C-arm fluoroscopic guidance. The patient experienced immediate symptom improvement that persisted throughout the 24-month follow-up. Our experience highlights that the volume effect technique is a valuable treatment option for symptomatic facet joint synovial cysts under fluoroscopic guidance.
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Gao K, Cao Y, Yu W, Liu W, Sun S, Wu Y. Postoperative discal pseudocyst caused by percutaneous endoscopic lumbar discectomy: two case reports and a literature review. J Int Med Res 2023. [DOI: 10.1177/03000605231158018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Postoperative discal pseudocyst (PDP) is a rare complication that can occur after percutaneous endoscopic lumbar discectomy (PELD), microendoscopic discectomy, and laminectomy. The PDP pathogenesis and pathological process remain unclear. We described two PDP cases following PELD, with long-term follow-up results. The first patient was an Asian male, 30 years old, who experienced unbearable low back pain with right lower limb radiating pain for 2 years. The second patient was also an Asian male, 21 years old, who experienced low back pain with bilateral lower limb numbness. Both patients were diagnosed with lumbar disc herniation, underwent PELD, and relapsed after discharge. The diagnosis was PDP in each case, and conservative treatment was initiated with oral anti-inflammatory drugs and rest. Eventually, the symptoms in both patients resolved. Magnetic resonance imaging showed that the discal cysts had disappeared. The follow-up of these two PDP cases after PELD showed good results, demonstrating that PDP may be a self-healing disease. Conservative treatment is effective, and surgery should be performed only in an emergency. These case reports and literature review can help improve the understanding of PDP.
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Affiliation(s)
- Kun Gao
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yafei Cao
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Weiji Yu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Weidong Liu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Shufen Sun
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yihong Wu
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Zhu B, Shang L, Han X, Li X, Wang H, Sang P, Lv C, Li J, Liu X. Revision surgery for symptomatic postoperative pseudocyst following full-endoscopic lumbar discectomy: clinical characteristics and surgical strategies. BMC Musculoskelet Disord 2022; 23:835. [PMID: 36057592 PMCID: PMC9440536 DOI: 10.1186/s12891-022-05791-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A symptomatic postoperative pseudocyst (PP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to worse symptoms. Some minority patients who developed PP experienced rapidly aggravating symptoms and could not be treated by any kind of conservative treatment. However, no clinical studies have evaluated the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after full-endoscopic lumbar discectomy (FELD). This study aimed to demonstrate the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after FELD. METHODS We retrospectively analyzed the data of patients who received FELD revision surgeries due to symptomatic PP formation between January 2016 and December 2021. Common characteristics, time intervals of symptom recurrence and revision surgery, strategies for conservative treatment and revision surgery, operative time, imaging characteristics, numeric rating scale (NRS) score, Oswestry disability index (ODI) and overall outcome rating based on modified MacNab criteria were analyzed. RESULTS Fourteen patients (males = 10, females = 4), with a mean age of 24.4 years, were enrolled. The mean time intervals of symptom recurrence and revision surgery were 43.5 and 18.9 days respectively. While the patients were conservatively managed with analgesics and physical therapy, pain persisted or progressively worsened. In comparison to the initial herniated disc, the PP was larger in 11 cases, and up- or down-migrated in four cases. The PP location included the lateral recess (n = 12), foraminal (n = 1), and centrolateral (n = 1) zones. One of the two cases treated by percutaneous aspiration (PA) was eventually treated by FELD as pain was not relieved. Follow-ups revealed an improved mean NRS score from 7.1 to 1.4, mean ODI from 68.6 to 7.9% and promising overall surgical outcomes. CONCLUSIONS The progressively severe pain experienced due to PP might be a result of its enlargement or migration to the lateral recess and foraminal zones. As complete removal of capsule is the goal, we recommend FELD instead of PA.
