Search Results (381)

Chronic pain is increasingly understood as a multidimensional condition in which, in a substantial subgroup of patients, a protective symptom can evolve into a persistent maladaptive disorder of the nervous system, while in others it may remain closely tied to ongoing mechanical or structural factors. Central sensitization (CS) represents a key mechanism underlying this transition, characterized by enhanced neural responsiveness and impaired endogenous pain inhibition, leading to a dissociation between pain and tissue pathology. The aim of this narrative review is to critically discuss current evidence on CS as a mechanism-based explanation for persistent pain, using lumbar disk herniation (LDH) as a clinical model of the radiological-clinical mismatch, and to discuss its direct implications for identifying sensitized phenotypes, multimodal assessment, and rehabilitation strategies. A total of 77 sources published between 2006 and 2026 were synthesized. These reviewed sources demonstrate that identification of the sensitized phenotype requires a multimodal assessment approach combining self-report measures, such as the Central Sensitization Inventory (CSI), with psychophysical methods including quantitative sensory testing (QST) and conditioned pain modulation (CPM). Cognitive-emotional factors are also critical, as postoperative kinesiophobia affects approximately 38.3% of LDH patients and is associated with increased pain intensity and reduced self-efficacy. Management strategies reported in these publications focus on mechanism-based interventions, particularly pain neuroscience education (PNE) and graded, time-contingent exercise, which aim to modify pain-related cognitions and restore endogenous inhibitory processes. These approaches may be supported by adjunctive therapies, including dry needling (DN), electro-dry needling (EDN), centrally acting pharmacological agents (e.g., serotonin–norepinephrine reuptake inhibitors [SNRIs] and gabapentinoids), and psychologically informed treatments such as cognitive behavioral therapy (CBT). While surgical decompression may reduce CS-related symptoms, preoperative sensitization does not necessarily predict poorer outcomes, highlighting the interaction between peripheral and central mechanisms. Adopting a sensitization-informed perspective may encourage a broader integration of contemporary pain models alongside traditional structural views in lumbar disc herniation clinical care. Full article

Background: Spinopelvic dissociation secondary to sacral fracture–dislocation is a rare but severe injury, most often resulting from high-energy trauma. Management remains challenging, particularly in adolescents, and the optimal choice between open and percutaneous fixation is still debated. Methods: We present two adolescent cases of traumatic sacral fracture–dislocation with spinopelvic dissociation, one treated with percutaneous fixation and one with open lumbopelvic stabilization both with the use of navigation. The systematic literature review included 29 published studies. Together with the present two-patient case series, the overall analysis comprised 30 studies/series and 739 patients. Data on demographics, mechanisms of injury, neurological involvement, treatment strategies, and outcomes were extracted and analyzed. Results: Case 1 (18 years) was managed with closed reduction and percutaneous fixation, achieving complete neurological and functional recovery at 6 months. Case 2 (14 years) underwent open reduction, decompression, and lumbopelvic fixation, with favorable radiological outcomes but residual sphincter dysfunction at follow-up. In the literature, the weighted mean age was 40.6 years (range 5–91), with 48.6% presenting neurological deficits, most frequently cauda equina syndrome. Surgical management was performed in nearly all cases, with mean time to fixation ranging from 3.6 to 8.6 days. Open techniques were predominantly used in patients with severe displacement or neurological compromise, whereas percutaneous fixation was associated with reduced surgical morbidity and satisfactory neurological recovery in selected patients. Permanent bladder and bowel dysfunction persisted in up to 33% of cases. Conclusions: Spinopelvic dissociation following sacral fracture–dislocation remains a rare and highly unstable injury with frequent neurological impairment. Early surgical stabilization may be beneficial when the patient’s clinical condition permits, and the choice between open and percutaneous fixation should be individualized according to fracture morphology, neurological status, and the need for direct decompression. Our adolescent cases highlight both the potential for complete recovery and the risk of residual dysfunction, reflecting the complexity of these injuries. Full article

