Pub Date : 2025-11-22DOI: 10.1016/j.inpm.2025.100650
David Hao , Gerald Yeung , Haewon Lee , Zheyan Chen , Ben Laplante , Paul Kitei , Reza Ehsanian , David Levi
This series of FactFinders presents a brief summary of the evidence and outlines recommendations regarding minimizing risks with radiofrequency neurotomy procedures.
The evidence in support of the following facts is presented: (1) While data on the safety of radiofrequency neurotomy in patients with implanted devices are limited, the procedure can likely be performed safely with careful adherence to best practices and manufacturer recommendations. (2) Basivertebral nerve radiofrequency neurotomy can be performed safely and effectively at the L3 through S1 vertebral levels. Scrutiny of preprocedural imaging may minimize risk. Although the transpedicular approach is preferred, patient anatomy may dictate a non-transpedicular trajectory.
{"title":"FACTFINDERS for PATIENT SAFETY: Minimizing complications in radiofrequency neurotomy: Part I—Implantable devices; Part II—Preprocedural BVNRFN imaging","authors":"David Hao , Gerald Yeung , Haewon Lee , Zheyan Chen , Ben Laplante , Paul Kitei , Reza Ehsanian , David Levi","doi":"10.1016/j.inpm.2025.100650","DOIUrl":"10.1016/j.inpm.2025.100650","url":null,"abstract":"<div><div>This series of FactFinders presents a brief summary of the evidence and outlines recommendations regarding minimizing risks with radiofrequency neurotomy procedures.</div><div>The evidence in support of the following facts is presented: (1) While data on the safety of radiofrequency neurotomy in patients with implanted devices are limited, the procedure can likely be performed safely with careful adherence to best practices and manufacturer recommendations. (2) Basivertebral nerve radiofrequency neurotomy can be performed safely and effectively at the L3 through S1 vertebral levels. Scrutiny of preprocedural imaging may minimize risk. Although the transpedicular approach is preferred, patient anatomy may dictate a non-transpedicular trajectory.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100650"},"PeriodicalIF":0.0,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic sternal pain is relatively common in adults and particularly in patients after surgery involving the chest wall such as with cardiac surgery or mastectomy. Treatment options for patients with chronic sternal pain have largely consisted of physical therapy and oral medications. The pecto-intercostal fascial plane block, while having proven efficacy in managing pain in the perioperative setting, has very limited evidence demonstrating its use within the outpatient setting.
Case report
This is a case of a 53-year-old female with chronic underlying sternal pain presumably from costochondritis who underwent radical bilateral mastectomy and radiation therapy for breast cancer, which significantly worsened her sternal pain. She failed conservative measures. A pecto-intercostal fascial plane block was ordered and administered. This brought 80–100 % pain relief and significant functional improvements for the patient which lasted for over three months.
Conclusion
This is a novel case where a patient with chronic sternal pain which worsened after bilateral mastectomy received a pecto-intercostal fascial plane block and had almost complete pain relief for over a three month period. Additional research is needed to further establish this procedure and its efficacy in managing patients in an outpatient setting with chronic sternal pain.
