Pub Date : 2024-06-01DOI: 10.1016/j.inpm.2024.100421
Cole Cheney, Jason Dauffenbach
Background
Blockade of the suprascapular nerve is an effective diagnostic tool in the workup and potential treatment of shoulder pain. For chronic shoulder pain, peripheral nerve stimulation has been shown to provide significant, sustained pain relief. However, no literature to date has described peripheral nerve stimulation for the treatment of oncologic shoulder pain.
Objectives
We describe two cases of chronic oncologic-related shoulder pain that responded to posterior suprascapular peripheral nerve stimulator placement to facilitate future progress and discussion in the fields of peripheral nerve stimulation and oncology pain.
Methods
Two subjects with chronic shoulder pain underwent ultrasound-guided peripheral nerve stimulation therapy at the suprascapular nerve.
Results
At follow-up visits (30 and 98 days after procedure), both subjects reported greater than 50% pain relief as measured by the numerical rating scale (NRS).
Conclusions
Peripheral nerve stimulator placement at the suprascapular nerve is a feasible procedure to treat oncologic shoulder pain via the described technique. Both subjects experienced clinically significant pain relief and decreased oral analgesic medication intake, and decreased medication-related side effects. This warrants further investigation including large comparative, prospective studies to better assess efficacy and safety of this approach.
{"title":"Suprascapular nerve peripheral nerve stimulation for malignancy-related pain: A case series","authors":"Cole Cheney, Jason Dauffenbach","doi":"10.1016/j.inpm.2024.100421","DOIUrl":"https://doi.org/10.1016/j.inpm.2024.100421","url":null,"abstract":"<div><h3>Background</h3><p>Blockade of the suprascapular nerve is an effective diagnostic tool in the workup and potential treatment of shoulder pain. For chronic shoulder pain, peripheral nerve stimulation has been shown to provide significant, sustained pain relief. However, no literature to date has described peripheral nerve stimulation for the treatment of oncologic shoulder pain.</p></div><div><h3>Objectives</h3><p>We describe two cases of chronic oncologic-related shoulder pain that responded to posterior suprascapular peripheral nerve stimulator placement to facilitate future progress and discussion in the fields of peripheral nerve stimulation and oncology pain.</p></div><div><h3>Methods</h3><p>Two subjects with chronic shoulder pain underwent ultrasound-guided peripheral nerve stimulation therapy at the suprascapular nerve.</p></div><div><h3>Results</h3><p>At follow-up visits (30 and 98 days after procedure), both subjects reported greater than 50% pain relief as measured by the numerical rating scale (NRS).</p></div><div><h3>Conclusions</h3><p>Peripheral nerve stimulator placement at the suprascapular nerve is a feasible procedure to treat oncologic shoulder pain via the described technique. Both subjects experienced clinically significant pain relief and decreased oral analgesic medication intake, and decreased medication-related side effects. This warrants further investigation including large comparative, prospective studies to better assess efficacy and safety of this approach.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 2","pages":"Article 100421"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000414/pdfft?md5=3a5749a52eeca516ac4f6f04628d8e22&pid=1-s2.0-S2772594424000414-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.inpm.2024.100420
William J. Beckworth , Gilad M. Ghanbari , Eduardo Lamas-Basulto , Benjamin Taylor
Background
In 2014 the FDA issued a drug safety warning that steroids in the epidural space may result in rare but serious neurological adverse events. The FDA identified 131 cases of neurological adverse events and most complications were related to cervical transforaminal epidural injections (TFESIs). These complications occurred before the standard use of non-particulate steroids. Many still consider cervical TFSEIs to be unsafe.
Objectives
The objective of this study was to evaluate the safety of cervical TFESIs with non-particulate steroids.
Methods
A review was done of all cervical TFESIs from 2004 to 2021 at an academic institution when non-particulate steroids became more commonly used by reviewing CPT code 64479 linked to the performing physician. All treating physicians and department directors were queried about catastrophic complications (stroke, spinal cord injury, death or other). A secondary analysis was done on 200 consecutive cervical TFESIs looking at immediate and delayed side-effects documented by the nurse in recovery, day-after phone calls and clinic follow-up notes.
