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- Anderberg, Leif
(författare)
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Cervical Radiculopathy: A Study With Selective Nerve Root Blocks
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cervical radiculopathy is diagnosed by history, clinical examination of the patient and magnetic resonance imaging (MRI) of the cervical spine. In many of the patients undergoing this diagnostic strategy, the nerve root/roots responsible for the radicular pain is difficult to define as clinical examination and MRI investigation does not provide information enough. The information from transforaminal selective diagnostic nerve root blocks with local anaesthetics (SNRB) when used in the cervical spine in patients with radiculopathy was evaluated in two prospective studies including 20 patients with mono segmental disc disease and 30 patients with two segmental disc disease. In another prospective study including nine patients, the contrast spread from three different volumes injected into the foraminal area was evaluated with multi-slice computed tomography. Furthermore, 40 patients were prospectively randomized for treatment with a transforaminal injection of saline and local anaesthetics or steroids and local anaesthetics in treatment of radicular pain. The patients were followed up after three weeks. In the mono-segmental study it was shown that positive response to a selective nerve root block predicted good/excellent surgical outcome in 100% of the patients. In the two segmental degenerated patients it was shown that diagnostic SNRB provided information not given by the MRI and/or clinical examination. The correlation between SNRB and MRI was 60 %, and between SNRB and clinical examination, 28 %. The positive response to the SNRB predicted good/excellent outcome in 82 % of the treated patients. Distribution from transforaminal SNRB was influenced by the injected volume and the foraminal area. Injection into a large foramen created a spread into the spinal canal distant from the injected site with possibility to reach nearby nerve roots. Injection into a narrow foramen created a spread along the vertebral artery with possible spread to other nerve roots. The nerve root above the injected level was more often at risk than the nerve root below and a volume of 0.5 of local anaesthetics is more reliable than 1.5 for diagnostic blocks. No difference was seen when comparing saline/local anaesthetics with steroids/local anaesthetics for the treatment of radiculopathy. Further studies have to be performed to evaluate the need for steroids in such treatment as the steroid component can produce serious complications when injected into spinal blood vessels.
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| 2. |
- Anderberg, Leif, et al.
(författare)
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Spinal cord injury : scientific challenges for the unknown future
- 2007
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Ingår i: Upsala Journal of Medical Sciences. - 0300-9734 .- 2000-1967. ; 112:3, s. 259-288
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Forskningsöversikt (övrigt vetenskapligt/konstnärligt)abstract
- The history of spinal cord injuries starts with the ancient Egyptian medical papyrus known as the Edwin Smith Surgical Papyrus. The papyrus, written about 2500 B. C. by the physician and architect of the Sakkara pyramids Imhotep, describes "crushed vertebra in his neck" as well as symptoms of neurological deterioration. An ailment not to be treated was the massage to the patients at that time. This fatalistic attitude remained until the end of World War II when the first rehabilitation centre focused on the rehabilitation of spinal cord injured patients was opened. Our knowledge of the pathophysiological processes, both the primary as well as the secondary, has increased tremendously. However, all this knowledge has only led to improved medical care but not to any therapeutic method to restore, even partially, the neurological function. Neuroprotection is defined as measures to counteract secondary injury mechanisms and/or limit the extent of damage caused by self-destructive cellular and tissue processes. The co-existence of several distinctly different injury mechanisms after trauma has provided opportunities to explore a large number of potentially neuroprotective agents in animal experiments such as methylprednisolone sodium succinate. The results of this research have been very discouraging and pharmacological neuroprotection for patients with spinal cord injury has fallen short of the expectations created by the extensive research and promising observations in animal experiments. The focus of research has now, instead, been transformed to the field of neural regeneration. This field includes the discovery of regenerating obstacles in the nerve cell and/or environmental factors but also various regeneration strategies such as bridging the gap at the site of injury as well as transplantation of foetal tissue and stem cells. The purpose of this review is to highlight selected experimental and clinical studies that form the basis for undertaking future challenges in the research field of spinal cord injury. We will focus our discussion on methods either preventing the consequences of secondary injury in the acute period ( neuroprotection) and/or various techniques of neural regeneration in the sub-acute and chronic phase and finally expose some thoughts about future avenues within this scientific field.
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