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Evaluating the effectiveness of 7-min basivertebral nerve ablation in treating vertebrogenic low back pain 评价椎体神经消融7分钟治疗椎源性腰痛的疗效
Pub Date : 2025-12-01 Epub Date: 2025-12-03 DOI: 10.1016/j.inpm.2025.100714
Andrew R. Stephens , Gabriella H. Wozniak , Ramzi El-Hassan , Adem F. Aktas

Background

Basivertebral nerve radiofrequency ablations (BVNRFA) is an established treatment for chronic vertebrogenic low back pain. However, published studies have exclusively evaluated the effectiveness of 15-min ablations for BVNRFA. Recently, industry has recommended performing 7-min ablations but there is no literature demonstrating this as an effective procedure.

Objective

The purpose of this study was to evaluate 7-min BVNRFA outcomes of pain and function.

Methods

Retrospective review of consecutive patients with chronic (>6 months) axial midline low back pain with a reported pain score ≥4 that had failed conservative treatment with corroborating Modic type I or Modic type II changes on MRI who underwent exclusively 7-min BVNRFA was conducted at a multidisciplinary spine center. Visual analog pain scores (VAS) were collected at baseline, 1-, 3-, 6-, and 12-month post-procedure. Consistent with prior literature, success was defined two ways: achieving a ≥50 % in VAS pain reduction at post-procedure visits compared to baseline scores and achieving a reduction of VAS greater than the minimally clinical important difference of 2. Wilcoxon signed-rank test was used to compare post-procedure scores with baseline scores. Percent of patients with a successful treatment was calculated at each follow-up time period.

Results

A total of 86 patients underwent BVNRFA during the study period and 75 met inclusion criteria. VAS scores significantly improved between baseline (7.1 ± 1.9) and 1-month (3.9 ± 3.0, p < 0.001), 3-months (3.4 ± 3.0, p < 0.001), 6-months (4.4 ± 2.6; p < 0.001) and 12-months post-procedure scores (3.7 ± 2.6; p < 0.001). The percentage of patients with a successful treatment of ≥50 % in VAS pain reduction was 50.7 % (95 % CI 38.8 %, 26.7 %) at 1-month, 56.9 % (95 % CI 44.9 %, 69.0 %) at 3-months, 42.9 % (95 % CI 29.0 %, 56.7 %) at 6-months and 50.0 % (95 % CI 23.1 %, 67.9 %) at 12-months. The percentage of patients with a successful treatment of ≥2 in VAS pain reduction was 67.2 % (95 % CI: 55.9 %, 78.4 %) at 1-month, 67.7 % (95 % CI: 56.3 %, 79.1 %) at 3-months, 65.3 % (95 % CI: 52.0 %, 78.6 %) at 6-months and 70.0 %, (95 % CI: 52.1 %, 90.8 %) at 12-months