Results
From 2004 to 2021 the CPT code 64479 was used 6967 times, with 6241 cervical TFESIs and 726 thoracic TFESIs. No catastrophic complications occurred. In the subset analysis of 200 consecutive cervical TFESIs, 7 patients (3.5 %, 95 % CI 1.0–6.0) had a transient increase in pain, 18 (9 %, 95 % CI 5.0–13.0) had no change in pain and 171 (85.5 %, 95 % CI 80.6–90.4) had a decrease in pain. The average pain score among all participants dropped 3.7 (95 % 3.0–4.4) points. A 2-point drop was seen in 75.5 % (95 % CI 69.5–81.5) and a 3-point drop was seen in 62.5 % (95 % CI 59.1–65.9). Five of the seven patients with transient increased pain had an increase of 3 points on numerical rating scale. There was one of each of the following reported: insomnia, glucose >500, transient thumb numbness with pain, and hypertension. Two cases of headaches were reported.
Conclusion
This study supports the safety of cervical TFESIs with non-particulate steroids as recommended by consensus opinions from medical societies.
{"title":"Safety of cervical transforaminal epidural steroid injections","authors":"William J. Beckworth , Gilad M. Ghanbari , Eduardo Lamas-Basulto , Benjamin Taylor","doi":"10.1016/j.inpm.2024.100420","DOIUrl":"https://doi.org/10.1016/j.inpm.2024.100420","url":null,"abstract":"<div><h3>Background</h3><p>In 2014 the FDA issued a drug safety warning that steroids in the epidural space may result in rare but serious neurological adverse events. The FDA identified 131 cases of neurological adverse events and most complications were related to cervical transforaminal epidural injections (TFESIs). These complications occurred before the standard use of non-particulate steroids. Many still consider cervical TFSEIs to be unsafe.</p></div><div><h3>Objectives</h3><p>The objective of this study was to evaluate the safety of cervical TFESIs with non-particulate steroids.</p></div><div><h3>Methods</h3><p>A review was done of all cervical TFESIs from 2004 to 2021 at an academic institution when non-particulate steroids became more commonly used by reviewing CPT code 64479 linked to the performing physician. All treating physicians and department directors were queried about catastrophic complications (stroke, spinal cord injury, death or other). A secondary analysis was done on 200 consecutive cervical TFESIs looking at immediate and delayed side-effects documented by the nurse in recovery, day-after phone calls and clinic follow-up notes.</p></div><div><h3>Results</h3><p>From 2004 to 2021 the CPT code 64479 was used 6967 times, with 6241 cervical TFESIs and 726 thoracic TFESIs. No catastrophic complications occurred. In the subset analysis of 200 consecutive cervical TFESIs, 7 patients (3.5 %, 95 % CI 1.0–6.0) had a transient increase in pain, 18 (9 %, 95 % CI 5.0–13.0) had no change in pain and 171 (85.5 %, 95 % CI 80.6–90.4) had a decrease in pain. The average pain score among all participants dropped 3.7 (95 % 3.0–4.4) points. A 2-point drop was seen in 75.5 % (95 % CI 69.5–81.5) and a 3-point drop was seen in 62.5 % (95 % CI 59.1–65.9). Five of the seven patients with transient increased pain had an increase of <span><math><mrow><mo>≥</mo></mrow></math></span> 3 points on numerical rating scale. There was one of each of the following reported: insomnia, glucose >500, transient thumb numbness with pain, and hypertension. Two cases of headaches were reported.</p></div><div><h3>Conclusion</h3><p>This study supports the safety of cervical TFESIs with non-particulate steroids as recommended by consensus opinions from medical societies.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 2","pages":"Article 100420"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000402/pdfft?md5=1cb589884e3bce3fbc2c404988c7ab1d&pid=1-s2.0-S2772594424000402-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-27DOI: 10.1016/j.inpm.2024.100416
