Interventional Pain Medicine最新文献

英文中文

Letter to the editor regarding "Trends in lumbar epidural injection selection: A survey of practitioner preferences and practice patterns" 致编辑关于“腰椎硬膜外注射选择的趋势：医生偏好和实践模式的调查”的信

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-08-27 DOI: 10.1016/j.inpm.2025.100638

Ryan Triglia , Andrew Walrond , Jesse Wagner , Paul M. Kitei , Jeffrey Boyd , Jeremy I. Simon

引用次数: 0

Standalone anteroposterior contrast spread pattern is insufficient to distinguish lumbar epidural from extradural spread: A prospective study 独立的正位造影剂扩散模式不足以区分腰椎硬膜外和硬膜外扩散：一项前瞻性研究

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-08-25 DOI: 10.1016/j.inpm.2025.100634

Afrin Sagir , Thomas T. Simopoulos , Jyotsna V. Nagda , Alexandra C.G. Fonseca , Viet L. Cai , Nasir Hussain , Chen Liang , Jatinder S. Gill

Background

There is debate about whether a standalone anteroposterior (AP) view can distinguish epidural contrast from non-epidural contrast spread.

Objectives

This study aims to assess the accuracy of the AP (anteroposterior) and Contralateral Oblique (CLO) views in distinguishing epidural contrast spread patterns from non-epidural contrast spread patterns.

Methods

Patients undergoing lumbar epidural steroid injections consented to participate in the study. A 20-gauge Tuohy needle was advanced very close to the epidural space, and 0.5–1 ml of contrast was then injected. CLO, AP, and lateral images of non-epidural spread were saved. The AP and CLO images were randomly mixed with images from historical controls with actual epidural spread.

Results

A total of 24 false epidurograms in the AP and CLO views were mixed with an equal number of true epidurograms, resulting in 48 images each in the AP and the CLO views, respectively. Among the cohort of 10 experienced interventional pain physicians, the mean accuracy of correctly identifying epidural spread as epidural using the AP view alone was 51 % (SD 19 %). In addition, the accuracy of correctly identifying non-epidural spread as non-epidural using the AP view alone was 64 % (SD 15 %). Cohen's Kappa was 0.15, indicating minimal agreement between the interventionalists. In contrast, the mean accuracy of correctly identifying epidural spread as epidural using the CLO view alone was 99 % (SD 2 %). In addition, the accuracy of correctly identifying non-epidural spread as non-epidural using the CLO view alone was 96 % (SD 9 %). Excluding one outlier, the accuracy for the rest of the reviewers in determining non-epidural spread as non-epidural was 99 %. Cohens' Kappa was 0.95, indicating a high degree of agreement between the interventionalists.

Conclusion

This study reveals that utilizing a standalone AP view without a CLO view was inadequate to distinguish epidural from non-epidural spread. Specifically, our study supports the continued use of CLO depth views to identify epidural contrast spread correctly.

关于独立的正位（AP）视图是否可以区分硬膜外对比和非硬膜外对比扩散存在争议。目的本研究旨在评估AP（正位）和对侧斜位（CLO）视图在区分硬膜外造影剂扩散模式和非硬膜外造影剂扩散模式中的准确性。方法接受腰椎硬膜外类固醇注射的患者同意参加研究。将一根20号的Tuohy针靠近硬膜外间隙，然后注射0.5-1 ml造影剂。保存了非硬膜外扩散的CLO、AP和侧位图像。AP和CLO图像与实际硬膜外扩散的历史对照图像随机混合。结果在AP和CLO视图中，共24张假硬膜外尿图与相同数量的真硬膜外尿图混合，AP和CLO视图各48张。在10名经验丰富的介入疼痛医生队列中，仅使用AP视图正确识别硬膜外扩散为硬膜外扩散的平均准确率为51% （SD为19%）。此外，仅使用AP视图正确识别非硬膜外扩散为非硬膜外扩散的准确率为64% （SD为15%）。科恩的Kappa值为0.15，表明干预主义者之间的共识极小。相比之下，仅使用CLO视图正确识别硬膜外扩散为硬膜外扩散的平均准确率为99% （SD为2%）。此外，仅使用CLO视图正确识别非硬膜外扩散为非硬膜外扩散的准确率为96% （SD为9%）。除一个异常值外，其余评论者将非硬膜外扩散确定为非硬膜外扩散的准确率为99%。Cohens’Kappa为0.95，表明干预主义者之间的一致性很高。结论：本研究表明，使用独立的AP视图而不使用CLO视图不足以区分硬膜外和非硬膜外扩散。具体来说，我们的研究支持继续使用CLO深度视图来正确识别硬膜外造影剂扩散。

