首页 > 最新文献

Interventional Pain Medicine最新文献

英文 中文
FACTFINDERS FOR PATIENT SAFETY: Minimizing risks with cervical epidural injections 患者安全实况调查:将颈椎硬膜外注射的风险降至最低
Pub Date : 2024-08-27 DOI: 10.1016/j.inpm.2024.100430
Eric K. Holder , Haewon Lee , Aditya Raghunandan , Benjamin Marshall , Adam Michalik , Minh Nguyen , Mathew Saffarian , Byron J. Schneider , Clark C. Smith , Christin A. Tiegs-Heiden , Patricia Zheng , Jaymin Patel , David Levi , International Pain and Spine Intervention Society's Patient Safety Committee
<div><p>This series of FactFinders presents a brief summary of the evidence and outlines recommendations to minimize risks associated with cervical epidural injections.</p><p>Evidence in support of the following facts is presented.</p><p><em>Minimizing Risks with Cervical Interlaminar Epidural Steroid Injections</em> – 1) CILESIs should be performed at C6-C7 or below, with C7-T1 as the preferred access point due to the more generous dorsal epidural space at this level compared to the more cephalad interlaminar segments. This reduces the risk of the minor complication of dural puncture and the major complication of spinal cord injury due to inadvertent needle placement. 2) LF gaps are most prevalent in the midline cervical spine. This can result in diminished tactile feedback with loss of resistance (LOR), increasing the risk for inadvertent dural puncture or spinal cord injury. Based on current evidence, needle placement in the paramedian portion of the interlaminar space is safest to avoid LF gaps. 3) An optimal AP trajectory view and the physician's ability to discern engagement in the LF and subsequent LOR are crucial. Confirmation of minimal needle insertion depth relative to the ventral margin of the lamina with either a lateral or contralateral oblique (CLO) safety view is critical to minimize the risk of inadvertently inserting the needle too ventral. 4) There have been closed claims and case reports of patients who have suffered catastrophic neurologic injuries while receiving CILESIs under deep sedation. If sedation is administered, the least amount necessary should be utilized to ensure the patient can provide verbal feedback during the procedure. 5) CILESIs are an elective procedure; therefore, necessity and likelihood of benefit must be foremost considerations. Current guidelines recommend holding ACAP therapy before CILESIs due to the potentially catastrophic complications associated with epidural hematoma (EH) formation. However, there is also a risk of severe systemic complications with ceasing ACAP in specific clinical scenarios. The treating physician is obligated to determine if the procedure is indicated and can ultimately decide to delay the intervention or not perform the procedure if the benefit does not outweigh the risks.</p><p><em>Minimizing Risks with Cervical Transforaminal Epidural Steroid Injections – the Role of Preprocedural Review of Advanced Imaging</em> -- Variations in vascular anatomy may warrant a modified approach to CTFESI. Preprocedural review of cross-sectional imaging can provide critical information for safe injection angle planning specific to individual patients and may help to decrease the risk of unintended vascular events with potentially catastrophic outcomes.</p><p><em>Safety of Multi-level or Bilateral Fluoroscopically-Guided Cervical Transforaminal Epidural Steroid Injections --</em> Safe performance of a CTFESI procedure requires the ability to detect inadvertent arterial injection. Contrast me
1) 颈椎层间硬膜外类固醇注射的风险最小化 - 1) 颈椎层间硬膜外类固醇注射应在 C6-C7 或以下进行,C7-T1 为首选进针点,因为该水平的背侧硬膜外腔比头侧的层间节段更宽敞。这降低了硬膜穿刺这一轻微并发症的风险,以及因进针不慎而导致脊髓损伤这一主要并发症的风险。2) LF间隙在颈椎中线最为普遍。这可能会导致阻力损失(LOR)时触觉反馈减弱,增加意外硬膜穿刺或脊髓损伤的风险。根据目前的证据,将针头放置在层间间隙的旁侧部分是最安全的,可避免 LF 间隙。3) 最佳的 AP 轨迹视图以及医生辨别 LF 和随后 LOR 啮合的能力至关重要。通过侧位或对侧斜位(CLO)安全视图确认相对于椎板腹缘的最小进针深度,对于最大限度地降低因疏忽而将针插入过腹侧的风险至关重要。4) 有已结案的索赔和病例报告显示,有患者在深度镇静的情况下接受 CILESI 时遭受了灾难性的神经损伤。如果使用镇静剂,应尽量少用,以确保患者能在手术过程中提供言语反馈。5) CILESI 是一种选择性手术;因此,必须首先考虑手术的必要性和获益的可能性。由于硬膜外血肿(EH)的形成可能带来灾难性的并发症,目前的指南建议在进行 CILESIs 之前暂停 ACAP 治疗。然而,在特定的临床情况下,停止 ACAP 也有可能导致严重的全身并发症。主治医生有责任确定手术是否适用,如果收益不能抵消风险,最终可以决定推迟干预或不实施手术。最大限度降低颈椎经硬膜外腔注射类固醇的风险--先进成像术前审查的作用 -- 血管解剖结构的变化可能会导致 CTFESI 的方法有所改变。多层次或双侧透视引导的颈椎经硬膜外类固醇注射的安全性 -- CTFESI手术的安全实施要求能够检测到意外的动脉注射。在最初的 CTFESI 中向硬膜外腔和/或沿脊神经出口注射造影剂,可能会使随后的 CTFESI 无法检测到无意中插入的髓桡动脉。虽然没有文献直接论述多层次或双侧 CTFESI 的潜在风险,但仍需谨慎。
{"title":"FACTFINDERS FOR PATIENT SAFETY: Minimizing risks with cervical epidural injections","authors":"Eric K. Holder ,&nbsp;Haewon Lee ,&nbsp;Aditya Raghunandan ,&nbsp;Benjamin Marshall ,&nbsp;Adam Michalik ,&nbsp;Minh Nguyen ,&nbsp;Mathew Saffarian ,&nbsp;Byron J. Schneider ,&nbsp;Clark C. Smith ,&nbsp;Christin A. Tiegs-Heiden ,&nbsp;Patricia Zheng ,&nbsp;Jaymin Patel ,&nbsp;David Levi ,&nbsp;International Pain and Spine Intervention Society's Patient Safety Committee","doi":"10.1016/j.inpm.2024.100430","DOIUrl":"10.1016/j.inpm.2024.100430","url":null,"abstract":"&lt;div&gt;&lt;p&gt;This series of FactFinders presents a brief summary of the evidence and outlines recommendations to minimize risks associated with cervical epidural injections.&lt;/p&gt;&lt;p&gt;Evidence in support of the following facts is presented.&lt;/p&gt;&lt;p&gt;&lt;em&gt;Minimizing Risks with Cervical Interlaminar Epidural Steroid Injections&lt;/em&gt; – 1) CILESIs should be performed at C6-C7 or below, with C7-T1 as the preferred access point due to the more generous dorsal epidural space at this level compared to the more cephalad interlaminar segments. This reduces the risk of the minor complication of dural puncture and the major complication of spinal cord injury due to inadvertent needle placement. 2) LF gaps are most prevalent in the midline cervical spine. This can result in diminished tactile feedback with loss of resistance (LOR), increasing the risk for inadvertent dural puncture or spinal cord injury. Based on current evidence, needle placement in the paramedian portion of the interlaminar space is safest to avoid LF gaps. 3) An optimal AP trajectory view and the physician's ability to discern engagement in the LF and subsequent LOR are crucial. Confirmation of minimal needle insertion depth relative to the ventral margin of the lamina with either a lateral or contralateral oblique (CLO) safety view is critical to minimize the risk of inadvertently inserting the needle too ventral. 4) There have been closed claims and case reports of patients who have suffered catastrophic neurologic injuries while receiving CILESIs under deep sedation. If sedation is administered, the least amount necessary should be utilized to ensure the patient can provide verbal feedback during the procedure. 5) CILESIs are an elective procedure; therefore, necessity and likelihood of benefit must be foremost considerations. Current guidelines recommend holding ACAP therapy before CILESIs due to the potentially catastrophic complications associated with epidural hematoma (EH) formation. However, there is also a risk of severe systemic complications with ceasing ACAP in specific clinical scenarios. The treating physician is obligated to determine if the procedure is indicated and can ultimately decide to delay the intervention or not perform the procedure if the benefit does not outweigh the risks.&lt;/p&gt;&lt;p&gt;&lt;em&gt;Minimizing Risks with Cervical Transforaminal Epidural Steroid Injections – the Role of Preprocedural Review of Advanced Imaging&lt;/em&gt; -- Variations in vascular anatomy may warrant a modified approach to CTFESI. Preprocedural review of cross-sectional imaging can provide critical information for safe injection angle planning specific to individual patients and may help to decrease the risk of unintended vascular events with potentially catastrophic outcomes.&lt;/p&gt;&lt;p&gt;&lt;em&gt;Safety of Multi-level or Bilateral Fluoroscopically-Guided Cervical Transforaminal Epidural Steroid Injections --&lt;/em&gt; Safe performance of a CTFESI procedure requires the ability to detect inadvertent arterial injection. Contrast me","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100430"},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000517/pdfft?md5=5f30e10e1c04a17ffd6649f739cd145f&pid=1-s2.0-S2772594424000517-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142084131","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}
引用次数: 0
Optimal caudal needle angulation for lumbar medial branch denervation: A 3D cadaveric and clinical imaging comparison study 腰椎内侧支神经支配的最佳尾针角度:三维尸体和临床成像对比研究
Pub Date : 2024-08-19 DOI: 10.1016/j.inpm.2024.100433
John Tran , Abdulrahman Alboog , Ujjoyinee Barua , Nicole Billias , Eldon Loh

Background

Lumbar medial branch (MB) radiofrequency ablation is a common intervention to treat facetogenic low back pain. The consensus among spine pain interventionalists is that capturing a greater length of the MB correlates with a longer duration of pain relief. Therefore, there has been interest in defining optimal needle angles to achieve parallel cannula placement. Presently, there is inconsistency regarding the optimal caudal needle angles.