Background/Objectives: Osteonecrosis of the femoral head is a progressive disease that frequently leads to femoral head collapse and secondary osteoarthritis. Although total hip arthroplasty provides reliable outcomes, its use in younger patients is limited due to concerns regarding implant longevity. Joint-preserving procedures such as core decompression have been widely used; however, their efficacy remains controversial. This study aims to evaluate a combined approach using arthroscopy-assisted core decompression and an osteoconductive bone substitute. Methods: This study is designed as a single-center, externally controlled trial conducted at Tohoku University Hospital. Patients with osteonecrosis of the femoral head (Japanese Investigation Committee Stage 1–3B, Type B–C2) will undergo arthroscopy-assisted core decompression combined with octacalcium phosphate/gelatin composite implantation. A total of 25 patients will be prospectively enrolled. Outcomes will be compared with a propensity score-matched historical control cohort. The primary outcome is disease progression within 1 year, defined as radiographic progression or conversion to total hip arthroplasty. Secondary outcomes include radiographic changes, clinical outcomes, and bone remodeling assessed by computed tomography. Expected Results: This study is expected to provide preliminary clinical evidence regarding the feasibility and potential effectiveness of arthroscopy-assisted core decompression combined with octacalcium phosphate/gelatin composite implantation for osteonecrosis of the femoral head. The intervention may promote bone remodeling and contribute to the prevention of femoral head collapse. Conclusions: The findings of this study may contribute to the development of improved minimally invasive joint-preserving treatment strategies for osteonecrosis of the femoral head and provide a basis for future large-scale clinical trials. Full article

In 1988, plastic surgeon Lee Dellon in Annals of Plastic Surgery hypothesized that there was “A Cause for Optimism in Diabetic Neuropathy”. He noted that entrapment neuropathy is common in diabetic peripheral neuropathy (DPN) and explained that multiple sites of local nerve entrapment can also produce the classically described clinical picture of progressive and irreversible ‘length dependent axonopathy’. This observation has justified for him the use of nerve decompression (ND) surgery for beneficial treatment of DPN pain, diabetic foot ulcer (DFU), ulcer recurrences and their subsequent complications. Subsequent observational and controlled reports have consistently demonstrated post-operative benefit for these problems, but ND has not yet been widely adopted. The lack of an etiologic explanation of the physiology changes which would allow surgery to modify the metabolic disturbances of diabetes has likely been involved in such hesitance. Recent explanations that glycolysis is altered in diabetes through intensified polyol metabolism which produces swollen nerves, local peripheral entrapments and compression neuropathy now provide plausible associations of hyperglycemia with epidermal hypoxia and nutrition deficit. Recognition that nerve enlargements can create secondary fibro-osseous compressions explains the well-known association of diabetes and compression syndromes. Peripheral nerve entrapments damage small c-fibers and produce sympathetic autonomic as well as sensorimotor dysfunction. This explains the diminished skin microcirculation, epidermal hypoxia and nutrition deficit seen in diabetes, DPN, DFU and Charcot neuroarthropathy. Laboratory and clinical evidence has demonstrated that ND in diabetes rejuvenates at least two sympathetically commanded skin microcirculation processes and explains how surgery is producing beneficial results. This article recapitulates the literature which clarifies the processes by which ND surgery can modify painful DPN, DFU occurrence, ulcer healing, DFU recurrence risk, amputations after DFU healing, and bilateral pain relief after unilateral surgery. Full article

