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Purpose: The treatment strategy of Distractive-Flexion Injury (DFI) depends on the preoperative reduction, and anterior surgery is usually sufficient for closely reduced DFI. In contrast, reduction-failed injuries should be reduced by more complex procedures. This study evaluated the risk factors of closed reduction and identified the factors that can predict reducibility. Materials and Methods: Fifty patients who underwent surgical treatment due to unstable DFI (Allen stage 2 or higher) from 1994 to 2018 were enrolled in this study. All patients underwent Gardner–Wells tongs traction preoperatively. The patients were subdivided into two groups (group A: reduced, group B: failed reduction). The degree of dislocation and subluxation of the facet joints were analyzed by computed tomography. The major injured facet (MIF) joint was defined as a dislocated joint with more damage, and the opposite facet joint was defined as a minor injured facet joint (mIF) with subluxation. The severity of a MIF injury was analyzed by vertically dividing into quarters of the dislocated facet joint. The severity of the mIF injury was analyzed by dividing the subluxated articular surface facet into quarters. The degree of soft tissue injury was measured by magnetic resonance imaging and divided into three grades. The correlation between preoperative reducibility and other variables was analyzed. Results: Group A contained 27 cases (DFI 2=21, DFI 3=6), and there were 23 cases in group B (nine partial reduction and 14 failures, DFI 2=13, DFI 3=9, DFI 4=1). In DFI 2, the more severe dislocation (D3 and D4), the higher the probability of reduction failure (p=0.001), and the probability of reduction failure increased with less subluxation (S1) (p=0.033). In DFI 3 and 4, the grade of dislocation (D4) also appeared to correlate with the reducibility (p=0.016). Conclusion: The degree of facet involvement could be used as a diagnostic and therapeutic tool in treating DFI of the lower cervical spine. In particular, in DFI 2, severe dislocation (50% or more) or mild subluxation (25% or less), and 75% or more dislocation in DFI 3 and 4 may be a risk factor for interrupting closed traction reduction. [ABSTRACT FROM AUTHOR]

Purpose To determine the short-term effect of fluoroscopic-guided steroid injection therapy of lumbar facet cyst-induced radicular pain. Materials and Methods Seventeen patients with radiculopathy due to lumbar synovial cysts, who were treated with fluoroscopically guided injection, were retrospectively evaluated. All plain radiographic images and MR images before the therapy were reviewed. Five patients underwent only the facet joint injection, whereas twelve patients underwent the facet joint injection with perineural injection therapy. The clinical course of pain was evaluated on the first follow-up after therapy. Results Effective pain relief was achieved in 11 (64.7%) of the 17 patients. Among 12 patients who underwent facet joint injection with perineural injection, 9 patients (75%) had an effective pain relief. Of 5 patients, 2 (40%) patients only took the facet joint injection and had an effective pain relief. Conclusion Fluoroscopic-guided steroid injection therapy shows a good short-term effect in patients with symptomatic lumbar facet joint synovial cysts.

Purpose: The purpose of this study was to compare accuracy of proper needle insertion angle between magnetic resonance imaging (MRI) and ultrasonography during lumbar medial branch nerve block procedure. Materials and Methods: Between January 2015 and June 2016, 80 people who underwent MRI in the past 3 months with improved lumbar pain after sono-guided medial branch nerve block were enrolled for analysis (male, 39; female, 41; average age, 63.3 years). The insertion angle and depth between the spinous process and needle at each target points were measured at various levels (superior, inferior segment of each facet joints from L2-3 to L5-S1). The needle was positioned 1 cm apart from both lateral sides of the probe, locating spinous process in the middle. A comparative analysis was performed between an ultrasonography and an MRI. We determined the statistical correlation between the two methods. Results: The average differences with respect to the distance between each level on a sono-guided medial branch nerve block were 1.28±1.07 mm in L2 (7 cases), 1.27±4.26 mm in L3 (25 cases), 1.63±5.89 mm in L4 (93 cases), 1.99±4.12 mm in L5 (141 cases), and 1.51±3.87 mm in S1 (66 cases). The average differences regarding the angle of each level were 1.69°±1.34° in L2 (7 cases), 2.03°±5.35° in L3 (25 cases), 1.49°±3.42° in L4 (93 cases), -1.55°±3.67° in L5 (141 cases), and 1.86°±4.83° in S1 (66 cases). All measurements followed a normal distribution (p＞0.05), showing statistical correlation without significant difference (p＞0.05). Conclusion: After measuring each level using an MRI prior to performing the procedure, a sono-guided lumbar medial branch nerve block can be performed with greater safety and efficacy, especially for beginners. [ABSTRACT FROM AUTHOR]