Conclusions

Although our study demonstrated that patients treated with BVNRFA with a 7-min ablation reported significant improvement in pain, the proportion of patients with a successful reduction of pain is likely lower than data published for 15-min ablations. Future controlled trials comparing outcomes and lesion sizes of 7- and 15-min BVNA are needed.
背景:椎体神经射频消融术(BVNRFA)是治疗慢性椎源性腰痛的常用方法。然而,已发表的研究专门评估了15分钟消融对BVNRFA的有效性。最近,业界建议进行7分钟的消融,但没有文献证明这是一种有效的方法。目的评价BVNRFA术后7分钟疼痛和功能的预后。方法:在多学科脊柱中心对连续的慢性(6个月)轴向中线腰痛患者进行回顾性研究,这些患者报告的疼痛评分≥4,保守治疗失败,MRI显示Modic I型或Modic II型改变,仅接受7分钟BVNRFA。在基线、术后1、3、6和12个月收集视觉模拟疼痛评分(VAS)。与先前的文献一致,成功被定义为两种方式:与基线评分相比,术后就诊时VAS疼痛减轻≥50%,VAS减轻大于2的最小临床重要差异。采用Wilcoxon符号秩检验比较术后评分与基线评分。在每个随访期间计算成功治疗的患者百分比。结果86例患者在研究期间接受了BVNRFA治疗,75例符合纳入标准。VAS评分在基线(7.1±1.9)、术后1个月(3.9±3.0,p < 0.001)、3个月(3.4±3.0,p < 0.001)、6个月(4.4±2.6,p < 0.001)和12个月评分(3.7±2.6,p < 0.001)之间显著改善。治疗成功的患者在VAS疼痛减轻≥50%的百分比为:1个月时50.7% (95% CI 38.8%, 26.7%), 3个月时56.9% (95% CI 44.9%, 69.0%), 6个月时42.9% (95% CI 29.0%, 56.7%), 12个月时50.0% (95% CI 23.1%, 67.9%)。治疗≥2次成功减轻VAS疼痛的患者比例为:1个月时67.2% (95% CI: 55.9%, 78.4%), 3个月时67.7% (95% CI: 56.3%, 79.1%), 6个月时65.3% (95% CI: 52.0%, 78.6%), 70.0% (95% CI:结论:尽管我们的研究表明,接受BVNRFA治疗的7分钟消融患者报告疼痛有显著改善,但成功减轻疼痛的患者比例可能低于15分钟消融的数据。未来的对照试验需要比较7和15分钟BVNA的结果和病变大小。
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引用次数: 0
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 颈椎神经根病患者经椎间孔硬膜外类固醇注射后颈椎手术和重复硬膜外注射的比率利用大型国家数据库
Pub Date : 2025-12-01 Epub Date: 2025-11-15 DOI: 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.
背景:颈椎经椎间孔硬膜外类固醇注射(CTFESI)通常用于治疗颈椎根性疼痛,减少手术的需要。关于CTFESI在避免需要颈椎手术方面的疗效,文献是混杂的。目的本研究的目的是评估首次CTFESI治疗神经根性疼痛患者后颈椎手术和脊柱干预的发生率。方法strinetx是一个大型国家数据库,从2004年到2025年,查询了接受CTFESI治疗颈椎神经根病的患者。计算初始CTFESI后的治疗进展率。治疗进展包括:无额外治疗,重复CTFEI,颈椎板间硬膜外类固醇注射(CIESI)和颈椎手术。颈椎手术包括前路颈椎减压融合术(ACDF)、椎间孔切开术和全椎间盘置换术(TDR)。还计算了第二次CTFESI后患者的治疗率。结果在本研究期间,共有28345例患者接受了CTFESI。在首次CTFESI后,57%的患者没有接受任何额外的手术,23.7%的患者再次接受CTFESI, 5.6%的患者接受了CILESI, 7.4%的患者接受了ACDF, 1.6%的患者接受了椎间孔切开术,1.8%的患者接受了TDR。总的来说,在最初的CTFESI后,10.8%的患者继续进行颈椎手术作为二线治疗。在6711名接受重复CTFESI的患者中,74.5%没有接受额外的介入治疗,8.2%接受了CIESI, 10.6%接受了ACDF, 2.5%接受了椎间孔切开术,2.2%接受了TDR。总的来说,15.3%的患者在第二次CTFESI后接受了颈椎手术。没有任何患者尝试连续第三次CTFESI。结论:本研究表明首次CTFESI和再次CTFESI后的手术率较低。
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引用次数: 0
The effectiveness of cervical medial branch radiofrequency ablation using a three-tined electrode: A real-world cross-sectional cohort study 使用三针电极射频消融颈内侧分支的有效性:一项真实世界的横断面队列研究
Pub Date : 2025-12-01 Epub Date: 2025-11-27 DOI: 10.1016/j.inpm.2025.100710
Hasan Sen , Napatpaphan Kanjanapanang , Amanda N. Cooper , Seth Bires , Audrey Adler , Akbar Nabi , Blake Dickenson , William Tang , Chase Young , Taylor Burnham , Allison Glinka Przybysz , Aaron Conger , Zachary L. McCormick

Background

Cervical medial branch radiofrequency ablation (CMBRFA) using conventional electrodes is a proven treatment for chronic cervical zygapophysial (facet) joint pain. More recently, multi-tined RFA technology has been adopted in clinical practice, warranting evaluation of treatment outcomes.

Objectives

Evaluate the effectiveness of CMBRFA using a three-tined RFA electrode for the treatment of cervical facet joint pain in a real-world cohort.

Methods

In this cross-sectional cohort study, electronic medical records of patients who underwent CMBRFA utilizing a three-tined RFA electrode at a single academic medical center between 2022 and 2024 were reviewed. Outcomes were collected at ≥6 months post-CMBRFA via standardized telephone survey, querying numerical rating scale (NRS) pain scores, patient global impression of change (PGIC) scores, and opioid use. The primary outcome was the proportion reporting ≥50 % NRS reduction. Secondary outcomes included ≥2-point NRS reduction, PGIC scores ≥6 (indicating at least “much improved”), and pre-versus post-CMBRFA opioid use. Potential predictors of treatment success were evaluated with multivariate Poisson regression analysis.