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引用次数: 0

Spinal cord stimulation for Tarlov cyst-related pain: Initial success and subsequent explantation in an elderly patient 脊髓刺激治疗塔洛夫囊肿相关疼痛：一位老年患者的初步成功和随后的移植

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-06-21 DOI: 10.1016/j.inpm.2025.100604

Alexandre J. Bourcier MD, MSc , Christina Im BA , Jane Phan BA , Michelle Nwufo MSc , Miad Hadaegh MD , Colton M. Malesovas MD , Jae Jung MD , Kyle Yang MD , Jonathan Droessler MD

引用次数: 0

Letter to the editor regarding “Trends in lumbar epidural injection selection: A survey of practitioner preferences and practice patterns” 致编辑关于“腰椎硬膜外注射选择的趋势：医生偏好和实践模式的调查”的信

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-08-27 DOI: 10.1016/j.inpm.2025.100637

Parth Aphale, Himanshu Shekhar, Shashank Dokania

引用次数: 0

Reconsidering neuraxial analgesia at end of life: Clinical, ethical, and socioeconomic perspectives 重新考虑生命末期的神经轴镇痛：临床、伦理和社会经济观点

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-02 DOI: 10.1016/j.inpm.2025.100610

Sanjeet Narang , Jason Yong , David Hao

Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination. By reframing neuraxial analgesia not as an extraordinary measure, but as a legitimate and potentially transformative option, we advocate for broader, more equitable integration of these therapies.

疼痛是接近生命终点的患者最普遍和最痛苦的症状之一，特别是在癌症患者中。虽然全身性阿片类药物是治疗的主要手段，但其局限性需要考虑替代策略。轴向镇痛，包括硬膜外和鞘内给药系统，提供有针对性的疼痛缓解，减轻全身负担。然而，尽管有支持性数据，由于临床、伦理、后勤和社会经济障碍，这些干预措施仍未得到充分利用。这篇文章探讨了在生命结束时提供神经轴镇痛所涉及的复杂决策，权衡风险和收益，改变病人的目标，以及护理协调的挑战。通过重新定义神经轴镇痛，而不是作为一种特殊的措施，而是作为一种合法的、潜在的变革选择，我们提倡更广泛、更公平地整合这些疗法。

引用次数: 0

Rates of complications after cervical transforaminal epidural steroid injections for patients with cervical radiculopathy utilizing a large national database 颈椎神经根病患者经椎间孔硬膜外类固醇注射后并发症的发生率利用大型国家数据库

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-09 DOI: 10.1016/j.inpm.2025.100606

Andrew R. Stephens , Ashley Rogerson , Rajeev K. Patel , Ramzi El-Hassan

Background

Cervical transforaminal epidural steroid injections (CTFESI) are commonly used to treat cervical radiculopathy. Though major adverse events have been published in case reports, larger cohort studies have not demonstrated this concern.

Objective

The purpose of this study was to assess the risk of major and minor complications after CTFESIs using a large database.

Methods

TriNetX, a global health research network, was queried from January 01, 2004–May 20, 2025 for patients with cervical radiculopathy undergoing CTFESI. All diagnostic and surgical codes after CTFESI were analyzed. Specific major complications queried for were stroke, seizures, and paralysis. Nervous system, musculoskeletal, infectious, and procedural diagnoses were evaluated for complications. Complications were reported as number and percent.

Results

A total of 32,913 patients underwent CTFESI with available follow-up data. There were ≤10 (≤0.03 %) patients who had intraoperative/post-procedure complications, ≤10 (≤0.03 %) with CSF leak. There were 143 (0.4 %) patients that had cerebral vascular disease related codes. Of these, 50 (0.15 %) had cerebral infarction codes and ≤10 (≤0.03 %). There were 39 (0.12 %) patients with seizure codes, and 18 (0.5 %) patients that had paralysis codes. There were 0 (0 %) patients who had mortality related codes within a day after CTFESI.

Conclusion

This study demonstrates the risk of major complications after CTFESI in a large cohort to be low.

背景颈椎经椎间孔硬膜外类固醇注射（CTFESI）通常用于治疗颈椎神经根病。虽然主要的不良事件已在病例报告中发表，但更大规模的队列研究尚未证实这一担忧。目的本研究的目的是利用大型数据库评估ctfis术后主要和次要并发症的风险。方法全球健康研究网络strinetx于2004年1月1日至2025年5月20日对接受CTFESI的颈椎神经根病患者进行了查询。分析CTFESI后的所有诊断和手术代码。询问的具体主要并发症是中风、癫痫发作和瘫痪。评估神经系统、肌肉骨骼、感染性和程序性诊断的并发症。报告并发症的数量和百分比。结果共有32,913例患者接受了CTFESI，并有随访数据。术中/术后并发症≤10例（≤0.03%），脑脊液漏≤10例（≤0.03%）。143例（0.4%）患者有脑血管疾病相关编码。其中50例（0.15%）有脑梗死编码，≤10例（≤0.03%）。39例（0.12%）患者有癫痫发作编码，18例（0.5%）患者有瘫痪编码。0例（0%）患者在CTFESI后1天内有死亡相关代码。结论本研究显示CTFESI后主要并发症的风险在大队列中较低。