Objectives

The objectives of this study were to: 1) use a dissection-based 3D modelling methodology to quantify optimal caudal needle angles from cadaveric models; and 2) compare optimal cadaver-derived caudal needle angles with real-world patient-derived needle angles.

Methods

Eighteen formalin embalmed lumbosacral spine specimens were dissected, digitized, and modelled in 3D. Virtual needles were simulated and placed parallel with the L1-L5 MBs. Cadaver-derived caudal needle angles were measured from the high-fidelity 3D models with optimally placed virtual needles. Lateral fluoroscopic images of patients (n = 200) that received lumbar MB denervation were reviewed to measure patient-derived caudal needle angles (L3-L5 MB levels). Descriptive statistics were used to analyze the cadaver (L1-L5 MB levels) and patient-derived (L3-L5 MB levels) caudal needle angles. The cadaver and patient-derived mean caudal needle angles for L3-L5 MB levels were compared.

Results

There was variability in the cadaver-derived mean caudal needle angles. The lowest mean caudal needle angle was the L1 MB level measured at 41.57 ± 8.56° (range: 27.14° - 53.96°). The highest was the L5 MB level with a mean caudal needle angle of 60.79 ± 8.55° (range: 46.97° - 79.74°). A total of 123 patients were included and 369 caudal needle angles (L3-L5 MB levels) were measured and analyzed. There was variability in the patient-derived mean caudal needle angles. The patient-derived mean caudal needle angles were 29.18 ± 8.77° (range: 11.80° - 61.31°), 33.34 ± 7.23° (range: 16.40° - 54.15°), and 49.08 ± 8.87° (range: 26.45° - 76.95°) for the L3, L4, and L5 MB levels, respectively. There was a significant difference in mean caudal needle angle between cadaver and patient-derived needle angles at the L3, L4, and L5 MB levels.

Conclusions

Analysis of cadaver-derived needle angles versus patient-derived data suggests optimization of lumbar MB denervation requires greater caudal angulation to achieve parallel needle placement. Further research is required to assess the clinical implications.