Results

66 patients were included. At mean follow-up of 16.3 ± 7.0 months, 51.5 % (95 %CI: 39.7–63.2) reported ≥50 % NRS reduction, 77.3 % (95 %CI: 65.8–85.7) experienced ≥2-point NRS reduction, and 63.6 % (95 %CI: 51.6–74.2) had PGIC ≥6. Opioid use was decreased significantly by 15.2 % (95 %CI: 5.0–25.3). Follow-up time and repeat CMBRFA were significantly associated with outcomes for PGIC.

Conclusion

In this real-world cohort, we observed clinically meaningful improvements in neck pain (defined as ≥50 % NRS reduction from baseline) in 51.5 % of participants at an average of approximately 16 months after treatment with CMBRFA using a three-tined electrode.
背景:使用传统电极的颈内侧支射频消融术(CMBRFA)是治疗慢性颈关节关节(小关节)疼痛的有效方法。最近,多次射频消融技术已在临床实践中采用,保证了治疗结果的评估。目的在现实世界队列中评估CMBRFA使用三针RFA电极治疗颈椎小关节疼痛的有效性。方法在这项横断面队列研究中,回顾了2022年至2024年间在单一学术医疗中心使用三针RFA电极进行CMBRFA的患者的电子病历。通过标准化电话调查收集cmbrfa后≥6个月的结果,查询数值评定量表(NRS)疼痛评分、患者总体印象变化(PGIC)评分和阿片类药物使用情况。主要终点为报告NRS降低≥50%的比例。次要结局包括NRS降低≥2点,PGIC评分≥6(表明至少“大大改善”),以及cmbrfa前后阿片类药物的使用。用多元泊松回归分析评估治疗成功的潜在预测因素。结果共纳入66例患者。在平均随访16.3±7.0个月时,51.5% (95% CI: 39.7-63.2)报告NRS降低≥50%,77.3% (95% CI: 65.8-85.7)报告NRS降低≥2点,63.6% (95% CI: 51.6-74.2)报告PGIC≥6。阿片类药物使用显著减少15.2% (95% CI: 5.0-25.3)。随访时间和重复CMBRFA与PGIC的预后显著相关。在这个真实世界的队列中,我们观察到51.5%的参与者在使用三针电极CMBRFA治疗后平均约16个月的颈部疼痛有临床意义的改善(定义为NRS从基线降低≥50%)。
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引用次数: 0
Feasibility of a mobile application to track longitudinal pain outcomes after epidural joint injections 跟踪硬膜外关节注射后纵向疼痛结果的移动应用程序的可行性
Pub Date : 2025-12-01 Epub Date: 2025-11-29 DOI: 10.1016/j.inpm.2025.100709
Patricia Z. Zheng , Ted Miclau , Brandon Goenawan , Gabriel Johnson , Conor O'Neill , Lyndly Tamura , Peter I-Kung Wu , Matthew Smuck

Background

Tracking spine intervention outcomes is costly and time-consuming, hindering research. Mobile health (mhealth) applications offer a promising solution to reduce the need to hire personnel to recruit patients and collect data. However, evidence supporting the use of mHealth to study pain and spine interventions is limited and heterogeneous.

Objectives

This study aims to understand how recruitment methods influence patient recruitment and retention in a digital study tracking pain. We hypothesize that in-person recruitment, especially with a physician rather than a research assistant, leads to higher recruitment and retention.

Methods

We designed a prospective observational study of patients scheduled for spine injections at an academic outpatient surgical center. Eligible patients were recruited via three methods: in-person research assistant, remote research assistant via phone, or in-person clinician. Upon enrollment, a mHealth application prompted patients to complete post-injection surveys at pre-defined intervals based on injection type. Enrollment and retention rates were then compared across recruitment groups.

Results

Of 194 patients approached, enrollment rates differed significantly by recruitment strategy: 94.1 % for in-person physicians (N = 32 enrolled/34 approached), 85.0 % for in-person research assistants (N = 51/60), and 30.0 % for remote research assistants (N = 30/100) (p < 0.009, Fisher's exact test). Of those recruited, survey completion rates were 74.4 % (physician-recruited patients), 55.1 % (in-person research assistant), and 58.4 % (remote research assistant). Neither demographic factors (age, sex, employment, payer type) nor injection type influenced enrollment. Retention differed significantly across groups (p = 0.0174, Kruskal-Wallis test), with physician-recruited patients completing the most surveys. Moreover, Medicare patients had significantly higher completion rates than those with Medicaid.