{"title":"Chronic sternal pain relief after a pecto-intercostal fascial plane block: A case report","authors":"Harlyn Naika Veloso-Evans, Kyle Wentz, Neville Campbell","doi":"10.1016/j.inpm.2025.100655","DOIUrl":"10.1016/j.inpm.2025.100655","url":null,"abstract":"<div><h3>Background</h3><div>Chronic sternal pain is relatively common in adults and particularly in patients after surgery involving the chest wall such as with cardiac surgery or mastectomy. Treatment options for patients with chronic sternal pain have largely consisted of physical therapy and oral medications. The pecto-intercostal fascial plane block, while having proven efficacy in managing pain in the perioperative setting, has very limited evidence demonstrating its use within the outpatient setting.</div></div><div><h3>Case report</h3><div>This is a case of a 53-year-old female with chronic underlying sternal pain presumably from costochondritis who underwent radical bilateral mastectomy and radiation therapy for breast cancer, which significantly worsened her sternal pain. She failed conservative measures. A pecto-intercostal fascial plane block was ordered and administered. This brought 80–100 % pain relief and significant functional improvements for the patient which lasted for over three months.</div></div><div><h3>Conclusion</h3><div>This is a novel case where a patient with chronic sternal pain which worsened after bilateral mastectomy received a pecto-intercostal fascial plane block and had almost complete pain relief for over a three month period. Additional research is needed to further establish this procedure and its efficacy in managing patients in an outpatient setting with chronic sternal pain.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100655"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.inpm.2025.100656
Hasan Sen, Audrey Adler, Amanda N. Cooper, Napatpaphan Kanjanapanang, Jason E. Mascoe, Alexandra E. Fogarty, Allison Glinka Przybysz, Aaron Conger, Zachary L. McCormick
Background
Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for refractory knee pain. However, refinements of GNRFA protocols are ongoing as new technologies emerge amidst accumulating evidence supporting expanded lesioning strategies.
Objectives
Describe a novel, comprehensive GNRFA protocol utilizing dual-tined electrodes to target six genicular nerves and report clinical outcomes in a cross-sectional cohort. This technique incorporates both bipolar and monopolar ablation for precise, effective lesioning.
Methods
Consecutive patients who underwent GNRFA with the described protocol at a tertiary academic center were contacted for follow-up. Baseline demographic and clinical data were collected from electronic medical records, and outcomes were assessed via standardized telephone survey. The primary outcome was the proportion of participants with ≥50 % numerical rating scale (NRS) pain score reduction. Secondary outcomes included the respective proportions of participants with ≥2-point NRS reduction and Patient Global Impression of Change (PGIC) scores ≥6, reflecting a “much improved” or better status.
Results
Fourteen patients (16 GNRFA procedures) were included. At a mean follow-up of 9.0 ± 1.5 months, 50.0 % (95 %CI:28.0–72.0 %) of participants reported ≥50 % NRS reduction, 62.5 % (95 %CI:38.6–81.5 %) experienced ≥2-point NRS reduction, and 56.3 % (95 %CI:33.2–76.9 %) reported PGIC scores ≥6. No new opioid use, arthroplasties, or procedural complications were reported at follow-up.
Conclusion
Our expanded, 6-nerve GNRFA protocol using dual-tined electrodes provided clinically significant pain relief in most patients with no associated complications. This technique shows promise as a safe, effective treatment option for refractory knee pain due to knee osteoarthritis in patients selected by single genicular nerve blocks requiring ≥50 % pain relief. Larger prospective studies with longer follow-up are needed to confirm these findings.