背景腰椎内侧支(MB)射频消融术是治疗面源性腰痛的常见干预方法。脊柱疼痛介入专家的共识是,捕捉到的内侧支长度越长,疼痛缓解的时间就越长。因此,人们对确定最佳针角度以实现平行套管置入很感兴趣。目前,关于尾椎针的最佳角度还不一致:1) 使用基于解剖的三维建模方法,从尸体模型中量化最佳尾椎针角度;以及 2) 将尸体得出的最佳尾椎针角度与真实世界中患者得出的针角度进行比较。方法对 18 个福尔马林防腐腰骶椎标本进行解剖、数字化和三维建模。模拟虚拟针,并将其与 L1-L5 MBs 平行放置。根据高保真三维模型和最佳放置的虚拟针测量尸体衍生的尾椎针角度。对接受腰椎 MB 神经支配的患者(n = 200)的侧向透视图像进行审查,以测量患者衍生的尾椎针角度(L3-L5 MB 水平)。描述性统计用于分析尸体(L1-L5 MB 水平)和患者衍生(L3-L5 MB 水平)尾针角度。结果尸体得出的平均尾针角度存在差异。L1 MB 水平的平均尾针角度最低,为 41.57 ± 8.56°(范围:27.14° - 53.96°)。最高的是 L5 MB 水平,平均尾针角度为 60.79 ± 8.55°(范围:46.97° - 79.74°)。共纳入 123 名患者,测量并分析了 369 个尾针角(L3-L5 MB 水平)。患者得出的平均尾针角度存在差异。患者得出的 L3、L4 和 L5 MB 水平平均尾针角度分别为 29.18 ± 8.77°(范围:11.80° - 61.31°)、33.34 ± 7.23°(范围:16.40° - 54.15°)和 49.08 ± 8.87°(范围:26.45° - 76.95°)。在 L3、L4 和 L5 MB 水平,尸体和患者得出的针角度在平均尾针角度上存在明显差异。需要进一步研究以评估其临床意义。
{"title":"Optimal caudal needle angulation for lumbar medial branch denervation: A 3D cadaveric and clinical imaging comparison study","authors":"John Tran ,&nbsp;Abdulrahman Alboog ,&nbsp;Ujjoyinee Barua ,&nbsp;Nicole Billias ,&nbsp;Eldon Loh","doi":"10.1016/j.inpm.2024.100433","DOIUrl":"10.1016/j.inpm.2024.100433","url":null,"abstract":"<div><h3>Background</h3><p>Lumbar medial branch (MB) radiofrequency ablation is a common intervention to treat facetogenic low back pain. The consensus among spine pain interventionalists is that capturing a greater length of the MB correlates with a longer duration of pain relief. Therefore, there has been interest in defining optimal needle angles to achieve parallel cannula placement. Presently, there is inconsistency regarding the optimal caudal needle angles.</p></div><div><h3>Objectives</h3><p>The objectives of this study were to: 1) use a dissection-based 3D modelling methodology to quantify optimal caudal needle angles from cadaveric models; and 2) compare optimal cadaver-derived caudal needle angles with real-world patient-derived needle angles.</p></div><div><h3>Methods</h3><p>Eighteen formalin embalmed lumbosacral spine specimens were dissected, digitized, and modelled in 3D. Virtual needles were simulated and placed parallel with the L1-L5 MBs. Cadaver-derived caudal needle angles were measured from the high-fidelity 3D models with optimally placed virtual needles. Lateral fluoroscopic images of patients (n = 200) that received lumbar MB denervation were reviewed to measure patient-derived caudal needle angles (L3-L5 MB levels). Descriptive statistics were used to analyze the cadaver (L1-L5 MB levels) and patient-derived (L3-L5 MB levels) caudal needle angles. The cadaver and patient-derived mean caudal needle angles for L3-L5 MB levels were compared.</p></div><div><h3>Results</h3><p>There was variability in the cadaver-derived mean caudal needle angles. The lowest mean caudal needle angle was the L1 MB level measured at 41.57 ± 8.56° (range: 27.14° - 53.96°). The highest was the L5 MB level with a mean caudal needle angle of 60.79 ± 8.55° (range: 46.97° - 79.74°). A total of 123 patients were included and 369 caudal needle angles (L3-L5 MB levels) were measured and analyzed. There was variability in the patient-derived mean caudal needle angles. The patient-derived mean caudal needle angles were 29.18 ± 8.77° (range: 11.80° - 61.31°), 33.34 ± 7.23° (range: 16.40° - 54.15°), and 49.08 ± 8.87° (range: 26.45° - 76.95°) for the L3, L4, and L5 MB levels, respectively. There was a significant difference in mean caudal needle angle between cadaver and patient-derived needle angles at the L3, L4, and L5 MB levels.</p></div><div><h3>Conclusions</h3><p>Analysis of cadaver-derived needle angles versus patient-derived data suggests optimization of lumbar MB denervation requires greater caudal angulation to achieve parallel needle placement. Further research is required to assess the clinical implications.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100433"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000542/pdfft?md5=7657db571bff7bfc29b01ee4eb0f5fdc&pid=1-s2.0-S2772594424000542-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011283","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}
引用次数: 0
Genicular nerve radiofrequency ablation practice patterns: A survey study of the International Pain and Spine Interventional Society Genicular nerve radiofrequency ablation practice patterns:国际疼痛与脊柱介入学会调查研究