Eldhose Abrahams
{"title":"Minimally invasive spine surgical procedures and interventional pain medicine: Need for standardization of training","authors":"Eldhose Abrahams","doi":"10.1016/j.inpm.2024.100416","DOIUrl":"https://doi.org/10.1016/j.inpm.2024.100416","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 2","pages":"Article 100416"},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000360/pdfft?md5=9eb0144e747ce538cecb8dc7b4acbda8&pid=1-s2.0-S2772594424000360-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141156238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20DOI: 10.1016/j.inpm.2024.100415
Daniel R. Briggi, Christian T. Vangeison, Peter D. Vu, Zane Shah, Brian M. Bruel
{"title":"Closed-loop spinal cord stimulation as a novel treatment for chronic pelvic pain: A letter to the editor","authors":"Daniel R. Briggi, Christian T. Vangeison, Peter D. Vu, Zane Shah, Brian M. Bruel","doi":"10.1016/j.inpm.2024.100415","DOIUrl":"https://doi.org/10.1016/j.inpm.2024.100415","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 2","pages":"Article 100415"},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000359/pdfft?md5=c72e872f8be2084c58ff64e19819c973&pid=1-s2.0-S2772594424000359-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lumbar medial branch (MB) radiofrequency ablation is a common intervention to treat facetogenic low back pain. Consensus among spine pain interventionalists is that the cannula tip should be placed adjacent to the periosteum of the lateral neck of the superior articular process (SAP) to ensure maximum contact with the MB. The spatial relationship of the nerve to the periosteum of the lateral neck of the SAP has not been quantified in 3D. The objectives of the current study were to: 1) use 3D modelling technology to quantify the location along the lateral neck of the SAP where the MB is in direct contact with the periosteum; and 2) identify target site(s) to optimize lumbar MB denervation.
Design
Seventy lumbar dorsal rami in 14 formalin-embalmed specimens were dissected, digitized, and modeled in 3D. The 3D positional data of the MB were used to generate a novel nerve proximity map which provided a method to quantify and visualize the 3D course of the MB in relation to the periosteum of the lateral neck of SAP. The percent of the lateral neck of SAP in contact with the MB was quantified and consistent target site(s) identified.
Results
There was variability in the percentage of the lateral neck of SAP in contact with the MB. The mean percentage of the lateral neck of SAP in contact with the MB for the L1-L5 levels ranged between 57.39 ± 10.72 % (for L1) to 81.54 ± 10.48 % (for L5). The nerve proximity map showed consistent course of the MB along the posterior portion of the lateral neck of SAP and at a novel target site distal to the mamillo-accessory notch (i.e. sub-mammillary landmark).
Conclusion
The percent of the lateral neck that was in contact with the MB was quantified and visualized using a novel nerve proximity mapping methodology which may be used to inform cannula tip depth placement. Further, the nerve proximity maps were used to identify an alternative landmark to extend the length of the MB captured. The proposed sub-mammillary landmark may be a viable target site pending future anatomical and clinical investigations.