{"title":"Comprehensive genicular nerve radiofrequency ablation for refractory knee pain using a dual-tined electrode: A technical description and cross-sectional cohort study","authors":"Hasan Sen, Audrey Adler, Amanda N. Cooper, Napatpaphan Kanjanapanang, Jason E. Mascoe, Alexandra E. Fogarty, Allison Glinka Przybysz, Aaron Conger, Zachary L. McCormick","doi":"10.1016/j.inpm.2025.100656","DOIUrl":"10.1016/j.inpm.2025.100656","url":null,"abstract":"<div><h3>Background</h3><div>Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for refractory knee pain. However, refinements of GNRFA protocols are ongoing as new technologies emerge amidst accumulating evidence supporting expanded lesioning strategies.</div></div><div><h3>Objectives</h3><div>Describe a novel, comprehensive GNRFA protocol utilizing dual-tined electrodes to target six genicular nerves and report clinical outcomes in a cross-sectional cohort. This technique incorporates both bipolar and monopolar ablation for precise, effective lesioning.</div></div><div><h3>Methods</h3><div>Consecutive patients who underwent GNRFA with the described protocol at a tertiary academic center were contacted for follow-up. Baseline demographic and clinical data were collected from electronic medical records, and outcomes were assessed via standardized telephone survey. The primary outcome was the proportion of participants with ≥50 % numerical rating scale (NRS) pain score reduction. Secondary outcomes included the respective proportions of participants with ≥2-point NRS reduction and Patient Global Impression of Change (PGIC) scores ≥6, reflecting a “much improved” or better status.</div></div><div><h3>Results</h3><div>Fourteen patients (16 GNRFA procedures) were included. At a mean follow-up of 9.0 ± 1.5 months, 50.0 % (95 %CI:28.0–72.0 %) of participants reported ≥50 % NRS reduction, 62.5 % (95 %CI:38.6–81.5 %) experienced ≥2-point NRS reduction, and 56.3 % (95 %CI:33.2–76.9 %) reported PGIC scores ≥6. No new opioid use, arthroplasties, or procedural complications were reported at follow-up.</div></div><div><h3>Conclusion</h3><div>Our expanded, 6-nerve GNRFA protocol using dual-tined electrodes provided clinically significant pain relief in most patients with no associated complications. This technique shows promise as a safe, effective treatment option for refractory knee pain due to knee osteoarthritis in patients selected by single genicular nerve blocks requiring ≥50 % pain relief. Larger prospective studies with longer follow-up are needed to confirm these findings.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100656"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.inpm.2025.100654
Justin Chau , Durga Ghosh , Sean Fox , Ayahiro D. Takashima , Andrew Stephens
Background
Basivertebral nerve ablation (BVNA) is an effective treatment for vertebrogenic chronic low back pain. However, data regarding rates of post-BVNA lumbar vertebral compression fracture (VCF), particularly among patients with osteoporosis or osteopenia, remains limited.
Objective
(1) Estimate the rate of lumbar VCF after BVNA. (2) Compare rates between patients with and without a pre-BVNA diagnosis of osteopenia/osteoporosis utilizing a large global database.
Methods
A retrospective cohort study was performed using TriNetX, a national database of de-identified health records from over 130 million patients. Adults (≥18 years) who underwent BVNA between January 2022 and August 2025 were identified via CPT code. Patients were stratified by presence or absence of ICD-10 code for osteoporosis/osteopenia before undergoing BVNA. The primary outcome was incidence of ICD-10 code diagnosis of lumbar VCF after undergoing BVNA.
Results
A total of 2387 patients underwent BVNA (mean age 63.7 years; 48.0 % female). Of these, 669 had a pre-BVNA diagnosis of osteoporosis/osteopenia (mean age 70.2 ± 10.7 years; 64.4 % female). Lumbar VCF occurred in 37 patients (1.55 %; 95 % CI, 1.11–2.16 %) after BVNA. Patients with osteoporosis/osteopenia had higher rate of post-BVNA lumbar VCF compared to those without (4.64 % vs 0.37 %), though rates of post-BVNA lumbar VCF were overall low across all patients (1.55 %). Osteoporosis/osteopenia was independently associated with post-BVNA VCF (adjusted OR 6.5; 95 % CI, 3.7–12.3; p < 0.001).
Conclusion
While patients with pre-BVNA ICD-10 code diagnosis of osteoporosis/osteopenia had higher rates and were at higher risk of post-BVNA VCF than those without, overall rates were still low. Risk of VCF should be considered and risks/benefits should be discussed with patients, but a diagnosis of osteoporosis/osteopenia should not be considered an absolute contraindication to BVNA.