Pub Date : 2024-08-19 DOI: 10.1016/j.inpm.2024.100432
Reza Ehsanian , Shawn Fernandez , Amanda Cooper , Daniel M. Cushman , Aaron Conger , Taylor Burnham , Alexandra E. Fogarty , Rohit Aiyer , Katie Smolinski , Zachary L. McCormick
<div><h3>Introduction</h3><p>Chronic knee pain often results from degenerative conditions such as knee osteoarthritis (OA) and can worsen after surgical interventions like total knee arthroplasty (TKA). Knee OA affects approximately 86 million individuals globally, leading to decreased function, mobility limitations, and disability. While TKA is a common surgical treatment for refractory knee OA, though up to 20 % of patients experience chronic post-operative knee pain worse than their pre-operative pain. Genicular nerve radiofrequency ablation (GnRFA) has emerged as a promising intervention for knee OA pain unresponsive to conservative management and for chronic post-TKA pain. GnRFA is an evidence-based technique supported by multiple prospective cohort studies and randomized controlled trials (RCTs). However, practice patterns and GnRFA techniques vary, and no peer-reviewed publication has yet quantified these variations in real-world clinical practice.</p></div><div><h3>Objective</h3><p>This study aims to understand the practice patterns of interventional pain physicians regarding patient selection, use of prognostic blocks, imaging, nerve targets, GnRFA types, and GnRFA techniques in treating knee pain secondary to OA or persistent post-TKA pain.</p></div><div><h3>Methods</h3><p>An anonymous 29-question survey was distributed via electronic mail to members of the International Pain and Spine Intervention Society (IPSIS) from January 16, 2024, to February 29, 2024. The survey assessed practice patterns related to patient selection, prognostic block use, and GnRFA techniques. Data were collected and stored using REDCap software, with descriptive statistics calculated.</p></div><div><h3>Results</h3><p>A total of 150 completed surveys were analyzed, representing a completion rate of 2.0 % of surveys sent, 3.5 % of emails opened, and 56.8 % of those who clicked on the survey link. Respondents generally use common selection protocols regarding OA grade (Kelgren-Lawrence 3 and 4), duration of failed conservative care (3–6 months), a single anesthetic block paradigm, and use of fluoroscopic guidance for the GnRFA procedure. More variability was reported between respondents regarding the volume of anesthetic used during prognostic blocks, the threshold to consider a prognostic block “positive,” the technology used, and nerves targeted during the GnRFA procedure.</p></div><div><h3>Conclusion</h3><p>The study provides valuable insights into the current practice patterns of GnRFA among interventional pain physicians. While there is consensus on some aspects of patient selection and procedural techniques, significant variability exists in prognostic block protocols and nerve targets for GnRFA. These findings highlight the need for further research to explore the long-term efficacy and safety of GnRFA and to standardize techniques and protocols across different practice settings, ultimately improving patient outcomes and quality of life. The low response r
导言:慢性膝关节疼痛通常由膝关节骨性关节炎(OA)等退行性病变引起,并可能在全膝关节置换术(TKA)等手术治疗后加重。全球约有 8600 万人受到膝关节 OA 的影响,导致功能减退、活动受限和残疾。虽然全膝关节置换术是治疗难治性膝关节 OA 的常见手术疗法,但多达 20% 的患者术后会出现比术前疼痛更严重的慢性膝关节疼痛。膝神经射频消融术(GnRFA)已成为治疗对保守治疗无效的膝关节OA疼痛和TKA术后慢性疼痛的一种很有前景的干预方法。GnRFA 是一种循证技术,得到了多项前瞻性队列研究和随机对照试验 (RCT) 的支持。本研究旨在了解介入疼痛科医生在治疗继发于 OA 的膝关节疼痛或 TKA 术后持续性疼痛时,在患者选择、预后阻滞的使用、成像、神经靶点、GnRFA 类型和 GnRFA 技术方面的实践模式。方法从 2024 年 1 月 16 日至 2024 年 2 月 29 日,通过电子邮件向国际疼痛与脊柱介入学会 (IPSIS) 的会员发放了一份包含 29 个问题的匿名调查。调查评估了与患者选择、预后区块使用和 GnRFA 技术相关的实践模式。使用 REDCap 软件收集和存储数据,并计算描述性统计数据。结果 共分析了 150 份完成的调查问卷,完成率为发出调查问卷的 2.0%,打开电子邮件的 3.5%,点击调查链接的 56.8%。受访者一般采用常见的选择方案,包括 OA 分级(Kelgren-Lawrence 3 级和 4 级)、保守治疗失败持续时间(3-6 个月)、单一麻醉阻滞范例以及在 GnRFA 手术中使用透视引导。在预后阻滞过程中使用的麻醉剂量、将预后阻滞视为 "阳性 "的阈值、所使用的技术以及 GnRFA 手术中的目标神经方面,受访者之间的差异较大。虽然在患者选择和手术技术的某些方面已达成共识,但在 GnRFA 的预后阻滞方案和神经靶点方面还存在很大差异。这些发现凸显了进一步研究的必要性,以探索 GnRFA 的长期疗效和安全性,并在不同的实践环境中实现技术和方案的标准化,最终改善患者的预后和生活质量。低回复率可能会限制其普遍性,而且该调查并不包括消融所使用的活动尖端尺寸的数据,也不包括在采用 GnRFA 之前是否应穷尽其他程序的数据。此外,仅对 IPSIS 会员进行调查可能无法完全代表疼痛治疗专家的多样性,从而可能导致抽样偏差。未来的研究应包括更广泛的专业组织成员,以提高代表性。
