Backgraund and Aim: We aimed to compare the results of the treatment of the patients with failed back surgery syndrome (FBSS) by mechanical lysis and steroid hylase injection via epiduroscopy due to their stabilization status and to detect the effect of pathological diagnostic markers on prognosis and ongoing tretment protocol. Methods: Eighty-two patients with FBSS symtoms were included. Two groups were composed as group I (stabilized) and group II (non-stabilized). All patients were evaluated using the oswestry disability index (ODI) and visual analogue scale (VAS) scores before and after treatment at 1, 3, 6, and 12 months and using the Patient Satisfaction Scale at 12 months following treatment. Epidural scar tissue visual and mechanical signs were also recorded. Results: Mean VAS scores were as 7.8 and 3.28 points in group I (p<0.001) and as 7.51 and 2.74 points in group II (p<0.001) at the beginning and 12th months, respectively. Mean ODI scores were as 34.05 and 22.16 points in group I (p<0.001) and as 30.74 and 19.46 points in group II (p<0.001) at the beginning and 12th months. VAS and ODI scores decreased significantly in both groups, but were more significant in non-stabilized group (p<0.001). Moderate or severe fibrous tissue was observed in 86.58% and patient satisfaction scores were very good or good in 78.06%. During the procedure, a dura rupture developed in four patients in the stabilization group and in two patients in the non-stabilization group, although none of these patients developed a spinal headache, and no significant permanent complication arose. Conclusion: We suggest that epidural adhesiolysis, hyaluronidase and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis and the possible course of the present findings and may be more effective in unstabilized patients. Key Words: Failed back surgery syndrome, epiduroscopic adhesiolysis, hyaluronidase.

Background/aim: Degenerative disc disease (DDD) is one of the main causes of lower back pain. In this study, we evaluate the efficacy of percutaneous intradiscal GelStix administration in patients with discogenic pain due to lumbar DDD who were unresponsive to conservative methods. Materials and methods: A total of 29 patients were included in the study, which took place between 2013 and 2017. Sedation was performed in the prone position in the operating room, and a C-arm was located so as to provide a lateral view of the surgical field. A 22-G, 3.5-inch needle was inserted into the center of the disc under fluoroscopy guidance, and a percutaneous intradiscal GelStix implantation was performed. All patients were evaluated using the Oswestry Disability Index (ODI) and a visual analogue scale (VAS) before and after treatment, and using the Patient Satisfaction Scale at 12 months following treatment. Results: The mean VAS scores were 7.14 +/- 0.64 at baseline and 2.48 +/- 0.63 at 12 months (P < 0.001). The mean ODI scores were 28.14 +/- 1.81 at baseline and 17.35 +/- 0.67 at 12 months (P < 0.001). 'I here was a statistically significant decrease in the VAS and ODI scores before and after treatment. A total of 86.2% of the patients rated the procedure as very good or good at 12 months. Conclusion: Our study results suggest that GelStix treatment is useful in pain relief in patients with DDD from the first month of treatment.

Objectives: Compare the effects of greater occipital nerve (GON) and sphenopalatine ganglion (SPG) blocks on headache intensity and duration, number of headache days, and disability in patients with episodic migraine. Methods: In this prospective single-blind randomized study, patients with episodic migraine were randomly divided into two groups: GON and SPG block groups. Patients received blocks once a week for 4 weeks, and once a month for 2 months. The number of headache days, the headache duration, numeric rating scale (NRS) scores, and number of acute medical treatments were assessed before the procedures and 1 month, 2 months, and 3 months after the procedures. Disability was evaluated using the migraine disability assessment (MIDAS) questionnaire at baseline and 3 months after treatment. This study protocol is registered at ClinicalTrials.gov (NCT06243874.). Results: 19 patients in the GON block group and 18 patients in the SPG block group were evaluated. Significant improvements in pain severity, headache duration, number of headache days, and the need for acute medical treatment were observed in the 1st, 2nd, and 3rd months compared to baseline in the two groups (p < 0.001). There were significant improvements in the MIDAS scores in the third month (p < 0.001). The GON block group showed a greater reduction in headache intensity, duration, number of headache days, and MIDAS scores compared to the SPG block group in the 3rd month (p < 0.001). Conclusions: GON block reduces headache duration, intensity, the number of headache days, and the need for acute medical treatment much more than SPG block in patients with episodic migraine.

Despite various pain management methods, chronic pain is still a challenging issue after thoracotomy. This retrospective study was designed to determine the possible factors affecting the development of chronic pain following open thoracotomy. The study included patients who underwent elective open thoracotomy at Ankara University İbni Sina Hospital, between 01.01.2016 and 31.12.2020. The medical files and electronic records of the patients were scanned from the system. Patient history, analgesic methods, and surgical details were recorded. The need for and usage analgesic drugs after the surgery were also recorded. A total of 229 patients who underwent thoracotomy were included in the study, and 83 (36.2%) patients had chronic pain. Duration of surgery, doses of remifentanil, fentanyl or NSAI drugs, duration or number of chest tubes (more than 4 days, or more than 2 tubes), diabetes, or PCEA usage were found as variables affecting pain. Logistic Regression, Multilayer Perceptron, Naive Bayes, AdaBoost, and Random Forest methods were used to evaluate the prediction performances. According to the model created with logistic regression, the rate of the correct classification was 90.8%. The duration of surgery, remifentanil administration, chest tube for more than 4 days, and diabetes were found to be risk factors for developing chronic pain. Fentanyl bolus, PCEA-bupivacaine, and NSAID bolus were determined as preventive factors. A careful analysis of risk factors should be performed for each patient to prevent chronic pain after thoracotomy, and preemptive effective analgesia methods should be performed.

Sacral Epidural Laser Discectomy (SELD) which is an effective and minimally invasive procedure for the direct visualization and therapeutic treatment of pain due to spinal disorders. The aim of this study is to share the effect of SELD on clinical findings and pain. 43 patients who had not undergone back surgery and were found to have lumbar intervertebral disc herniation at L4-5 or L5-S1 level without any indication for back surgery, and who underwent SELD for the treatment patients with low back and/or radicular pain were evaluated. Physical examination findings (the straight leg raising test (SLR) 45 degrees negative(-) test were accepted) and visual pain scale (VAS) values were evaluated at admission, on the same day of post-op, 1st and 6th months. Disc herniation was observed at L4-5 level in 27 patients (62.79%) and at L5-S1 level in 16 patients (37.21%). 31 patients (72.09%) benefited from SELD treatment, while surgery was recommended for 10 patients (23.26%). With SELD procedure no permanent complication was observed. The clinical response of SELD according to the lumbar disc level, a more significant improvement was found in both physical examination and VAS scores in patients with disc herniation at the L5-S1 level (p<0.001). There was no statistically significant relationship between the SLR (+) side and the outcome. SELD is a more effective option, especially in patients with good physical examination findings at admission and mild-to-moderate soft disc herniation at the L5-S1 level.