Background: Vertebral column resection (VCR) has historically been recognized as the most efficacious corrective intervention for severe rigid spinal deformities. Nevertheless, advancements in preoperative optimization, staged corrective methodologies, osteotomies, and contemporary instrumentation have broadened the spectrum of therapeutic options available. The definitive role of VCR in the modern management of rigid congenital spinal deformities remains a topic of ongoing scholarly discourse. Methods: This study presents two illustrative cases of severe congenital spinal deformities that were addressed employing various surgical methodologies, alongside a comprehensive review of the current literature pertaining to VCR and less invasive alternatives, including halo-gravity traction (HGT), temporary internal distraction techniques, pedicle subtraction osteotomy (PSO), asymmetric pedicle subtraction osteotomy (APSO), and multi-rod constructs. Results: The cases elucidated herein underscore the necessity for treatment strategies to be tailored specifically to the characteristics of the deformity, its flexibility, the neurological risks involved, and the individual patient’s specific attributes. In one case, significant deformity correction achieved via preoperative HGT facilitated successful management through multilevel Ponte osteotomies and posterior spinal fusion, thereby obviating the need for VCR. In other patient suffering from severe rigid congenital kyphotic deformity with pronounced anterior column deficiencies, VCR was deemed essential to realize adequate correction and neural decompression. All patients exhibited substantial radiographic correction, enhancements in health-related quality-of-life metrics, diminished disability and pain, while maintaining correction without neurological complications or implant failure at the final follow-up evaluation. Conclusions: VCR continues to be a vital element within the surgical repertoire for the treatment of severe rigid spinal deformities; however, it should not be deemed obligatory in every instance. Diligent preoperative evaluation, staged correction methodologies, and less invasive osteotomy techniques may permit satisfactory correction while mitigating surgical morbidity in suitably selected patients. Treatment approaches should be customized, favoring the least invasive procedure capable of achieving safe and lasting correction whenever practicable. Full article

Obstructive jaundice is a common digestive disorder with multiple etiologies. Non-tuberculous mycobacterial (NTM) infection is an opportunistic disease that may present with localized pulmonary involvement or disseminated multi-organ manifestations. However, biliary involvement in disseminated NTM infection is rare, and its characteristics and progression remain poorly understood. We report a patient with progressive jaundice who was eventually considered to have probable biliary NTM infection after comprehensive evaluation, exclusion of alternative etiologies, and a favorable therapeutic response despite negative microbiological testing. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to relieve biliary obstruction, but the patient developed recurrent and refractory ampullary bleeding requiring repeated endoscopic interventions. Clinical improvement was achieved following combined antimycobacterial therapy and immunomodulatory treatment. Biliary NTM infection is a rare cause of obstructive jaundice, and ERCP remains necessary for biliary decompression, while post-ERCP bleeding risk should be carefully monitored. Full article

Endobiliary photodynamic therapy (PDT) in cholangiocarcinoma (CCA) is used mainly for local palliation of malignant biliary obstruction, particularly in extrahepatic and perihilar disease. This Review synthesizes the clinical evidence on endobiliary PDT while using drainage, infection control, stent strategy, light delivery, and systemic-therapy context as an interpretive framework rather than as practice recommendations. This narrative review was informed by targeted searching of PubMed/MEDLINE, Embase, and Web of Science from database inception through to 31 December 2025, supplemented by reference-list screening. We prioritized prospective studies, comparative cohorts, systematic reviews, and relevant guidance documents. Across the literature, the clearest support for PDT concerns selected local biliary palliation, including decompression, stent patency or delayed dysfunction, and symptom relief. Survival signals remain inconsistent: early positive studies contrast with the negative PHOTOSTENT-02 randomized trial and are highly confounded by drainage adequacy, infection control, retreatment strategy, and systemic-therapy access. We therefore interpret PDT as a context-dependent local biliary strategy rather than an established survival-prolonging treatment, and we highlight the clinical variables that make published outcome signals more or less interpretable. Full article