{"title":"Genicular nerve radiofrequency ablation practice patterns: A survey study of the International Pain and Spine Interventional Society","authors":"Reza Ehsanian ,&nbsp;Shawn Fernandez ,&nbsp;Amanda Cooper ,&nbsp;Daniel M. Cushman ,&nbsp;Aaron Conger ,&nbsp;Taylor Burnham ,&nbsp;Alexandra E. Fogarty ,&nbsp;Rohit Aiyer ,&nbsp;Katie Smolinski ,&nbsp;Zachary L. McCormick","doi":"10.1016/j.inpm.2024.100432","DOIUrl":"10.1016/j.inpm.2024.100432","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;Chronic knee pain often results from degenerative conditions such as knee osteoarthritis (OA) and can worsen after surgical interventions like total knee arthroplasty (TKA). Knee OA affects approximately 86 million individuals globally, leading to decreased function, mobility limitations, and disability. While TKA is a common surgical treatment for refractory knee OA, though up to 20 % of patients experience chronic post-operative knee pain worse than their pre-operative pain. Genicular nerve radiofrequency ablation (GnRFA) has emerged as a promising intervention for knee OA pain unresponsive to conservative management and for chronic post-TKA pain. GnRFA is an evidence-based technique supported by multiple prospective cohort studies and randomized controlled trials (RCTs). However, practice patterns and GnRFA techniques vary, and no peer-reviewed publication has yet quantified these variations in real-world clinical practice.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;This study aims to understand the practice patterns of interventional pain physicians regarding patient selection, use of prognostic blocks, imaging, nerve targets, GnRFA types, and GnRFA techniques in treating knee pain secondary to OA or persistent post-TKA pain.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;An anonymous 29-question survey was distributed via electronic mail to members of the International Pain and Spine Intervention Society (IPSIS) from January 16, 2024, to February 29, 2024. The survey assessed practice patterns related to patient selection, prognostic block use, and GnRFA techniques. Data were collected and stored using REDCap software, with descriptive statistics calculated.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 150 completed surveys were analyzed, representing a completion rate of 2.0 % of surveys sent, 3.5 % of emails opened, and 56.8 % of those who clicked on the survey link. Respondents generally use common selection protocols regarding OA grade (Kelgren-Lawrence 3 and 4), duration of failed conservative care (3–6 months), a single anesthetic block paradigm, and use of fluoroscopic guidance for the GnRFA procedure. More variability was reported between respondents regarding the volume of anesthetic used during prognostic blocks, the threshold to consider a prognostic block “positive,” the technology used, and nerves targeted during the GnRFA procedure.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;The study provides valuable insights into the current practice patterns of GnRFA among interventional pain physicians. While there is consensus on some aspects of patient selection and procedural techniques, significant variability exists in prognostic block protocols and nerve targets for GnRFA. These findings highlight the need for further research to explore the long-term efficacy and safety of GnRFA and to standardize techniques and protocols across different practice settings, ultimately improving patient outcomes and quality of life. The low response r","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100432"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000530/pdfft?md5=27358e3074b9a4ef7065c18af0ba236b&pid=1-s2.0-S2772594424000530-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011313","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}
引用次数: 0
A description and outcome evaluation of sacrococcygeal joint radiofrequency neurotomy for treatment of chronic coccydynia – A dorsal approach 骶尾关节射频神经切断术治疗慢性尾骨痛的描述和疗效评估--背侧法
Pub Date : 2024-08-10 DOI: 10.1016/j.inpm.2024.100431