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Affiliation(s)
- Bin Zhu
- Department of Orthopaedics, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Lanpu Shang
- Pain Medicine Centre, Peking University Third Hospital, Beijing, China
| | - Xiao Han
- Department of Spine, Beijing Jishuitan Hospital, Beijing, China
| | - Xingchen Li
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hongchen Wang
- Department of Orthopaedics, Beijing Renhe Hospital, Beijing, China
| | - Peiming Sang
- Department of Orthopaedics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Chaoliang Lv
- Department of Orthopaedics, Jining NO.1 People's Hospital, Jining, Shandong, China
| | - Jian Li
- Department of Orthopaedics, Jinan Central Hospital, Jinan, Shandong, China
| | - Xiaoguang Liu
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, 100191, Beijing, People's Republic of China.
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Jadhav N, Sivakumar L, Talibi SS, Momoh P, Rasul F, Hussain R, Shad A. Lumbar discal cyst and post-operative discal pseudocyst: a case series. J Surg Case Rep 2022; 2022:rjac239. [PMID: 35665395 DOI: 10.1093/jscr/rjac239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022] Open
Abstract
Four cases of lumbar cyst (2 discal cysts and 2 post-operative discal pseudocysts) who presented predominantly with features of sciatica without any motor, sensory or sphincteric disturbances. The patients were treated conservatively, and the management was aimed to avert any untoward surgical intervention taking into consideration patient safety and care. Two had previous lumbar decompressive discectomy. During the mean follow-up period of 13 months, there was progressive recovery of symptoms in all our 4 patients. All our patients were successfully managed by conservative approach. An intervertebral disc cyst should be considered in young patients in the differential diagnosis of any extradural intraspinal mass ventral to the thecal sac, notwithstanding its rarity. Alongside, conservative management can be offered as first line of management with appropriate patient selection that is absence of any motor/sensory/sphincteric disturbances. Facetal micro-instability could be one of the aetiologies of this pathology which necessitates further study.
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Affiliation(s)
- Neha Jadhav
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Lawrence Sivakumar
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Sayed Samed Talibi
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Pearl Momoh
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Fahid Rasul
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Rahim Hussain
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
| | - Amjad Shad
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS trust, Coventry, UK
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Fu CF, Tian ZS, Yao LY, Yao JH, Jin YZ, Liu Y, Wang YY. Postoperative discal pseudocyst and its similarities to discal cyst: A case report. World J Clin Cases 2021; 9:1439-1445. [PMID: 33644213 PMCID: PMC7896671 DOI: 10.12998/wjcc.v9.i6.1439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative discal pseudocyst (PDP) is a rare condition that presents after surgery for lumbar disc herniation. Due to the lack of information, the diagnosis and treatment of PDP remain controversial. Herein, we report a PDP case that occurred following percutaneous endoscopic lumbar discectomy and received conservative treatment. Additionally, we review all the published literature regarding PDP and propose our hypothesis regarding PDP pathology.
CASE SUMMARY A 23-year-old man presented with a relapse of low back pain and numbness in his left lower extremity after undergoing percutaneous endoscopic lumbar discectomy for lumbar disc herniation. Repeat magnetic resonance imaging demonstrated a cystic lesion at the surgical site with communication with the inner disc. The patient was diagnosed as having PDP. The patient received conservative treatment, which resulted in rapid improvement and spontaneous regression of the lesion, and had a favorable outcome in follow-up.
CONCLUSION PDP and discal cyst (DC) exhibit similarities in both histological and epidemiological characteristics, which indicates the same pathological origin of PDP and DC. The iatrogenic annular injury during discectomy might accelerate the pathological progression of DC. For patients with mild to moderate symptoms, conservative treatment can lead to great improvement, even inducing spontaneous regression. However, surgical cystectomy is necessary in patients with neurological deficits and where conservative treatment is ineffective.