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引用次数: 0

The impact on fluoroscopic image review on perceived benefit, patient satisfaction, and short-term improvement following lumbosacral epidural steroid injections 腰骶部硬膜外类固醇注射后透视图像回顾对感知获益、患者满意度和短期改善的影响

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-08-31 DOI: 10.1016/j.inpm.2025.100640

Tahsin Choudhury, John Jung, Monica Barnes, SriKrishna Chandran, James T. Eckner, Michael Geisser, David J. Kohns

Background

Interventional spine and pain physicians rarely review fluoroscopic images with their patients following spine procedures. Despite high patient satisfaction with these procedures, there may be further steps to enhance the patient experience.

Objectives

The purpose of this study is to analyze the impact of physician's post-procedure fluoroscopic image review on perceived benefit, patient satisfaction, and short-term improvement.

Methods

This single blinded prospective comparative study evaluated post-procedure questionnaires following non-sedation lumbosacral transforaminal epidural steroid injection (TFESIs). The control group received a scripted verbal explanation of the procedure results. The intervention group received a similar explanation that was enhanced with a review of the fluoroscopic procedure images. The perceived benefit was assessed by asking the participants to rate the degree of helpfulness of image review. A modified Press Ganey Satisfaction Questionnaire was used to assess patient satisfaction. Short-term improvement following the procedure was measured at two weeks with a Patient Global Impression of Change (PGIC). In the case of missing PGIC data, manual chart reviews were conducted to assess outcomes.

Results

The control group (no image review) included 70 participants, while the intervention group (image reviewed) included 71. There were 95.8 % of the intervention group that rated their actual image review as helpful to very helpful, while 68.6 % of the control group felt that image review would have been helpful to very helpful. The intervention group also reported significantly higher confidence in their provider (p = 0.03). There was no significant difference between groups in other domains of patient satisfaction or short-term improvement following the spine procedure.

Conclusion

Consistent with prior literature, all participants reported high satisfaction following a lumbosacral TFESI. This study demonstrated that a brief post-procedure image review was highly beneficial and improved confidence in the care providers, whereas the control group likely underestimated the potential helpfulness of receiving an image review. Further studies are required to explore the best use of post-procedure image review and the potential further impact on patient-centered care.

Registered

ClinicalTrials.gov NCT05884684.

背景：介入脊柱和疼痛医生很少与脊柱手术后的患者回顾透视图像。尽管患者对这些程序的满意度很高，但可能需要采取进一步的措施来提高患者的体验。目的本研究的目的是分析医生术后透视图像回顾对感知获益、患者满意度和短期改善的影响。方法：本研究采用单盲前瞻性比较研究，对非镇静腰骶经椎间孔硬膜外类固醇注射（TFESIs）术后问卷进行评估。对照组收到了一份关于手术结果的书面口头解释。干预组得到了类似的解释，并通过回顾透视过程图像加强了解释。通过要求参与者评价图像回顾的帮助程度来评估感知到的益处。采用改良的Press Ganey满意度问卷评估患者满意度。手术后的短期改善在两周时通过患者整体印象变化（PGIC）进行测量。在缺少PGIC数据的情况下，进行手动图表审查以评估结果。结果对照组（无图像回顾）70例，干预组（图像回顾）71例。干预组中有95.8%的人认为他们的实际图像回顾有帮助到非常有帮助，而对照组中有68.6%的人认为图像回顾将有帮助到非常有帮助。干预组对其提供者的信心也显著提高（p = 0.03）。在脊柱手术后患者满意度或短期改善的其他方面，两组间无显著差异。结论：与先前的文献一致，所有参与者都报告了腰骶部TFESI后的高满意度。本研究表明，术后简短的图像回顾是非常有益的，并提高了对护理提供者的信心，而对照组可能低估了接受图像回顾的潜在帮助。需要进一步的研究来探索手术后图像审查的最佳用途以及对以患者为中心的护理的潜在进一步影响。

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引用次数: 0

True segmental lumbar imaging: Technical precision matters 真节段性腰椎成像：技术精度很重要

Interventional Pain Medicine

Pub Date : 2025-09-01 DOI: 10.1016/j.inpm.2025.100641

Vinil Shah MD

引用次数: 0

Safety practices for interventional pain procedures: Disc access/provocation discography, vertebral augmentation, and neurostimulation procedures 介入性疼痛手术的安全措施：椎间盘进入/激发性椎间盘造影术、椎体增强术和神经刺激手术