Background and Clinical Significance: Mandibular cystic lesions are heterogeneous in biologic behavior, radiologic appearance, and surgical management. Treatment selection is influenced by lesion extent, cortical bone condition, structural stability, and proximity to adjacent teeth and vital anatomical structures. In large mandibular lesions, case-specific decision-making may range from staged decompression or marsupialization to single-stage enucleation, peripheral ostectomy, graft-assisted reconstruction, and preventive mandibular plating (PMP). Case Presentation: In the first case, a 60-year-old female presented with bilateral mandibular lesions: a dentigerous cyst on the right side, treated with marsupialization followed by enucleation, and a contralateral glandular odontogenic cyst (GOC) managed with primary enucleation alone. The second case involved a large, unilateral odontogenic keratocyst (OKC) managed with a radical approach, including enucleation followed by peripheral ostectomy and PMP. Histopathologic evaluation was performed in both cases to confirm diagnosis and support definitive treatment planning. Radiologic follow-up at 1 year demonstrated bone regeneration in all treated sites. Conclusions: This case report presents two different clinical cases involving three mandibular cystic lesions managed according to case-specific surgical indications and evaluated with standardized postoperative panoramic and CBCT imaging; limited supportive assessment of trabecular bone remodeling was also performed to further characterize radiologic healing patterns. The authors aimed to descriptively document postoperative bone condition, radiologic healing, and patient safety in these cases, and to highlight the most important surgical and radiological findings that may influence case-specific clinical decision-making. Full article

Background: Neurovascular compression syndromes (NVCS) represent a spectrum of disabling neurologic disorders caused by vascular or structural compression of cranial nerves, most commonly at the root entry zone. Conditions such as trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GN) are associated with significant pain, functional impairment, and reduced quality of life. This review provides a multidisciplinary, anatomically grounded overview of the pathophysiology, diagnosis, imaging, and contemporary management strategies for NVCS. Methods: A narrative review of the literature was conducted, synthesizing historical perspectives, neuroanatomy of the cerebellopontine angle, mechanisms of neurovascular conflict, advances in imaging and neuromonitoring, and current treatment modalities. Medical, percutaneous, surgical, radiosurgical, and neuromodulatory approaches were evaluated, with emphasis on patient selection and outcome considerations. Results: Neurovascular compression, most frequently arterial compression at the root entry zone, leads to focal demyelination, ephaptic transmission, and neuronal hyperexcitability. High-resolution Magnetic resonance imagin (MRI) remains the diagnostic gold standard. First-line management for TN and related syndromes typically includes pharmacotherapy, particularly sodium channel blockers. Refractory cases may benefit from percutaneous rhizotomy, balloon compression, stereotactic radiosurgery, or microvascular decompression (MVD), which offers the most durable relief in appropriately selected patients. Emerging technologies, including endoscopic visualization, advanced neuromodulation, and virtual reality-assisted surgical planning, continue to refine treatment precision and safety. Conclusions: Effective management of NVCS requires a comprehensive understanding of neuroanatomy, pathogenesis, and individualized risk–benefit profiles. A multidisciplinary, stepwise approach optimizes outcomes and improves quality of life in patients with these complex disorders. Full article

Background: Optimal biliary drainage in unresectable malignant hilar obstruction remains challenging, particularly in Bismuth type III disease due to complex biliary anatomy. Emerging evidence suggests that the adequacy of biliary decompression may be more important than the drainage modality itself in determining clinical outcomes. Aim: To compare the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) in unresectable Bismuth type III malignant hilar obstruction, with particular emphasis on drainage adequacy. Methods: This retrospective two-center study included 199 patients with unresectable Bismuth type III malignant hilar obstruction (ERCP: n = 102; PTBD: n = 97). Drainage adequacy was defined as decompression of at least 50% of the non-atrophic liver using a segment-based anatomical approach. Bilirubin response was evaluated at predefined time points (days 7, 14, and 28). The primary outcome was biochemical response, while secondary outcomes included reintervention, complications, hospital stay, receipt of systemic therapy, and mortality. Results: Baseline characteristics were comparable between groups (mean age 66.8 ± 11.2 vs. 68.4 ± 10.7 years, p = 0.412; male sex 58.3% vs. 61.5%, p = 0.721). PTBD achieved significantly higher rates of adequate drainage than ERCP (p = 0.006). Although biochemical response rates were numerically higher in the PTBD group, multivariable analysis identified drainage adequacy—rather than drainage modality—as the strongest independent predictor of treatment success. Reintervention rates were significantly higher and time to reintervention significantly shorter in the ERCP group (p < 0.001). Cholangitis and post-procedural pain scores were more frequent following PTBD, whereas post-ERCP pancreatitis occurred exclusively after ERCP. No significant differences were observed in 30-day or 1-year mortality between groups. Conclusions: In unresectable Bismuth type III malignant hilar obstruction, drainage adequacy appears to be the principal determinant of clinical success. Although PTBD more frequently achieves adequate biliary decompression, outcomes seem to depend primarily on the effectiveness of drainage rather than the drainage modality itself. Full article