Conclusion

Tracking post-injection pain using mHealth applications is feasible, though success depends heavily on recruitment strategy. In-person physician-led enrollment resulted in the highest recruitment and retention rates though the drop-out rates were still significant. Future studies should focus on refining recruitment approaches to optimize patient participation.
背景:跟踪脊柱干预结果既昂贵又耗时,阻碍了研究。移动医疗(mhealth)应用程序提供了一个很有前途的解决方案,可以减少招聘人员招募患者和收集数据的需要。然而,支持使用移动健康来研究疼痛和脊柱干预措施的证据是有限的和不一致的。目的:本研究旨在了解在一项追踪疼痛的数字化研究中,招募方法如何影响患者招募和保留。我们假设,亲自招聘,特别是与医生而不是研究助理,导致更高的招聘和保留。方法我们设计了一项前瞻性观察研究,研究对象是在一家学术门诊外科中心接受脊柱注射的患者。通过现场研究助理、电话远程研究助理或现场临床医生三种方法招募符合条件的患者。在登记时,移动健康应用程序提示患者根据注射类型按预先定义的间隔完成注射后调查。然后比较不同招募组的入学率和保留率。结果在194例患者中,不同招募策略的入组率差异显著:现场医生入组率为94.1% (N = 32名入组/34名入组),现场研究助理入组率为85.0% (N = 51/60),远程研究助理入组率为30.0% (N = 30/100) (p < 0.009, Fisher精确检验)。在这些被招募的患者中,调查完成率为74.4%(医生招募的患者),55.1%(亲自研究助理)和58.4%(远程研究助理)。人口统计学因素(年龄、性别、就业、付款人类型)和注射类型均不影响入组。保留率在各组之间差异显著(p = 0.0174, Kruskal-Wallis检验),医生招募的患者完成的调查最多。此外,医疗保险患者的完成率明显高于医疗补助患者。结论使用移动健康应用跟踪注射后疼痛是可行的,但成功与否很大程度上取决于招募策略。由医生亲自指导的注册导致了最高的招聘率和保留率,尽管辍学率仍然很高。未来的研究应侧重于改进招募方法,以优化患者参与。
{"title":"Feasibility of a mobile application to track longitudinal pain outcomes after epidural joint injections","authors":"Patricia Z. Zheng ,&nbsp;Ted Miclau ,&nbsp;Brandon Goenawan ,&nbsp;Gabriel Johnson ,&nbsp;Conor O'Neill ,&nbsp;Lyndly Tamura ,&nbsp;Peter I-Kung Wu ,&nbsp;Matthew Smuck","doi":"10.1016/j.inpm.2025.100709","DOIUrl":"10.1016/j.inpm.2025.100709","url":null,"abstract":"<div><h3>Background</h3><div>Tracking spine intervention outcomes is costly and time-consuming, hindering research. Mobile health (mhealth) applications offer a promising solution to reduce the need to hire personnel to recruit patients and collect data. However, evidence supporting the use of mHealth to study pain and spine interventions is limited and heterogeneous.</div></div><div><h3>Objectives</h3><div>This study aims to understand how recruitment methods influence patient recruitment and retention in a digital study tracking pain. We hypothesize that in-person recruitment, especially with a physician rather than a research assistant, leads to higher recruitment and retention.</div></div><div><h3>Methods</h3><div>We designed a prospective observational study of patients scheduled for spine injections at an academic outpatient surgical center. Eligible patients were recruited via three methods: in-person research assistant, remote research assistant via phone, or in-person clinician. Upon enrollment, a mHealth application prompted patients to complete post-injection surveys at pre-defined intervals based on injection type. Enrollment and retention rates were then compared across recruitment groups.</div></div><div><h3>Results</h3><div>Of 194 patients approached, enrollment rates differed significantly by recruitment strategy: 94.1 % for in-person physicians (N = 32 enrolled/34 approached), 85.0 % for in-person research assistants (N = 51/60), and 30.0 % for remote research assistants (N = 30/100) (<em>p</em> &lt; 0.009, Fisher's exact test). Of those recruited, survey completion rates were 74.4 % (physician-recruited patients), 55.1 % (in-person research assistant), and 58.4 % (remote research assistant). Neither demographic factors (age, sex, employment, payer type) nor injection type influenced enrollment. Retention differed significantly across groups (<em>p</em> = 0.0174, Kruskal-Wallis test), with physician-recruited patients completing the most surveys. Moreover, Medicare patients had significantly higher completion rates than those with Medicaid.</div></div><div><h3>Conclusion</h3><div>Tracking post-injection pain using mHealth applications is feasible, though success depends heavily on recruitment strategy. In-person physician-led enrollment resulted in the highest recruitment and retention rates though the drop-out rates were still significant. Future studies should focus on refining recruitment approaches to optimize patient participation.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100709"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624046","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}
引用次数: 0
Ultrasound-guided genicular nerve radiofrequency ablation: A revised protocol illustrated through high-definition video 超声引导膝神经射频消融术:通过高清视频说明的修订方案
Pub Date : 2025-12-01 Epub Date: 2025-10-18 DOI: 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.
背景:膝关节射频消融术(RFA)可能是治疗慢性膝关节疼痛的有效选择。准确的解剖学知识对于优化手术的精度和结果至关重要。膝关节的神经支配是复杂的。超声(US)引导为定位感觉神经提供了一种广泛可行的方法。鉴于关于膝关节射频消融的高质量视频文献有限,我们制作了一个教育视频,说明了一个广泛修订的超声引导方案。目的介绍一种基于视频的改进的超声引导下膝关节射频治疗方案,通过解剖象限靶向特定神经:上内侧象限(视频1)- NVI内侧分支,SMGN;内象限(视频2)- IMGN;上外侧象限(视频3)- NVI、SLGN的外侧分支;和内外侧象限(视频4)- RFN。方法7例对保守治疗无反应的晚期膝关节骨性关节炎患者,根据疼痛的分布,选择内侧或外侧象限的RFA。这些程序以高清晰度记录下来,并附有注释,以供教育之用。结论视频演示可以提高程序清晰度,方便临床医生培训。由于耗时和潜在的疼痛与所描述的手术相关,针对所有神经可能不适合每个患者。一种个性化的方法,根据患者的具体特征和疼痛的定位来调整目标的选择可能是更理想的。
{"title":"Ultrasound-guided genicular nerve radiofrequency ablation: A revised protocol illustrated through high-definition video","authors":"Tomás Caroço ,&nbsp;Giovanni Leoni ,&nbsp;Daniela Teixeira ,&nbsp;Jorge Ribeiro ,&nbsp;Bruno Paiva ,&nbsp;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":"2025-12-01","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}
引用次数: 0
Timing and trajectory of pain and functional outcomes after basivertebral nerve ablation: a prospective cohort study 椎体神经消融后疼痛和功能结局的时间和轨迹:一项前瞻性队列研究
Pub Date : 2025-12-01 Epub Date: 2025-11-28 DOI: 10.1016/j.inpm.2025.100652
Charles A. Odonkor , Oghenewoma Oghenesume , Sera Yoo , Sergio Mosquera Limas , Jacky Yeung , Patrick Doherty , Sumeet Kadian , Jared Rosenberg , Sudhir K. Kadian , Peter G. Whang