背景：椎体神经消融术（BVNA）是治疗椎源性慢性腰痛的有效方法。然而，关于bvna后腰椎压缩性骨折（VCF）发生率的数据，特别是骨质疏松或骨质减少患者的数据仍然有限。目的(1)评估BVNA术后腰椎VCF发生率。(2)利用一个大型的全球数据库，比较有和没有bvna前诊断骨质减少/骨质疏松症的患者之间的比率。方法使用TriNetX进行回顾性队列研究，TriNetX是一个包含超过1.3亿患者的未识别健康记录的国家数据库。在2022年1月至2025年8月期间接受BVNA的成人（≥18岁）通过CPT代码进行识别。在接受BVNA之前，根据是否存在骨质疏松症/骨质减少症的ICD-10代码对患者进行分层。主要观察指标为行BVNA后腰椎VCF的ICD-10码诊断发生率。结果共2387例患者行BVNA，平均年龄63.7岁，女性48.0%。其中，669例bvna前诊断为骨质疏松/骨质减少（平均年龄70.2±10.7岁，64.4%为女性）。37例患者在BVNA后发生腰椎VCF （1.55%; 95% CI, 1.11 - 2.16%）。骨质疏松/骨质减少患者的bvna后腰椎VCF发生率高于无bvna患者（4.64% vs 0.37%），尽管所有患者的bvna后腰椎VCF发生率总体较低（1.55%）。骨质疏松/骨质减少与bvna后VCF独立相关（校正OR 6.5; 95% CI, 3.7-12.3; p < 0.001）。结论虽然bvna前ICD-10编码诊断为骨质疏松/骨质减少的患者比未诊断为bvna后发生VCF的患者有更高的发生率和风险，但总体发生率仍较低。应考虑VCF的风险，并与患者讨论风险/益处，但不应将骨质疏松/骨质减少的诊断视为BVNA的绝对禁忌症。
{"title":"Rates of lumbar vertebral body compression fracture after basivertebral nerve ablation: A retrospective study utilizing a large national database","authors":"Justin Chau , Durga Ghosh , Sean Fox , Ayahiro D. Takashima , Andrew Stephens","doi":"10.1016/j.inpm.2025.100654","DOIUrl":"10.1016/j.inpm.2025.100654","url":null,"abstract":"<div><h3>Background</h3><div>Basivertebral nerve ablation (BVNA) is an effective treatment for vertebrogenic chronic low back pain. However, data regarding rates of post-BVNA lumbar vertebral compression fracture (VCF), particularly among patients with osteoporosis or osteopenia, remains limited.</div></div><div><h3>Objective</h3><div>(1) Estimate the rate of lumbar VCF after BVNA. (2) Compare rates between patients with and without a pre-BVNA diagnosis of osteopenia/osteoporosis utilizing a large global database.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed using TriNetX, a national database of de-identified health records from over 130 million patients. Adults (≥18 years) who underwent BVNA between January 2022 and August 2025 were identified via CPT code. Patients were stratified by presence or absence of ICD-10 code for osteoporosis/osteopenia before undergoing BVNA. The primary outcome was incidence of ICD-10 code diagnosis of lumbar VCF after undergoing BVNA.</div></div><div><h3>Results</h3><div>A total of 2387 patients underwent BVNA (mean age 63.7 years; 48.0 % female). Of these, 669 had a pre-BVNA diagnosis of osteoporosis/osteopenia (mean age 70.2 ± 10.7 years; 64.4 % female). Lumbar VCF occurred in 37 patients (1.55 %; 95 % CI, 1.11–2.16 %) after BVNA. Patients with osteoporosis/osteopenia had higher rate of post-BVNA lumbar VCF compared to those without (4.64 % vs 0.37 %), though rates of post-BVNA lumbar VCF were overall low across all patients (1.55 %). Osteoporosis/osteopenia was independently associated with post-BVNA VCF (adjusted OR 6.5; 95 % CI, 3.7–12.3; p < 0.001).</div></div><div><h3>Conclusion</h3><div>While patients with pre-BVNA ICD-10 code diagnosis of osteoporosis/osteopenia had higher rates and were at higher risk of post-BVNA VCF than those without, overall rates were still low. Risk of VCF should be considered and risks/benefits should be discussed with patients, but a diagnosis of osteoporosis/osteopenia should not be considered an absolute contraindication to BVNA.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100654"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-15DOI: 10.1016/j.inpm.2025.100651
Andrew R. Stephens , Ramzi El-Hassan , Ashley Rogerson
Background
Cervical transforaminal epidural steroid injections (CTFESI) are commonly performed to treat cervical radicular pain and decrease the need of surgery. The literature is mixed regarding the efficacy of CTFESI in obviating the need for cervical spine surgery.
