Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety.

Introduction: Epidural steroid injections (ESIs) have been widely used for over 50 years in the treatment of low-back pain with radiculopathy. Most interventional pain physicians strongly believe in their efficacy and safety. Recent Cochrane systematic reviews have disclosed controversial results and have questioned the effectiveness of ESIs.

Camptocormia: the bent spine syndrome, an update.

Camptocormia, also referred to as bent spine syndrome (BSS) is defined as an abnormal flexion of the trunk, appearing in standing position, increasing during walking and abating in supine position. BSS was initially considered, especially in wartime, as a psychogenic disorder. It is now recognized that in addition to psychiatric syndromes, many cases of reducible BSS have a somatic origin related to a number of musculo-skeletal or neurological disorders.

Recent data on the pathophysiology of nerve root compression and pain.

Both mechanical and biochemical factors are involved in the pathophysiology of nerve root compression. Chronic compression produces severe demyelination and fibrosis of the nerve root. Similar lesions can result from exposure to irritant substances released from the nucleus pulposus.

[Motor evoked potentials].

Due to the motor evoked potentials recorded in limb muscles after transcranial and spinal magnetic stimulation, conduction in the central motor pathways can now be evaluated safely and painlessly in man. The central motor conduction time obtained includes the time required for transmission, along the fast pyramidal fibres, from the cortex to the spinal motoneurons, the synaptic transmission to motoneurons and the conduction on a short segment of the motor nerve root. Lengthening of this time almost always reflects dysfunction of the central motor pathways.

[Iatrogenic neuropathies].

During the last few years the list of drugs capable of inducing a iatrogenic neuropathy has been considerably lengthened. Drug toxicity to peripheral nerves may be discovered at the experimental stage, but it is usually recognized after the drug has been launched on the market, hence the importance of pharmacovigilance. The responsibility of a drug for the occurrence of neuropathy may be difficult to prove, particularly when the drug is used in the treatment of a disease which, by itself, may be responsible for a lesion of the peripheral nervous system.