Scott WJ. Moorman , Josh Kutcher , Robert Burnham
<div><h3>Background</h3><p>Coccydynia is a condition characterized by pain and tenderness in the coccyx region of the spine. Chronic coccydynia (≥3-months) management remains a clinical challenge. Radiofrequency neurotomy (RFN) targeting the sacrococcygeal joint (SCJ) and/or 1st intercoccygeal joint (ICJ) margins has emerged as an alternative, minimally invasive intervention for refractory coccydynia.</p></div><div><h3>Objective</h3><p>The objective of this study was to evaluate the safety and effectiveness of an RFN technique targeting the dorsal aspect of SCJ and/or 1st ICJ for treatment of patients with chronic coccydynia.</p></div><div><h3>Methods</h3><p>Retrospective analysis of prospective outcomes for patients with chronic coccydynia (≥3-months) who underwent RFN to dorsal SCJ and/or 1st ICJ between 2009 - 2023. RFN technique was a dorsal approach targeting the distal sacrum and proximal coccyx, which form the SCJ or 1st ICJ margins. Numerical rating scale (NRS) and Pain Disability Quality-of-Life Questionnaire-Spine (PDQQ-S) scores were completed pre- and 3-months post-RFN. Successful RFN was defined as ≥50% reduction or minimal clinical important difference (MCID) in PDQQ-S and NRS pain scores. The primary outcome measures were the proportion of patients achieving ≥50% reduction in NRS pain and PDDQ-S scores following primary and repeat RFN to SCJ and/or 1st ICJ. Secondary outcomes included the proportion of patients achieving MCID on NRS pain and PDQQ-S scores following RFN, as well as mean NRS and PDQQ-S scores pre- and 3-months post-RFN, and magnitude of improvement for patients following successful RFN procedures.</p></div><div><h3>Results</h3><p>A total of 52 RFN procedures (n = 30 primary, and n = 22 repeat procedures) were performed on 30 patients (female = 25, male = 5, mean age 55.1 ± 13.0yrs). Ten patients (33.3%; 95% CI = 17.3–52.8) reported ≥50% pain reduction as measured by NRS pain and PDQQ-S scores following primary SCJ and/or 1st ICJ RFN at 3-months follow-up. Fifteen patients (50%; 95% CI = 31.3–68.7) reported MCID NRS pain reduction and 12 patients (40.0%; 95% CI = 22.7–59.4) reported MCID PDQQ-S scores at 3-months following primary RFN. The mean magnitude of improvement for patients with primary successful RFN, as defined as ≥50% reduction in either NRS pain or PDQQ-S scores, was 77.4% (±SD 21.4%) and 74.9% (±SD = 19.9%), respectively. Similarly, the mean magnitude of improvement for patients with successful RFN, as defined by MCID reduction in NRS pain or PDQQ-S scores, was 62.6% (±SD = 28.2%) and 69.3% (±SD = 22.3%), respectively. At 3-months follow-up, 14 patients (63.6%; 95% CI = 40.7–82.8) reported ≥50% pain reduction as measured by either NRS pain and PDQQ-S scores following repeat RFN. Nineteen patients (86.4%; 95% CI = 65.1–97.1) reported MCID NRS pain reduction and 16 patients (72.7%; 95% CI = 49.8–89.3) reported MCID PDQQ-S scores at 3-months following repeat RFN. Statistically significant differences were ob
背景尾骨痛是一种以脊柱尾骨部位疼痛和触痛为特征的疾病。慢性尾骨痛(≥3 个月)的治疗仍是一项临床挑战。针对骶尾关节(SCJ)和/或第一尾骨间关节(ICJ)边缘的射频神经切断术(RFN)已成为治疗难治性尾骨痛的另一种微创干预方法。本研究旨在评估针对 SCJ 和/或第一 ICJ 背侧的 RFN 技术治疗慢性尾骨痛患者的安全性和有效性。方法对 2009-2023 年间接受 SCJ 和/或第一 ICJ 背侧 RFN 治疗的慢性尾骨痛患者(≥3 个月)的前瞻性结果进行回顾性分析。RFN 技术采用背侧入路,以骶骨远端和尾骨近端为目标,这两个部位构成了 SCJ 或第一 ICJ 边缘。RFN前和RFN后3个月完成数字评分量表(NRS)和疼痛残疾生活质量问卷-脊柱(PDQQ-S)评分。PDQQ-S和NRS疼痛评分降低≥50%或最小临床重要差异(MCID)即为RFN成功。主要结果指标是在对 SCJ 和/或第一 ICJ 进行初次和重复 RFN 后,NRS 疼痛和 PDDQ-S 评分降低≥50%的患者比例。次要结果包括 RFN 术后 NRS 疼痛评分和 PDQQ-S 评分达到 MCID 的患者比例、RFN 术前和术后 3 个月的平均 NRS 评分和 PDQQ-S 评分,以及成功 RFN 术后患者的改善程度。10名患者(33.3%;95% CI = 17.3-52.8)在接受初次SCJ和/或第1次ICJ RFN术后3个月随访时,根据NRS疼痛评分和PDQQ-S评分,疼痛减轻了≥50%。15 名患者(50%;95% CI = 31.3-68.7)报告在初级 RFN 治疗 3 个月后,MCID NRS 疼痛减轻,12 名患者(40.0%;95% CI = 22.7-59.4)报告在初级 RFN 治疗 3 个月后,MCID PDQQ-S 得分降低。初治成功的 RFN 患者(定义为 NRS 疼痛或 PDQQ-S 评分降低≥50%)的平均改善幅度分别为 77.4%(±SD 21.4%)和 74.9%(±SD = 19.9%)。同样,以NRS疼痛或PDQQ-S评分的MCID降低为标准,成功RFN患者的平均改善幅度分别为62.6%(±SD = 28.2%)和69.3%(±SD = 22.3%)。在 3 个月的随访中,有 14 名患者(63.6%;95% CI = 40.7-82.8)报告在重复 RFN 治疗后,根据 NRS 疼痛评分和 PDQQ-S 评分,疼痛减轻了≥50%。重复 RFN 治疗 3 个月后,19 名患者(86.4%;95% CI = 65.1-97.1)的 NRS 疼痛评分达到 MCID 标准,16 名患者(72.7%;95% CI = 49.8-89.3)的 PDQQ-S 评分达到 MCID 标准。在初次手术和重复手术中,RFN前后的NRS疼痛和PDQQ-S评分之间存在统计学意义上的重大差异(p < 0.005)。33.3%的患者在接受初级 RFN 治疗 3 个月后疼痛减轻、功能改善。该疗法仍存在一些局限性,包括患者群体的异质性、样本量较小以及没有对照组。未来的详细研究包括尸体研究,以明确感觉神经支配,提高 RFN 期间目标的可靠性。还需要对长期疗效进行更大规模的前瞻性研究,包括与对照组的比较,以进一步评估我们的背侧 RFN 方法的疗效。