Objective
The purpose of this study was to assess the rates of cervical spine surgery and spinal interventions after initial CTFESI for patients with radicular pain.
Methods
TriNetX, a large national database, was queried from 2004 to 2025 for patients who underwent CTFESI for cervical radiculopathy. The rates of treatment progression after initial CTFESI were calculated. Treatment progression included: no additional treatment, repeat CTFEI, cervical interlaminar epidural steroid injection (CIESI), and cervical spine surgery. Cervical spine surgeries analyzed included anterior cervical decompression and fusion (ACDF), foraminotomy, and total disc replacement (TDR). Treatment rates were also calculated for patients after a second CTFESI.
Results
There were 28,345 patients who underwent CTFESI during this study period. After initial CTFESI, 57 % of patients did not undergo any additional procedures/surgeries, 23.7 % had a repeat CTFESI, 5.6 % received a CILESI, 7.4 % underwent ACDF, 1.6 % underwent a foraminotomy, and 1.8 % underwent a TDR. Together, after initial CTFESI, 10.8 % of patients went on to cervical spine surgery as a second line treatment. Of the 6,711 patients who received a repeat CTFESI, 74.5 % had no additional interventional treatment, 8.2 % underwent a CIESI, 10.6 % underwent ACDF, 2.5 % underwent a foraminotomy, and 2.2 % underwent a TDR. In total, 15.3 % of patients underwent cervical spine surgery after a second CTFESI. A third consecutive CTFESI was not attempted in any patients.
Conclusion
This study demonstrates rates of surgery after an initial CTFESI and a repeat CTFEIS to be low.
{"title":"Rates of cervical spine surgery and repeat epidural injections after cervical transforaminal epidural steroid injections for patients with cervical radiculopathy utilizing a large national database","authors":"Andrew R. Stephens , Ramzi El-Hassan , Ashley Rogerson","doi":"10.1016/j.inpm.2025.100651","DOIUrl":"10.1016/j.inpm.2025.100651","url":null,"abstract":"<div><h3>Background</h3><div>Cervical transforaminal epidural steroid injections (CTFESI) are commonly performed to treat cervical radicular pain and decrease the need of surgery. The literature is mixed regarding the efficacy of CTFESI in obviating the need for cervical spine surgery.</div></div><div><h3>Objective</h3><div>The purpose of this study was to assess the rates of cervical spine surgery and spinal interventions after initial CTFESI for patients with radicular pain.</div></div><div><h3>Methods</h3><div>TriNetX, a large national database, was queried from 2004 to 2025 for patients who underwent CTFESI for cervical radiculopathy. The rates of treatment progression after initial CTFESI were calculated. Treatment progression included: no additional treatment, repeat CTFEI, cervical interlaminar epidural steroid injection (CIESI), and cervical spine surgery. Cervical spine surgeries analyzed included anterior cervical decompression and fusion (ACDF), foraminotomy, and total disc replacement (TDR). Treatment rates were also calculated for patients after a second CTFESI.</div></div><div><h3>Results</h3><div>There were 28,345 patients who underwent CTFESI during this study period. After initial CTFESI, 57 % of patients did not undergo any additional procedures/surgeries, 23.7 % had a repeat CTFESI, 5.6 % received a CILESI, 7.4 % underwent ACDF, 1.6 % underwent a foraminotomy, and 1.8 % underwent a TDR. Together, after initial CTFESI, 10.8 % of patients went on to cervical spine surgery as a second line treatment. Of the 6,711 patients who received a repeat CTFESI, 74.5 % had no additional interventional treatment, 8.2 % underwent a CIESI, 10.6 % underwent ACDF, 2.5 % underwent a foraminotomy, and 2.2 % underwent a TDR. In total, 15.3 % of patients underwent cervical spine surgery after a second CTFESI. A third consecutive CTFESI was not attempted in any patients.</div></div><div><h3>Conclusion</h3><div>This study demonstrates rates of surgery after an initial CTFESI and a repeat CTFEIS to be low.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100651"},"PeriodicalIF":0.0,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-31DOI: 10.1016/j.inpm.2025.100649
Hasan Sen , Edvin Koshi , Matthew Essman , Amanda N. Cooper , Audrey Adler , Akbar Nabi , Blake Dickenson , William Tang , Chase Young , Taylor Burnham , Alexandra E. Fogarty , Allison Glinka Przybysz , Aaron M. Conger , Zachary L. McCormick
Background
Thoracic medial branch radiofrequency ablation (TMBRFA) is used to treat chronic thoracic spine pain, but data regarding its effectiveness and technique remain limited.
