Effect of long-term intake of spa water on gastric mucosal blood flow was evaluated using an endoscopic organ reflex spectrophotometry together with an Olympus XQ-10 forward-viewing gastrofiberscope. Three healthy volunteers and nine patients with gastric diseases in remission (six with healed gastric ulcer and three with chronic gastritis) underwent two-week treatment consisting of daily intake of Misasa spa water (weakly radon containing bicarbonate salt spring, 38 to 42°C, 200ml, two times a day between meals), and gastric mucosal blood flow was measured at three spots of the stomach (lesser curvature of the pylorus, antrm, and angle) before and after the treatment period. Life style and medication were kept unchanged during the period. The following results were obtained:
1) Gastric mucosal blood flows (IHb) measured before and after the treatment were respectively 95.0±18.0 and 98.2±15.4 at the pylorus, 104.8±16.9 and 110.8±12.8 at the antrum, 116.1±20.4 and 118.7±18.5 at the angle.
2) Values measured after the treatment were higher than those measured before the treatment at pylorus in 75% of the patients and at the antrum and angle in 67% of the pa-tients.
3) However, assessment of the mean values before and after the treatment using the student's paired t-test revealed a significant increase in blood flow (P<0.05) only at the antrum.
Further studies are in progress to determine (1) the clinical significance of the improvement in gastric mucosal blood flow, such as the maintenance of remission, and (2) the characteristics of gastric diseases which are likely to respond favorably to the treament of taking spa water.

STUDY DESIGN: Retrospective analysis. PURPOSE: The present study aimed to investigate the features of low back pain (LBP) due to superior cluneal nerve (SCN) entrapment neuropathy (SCN-EN) using the Roland Morris Disability Questionnaire (RMDQ), and to analyze the differences between LBP due to SCN-EN and lumbar spinal canal stenosis (LSS). OVERVIEW OF LITERATURE: The SCN is derived from the cutaneous branches of the dorsal rami of T11–L5 and passes through the thoracolumbar fascia. LBP due to SCN-EN is exacerbated by various types of lumbar movement, and its features remain to be fully elucidated, often resulting in the misdiagnosis of lumbar spine disorder. METHODS: The present study included 35 consecutive patients with SCN-EN treated via nerve blocks or surgical release between April 2016 and August 2017 (SCN-EN group; 16 men, 19 women; mean age, 65.5±17.0 years; age range, 19–89 years). During the same period, 33 patients were surgically treated with LSS (LSS group; 19 men, 14 women; mean age, 65.3±12.0 years; age range, 35–84 years). The characteristics of LBP were then compared between patients with SCN-EN and those with LSS using the RMDQ. RESULTS: The duration of disease was significantly longer in the SCN-EN group than in the LSS group (26.0 vs. 16.0 months, p=0.012). Median RMDQ scores were significantly higher in the SCN-EN group (13 points; interquartile range, 8–15 points) than in the LSS group (7 points; interquartile range, 4–9 points; p<0.001). For seven items (question number 1, 8, 11, and 20–23), the ratio of positive responses was higher in the SCN-EN group than in the LSS group. CONCLUSIONS: Patients with SCN-EN exhibit significantly higher RMDQ scores and greater levels of disability due to LBP than patients with LSS. The findings further demonstrate that SCN-EN may affect physical and psychological function.

STUDY DESIGN: Retrospective study (level of evidence=3). PURPOSE: We examine the relationship between residual symptoms after discectomy for lumbar disc herniation and peripheral nerve (PN) neuropathy. OVERVIEW OF LITERATURE: Patients may report persistent or recurrent symptoms after lumbar disc herniation surgery; others fail to respond to a variety of treatments. Some PN neuropathies elicit symptoms similar to those of lumbar spine disease. METHODS: We retrospectively analyzed data for 13 patients treated for persistent (n=2) or recurrent (n=11) low back pain (LBP) and/or leg pain after primary lumbar discectomy. RESULTS: Lumbar re-operation was required for four patients (three with recurrent lumbar disc herniation and one with lumbar canal stenosis). Superior cluneal nerve (SCN) entrapment neuropathy (EN) was noted in 12 patients; SCN block improved the symptoms for eight of these patients. In total, nine patients underwent PN surgery (SCN-EN, n=4; peroneal nerve EN, n=3; tarsal tunnel syndrome, n=1). Their symptoms improved significantly. CONCLUSIONS: Concomitant PN disease should be considered for patients with failed back surgery syndrome manifesting as persistent or recurrent LBP.
Diskectomy ; Failed Back Surgery Syndrome ; Humans ; Leg ; Low Back Pain ; Lumbosacral Region ; Nerve Compression Syndromes ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Retrospective Studies ; Spine ; Tarsal Tunnel Syndrome