{"title":"A description and outcome evaluation of sacrococcygeal joint radiofrequency neurotomy for treatment of chronic coccydynia – A dorsal approach","authors":"Scott WJ. Moorman ,&nbsp;Josh Kutcher ,&nbsp;Robert Burnham","doi":"10.1016/j.inpm.2024.100431","DOIUrl":"10.1016/j.inpm.2024.100431","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Coccydynia is a condition characterized by pain and tenderness in the coccyx region of the spine. Chronic coccydynia (≥3-months) management remains a clinical challenge. Radiofrequency neurotomy (RFN) targeting the sacrococcygeal joint (SCJ) and/or 1st intercoccygeal joint (ICJ) margins has emerged as an alternative, minimally invasive intervention for refractory coccydynia.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;The objective of this study was to evaluate the safety and effectiveness of an RFN technique targeting the dorsal aspect of SCJ and/or 1st ICJ for treatment of patients with chronic coccydynia.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Retrospective analysis of prospective outcomes for patients with chronic coccydynia (≥3-months) who underwent RFN to dorsal SCJ and/or 1st ICJ between 2009 - 2023. RFN technique was a dorsal approach targeting the distal sacrum and proximal coccyx, which form the SCJ or 1st ICJ margins. Numerical rating scale (NRS) and Pain Disability Quality-of-Life Questionnaire-Spine (PDQQ-S) scores were completed pre- and 3-months post-RFN. Successful RFN was defined as ≥50% reduction or minimal clinical important difference (MCID) in PDQQ-S and NRS pain scores. The primary outcome measures were the proportion of patients achieving ≥50% reduction in NRS pain and PDDQ-S scores following primary and repeat RFN to SCJ and/or 1st ICJ. Secondary outcomes included the proportion of patients achieving MCID on NRS pain and PDQQ-S scores following RFN, as well as mean NRS and PDQQ-S scores pre- and 3-months post-RFN, and magnitude of improvement for patients following successful RFN procedures.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 52 RFN procedures (n = 30 primary, and n = 22 repeat procedures) were performed on 30 patients (female = 25, male = 5, mean age 55.1 ± 13.0yrs). Ten patients (33.3%; 95% CI = 17.3–52.8) reported ≥50% pain reduction as measured by NRS pain and PDQQ-S scores following primary SCJ and/or 1st ICJ RFN at 3-months follow-up. Fifteen patients (50%; 95% CI = 31.3–68.7) reported MCID NRS pain reduction and 12 patients (40.0%; 95% CI = 22.7–59.4) reported MCID PDQQ-S scores at 3-months following primary RFN. The mean magnitude of improvement for patients with primary successful RFN, as defined as ≥50% reduction in either NRS pain or PDQQ-S scores, was 77.4% (±SD 21.4%) and 74.9% (±SD = 19.9%), respectively. Similarly, the mean magnitude of improvement for patients with successful RFN, as defined by MCID reduction in NRS pain or PDQQ-S scores, was 62.6% (±SD = 28.2%) and 69.3% (±SD = 22.3%), respectively. At 3-months follow-up, 14 patients (63.6%; 95% CI = 40.7–82.8) reported ≥50% pain reduction as measured by either NRS pain and PDQQ-S scores following repeat RFN. Nineteen patients (86.4%; 95% CI = 65.1–97.1) reported MCID NRS pain reduction and 16 patients (72.7%; 95% CI = 49.8–89.3) reported MCID PDQQ-S scores at 3-months following repeat RFN. Statistically significant differences were ob","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100431"},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000529/pdfft?md5=9aaa6430e08777ccc86d021a4466e40b&pid=1-s2.0-S2772594424000529-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963752","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}
引用次数: 0
Comparison of curved and straight tip radiofrequency cannula deflection in a ballistic model 在弹道模型中比较弯头和直头射频套管的偏转情况
Pub Date : 2024-07-31 DOI: 10.1016/j.inpm.2024.100429
Allen Chen , Udai Nanda , Joseph Solberg , Ethan Rand , George Christolias , Jaspal Ricky Singh