Background

Basivertebral nerve ablation (BVNA) is an FDA-cleared treatment for vertebrogenic low back pain. However, limited data exist detailing the specific timing and durability of patient-reported relief.

Objective

To characterize the weekly temporal trajectory of patient-reported ≥50 % pain relief and evaluate the predictive value for short-term and sustained response.

Methods

This prospective observational cohort study included 86 consecutive patients with MRI-confirmed Modic Type 1 or 2 changes treated with intraosseous BVNA between April 2024 and April 2025 at an academic center. Patients reported weekly pain relief for 8 weeks, then again at 12 and 24 weeks. Primary outcomes were time to first ≥50 % relief and the positive and negative likelihood ratios (LR+, LR) of early improvement for predicting response. Secondary outcomes included changes in Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and adjunctive spine interventions.

Results

Pain reduction was rapid and durable: By Week 1, 34 % of patients achieved ≥50 % relief, increasing to 76 % by Week 3 and 91 % by Week 6. These improvements plateaued through Week 12 and persisted at 24 weeks. Median time to first ≥50 % relief was 3 weeks. Early responders (Week 3) were 6.6 times more likely to maintain relief at Week 12 (LR+ = 6.56, 95 % CI 2.50–17.0); predictive utility peaked at Weeks 4–6 (LR+ 7.1–9.0; LR ≤ 0.13). Mean ODI improved from 66.5 ± 13.5 to 32.3 ± 15.8 and NRS from 8.3 ± 1.5 to 3.0 ± 2.6 (p < 0.0001 for both). Nearly 90 % achieved ≥15-point ODI and ≥2-point NRS improvement; 21 % were pain-free by Week 12. Use of adjunctive spine injections declined from 86 % pre-procedure to 22 % post-procedure (p < 0.0001).

