Yuzhao Huang

Battered Sensory Never Syndrome (BSNS) is a condition characterized by persistent, long-term mechanical compression of the sensory roots, dorsal root ganglia (DRG), and sensory fibers of the spinal nerve roots. This leads to symptoms such as hyperalgesia or allodynia, paresthesia, and radicular pain-like syndromes where pain worsens with weight-bearing or physical activity. High-voltage DRG pulsed radiofrequency (PRF) is effective for BSNS, but optimal treatment parameters for the best clinical efficacy remain undefined. This study aims to compare the clinical outcomes of various PRF temperatures and durations in patients with BSNS. Patients with BSNS were randomized to one of four high-voltage (80 V) PRF parameter groups: 42℃/3min, 42℃/12min, 55℃/3min, and 55℃/12min. The primary outcome measures included the Numerical Rating Scale (NRS) and the Oswestry Disability Index (ODI). The secondary outcome measures included the Hamilton Anxiety Scale (HAMA), the Hamilton Depression Scale (HAMD), the Pittsburgh Sleep Quality Index (PSQI) scores, the effective rate of pain relief, the proportion of patients with a ≥ 50% reduction in ODI score, and medication usage. These were evaluated before PRF and within 12 months after surgery. All patients included in our study had a mean age over 60, with the majority being female. Four patient groups showed significant reductions in NRS, ODI, HAMA, HAMD scores (P < 0.05) and decreased medication use within 12 months post-PRF, with no statistically significant differences between the groups (P > 0.05). The PSQI scores decreased significantly only in the 42 °C/3min group at 1 month,3 and 6 months (P < 0.05), also without intergroup significance (P > 0.05). The subgroup analysis by time and temperature revealed that NRS scores (P = 0.009), the number of patients with effective pain relief (P = 0.039) and ODI reduction ≥ 50% (P = 0.045) 1 month after PRF in the 55℃ group were significantly better than those in the 42℃ group, while no statistically significant difference was found between 3-min and 12-min durations (P > 0.05). High-voltage DRG PRF effectively treats BSNS patients within a treatment duration range of 3 to 12 min. Treatment at 55 °C offers superior pain relief and physical function improvement without neuropathic complications.

Introduction Pulsed radiofrequency (PRF) is a well-established neuromodulation technique widely used for managing neuropathic pain. Lumbosacral radicular pain, a common neuropathic condition, is often refractory to conventional treatments. Although dorsal root ganglion (DRG) PRF has emerged as a promising intervention, its therapeutic efficacy is often limited and variable, likely due to an incomplete understanding of its mechanisms. To elucidate the neural mechanisms underlying DRG PRF analgesia, this study characterized treatment-induced alterations in microstate spatiotemporal dynamics and examined their correlation with pain intensity, thereby assessing their potential as neurophysiological markers. Methods We recorded high-density electroencephalograms (EEG) in healthy controls and patients before and after DRG PRF treatment. Topographic differences were assessed using topographic analysis of variance (TANOVA). Microstate temporal parameters (duration, occurrence, coverage) and transition probabilities were analyzed. Pearson correlation analysis was performed between transition probabilities and visual analogue scale (VAS) scores. Results TANOVA revealed significant differences in microstate topographies among the three groups (p = 0.033), primarily attributed to microstates C and E. Although we found no significant differences in global temporal parameters or transition probabilities, our exploratory analysis revealed a reduction in the transition probability from microstate D to E (Delta TM D to E) in patients before DRG PRF treatment compared to healthy controls (p = 0.016, uncorrected). Notably, this reduction showed a trend toward normalization after treatment. Furthermore, we observed a significant negative correlation between Delta TM D to E and VAS scores (r = −0.459, p = 0.008). Conclusion DRG PRF alleviates neuropathic pain by normalizing interactions between large-scale brain networks, as evidenced by topographic reorganizations and trends toward normalized transition dynamics. The sensitivity of microstate metrics to these changes supports their potential as neurophysiological markers for assessing both pain-related brain dysfunction and treatment response. Trial Registration The trial was registered on ClinicalTrials.gov with the following number: ChiCTR2500104921.