Objectives
Evaluate outcomes of TMBRFA using a three-tined electrode in patients with thoracic facet joint pain.
Methods
Consecutive patients who underwent first-time TMBRFA at a single tertiary academic center between 2022 and 2024 were identified and contacted for follow-up via standardized telephone survey at ≥6 months post-procedure. Baseline demographic and clinical data were extracted from electronic medical records. Outcomes included the proportions of patients with ≥50% numerical rating scale (NRS) pain score reduction, ≥2-point NRS reduction, and Patient Global Impression of Change (PGIC) scores ≥6 (indicating at least “much improved”). Mean NRS pain score reduction and changes in opioid use from baseline were also assessed.
Results
Outcomes were successfully collected from 11 patients. At a mean follow-up of 20.6 ± 7.6 months, 36.4% (95%CI: 15.2–64.6) and 45.5% (95%CI: 21.3–72.0) of patients reported ≥50% and ≥2-point NRS reductions, respectively, with 54.6% (95%CI: 28.0–78.7) reporting PGIC scores ≥6. Mean NRS pain score reduction was 1.9 ± 2.7 points. Two patients had ceased using opioids at follow-up, representing a proportional decrease of 18.2% compared to baseline.
Conclusion
In this cohort, approximately half of patients who underwent first-time TMBRFA with a three-tined electrode experienced clinically meaningful pain relief and perceived overall improvement at an average follow-up of nearly 2 years. Larger, prospective studies are needed to corroborate these findings.
{"title":"The effectiveness of thoracic medial branch radiofrequency ablation using a three-tined electrode: A real-world cross-sectional cohort study","authors":"Hasan Sen , Edvin Koshi , Matthew Essman , Amanda N. Cooper , Audrey Adler , Akbar Nabi , Blake Dickenson , William Tang , Chase Young , Taylor Burnham , Alexandra E. Fogarty , Allison Glinka Przybysz , Aaron M. Conger , Zachary L. McCormick","doi":"10.1016/j.inpm.2025.100649","DOIUrl":"10.1016/j.inpm.2025.100649","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic medial branch radiofrequency ablation (TMBRFA) is used to treat chronic thoracic spine pain, but data regarding its effectiveness and technique remain limited.</div></div><div><h3>Objectives</h3><div>Evaluate outcomes of TMBRFA using a three-tined electrode in patients with thoracic facet joint pain.</div></div><div><h3>Methods</h3><div>Consecutive patients who underwent first-time TMBRFA at a single tertiary academic center between 2022 and 2024 were identified and contacted for follow-up via standardized telephone survey at ≥6 months post-procedure. Baseline demographic and clinical data were extracted from electronic medical records. Outcomes included the proportions of patients with ≥50% numerical rating scale (NRS) pain score reduction, ≥2-point NRS reduction, and Patient Global Impression of Change (PGIC) scores ≥6 (indicating at least “much improved”). Mean NRS pain score reduction and changes in opioid use from baseline were also assessed.</div></div><div><h3>Results</h3><div>Outcomes were successfully collected from 11 patients. At a mean follow-up of 20.6 ± 7.6 months, 36.4% (95%CI: 15.2–64.6) and 45.5% (95%CI: 21.3–72.0) of patients reported ≥50% and ≥2-point NRS reductions, respectively, with 54.6% (95%CI: 28.0–78.7) reporting PGIC scores ≥6. Mean NRS pain score reduction was 1.9 ± 2.7 points. Two patients had ceased using opioids at follow-up, representing a proportional decrease of 18.2% compared to baseline.