Conclusion

This is the first study to prospectively characterize the weekly time course of response following BVNA and demonstrates early, substantial, and durable improvements in pain and function. Most patients experienced meaningful relief within 3–6 weeks, and early response was sustained through 24 weeks. These findings support BVNA as a robust real-world intervention for vertebrogenic pain and highlight the prognostic value of early pain trajectory monitoring in predicting sustained outcomes.
背景:椎体神经消融术(BVNA)是一种经fda批准的治疗椎体源性腰痛的方法。然而,详细说明患者报告的缓解的具体时间和持久性的数据有限。目的描述患者报告≥50%疼痛缓解的每周时间轨迹,并评估短期和持续反应的预测价值。该前瞻性观察队列研究纳入了2024年4月至2025年4月在某学术中心接受骨内BVNA治疗的86例mri确诊的modc 1型或2型病变患者。患者每周报告疼痛缓解,持续8周,然后在12周和24周再次报告。主要结局是到达首次≥50%缓解的时间,以及早期改善的正似然比和负似然比(LR+, LR -)用于预测缓解。次要结局包括Oswestry残疾指数(ODI)、数字评定量表(NRS)和辅助脊柱干预的变化。西班牙的缓解是快速和持久的:到第1周,34%的患者达到≥50%的缓解,到第3周增加到76%,到第6周增加到91%。这些改善在第12周趋于稳定,并持续到第24周。首次≥50%缓解的中位时间为3周。早期应答者(第3周)在第12周维持缓解的可能性是前者的6.6倍(LR+ = 6.56, 95% CI 2.50-17.0);预测效用在第4-6周达到峰值(LR+ 7.1-9.0; LR−≤0.13)。平均ODI从66.5±13.5改善到32.3±15.8,NRS从8.3±1.5改善到3.0±2.6 (p < 0.0001)。近90% ODI改善≥15分,NRS改善≥2分;到第12周,21%的患者疼痛消失。辅助脊柱注射的使用率从术前的86%下降到术后的22% (p < 0.0001)。结论:这是第一个前瞻性描述BVNA后每周反应时间过程的研究,并证明了疼痛和功能的早期、实质性和持久改善。大多数患者在3-6周内获得有意义的缓解,早期反应持续到24周。这些发现支持BVNA作为椎体源性疼痛的一种强大的现实干预手段,并强调了早期疼痛轨迹监测在预测持续预后方面的预后价值。
{"title":"Timing and trajectory of pain and functional outcomes after basivertebral nerve ablation: a prospective cohort study","authors":"Charles A. Odonkor ,&nbsp;Oghenewoma Oghenesume ,&nbsp;Sera Yoo ,&nbsp;Sergio Mosquera Limas ,&nbsp;Jacky Yeung ,&nbsp;Patrick Doherty ,&nbsp;Sumeet Kadian ,&nbsp;Jared Rosenberg ,&nbsp;Sudhir K. Kadian ,&nbsp;Peter G. Whang","doi":"10.1016/j.inpm.2025.100652","DOIUrl":"10.1016/j.inpm.2025.100652","url":null,"abstract":"<div><h3>Background</h3><div>Basivertebral nerve ablation (BVNA) is an FDA-cleared treatment for vertebrogenic low back pain. However, limited data exist detailing the specific timing and durability of patient-reported relief.</div></div><div><h3>Objective</h3><div>To characterize the weekly temporal trajectory of patient-reported ≥50 % pain relief and evaluate the predictive value for short-term and sustained response.</div></div><div><h3>Methods</h3><div>This prospective observational cohort study included 86 consecutive patients with MRI-confirmed Modic Type 1 or 2 changes treated with intraosseous BVNA between April 2024 and April 2025 at an academic center. Patients reported weekly pain relief for 8 weeks, then again at 12 and 24 weeks. Primary outcomes were time to first ≥50 % relief and the positive and negative likelihood ratios (LR<sup>+</sup>, LR<sup>−</sup>) of early improvement for predicting response. Secondary outcomes included changes in Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and adjunctive spine interventions.</div></div><div><h3>Results</h3><div>Pain reduction was rapid and durable: By Week 1, 34 % of patients achieved ≥50 % relief, increasing to 76 % by Week 3 and 91 % by Week 6. These improvements plateaued through Week 12 and persisted at 24 weeks. Median time to first ≥50 % relief was 3 weeks. Early responders (Week 3) were 6.6 times more likely to maintain relief at Week 12 (LR<sup>+</sup> = 6.56, 95 % CI 2.50–17.0); predictive utility peaked at Weeks 4–6 (LR<sup>+</sup> 7.1–9.0; LR<sup>−</sup> ≤ 0.13). Mean ODI improved from 66.5 ± 13.5 to 32.3 ± 15.8 and NRS from 8.3 ± 1.5 to 3.0 ± 2.6 (p &lt; 0.0001 for both). Nearly 90 % achieved ≥15-point ODI and ≥2-point NRS improvement; 21 % were pain-free by Week 12. Use of adjunctive spine injections declined from 86 % pre-procedure to 22 % post-procedure (p &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>This is the first study to prospectively characterize the weekly time course of response following BVNA and demonstrates early, substantial, and durable improvements in pain and function. Most patients experienced meaningful relief within 3–6 weeks, and early response was sustained through 24 weeks. These findings support BVNA as a robust real-world intervention for vertebrogenic pain and highlight the prognostic value of early pain trajectory monitoring in predicting sustained outcomes.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100652"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624040","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}
引用次数: 0
Targeting the intrinsic bone nerve supply for joint denervation in osteoarthritis: A Copernican revolution, or just another fad relegated to the graveyard of scientific history? 针对骨关节炎中关节去神经的内在骨神经供应:哥白尼式的革命,还是另一个被扔进科学史墓地的时尚?
Pub Date : 2025-12-01 Epub Date: 2025-11-25 DOI: 10.1016/j.inpm.2025.100704
Nafisseh S. Warner MD , Steven P. Cohen MD
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引用次数: 0
2-Year clinical outcomes following combined iliotibial band and gluteus medius percutaneous ultrasound tenotomy in refractory GTPS 髂胫束联合臀中肌经皮超声肌腱切开术治疗难治性GTPS 2年临床观察
Pub Date : 2025-12-01 Epub Date: 2025-12-04 DOI: 10.1016/j.inpm.2025.100717
Ugur Yener , Mohamed Awad , Tahereh Naeimi , Kyle Max Mayblum , Sebastian H. Lujan Varela , Joseph M. Seldin , Hatice Begum Ciftci , Alaa Abd-Elsayed , Sayed Emal Wahezi