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Affiliation(s)
- Chang-Feng Fu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zhi-Sen Tian
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Li-Yu Yao
- Department of Pediatric Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ji-Hang Yao
- Department of Traumatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yuan-Zhe Jin
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ying Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yuan-Yi Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
- Department of Spine Surgery, Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun 130021, Jilin Province, China
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Li J, Liang S, Xie W, Luo J, Tang J, Liu L, Li Y, Wu C, Li X. Symptomatic postoperative discal pseudocyst following percutaneous endoscopic lumbar discectomy: A case report and review of the literature. Medicine (Baltimore) 2021; 100:e24026. [PMID: 33545999 PMCID: PMC7837847 DOI: 10.1097/md.0000000000024026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Percutaneous endoscopic lumbar discectomy (PELD) is an effective treatment for lumbar disc herniation and postoperative discal pseudocyst (PDP) can rarely develop after PELD. PATIENT CONCERNS A 30-year-old man experienced low back pain and pain in the right lower extremity for 1 month, which aggravated for 3 days. DIAGNOSES Preoperative CT and MRI showed lumbar disc herniation at the L4/5 level. Then the patient underwent PELD under local anesthesia and his symptoms disappeared immediately after surgery. After 37 days of PELD, the patient complained of recurrent low back pain on the right side, and pain on the outer side of his lower leg. MR imaging revealed cystic mass with low signal on T1-weighted images (T1WI), and high signal on T2-weighted images (T2WI). The patient was diagnosed with a symptomatic PDP after PELD. INTERVENTIONS Initially, the patient was treated with conservative treatment, including administration of aescin and mannitol by intravenous infusion, physical therapy, sacral canal injection. Then he underwent discography at L4/5 and ozone ablation under local anesthesia. OUTCOMES The patient's condition improved significantly after 1 week of surgery and was discharged. One-year and 3-month follow-up revealed no recurrence of low back pain and leg pain. LESSONS PDP is one of the rare complications of PELD, usually occurs in young patients. Patients with PDP have a low signal intensity on T1WI and high signal intensity on T2WI, which can be treated by conservative treatment, interventional therapy, and surgical treatment.
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Affiliation(s)
- Junjie Li
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, 430079, Hubei
| | - Shuhan Liang
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, 430079, Hubei
| | - Wei Xie
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, 430079, Hubei
| | - Jinxin Luo
- Hunan Liuyang Orthopaedics Hospital, Liuyang, 410327, Hunan, China
| | - Jin Tang
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, 430079, Hubei
| | - Liu Liu
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, 430079, Hubei
| | - Ying Li
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, 430079, Hubei
| | - Congjun Wu
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, 430079, Hubei
| | - Xugui Li
- Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, 430079, Hubei
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Park JW, Lee BJ, Jeon SR, Rhim SC, Park JH, Roh SW. Surgical Treatment of Lumbar Spinal Discal Cyst: Is It Enough to Remove the Cyst Only without Following Discectomy? Neurol Med Chir (Tokyo) 2019; 59:204-212. [PMID: 31068543 PMCID: PMC6580042 DOI: 10.2176/nmc.oa.2018-0219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Discal cysts are a rare cause of low back pain and radiculopathy with unknown pathophysiologic mechanism. Associated symptoms are difficult to distinguish from those caused by extruded discs and other spinal canal lesions. Most discal cysts are treated surgically, but it is unclear whether the corresponding intervertebral disc should be excised along with cyst. We conducted a retrospective clinical review of 27 patients who underwent discal cyst excision at our institution between 2000 and 2017. The mean follow-up period was 63.6 months. We recorded symptoms, radiographs, operative findings, postoperative complications, and short- and long-term outcomes. Structured outcome assessment was based on Numeric Rating Scale (NRS) for pain intensity, Oswestry disability index, and Macnab classification. All patients underwent partial hemilaminectomy and microscopic cyst resection without discectomy. All patients had preoperative back or leg pain. Other preoperative clinical features included motor weakness, neurogenic intermittent claudication, and cauda equina syndrome. After surgery, NRS scores of back and leg pain decreased. The other symptoms also improved. During long-term follow-up, patients reported no restrictions on daily life activities, and were satisfied with our intervention. There were no cases of cyst recurrence. We conducted a review of the literature on lumbar discal cysts published before January, 2018. Including our cases, 126 patients were described. We compared two surgical modalities—cystectomy with and without discectomy—to elucidate both effectiveness and long-term complications. We found that microsurgical cystectomy without corresponding discectomy is an effective surgical treatment for lumbar discal cysts, and is associated with a low recurrence rate.