{"title":"3D nerve proximity mapping of the medial branch of lumbar dorsal ramus: An anatomical study","authors":"John Tran PhD , Arden Lawson , Nicole Billias , Eldon Loh","doi":"10.1016/j.inpm.2024.100414","DOIUrl":"https://doi.org/10.1016/j.inpm.2024.100414","url":null,"abstract":"<div><h3>Objective</h3><p>Lumbar medial branch (MB) radiofrequency ablation is a common intervention to treat facetogenic low back pain. Consensus among spine pain interventionalists is that the cannula tip should be placed adjacent to the periosteum of the lateral neck of the superior articular process (SAP) to ensure maximum contact with the MB. The spatial relationship of the nerve to the periosteum of the lateral neck of the SAP has not been quantified in 3D. The objectives of the current study were to: 1) use 3D modelling technology to quantify the location along the lateral neck of the SAP where the MB is in direct contact with the periosteum; and 2) identify target site(s) to optimize lumbar MB denervation.</p></div><div><h3>Design</h3><p>Seventy lumbar dorsal rami in 14 formalin-embalmed specimens were dissected, digitized, and modeled in 3D. The 3D positional data of the MB were used to generate a novel nerve proximity map which provided a method to quantify and visualize the 3D course of the MB in relation to the periosteum of the lateral neck of SAP. The percent of the lateral neck of SAP in contact with the MB was quantified and consistent target site(s) identified.</p></div><div><h3>Results</h3><p>There was variability in the percentage of the lateral neck of SAP in contact with the MB. The mean percentage of the lateral neck of SAP in contact with the MB for the L1-L5 levels ranged between 57.39 ± 10.72 % (for L1) to 81.54 ± 10.48 % (for L5). The nerve proximity map showed consistent course of the MB along the posterior portion of the lateral neck of SAP and at a novel target site distal to the mamillo-accessory notch (i.e. sub-mammillary landmark).</p></div><div><h3>Conclusion</h3><p>The percent of the lateral neck that was in contact with the MB was quantified and visualized using a novel nerve proximity mapping methodology which may be used to inform cannula tip depth placement. Further, the nerve proximity maps were used to identify an alternative landmark to extend the length of the MB captured. The proposed sub-mammillary landmark may be a viable target site pending future anatomical and clinical investigations.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 2","pages":"Article 100414"},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000347/pdfft?md5=e59d5fb8f5428c8c2f401415c815fa25&pid=1-s2.0-S2772594424000347-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140948558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-14DOI: 10.1016/j.inpm.2024.100413
Patrick H. Waring , Isaac Cohen , Timothy P. Maus , Belinda Duszynski , Michael B. Furman
Background
True lateral imaging (TLI), obtained by superimposing bilateral lumbar spine structures and aligning superior endplate cortical bone, requires deliberate rotational adjustments of the laterally positioned fluoroscope in both the axial and longitudinal planes. True lateral segmental imaging is necessary to depict true and accurate radiofrequency (RF) cannula positioning relative to bony anatomy during lumbar medial branch radiofrequency neurotomy (LMBRFN).
Objective
To determine the interobserver reliability of TLI during LMBRFN.
Methods
This was a retrospective review of a prospectively generated collection of lateral fluoroscopic images to determine the interobserver reliability of TLI during LMBRFN. Lateral fluoroscopic images were prospectively collected from 34 consecutive L4-5 and L5-S1 LMBRFN procedures during routine clinical practice. Employing International Pain and Spine Intervention Society (IPSIS) LMBRFN and TLI techniques, an RF cannula was positioned parallel to the L3 and L4 medial branches and the L5 dorsal rami. During the normal course of TLI, untrue and final true lateral segmental images were obtained and saved. An original data set of 100 pairs of true and untrue lateral images was reviewed to verify true laterality using established criteria; disagreement was resolved by consensus or discarding ambiguous cases. To measure interobserver reliability (Cohen's Kappa), two blinded expert reviewers independently reviewed the image set, identifying the true lateral image and the plane requiring correction.
Results
The observers agreed upon 98/98 true lateral RF-segment images (Kappa score 1.0 [1.00,1.00]). The observers agreed upon 86/98 maneuvers to correct the untrue RF-segment image. The Kappa score for determining the most appropriate corrective maneuver was 0.76 (0.63,0.89), showing substantial interobserver agreement.
Conclusions
The true lateral image of the targeted RF segment during LMBRFN was reliably determined with perfect interobserver agreement. Interobserver agreement was substantial regarding the maneuver to achieve TLI.