Background

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of chronic lateral hip pain, often refractory to conservative medical management (CMM). Combined percutaneous ultrasound-guided tenotomy (PUT) of the gluteus medius (GMed) and iliotibial band (ITB) has shown promising one-year results, but data on long-term outcomes remain limited. This study evaluates two-year clinical outcomes in patients undergoing combined GMed and ITB PUT for recalcitrant GTPS.

Methods

This retrospective cohort study included 69 patients (79 hips) treated with combined GMed and ITB PUT between January 2022 and August 2023. Baseline and follow-up data, collected for an average of 2-year, were obtained through chart review and structured phone interviews. The primary outcome was ≥50 % reduction in Numeric Rating Scale (NRS) pain scores. Secondary outcomes included side-lying tolerance, sitting-to-standing ability, responder rate and need for additional hip interventions. Responder status required both pain reduction and complete side-lying tolerance. Statistical significance was evaluated using paired t-tests with p < 0.05.

Results

Median baseline Numeric Rating Scale (NRS) pain score was 10 interquartile range (IQR 9–10), decreasing significantly to 2 (IQR 1–4) at 1, 6, and 12 months, then increasing to 6 (IQR 4–10) at 24 months (p < 0.001 vs. baseline). Rates of ≥50 % improvement in NRS were 88.6 % at 1 month, 89.6 % at 6 months, 83.0 % at 12 months, and 59.5 % at 24 months. Side-lying tolerance improved from 21.5 % hips at baseline to 88.9 % reporting improvement at 1 month and 55.7 % at 24 months (p < 0.001). Sitting-to-standing ability showed sustained improvement at 81.0 % at 24 months. Composite responder rate declined from 88.6 % at 1 month to 57.0 % at 24 months. Subsequent invasive interventions were required in a minority of cases (2.5 % total hip arthroplasty; 11.4 % repeat TENEX).