Objective: This study aimed to evaluate the clinical and radiological efficacy of percutaneous laser disc decompression (PLDD) in patients with disc-related lumbar spinal stenosis. Methods: Data from 96 patients who underwent PLDD between January 2023 and January 2025 were reviewed retrospectively. Pain intensity (visual analogue scale [VAS]), functional capacity (pain-free walking distance), patient satisfaction (global patient evaluation), and radiological canal diameter were assessed before the procedure and at 1, 3, and 6 months postoperatively. Treatment response was determined based on a ≥2-point decrease in the VAS score, which is the minimal clinically important difference (MCID) criterion. Results: A marked improvement in VAS scores was observed from the early period following PLDD, with the mean VAS score decreasing from 8.02 to 5.02 ± 1.99 at 6 months (p < 0.001). The pain-free walking distance increased from 212.7 m to 345.8 m, resulting in a significant improvement in functional capacity (p < 0.001). A significant increase in the anteroposterior diameter of the spinal canal from 7.1 ± 1.7 mm to 7.9 ± 1.8 mm (p < 0.001) was observed, corresponding to a mean increase of 0.8 mm; however, the magnitude of this radiological change was modest and should be interpreted cautiously. A moderate correlation was found between radiological expansion and VAS change (r = 0.52). At 6 months, 72.9% of patients met the MCID criterion. Although ODI improved significantly over follow-up, the mean reduction remained below commonly accepted MCID thresholds, suggesting that the functional benefit may be modest. No major complications were observed; only short-term transient radicular irritation (2.1%) was seen. Conclusions: PLDD was associated with improvements in pain control, functional capacity, and modest radiological canal enlargement in this cohort of carefully selected patients with single-level, predominantly disc-driven lumbar spinal stenosis. However, because of the retrospective design and absence of a control group, no conclusions regarding comparative effectiveness can be drawn. PLDD should therefore be viewed as a selectively applicable minimally invasive option rather than a general treatment for all forms of lumbar spinal stenosis. The observed clinical benefit was limited to the 6-month follow-up available in this cohort, and its durability beyond this period remains uncertain. Prospective and comparative studies are required to better define its long-term role and its position relative to conservative treatment and surgery. Full article

