BACKGROUND: Although both pregabalin and gabapentin are known to be useful for treating lumbar radiating pain and reducing the incidence of surgery, the oral corticosteroids sometimes offer a dramatic effect on severe radiating pain despite the lack of scientific evidence. METHODS: A total of 54 patients were enrolled among 703 patients who complained of lumbar radiating pain. Twenty patients who received an oral corticosteroid was classified as group A and 20 patients who received the control drugs (pregabalin or gabapentin) as group B. Oswestry Disability Index (ODI), Revised Roland Morris disability questionnaire (RMDQ), Short Form 36 (SF-36) questionnaire, lumbar radiating pain, objective patient satisfaction, and objective improvement of patients or physicians were assessed at 2, 6, and 12 weeks after medication. RESULTS: No difference in the sex ratio and age was observed between the groups (p = 0.70 and p = 0.13, respectively). Group A showed greater improvement in radiating pain after 2, 6, and 12 weeks than group B (p < 0.001, p = 0.001, and p < 0.001, respectively). No differences were observed between the groups in satisfaction at the beginning and 12 weeks after taking the medication (p = 0.062 and p = 0.061, respectively) and in objective improvement of patients and physicians (p = 0.657 and p = 0.748, respectively). Group A was less disabled and had greater physical health scores than group B (p = 0.014 and p = 0.017, respectively). CONCLUSIONS: Oral corticosteroids for the treatment of lumbar radiating pain can be more effective in pain relief than gabapentin or pregabalin. The satisfaction of patients and physicians with the drug and objective improvement status were not inferior to that with gabapentin or pregabalin.
Adolescent ; Adrenal Cortex Hormones/*therapeutic use ; Adult ; Aged ; Amines/therapeutic use ; Analgesics/therapeutic use ; Cyclohexanecarboxylic Acids/therapeutic use ; Female ; Humans ; Low Back Pain/*drug therapy/*physiopathology ; Lumbosacral Region/physiopathology ; Male ; Middle Aged ; Patient Satisfaction/statistics & numerical data ; Pregabalin/therapeutic use ; Quality of Life ; Radiculopathy/drug therapy ; Surveys and Questionnaires ; Young Adult ; gamma-Aminobutyric Acid/therapeutic use

STUDY DESIGN: Case report. OBJECTIVES: To report a rare case in which a tack was used to control bleeding due to a torn iliac vein during revisional anterior spine surgery. SUMMARY OF LITERATURE REVIEW: During anterior lumbar surgery, bleeding following a vascular injury is possible to control and reparable in most cases. During revisional anterior lumbar surgery, however, there are irreparable cases of bleeding as well. In some cases, it can threaten the patient's life. MATERIALS AND METHODS: A 56-year-old man suffered from potentially fatal bleeding following iliac vein rupture during revisional anterior lumbar surgery. Primary vascular closure was impossible due to severe adhesion. We attempted to stop the venous bleeding with a tack, as an alternative treatment. The potentially fatal bleeding was controlled and the patient's vital signs stabilized after hemostasis by the tack. RESULTS: Hemostasis using the tack saved the patient's life without any rebleeding. CONCLUSIONS: During revisional anterior lumbar surgery, bleeding following an iliac vein rupture can be controlled by a tack in cases that are irreparable due to severe adhesion.
Hemorrhage ; Hemostasis ; Humans ; Iliac Vein* ; Middle Aged ; Rupture* ; Spine ; Vascular System Injuries ; Vital Signs

Chronic expanding organizing hematoma (CEH) occasionally mimics a soft tissue tumor on MRI, which becomes more problematic in patients with a history of surgical resection for musculoskeletal malignancy. Herein, we present a case of CEH which we were able to differentiate from recurrent tumor through MRI follow-up, including diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) imaging. A 66-year-old male visited our institution under suspicion of recurrent leiomyosarcoma of the thigh, 19 months after surgery and radiation therapy. Due to inconclusive results, three US-guided biopsies and 6 MRI examinations were performed over 2 years. In the end, we could diagnose a CEH using conventional and functional MRI techniques, and it was histopathologically confirmed after surgical resection. A CEH may occur remotely after an initiating event, and it may persist and expand over several years. Functional MR sequences, in addition to conventional sequences, are helpful in differentiating CEH from malignant neoplasms.
Aged ; Biopsy ; Follow-Up Studies ; Hematoma* ; Humans ; Leiomyosarcoma ; Magnetic Resonance Imaging* ; Male ; Thigh