{"title":"True lateral imaging during lumbar medial branch radiofrequency neurotomy: Interobserver reliability","authors":"Patrick H. Waring , Isaac Cohen , Timothy P. Maus , Belinda Duszynski , Michael B. Furman","doi":"10.1016/j.inpm.2024.100413","DOIUrl":"https://doi.org/10.1016/j.inpm.2024.100413","url":null,"abstract":"<div><h3>Background</h3><p>True lateral imaging (TLI), obtained by superimposing bilateral lumbar spine structures and aligning superior endplate cortical bone, requires deliberate rotational adjustments of the laterally positioned fluoroscope in both the axial and longitudinal planes. True lateral segmental imaging is necessary to depict true and accurate radiofrequency (RF) cannula positioning relative to bony anatomy during lumbar medial branch radiofrequency neurotomy (LMBRFN).</p></div><div><h3>Objective</h3><p>To determine the interobserver reliability of TLI during LMBRFN.</p></div><div><h3>Methods</h3><p>This was a retrospective review of a prospectively generated collection of lateral fluoroscopic images to determine the interobserver reliability of TLI during LMBRFN. Lateral fluoroscopic images were prospectively collected from 34 consecutive L4-5 and L5-S1 LMBRFN procedures during routine clinical practice. Employing International Pain and Spine Intervention Society (IPSIS) LMBRFN and TLI techniques, an RF cannula was positioned parallel to the L3 and L4 medial branches and the L5 dorsal rami. During the normal course of TLI, untrue and final true lateral segmental images were obtained and saved. An original data set of 100 pairs of true and untrue lateral images was reviewed to verify true laterality using established criteria; disagreement was resolved by consensus or discarding ambiguous cases. To measure interobserver reliability (Cohen's Kappa), two blinded expert reviewers independently reviewed the image set, identifying the true lateral image and the plane requiring correction.</p></div><div><h3>Results</h3><p>The observers agreed upon 98/98 true lateral RF-segment images (Kappa score 1.0 [1.00,1.00]). The observers agreed upon 86/98 maneuvers to correct the untrue RF-segment image. The Kappa score for determining the most appropriate corrective maneuver was 0.76 (0.63,0.89), showing substantial interobserver agreement.</p></div><div><h3>Conclusions</h3><p>The true lateral image of the targeted RF segment during LMBRFN was reliably determined with perfect interobserver agreement. Interobserver agreement was substantial regarding the maneuver to achieve TLI.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 2","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000335/pdfft?md5=55d4c636aae5be5088fab5099adab804&pid=1-s2.0-S2772594424000335-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140918677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1016/j.inpm.2024.100412
Peter S. Staats , Michael J. Dorsi , David E. Reece , Natalie H. Strand , Lawrence Poree , Jonathan M. Hagedorn
Background
This prospective longitudinal study compares outcomes for Medicare beneficiaries receiving outpatient percutaneous image-guided lumbar decompression (PILD) using the mild® procedure to patients undergoing outpatient laminectomy. All patients were diagnosed with lumbar spinal stenosis (LSS) with neurogenic claudication (NC).
Methods
All medical claims for 100 % of Medicare beneficiaries were reviewed, with study subjects identified using Centers for Medicare and Medicaid Research Identifiable Files. Baseline data were extracted individually to allow for longitudinal analysis through two-year follow-up. The index procedure was defined as the first mild or outpatient laminectomy during the enrollment period. The rate of subsequent surgical procedures and incidence of harms were used as study outcomes.
Results
Cohorts included 2197 mild and 7416 laminectomy patients. mild patients were significantly older (76.7 years versus 73.4 years, respectively; p < 0.0001), and 57.4 % of mild were female, compared to 43.3 % of laminectomy (p < 0.0001). mild patients presented with significantly more baseline comorbidities compared to laminectomy patients (mean of 5.7 versus 4.8, respectively; p < 0.0001). Subsequent surgical procedure rate of 9.0 % for mild was significantly higher than 5.5 % for laminectomy (p < 0.0001). mild experienced harms at a significantly lower rate than laminectomy (1.9 % versus 5.8 %, respectively; p < 0.0001). The composite rate of subsequent surgical procedures and harms was similar between groups at 10.8 % for mild and 11.0 % for laminectomy.
Conclusions
mild can be considered a viable option for treatment of LSS with NC as evidenced by real-world data in this study. At two-years, mild patients experienced fewer harms and underwent more subsequent surgical procedures than laminectomy patients. The higher rate of subsequent surgical procedures for mild may be attributable to its position earlier in the LSS treatment algorithm. The overall rate of harms and subsequent surgical procedures was similar between groups, suggesting that mild should be considered as a treatment option, particularly for older patients with multiple comorbidities.