</div></div><div><h3>Conclusion</h3><div>In this cohort, approximately half of patients who underwent first-time TMBRFA with a three-tined electrode experienced clinically meaningful pain relief and perceived overall improvement at an average follow-up of nearly 2 years. Larger, prospective studies are needed to corroborate these findings.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100649"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-29DOI: 10.1016/j.inpm.2025.100648
Dorsa Kavandi , Eileen T. Jin , Salim M. Hayek , David Hao
{"title":"Perioperative considerations for spinal cord stimulation devices: A practical guide","authors":"Dorsa Kavandi , Eileen T. Jin , Salim M. Hayek , David Hao","doi":"10.1016/j.inpm.2025.100648","DOIUrl":"10.1016/j.inpm.2025.100648","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100648"},"PeriodicalIF":0.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.inpm.2025.100647
Rachel Pooley , Adam Delora , Mingda Chen , Muhammad T. Amjad , Nicolas R. Thompson , Kush K. Goyal
Introduction
A lumbosacral transitional vertebra (LSTV) is an articulation or fusion of the transverse process of the fifth lumbar vertebra and the sacrum or ilium, and, when associated with pain, it is referred to as Bertolotti's syndrome. Few studies have examined the diagnostic utility of LSTV injections and their ability to provide relief in cases of Bertolotti's syndrome. In this study, we investigate predictors of positive clinical outcomes following LSTV injection and examine the relationship between a positive diagnostic injection and outcomes after LSTV resection in patients with Bertolotti's syndrome.
Methods
This study was a retrospective analysis of 56 patients from September 2013 through August 2024 who were diagnosed with Bertolotti's syndrome and who had received a pseudojoint injection with a steroid and an anesthetic. Demographic information, comorbid conditions, and information about pain and multiple validated outcomes were extracted from the electronic health record.
Results
The patients had a mean age of 44 years, and 62.5 % (35/56) of the patients were female. Lumbar spondylolisthesis was found in 20.0 % of patients (11/55). Using the Castellvi classification, the most common type of LSTV was Type 2a (42/56, 75.0 %). Of the patients, 55.4 % had an anxiety disorder (N = 31/56) and 42.9 % had depression (24/56). Numeric rating scale (NRS) scores significantly improved from preprocedure to immediate postprocedure (P < 0.001), with 39/45 (86.7 %) achieving a minimal clinically important difference (MCID) of 2.5, and from preprocedure to follow-up (P < 0.001), with 8/25 (32.0 %) achieving an MCID of 2.5. The median duration of pain relief was 14 days. There was no statistically significant difference in PROMIS-GH physical and mental scores, and no difference in PHQ-9 in patients between preprocedure and follow-up. Patients with a higher American Society of Anesthesiologists (ASA) physical status classification were less likely to experience relief (p = 0.025). Additionally, patients who received an injection of Triamcinolone (p = 0.018) were less likely to experience relief at follow-up than those who received methylprednisolone, although this difference was not observed immediately after injection. Only 13 patients underwent a resection of the pseudojoint, of which 8 (61.5 %) reported improvement after resection.