Conclusion

Combined PUT of the GMed and ITB provides durable pain relief and functional improvement in patients with refractory GTPS at two years post-procedure. Despite declining responder rates over time, this minimally invasive dual-target technique demonstrates a favorable safety profile and may delay or reduce the need for more invasive surgery. Further prospective studies are warranted to optimize patient selection and validate long-term efficacy.
背景:大转子疼痛综合征(GTPS)是慢性髋外侧疼痛的常见原因,通常难以保守治疗(CMM)。联合经皮超声引导下的臀中肌(GMed)和髂胫束(ITB)的肌腱切开术(PUT)显示出有希望的一年效果,但长期结果的数据仍然有限。这项研究评估了联合GMed和ITB PUT治疗顽固性GTPS患者的两年临床结果。方法本回顾性队列研究包括69例(79髋)患者,于2022年1月至2023年8月期间接受GMed和ITB PUT联合治疗。通过图表回顾和结构化电话访谈获得平均2年的基线和随访数据。主要结局是数字评定量表(NRS)疼痛评分降低≥50%。次要结果包括侧躺耐受性、坐立能力、应答率和额外髋关节干预的需要。反应状态需要疼痛减轻和完全侧躺耐受。采用配对t检验,p <; 0.05评价统计学意义。结果基线数值评定量表(NRS)疼痛评分中位数为10分位(IQR 9-10),在1、6和12个月时显著下降至2分位(IQR 1 - 4),在24个月时上升至6分位(IQR 4-10)(与基线相比p <; 0.001)。NRS≥50%的改善率分别为:1个月时88.6%,6个月时89.6%,12个月时83.0%,24个月时59.5%。侧躺容忍度从基线时的21.5%提高到1个月时的88.9%和24个月时的55.7% (p < 0.001)。坐-站能力在24个月时持续改善81.0%。综合应答率从1个月时的88.6%下降到24个月时的57.0%。少数病例需要后续的侵入性干预(2.5%全髋关节置换术;11.4%重复TENEX)。结论GMed和ITB联合应用可在术后2年对难治性GTPS患者提供持久的疼痛缓解和功能改善。尽管随着时间的推移应答率不断下降,但这种微创双靶技术显示出良好的安全性,并可能延迟或减少对更多侵入性手术的需要。进一步的前瞻性研究有必要优化患者选择并验证长期疗效。
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引用次数: 0
The sphenopalatine ganglion as a target in interventional pain therapy 蝶腭神经节在介入性疼痛治疗中的作用
Pub Date : 2025-12-01 Epub Date: 2025-11-25 DOI: 10.1016/j.inpm.2025.100705
Stephan Klessinger
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引用次数: 0
Fluoroscopy-guided celiac plexus block – Trans-Aortic approach 透视引导下腹腔丛阻滞-经主动脉入路
Pub Date : 2025-12-01 Epub Date: 2025-10-10 DOI: 10.1016/j.inpm.2025.100644
Kelly Li , Ivy Liu , Robert Jason Yong , David Hao
Transaortic celiac plexus block is an image-guided procedure used to manage refractory abdominal pain, often related to malignancy or chronic conditions like pancreatitis. This educational video demonstrates the transaortic approach for celiac plexus block under fluoroscopic guidance. The video reviews indications, relevant anatomy, procedural steps, and potential complications. This content is intended to supplement formal instruction and enhance understanding of a targeted technique used in the management of abdominal pain.
经主动脉腹腔丛阻滞是一种图像引导手术,用于治疗难治性腹痛,通常与恶性肿瘤或慢性疾病如胰腺炎有关。本教育视频演示了在透视引导下经主动脉入路治疗乳糜丛神经阻滞。视频回顾了适应症、相关解剖、手术步骤和潜在并发症。本内容旨在补充正式的指导,提高对腹痛治疗中使用的有针对性的技术的理解。
{"title":"Fluoroscopy-guided celiac plexus block – Trans-Aortic approach","authors":"Kelly Li ,&nbsp;Ivy Liu ,&nbsp;Robert Jason Yong ,&nbsp;David Hao","doi":"10.1016/j.inpm.2025.100644","DOIUrl":"10.1016/j.inpm.2025.100644","url":null,"abstract":"<div><div>Transaortic celiac plexus block is an image-guided procedure used to manage refractory abdominal pain, often related to malignancy or chronic conditions like pancreatitis. This educational video demonstrates the transaortic approach for celiac plexus block under fluoroscopic guidance. The video reviews indications, relevant anatomy, procedural steps, and potential complications. This content is intended to supplement formal instruction and enhance understanding of a targeted technique used in the management of abdominal pain.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 4","pages":"Article 100644"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145270421","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}
引用次数: 0
期刊
Interventional Pain Medicine
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