{"title":"Percutaneous image-guided lumbar decompression and outpatient laminectomy for the treatment of lumbar spinal stenosis: a 2-year Medicare claims benchmark study","authors":"Peter S. Staats , Michael J. Dorsi , David E. Reece , Natalie H. Strand , Lawrence Poree , Jonathan M. Hagedorn","doi":"10.1016/j.inpm.2024.100412","DOIUrl":"https://doi.org/10.1016/j.inpm.2024.100412","url":null,"abstract":"<div><h3>Background</h3><p>This prospective longitudinal study compares outcomes for Medicare beneficiaries receiving outpatient percutaneous image-guided lumbar decompression (PILD) using the <em>mild</em>® procedure to patients undergoing outpatient laminectomy. All patients were diagnosed with lumbar spinal stenosis (LSS) with neurogenic claudication (NC).</p></div><div><h3>Methods</h3><p>All medical claims for 100 % of Medicare beneficiaries were reviewed, with study subjects identified using Centers for Medicare and Medicaid Research Identifiable Files. Baseline data were extracted individually to allow for longitudinal analysis through two-year follow-up. The index procedure was defined as the first <em>mild</em> or outpatient laminectomy during the enrollment period. The rate of subsequent surgical procedures and incidence of harms were used as study outcomes.</p></div><div><h3>Results</h3><p>Cohorts included 2197 <em>mild</em> and 7416 laminectomy patients. <em>mild</em> patients were significantly older (76.7 years versus 73.4 years, respectively; p < 0.0001), and 57.4 % of <em>mild</em> were female, compared to 43.3 % of laminectomy (p < 0.0001). <em>mild</em> patients presented with significantly more baseline comorbidities compared to laminectomy patients (mean of 5.7 versus 4.8, respectively; p < 0.0001). Subsequent surgical procedure rate of 9.0 % for <em>mild</em> was significantly higher than 5.5 % for laminectomy (p < 0.0001). <em>mild</em> experienced harms at a significantly lower rate than laminectomy (1.9 % versus 5.8 %, respectively; p < 0.0001). The composite rate of subsequent surgical procedures and harms was similar between groups at 10.8 % for <em>mild</em> and 11.0 % for laminectomy.</p></div><div><h3>Conclusions</h3><p><em>mild</em> can be considered a viable option for treatment of LSS with NC as evidenced by real-world data in this study. At two-years, <em>mild</em> patients experienced fewer harms and underwent more subsequent surgical procedures than laminectomy patients. The higher rate of subsequent surgical procedures for <em>mild</em> may be attributable to its position earlier in the LSS treatment algorithm. The overall rate of harms and subsequent surgical procedures was similar between groups, suggesting that <em>mild</em> should be considered as a treatment option, particularly for older patients with multiple comorbidities.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 2","pages":"Article 100412"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000323/pdfft?md5=1f43b86195935ebe85348fcc9af91f48&pid=1-s2.0-S2772594424000323-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140638926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.1016/j.inpm.2024.100411
Marc Caragea , Austin Le , Tim Curtis , Amelia Ni , Tyler Clark , Andrew Joyce , Colton Hickman , Brandon Lawrence , Zane Randell , Perry Goodman , Addisyn Poduska , Michella Rasmussen , Amanda Cooper , Masaru Teramoto , Allison Glinka Przybysz , Taylor Burnham , Aaron Conger , Zachary L. McCormick
Background
Lumbar radiofrequency neurotomy (LRFN) effectively alleviates zygapophyseal joint-mediated pain by coagulating medial branch nerves to disrupt nociceptive signaling pathways. The concomitant denervation of multifidus fibers has led to concern that LRFN may increase segmental instability and accelerate degenerative changes in patients with certain pre-existing spinal pathologies. There is a paucity of literature evaluating whether LRFN increases the progression of spinal curvature in patients with adult scoliosis.