Pulsed radiofrequency (PRF) has demonstrated therapeutic potential for neuropathic pain, yet its efficacy in alleviating pain induced by chronic dorsal root ganglion (DRG) compression remains unclear. This study evaluated the analgesic effects of DRG-targeted PRF in a chronic compression of DRG (CCD) rat model. Adult male Sprague Dawley rats were divided into four groups: sham, CCD, CCD+PRF, and CCD+freePRF. CCD was induced by inserting stainless-steel rods into the intervertebral foramen to compress L4/L5 DRGs. Pain behaviors, including spontaneous pain, mechanical/cold allodynia, and heat hypersensitivity, were assessed pre- and post-PRF treatment. On day 14 post-CCD, DRG ultrastructural changes and myelin basic protein (MBP) expression were analyzed via transmission electron microscopy and immunofluorescence. Compared to sham rats, CCD animals exhibited significant pain behaviors ( P < .0001). PRF treatment in CCD+PRF rats significantly attenuated these behaviors ( P < .01). Ultrastructural analysis revealed intact myelin sheaths in sham DRGs, whereas CCD DRGs showed myelin damage and reduced MBP expression ( P < .01). Notably, PRF repaired myelin structural integrity and restored MBP levels. These findings demonstrate that DRG PRF alleviates neuropathic pain by reversing ultrastructural damage caused by chronic compression, providing mechanistic insights into PRF's analgesic effects and supporting its therapeutic value for neuropathic pain management.

Introduction: Post-stroke central pain is disabling yet ineffectively treated with routine medical intervention. In this study, the authors presented an alternative neuromodulation therapy and conducted a brief narrative literature review to examine current evidence of spinal cord stimulation treatment for central post-stroke pain Case presentation: Here, the authors reported a case of severe post-stroke syndrome, who achieved satisfactory improvement of pain symptom, as well as muscle rigidity with a novel neuromodulation therapy of short-term implantation of cervical spinal cord stimulation. Clinical discussion: It remains a great challenge in the management of post-stroke pain, which in turn significantly reduces the quality of life and worsens the burden on the public health system. Spinal cord stimulation therapy is an emerging neuromodulation approach to restore pathological pain status and functional impairment to provide a prospective insight into neuromodulation and rehabilitation options in the management of post-stroke syndrome. Conclusion: A potential role of spinal cord stimulation in the treatment of post-stroke pain is proposed in combined with traditional medication or other neuromodulation strategies, to achieve better control of pain in the future.

Background: How to treat the posterior cruciate ligament (PCL) tibial insertion small and comminuted avulsion fracture is still challenging. Our study evaluated the clinical and radiological outcomes after ORIF of PCL tibial insertion avulsion fractures through the inverted L-shaped postero-medial approach using a homemade pin-hook. Methods: Between January 2009 and December 2020, twenty-four patients with isolated PCL tibial insertion bony avulsion were enrolled. There were 16 males and 8 females. The age range was 18-48 (32.5 ± 9.3) years. The time from injury to surgery was 1-10 (4.4 ± 2.8) days. There were 11 cases in the left knee and 13 cases in the right knee. The patients received anticoagulant therapy to prevent thrombosis. Preoperative standard X-ray, computerized tomography (CT) and magnetic resonance imaging (MRI) were performed. According to the Meyers-McKeever classification, there were 8 cases of type II and 16 cases of type III. Results: The operation time was 60-120 (89.6 ± 19.8) min. Postoperative follow-up ranged from 3 to 18 months. The average follow-up was 11.4 ± 4.3 months. In all patients, one or two homemade pin-hooks were used to fix different sizes of fracture segments. X-ray or CT scans taken after surgery revealed fracture union. The fractures healed in 9-16 (11.8 ± 1.7) weeks. At the last follow-up, the patients were able to fully straighten. The ROM (132.6° ± 3.9°), the Tegner-Lysholm score (96.2 ± 2.3) and the IKDC scores (95.5 ± 1.6) were all significantly improved compared with the preoperative values (77.5° ± 13.1°, 46.8 ± 8.9, 36.2 ± 7.9). The posterior drawer test was negative. The gastrocnemius muscle strength did not diminish. No internal fixation migration was observed during the follow-up. No neurovascular bundle- or hardware-related complications were reported. Conclusions: The inverted L-shaped postero-medial approach with homemade pin-hook fixation for the treatment of PCL avulsion fractures produces acceptable clinical and radiological results. Moreover, the homemade pin-hook made of K-wires is affordable and reduces patient costs. It is a practical application and worth recommending, especially for community hospitals.