Background: Trigeminal neuralgia (TN) is clinically defined, but patients presenting to tertiary practice with trigeminal-region pain are often diagnostically heterogeneous and may follow prolonged medication, dental, imaging, and procedural pathways before a stable phenotype is established. We aimed to characterize diagnostic phenotypes, secondary causes, and treatment-escalation patterns in a large retrospective tertiary-center trigeminal pain cohort derived from routine free-text clinical documentation. Methods: We conducted a retrospective single-center cohort study based on a clinical dataset containing 18,007 note fragments linked to 672 unique patient records between 12 October 2010 and 21 April 2026. A rule-based natural-language-processing-assisted chart review framework was used to identify patients with trigeminal pain and to extract documentation-derived demographic features, pain distribution, secondary causes, dental pathway variables, imaging signals, medication exposure, procedures, and outcome language. Patients were grouped into primary/classical TN, secondary TN/trigeminal pain, and dental-first or mimic pathways using predefined operational criteria. Results: A total of 455 patients met criteria for the analytic trigeminal pain cohort; 311 (68.4%) carried explicit TN terminology. Mean age was 58.7 years, median age 60 years, and 267 of 428 patients with recoverable sex data (62.4%) were women. Trigeminal branch involvement could be extracted in 351 patients (77.1%), with V2 involvement documented in 256 (56.3%), V3 involvement in 218 (47.9%), and V1 involvement in 138 (30.3%). The final NLP-derived phenotypic distribution comprised 201 primary/classical TN cases (44.2%), 146 secondary TN/trigeminal pain cases (32.1%), and 108 dental-first or mimic presentations (23.7%). MRI was documented in 384 patients (84.4%), neurovascular conflict or vascular loop in 253 (55.6%), multiple-sclerosis-related disease in 69 (15.2%), and tumor-related trigeminal involvement in 84 (18.5%). Prior dental evaluation was identified in 169 patients (37.1%), and prior dental procedures in 114 (25.1%). Carbamazepine exposure was documented in 367 patients (80.7%), pregabalin in 221 (48.6%), gabapentin in 150 (33.0%), oxcarbazepine in 116 (25.5%), and phenytoin in 73 (16.0%). At least one invasive or image-guided procedure was documented in 390 patients (85.7%), including nerve blocks/injections in 355 (78.0%), radiofrequency procedures in 126 (27.7%), balloon compression in 90 (19.8%), microvascular decompression in 113 (24.8%), and stereotactic radiosurgery in 55 (12.1%). Dental-first patients were significantly more likely to have undergone prior dental procedures (65.7% vs. 3.5% in primary/classical TN and 24.7% in secondary TN; p < 0.001), whereas secondary TN/trigeminal pain was associated with higher use of radiofrequency procedures (36.3%; p = 0.017), higher use of stereotactic radiosurgery (19.9%; p = 0.002), higher recurrence documentation (70.5%; p = 0.001), and a higher rate of complete pain relief documented at last follow-up (46.6%; p = 0.004). Conclusions: In tertiary practice, trigeminal pain is substantially broader than a formal TN label. Secondary disease and dental-first pathways account for a large fraction of referrals, and management is characterized by heavy medication burden, frequent escalation, and recurrent retreatment. A structured phenotyping approach may help convert routine clinical documentation into a clinically meaningful framework for diagnostic triage and treatment selection, although imaging and outcome variables require cautious interpretation when derived from retrospective free text. Full article

Background: Carpal tunnel syndrome (CTS) is the most prevalent peripheral nerve entrapment neuropathy, with rising incidence in aging populations. Uncertainty persists regarding the efficacy and safety of carpal tunnel release (CTR) in patients aged ≥ 70 years. Objectives: To systematically evaluate the indications, clinical outcomes, and utility of CTR in elderly patients (≥70 years), with comparison to younger cohorts. Methods: Following PRISMA 2020 guidelines, PubMed/MEDLINE, Scopus, CENTRAL, Embase, Web of Science, and grey literature sources were searched from inception through September 2025. Two independent reviewers extracted data; inter-rater agreement was strong (κ = 0.81–0.86). The primary outcome was the Boston Carpal Tunnel Questionnaire (BCTQ). Weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using DerSimonian–Laird random-effects models. Certainty of evidence was assessed using the GRADE framework. Results: A total of 20 studies encompassing 3841 operated hands, including 1139 hands in elderly patients and 2702 hands in younger comparators across comparative studies, were analyzed. Mean SS-BCTQ improvement was 1.8 points (95%CI: 1.6–2.0; exceeding the established MCID of 1.04–1.05 points). FS-BCTQ improvement was 1.1 points (95%CI: 0.9–1.3; marginally below the pooled MCID of 1.13 points). Elderly patients demonstrated SS-BCTQ improvement of 1.7 points and satisfaction rates of 72–94%, comparable to younger cohorts (75–95%; p = 0.38). Grip strength improved 15–25% in younger patients but remained unchanged in elderly patients (p < 0.001). Sensory recovery reached 42% in elderly versus 58% in younger patients (p < 0.01). Complication rates were low and age-independent (3.1%; RR 1.08; 95%CI: 0.86–1.35; p = 0.52). GRADE certainty was as follows: low for symptom and functional improvement; very low for surgery versus conservative management. Conclusions: CTR is associated with significant symptomatic benefit in elderly patients when conservative treatment fails, with complication rates comparable to younger populations. Age alone should not constitute a surgical contraindication. Preoperative counseling must establish realistic expectations regarding grip strength and functional recovery. High-quality randomized trials in elderly populations remain an urgent research priority. Full article