Objective
Compare the lumbosacral Cobb angle progression rate in patients with adult scoliosis who underwent LRFN to the annual progression rate of 0.83 ± 1.1° expected by natural history.
Design
Cross-sectional study.
Methods
Consecutive patients diagnosed with adult scoliosis who underwent LRFN to treat zygapophyseal joint-related low back pain were identified. Patient demographics, LRFN procedure details, and radiographs confirming scoliosis were collected from electronic medical records. Pre- and post-LRFN radiographs were used to calculate the average annual rate of Cobb angle progression. Data were analyzed using a Wilcoxon signed-rank test and a linear regression model.
Results
Sixty patients (mean age 69.2 ± 11.6 years; 70.0 % female) met the criteria and were included in the analyses. The mean time to radiographic follow-up was 35.0 ± 22.7 months post-LRFN. The average Cobb angle progression was 0.54 ± 3.03° per year and did not differ significantly from the known natural progression rate of 0.83 ± 1.1° per year. None of the included covariates (body mass index, LRFN laterality, and number of levels denervated) were significantly associated with the average annual Cobb angle progression rate.
Conclusions
Our results suggest that LRFN has no appreciable effect on the rate of Cobb angle progression in patients with adult scoliosis.
{"title":"The effect of lumbar medial branch radiofrequency neurotomy on cobb angle progression in individuals with adult scoliosis compared to natural history: A cross-sectional study","authors":"Marc Caragea , Austin Le , Tim Curtis , Amelia Ni , Tyler Clark , Andrew Joyce , Colton Hickman , Brandon Lawrence , Zane Randell , Perry Goodman , Addisyn Poduska , Michella Rasmussen , Amanda Cooper , Masaru Teramoto , Allison Glinka Przybysz , Taylor Burnham , Aaron Conger , Zachary L. McCormick","doi":"10.1016/j.inpm.2024.100411","DOIUrl":"https://doi.org/10.1016/j.inpm.2024.100411","url":null,"abstract":"<div><h3>Background</h3><p>Lumbar radiofrequency neurotomy (LRFN) effectively alleviates zygapophyseal joint-mediated pain by coagulating medial branch nerves to disrupt nociceptive signaling pathways. The concomitant denervation of multifidus fibers has led to concern that LRFN may increase segmental instability and accelerate degenerative changes in patients with certain pre-existing spinal pathologies. There is a paucity of literature evaluating whether LRFN increases the progression of spinal curvature in patients with adult scoliosis.</p></div><div><h3>Objective</h3><p>Compare the lumbosacral Cobb angle progression rate in patients with adult scoliosis who underwent LRFN to the annual progression rate of 0.83 ± 1.1° expected by natural history.</p></div><div><h3>Design</h3><p>Cross-sectional study.</p></div><div><h3>Methods</h3><p>Consecutive patients diagnosed with adult scoliosis who underwent LRFN to treat zygapophyseal joint-related low back pain were identified. Patient demographics, LRFN procedure details, and radiographs confirming scoliosis were collected from electronic medical records. Pre- and post-LRFN radiographs were used to calculate the average annual rate of Cobb angle progression. Data were analyzed using a Wilcoxon signed-rank test and a linear regression model.</p></div><div><h3>Results</h3><p>Sixty patients (mean age 69.2 ± 11.6 years; 70.0 % female) met the criteria and were included in the analyses. The mean time to radiographic follow-up was 35.0 ± 22.7 months post-LRFN. The average Cobb angle progression was 0.54 ± 3.03° per year and did not differ significantly from the known natural progression rate of 0.83 ± 1.1° per year. None of the included covariates (body mass index, LRFN laterality, and number of levels denervated) were significantly associated with the average annual Cobb angle progression rate.</p></div><div><h3>Conclusions</h3><p>Our results suggest that LRFN has no appreciable effect on the rate of Cobb angle progression in patients with adult scoliosis.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 2","pages":"Article 100411"},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000311/pdfft?md5=844938a50169ecb159c30a23575d8a49&pid=1-s2.0-S2772594424000311-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140557731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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