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-12 DOI: 10.1016/j.inpm.2025.100612

Ameet Nagpal , Fred DeFrancesch , Kevin Martinez , George Rappard , D. Scott Kreiner , Jatinder S. Gill , Yakov Vorobeychik , International Pain and Spine Intervention Society

引用次数: 0

Bone marrow concentrate intradiscal injection for chronic discogenic low back pain: A double-blind randomized sham-controlled trial 骨髓浓缩液椎间盘内注射治疗慢性椎间盘源性腰痛：一项双盲随机假对照试验

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-17 DOI: 10.1016/j.inpm.2025.100611

David Levi , Sara Tyszko , Scott Horn , Nicole Pham , Joshua Levin

Summary of background

The field of orthobiologics has attempted to address the challenge of discogenic low back pain (LBP). Research in areas such as stem cells, platelet-rich plasma, and specific growth factor injections has seen limited success.

Objective

The purpose of this trial was to determine the efficacy of a single intradiscal bone marrow concentrate (BMC) injection on pain and function for chronic discogenic LBP.

Methods

Patients with presumed discogenic LBP participated in a prospective, double-blind, randomized, sham controlled trial of a single intradiscal BMC injection compared to a sham procedure. Pain and function were assessed at baseline, 3, 6, and 12 months by Clinical Outcome Measurement Brief Instrument (COMBI) which includes the Numeric Rating Scale (NRS). Function was also assessed by the Oswestry Disability Index (ODI). The primary outcome was based upon clinical success, defined by at least 50 % pain relief from baseline to 3, 6, and 12 months.

Results

Sixty-three patients were included in the trial (45 BMC, 18 sham). There were no significant differences in the primary outcome (>50 % relief in NRS) at 3 months (40 % BMC group [95 %CI: 27–50 %] vs 33 % sham group [95 %CI: 15–56 %]), 6 months (40 % BMC [95 %CI: 27–50 %] vs 39 % sham [95 %CI: 20–61 %]), or 12 months (44 % BMC [95 %CI: 31–59 %] vs 56 % sham [95 %CI: 34–75 %]). There were no significant differences in the proportion of patients achieving at least a 30 % improvement on the ODI at 3 months (51 % BMC group [95 %CI: 37–65 %] vs 33 % sham group [95 %CI: 16–56 %]), 6 months (53 % BMC [95 %CI: 39–67 %] vs 44 % sham [95 %CI: 25–65 %]), or 12 months (56 % BMC [95 %CI: 41–69 %] vs 61 % sham [95 %CI: 39–80 %]).

Conclusions

Intradiscal BMC was equivalent to a sham procedure for chronic discogenic LBP. Both groups had a high, but statistically equivalent success rate. Unfortunately, the significant limitations of this trial, including lack of quality cell analysis, limit the ability to draw conclusions on the effectiveness of intradiscal BMC.

背景概述骨科领域试图解决椎间盘源性腰痛（LBP）的挑战。在干细胞、富血小板血浆和特定生长因子注射等领域的研究取得了有限的成功。目的探讨单次椎间盘内骨髓浓缩液（BMC）注射对慢性盘源性腰痛的镇痛作用。方法假定椎间盘源性腰痛患者参加了一项前瞻性、双盲、随机、假对照试验，与假手术相比，单次椎间盘内BMC注射。疼痛和功能在基线、3、6和12个月通过临床结果测量简短工具（COMBI）进行评估，其中包括数字评定量表（NRS）。并用Oswestry残疾指数（ODI）评估功能。主要结局是基于临床成功，定义为从基线到3,6和12个月至少有50%的疼痛缓解。结果共纳入63例患者（BMC组45例，假手术组18例）。3个月（40% BMC组[95% CI: 27 - 50%] vs 33%假手术组[95% CI: 15 - 56%]）、6个月（40% BMC组[95% CI: 27 - 50%] vs 39%假手术组[95% CI: 20 - 61%]）或12个月（44% BMC组[95% CI: 31 - 59%] vs 56%假手术组[95% CI: 34 - 75%]）的主要结局（NRS缓解>； 50%）无显著差异。3个月（51% BMC组[95% CI: 37 - 65%] vs 33%假手术组[95% CI: 16 - 56%]）、6个月（53% BMC组[95% CI: 39 - 67%] vs 44%假手术组[95% CI: 25 - 65%]）或12个月（56% BMC组[95% CI: 41 - 69%] vs 61%假手术组[95% CI: 39 - 80%]）的患者比例无显著差异。结论椎间盘下基底区BMC等同于假手术治疗慢性椎间盘源性腰痛。两组的成功率都很高，但在统计学上是相等的。不幸的是，该试验的重大局限性，包括缺乏高质量的细胞分析，限制了对椎间盘内BMC有效性得出结论的能力。

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