Background/Objectives: Diving exposure can cause auditory injury involving both the middle and inner ear structures. Inner ear barotrauma (IEB) and inner ear decompression sickness (IEDCS) are the major inner ear disorders and frequently present with auditory and vestibular symptoms. This study examined how diving characteristics relate to patterns of auditory trauma. Methods: A retrospective chart review of 30 patients, with 36 affected ears, was performed. Diving depth, clinical manifestations, and treatment responses were analyzed to identify factors influencing related prognosis. Results: Diving depth was an important factor associated with symptom severity and the type of injury. Dives deeper than 30 m of seawater were linked to a higher incidence of sudden sensorineural hearing loss and vertigo. In contrast, transient symptoms with minimal objective abnormalities were typically observed in shallow dives. Patients with concomitant decompression sickness (DCS) showed poorer auditory and vestibular recovery following hyperbaric oxygen therapy, while those without DCS showed better hearing improvement. Vertigo was observed in 80% of IEB cases and 66.7% of IEDCS cases. Hearing recovery appeared to be more frequently observed in cases presenting with middle ear symptoms, suggesting a relatively favorable prognosis for IEB compared with IEDCS. Conclusions: The findings suggest potential associations between diving depth and DCS, and its involvement may play a role in the severity and prognosis of diving-related inner ear injury. IEB appeared to be associated with more favorable auditory outcomes compared with IEDCS; however, this observation should be interpreted with caution due to potential diagnostic uncertainty. Given the descriptive nature of the study, further studies with larger cohorts are needed to refine prognostic indicators and optimize management strategies. Full article

Background: Chronic low back pain (CLBP) with sciatica caused by lumbar disc herniation is a common and disabling condition. Combined therapeutic protocols that include high force machine spinal decompression therapy (SDT), infrared therapy, and interferential therapy are increasingly used in clinical practice, although evidence in chronic populations remains limited. Because this study did not include a control group, only observed pre–post changes can be reported. This study primarily aimed to assess observed changes in pain intensity following a multimodal therapy protocol in adults with chronic lumbar radiculopathy. Methods: A pre–post observational study was conducted in 234 adults with chronic lumbar radiculopathy lasting ≥12 weeks and MRI confirmed disc herniation at L4–L5 and/or L5–S1. Participants completed ten treatment sessions delivered twice weekly over five weeks. Each session included infrared therapy, high force SDT, and interferential therapy. Pain intensity (VAS 0–10) was measured before the first and before the tenth session. Results: Pain intensity decreased significantly after treatment (Wilcoxon W = 18,830, p < 0.001), with a mean reduction of 2.5 points, exceeding the minimal clinically important change threshold, and with a very large effect size (rank biserial correlation = 0.991). No significant gender differences were observed. Baseline pain (β = 0.312, p < 0.001) and age (β = 0.145, p = 0.020) independently predicted post-treatment pain (R² = 0.129). Conclusion: A reduction in pain intensity was observed after five-week combined therapy protocol. Due to the absence of a control group and the simultaneous use of multiple modalities, no causal conclusions can be drawn, nor can improvements be attributed to SDT alone. Randomized controlled trials with functional outcomes and long-term follow-up are warranted. Full article