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Affiliation(s)
- Jung Won Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Byung-Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Research Center
| | - Sang-Ryong Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Seung-Chul Rhim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung Woo Roh
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine
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Manabe H, Higashino K, Sugiura K. A Rare Case of a Discal Cyst Following Percutaneous Endoscopic Lumbar Discectomy via a Transforaminal Approach. Int J Spine Surg 2019; 13:92-94. [PMID: 30805291 DOI: 10.14444/6012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A discal cyst is a rare lesion that causes low back pain and radiculopathy of the lower extremities. There are several reports of discal cysts occurring after surgery, but data are limited on their occurrence after percutaneous endoscopic discectomy (PED). A 21-year-old man with disc herniation at the L4-L5 disc level underwent PED via a transforaminal approach. The immediate postoperative course was uneventful and his symptoms were relieved. Six weeks after surgery, low back pain and mild pain in the left thigh recurred. Magnetic resonance imaging (MRI) revealed a cystic lesion adjacent to the left side of the L4-L5 intervertebral disc. Conservative treatment was ineffective, so we reoperated using PED with the same approach. Pain improved and MRI revealed disappearance of the cystic lesion. When symptoms relapse after PED, it is necessary to consider the occurrence of a cyst.
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Affiliation(s)
- Hiroaki Manabe
- Orthopedic Surgery, Takamatsu Municipal Hospital, Takamatsu City, Kagawa, Japan
| | - Kosaku Higashino
- Orthopedic Surgery, Takamatsu Municipal Hospital, Takamatsu City, Kagawa, Japan
| | - Kosuke Sugiura
- Orthopedic Surgery, Takamatsu Municipal Hospital, Takamatsu City, Kagawa, Japan
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Park CJ, Shin YD, Lim SW, Bae YM. The effect of facet joint injection on lumbar spinal stenosis with radiculopathy. Pak J Med Sci 2018; 34:968-973. [PMID: 30190763 PMCID: PMC6115579 DOI: 10.12669/pjms.344.15010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: Facet Joint Injection (FJI) is known to be effective in axial back pain, but the purpose of this study was to assess the effects of FJI on patients treated with it among those with Lumbar Spinal Stenosis (LSS). Methods: We conducted a retrospective database analysis and investigated electronic medical records of 125 LSS patients treated with FJI in the pain clinic of Chungbuk National University Hospital from November 2, 2016 to July 31, 2017. Sex, age, histories of low back surgery, complaining of neurogenic claudication, symptomatic sites of patients, FJI sites, number of sites of FJI, triamcinolone dosage, Numeric Rating Scale (NRS) before and after treatment, facet joint capsule rupture during treatment, and improvement of neurogenic claudication after treatment, were examined. Results: Among 125 patients, we investigated 91 patients who met the criteria. There was significant difference in NRS before and after treatment (p<0.000). Forty one patients with reduction of NRS more than 30% after FJI were allocated to effect group. FJI was more effective in patients who did not have the surgery (p=0.044), as well as those who showed an improved neurogenic claudication after treatment (p=0.001). Other measured values did not show statistical significances. Conclusions: FJI has relatively a lower risk and is simpler in terms of techniques than other interventional treatments performed within the spinal canal. Therefore, FJI may be another interventional treatment option in patients with pain by LSS. In the future, studies for FJI indication in LSS patients should be additionally required.
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Affiliation(s)
- Chan Jin Park
- Chan Jin Park, MD. Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Korea
| | - Young Duck Shin
- Prof. Dr. Young Duck Shin, MD, PhD. Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Korea
| | - Seung Woon Lim
- Seung Woon Lim, MD, PhD. Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Korea
| | - Yoo Mee Bae
- Yoo Mee Bae, MD. Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Korea
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