Discussion
Injections into the pseudojoint under fluoroscopic guidance may provide therapeutic benefits and may have some diagnostic impact on surgical intervention. Future randomized prospective research should be performed to determine the appropriate utilization of pseudojoint injections and create an evidence-based diagnostic and therapeutic algorithm to isolate pain generators in Bertolotti's syndrome and create an appropriate individualized treatment.
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Pub Date : 2025-10-18DOI: 10.1016/j.inpm.2025.100643
Tomás Caroço , Giovanni Leoni , Daniela Teixeira , Jorge Ribeiro , Bruno Paiva , Jorge Barbosa
Background
Radiofrequency ablation (RFA) of the knee joint may be an effective therapeutic option for the management of chronic knee pain. Accurate anatomical knowledge is essential for optimizing the precision and outcomes of the procedure. The innervation of the knee joint is complex. Ultrasound (US) guidance offers a widely accessible method for targeting sensory nerves. Given the limited availability of high-quality video literature on knee RFA, we developed an educational video illustrating an extensive revised ultrasound-guided protocol.
Objective
To present a video-based description of a revised ultrasound-guided RFA protocol for the knee, targeting specific nerves by anatomical quadrant: superomedial quadrant (Video 1)– medial branch of the NVI, SMGN; inferomedial quadrant (Video 2) – IMGN; superolateral quadrant (Video 3) – lateral branch of the NVI, SLGN; and inferolateral quadrant (Video 4) - RFN.
Methods
Seven patients with advanced knee osteoarthritis, unresponsive to conservative treatment, underwent selective RFA of either the medial or lateral quadrants, based on the distribution of their pain. The procedures were recorded in high definition and annotated to serve educational purposes.
Conclusions
The video-based illustrations presented may enhance procedural clarity and facilitate clinician training. Due to the time consuming and potential for pain associated with the procedure described, targeting all nerves may be not appropriate in every patient. An individualized approach, tailoring the selection of targets based on patient-specific characteristics and localization of pain is likely more optimal.
{"title":"Ultrasound-guided genicular nerve radiofrequency ablation: A revised protocol illustrated through high-definition video","authors":"Tomás Caroço , Giovanni Leoni , Daniela Teixeira , Jorge Ribeiro , Bruno Paiva , Jorge Barbosa","doi":"10.1016/j.inpm.2025.100643","DOIUrl":"10.1016/j.inpm.2025.100643","url":null,"abstract":"<div><h3>Background</h3><div>Radiofrequency ablation (RFA) of the knee joint may be an effective therapeutic option for the management of chronic knee pain. Accurate anatomical knowledge is essential for optimizing the precision and outcomes of the procedure. The innervation of the knee joint is complex. Ultrasound (US) guidance offers a widely accessible method for targeting sensory nerves. Given the limited availability of high-quality video literature on knee RFA, we developed an educational video illustrating an extensive revised ultrasound-guided protocol.</div></div><div><h3>Objective</h3><div>To present a video-based description of a revised ultrasound-guided RFA protocol for the knee, targeting specific nerves by anatomical quadrant: superomedial quadrant (Video 1)– medial branch of the NVI, SMGN; inferomedial quadrant (Video 2) – IMGN; superolateral quadrant (Video 3) – lateral branch of the NVI, SLGN; and inferolateral quadrant (Video 4) - RFN.</div></div><div><h3>Methods</h3><div>Seven patients with advanced knee osteoarthritis, unresponsive to conservative treatment, underwent selective RFA of either the medial or lateral quadrants, based on the distribution of their pain. The procedures were recorded in high definition and annotated to serve educational purposes.</div></div><div><h3>Conclusions</h3><div>The video-based illustrations presented may enhance procedural clarity and facilitate clinician training. Due to the time consuming and potential for pain associated with the procedure described, targeting all nerves may be not appropriate in every patient. An individualized approach, tailoring the selection of targets based on patient-specific characteristics and localization of pain is likely more optimal.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100643"},"PeriodicalIF":0.0,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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