Purpose Treating scapular fractures is still a challenging task for surgeons. We aimed to evaluate the feasibility, accuracy, and effectiveness of augmented reality (AR) and three-dimensional (3D) plate library-assisted posterior minimally invasive surgery, named AR-scapular system for scapula fracture. We speculated that using AR-scapular system would improve efficiency and quality for scapular fracture surgery. Methods We retrospectively reviewed the records of 21 patients with scapular fractures treated by posterior minimally invasive surgery with reconstruction plates: nine patients were treated with conventional fixation in group I; whereas 12 patients were treated with pre-operative virtual simulation and intra-operative navigation–assisted fixation using AR-scapular system. We compared operative time, blood loss, complication, and Hardegger function between two groups. Statistical analyses evaluated significant differences between the groups for each of these variables. Results In group II, the pre-operative virtual simulation time was 44.42 ± 15.54 min. The time required for pre-operative contouring of the plates was 16.08 ± 5.09 minutes. The patients in group II had significantly shorter operation time and less blood loss (− 28.75 min and − 81.94 ml, respectively; P < 0.05) than patients in the conventional surgery group. The average numbers of plates used were 1.56 ± 0.53 in group I and 1.25 ± 0.45 in group II. The difference was not statistically significant (P > 0.05). The follow-up function outcome results were similar between groups (P > 0.05). There were no intra-operative or post-operative complications for all patients. Conclusion Augmented reality and 3D plate library-assisted posterior minimally invasive surgery is an effective and reliable method for treating scapular fractures which can provide precise pre-operative planning and intraoperative navigation. This time-saving approach can give a more customized treatment plan, allowing for a safer reduction surgery. What is more, the portable projector is cheap and easy to use.

(1) Background: Chronic kidney disease (CKD) increases the susceptibility to the presence of herpes zoster (HZ). Little is known about the risk factors of HZ in CKD patients; (2) Methods: This is a case-control study. CKD patients diagnosed with HZ between January 2015 and June 2021 in a tertiary hospital were identified. One age- and gender- matched control was paired for each case, matched to the date of initial HZ diagnosis. Conditional multiple logistic regression was used to evaluate the risk factors associated with the presence of HZ; (3) Results: Forty-seven HZ patients and controls were identified. In general, about 73.40% (69 out of 94) patients were classified at IV to V stages of CKD. Immunosuppressive agents (p = 0.0012) and dialysis therapy (p = 0.021) were reported more frequently in the HZ cohort. Compared with the control group, the total white cell count and lymphocyte count were significantly lower in the HZ group (p value of 0.032 and 0.003, respectively). The conditional logistics regression model revealed that previous immunosuppressants administration (odds ratio: 10.861, 95% CI: 2.092~56.392, p = 0.005) and dialysis therapy (odds ratio: 3.293, 95% CI: 1.047~10.355, p = 0.041) were independent risk factors of HZ in the CKD population; (4) Conclusions: Dialysis and immunosuppressants therapy were associated with greater risk of HZ disease in CKD patients. Further guideline may highlight the necessity of zoster vaccine for patients with CKD, who undertake associated treatment.