Background

Percutaneous pain and spine procedures play an important diagnostic and therapeutic role in the treatment of various pain diagnoses. Accurate placement of needles or cannulae during these procedures is paramount to the success of these procedures.

Objective

The purpose of this study is to examine and quantify the amount of deflection of radiofrequency cannulae based on curved tip versus no curved tip, using a ballistic gel tissue simulant.

Materials and methods

Six different types of cannulae commonly used for spinal and peripheral nerve ablations were selected, including 18, 20, and 22 gauge curved and straight radiofrequency cannulae. Ballistic gel samples were made in molds of 40 mm and 80 mm. Each cannula was mounted in a drill press to ensure accurate trajectory.

Results

Curved RFA cannula had increased deflection when compared to straight cannula for 18-, 20-, and 22-gauge cannulae at a depth of 40 mm. Curved RFA cannula had increased deflection when compared to straight cannula for 20- and 22-gauge cannulae at a depth of 80 mm. Overall, the mean deflection for a curved cannula increased 1.9x for 20-gauge cannulae and 2.5x for 22-gauge cannulae when compared to a straight cannula.

Conclusions

For interventionalists, understanding the effects of needle or cannula shape is crucial for accurate placement. When a procedure requires additional steerability, additional deflection up to 2.5x obtained by placing a bend in the needle or cannula tip should be considered.

背景经皮疼痛和脊柱手术在治疗各种疼痛诊断中发挥着重要的诊断和治疗作用。本研究的目的是使用弹道凝胶组织模拟物检查和量化射频套管的偏转量,根据弯曲尖端与无弯曲尖端进行比较。材料和方法选择了脊柱和周围神经消融常用的六种不同类型的套管,包括 18 号、20 号和 22 号弯曲和笔直射频套管。弹道凝胶样品分别用 40 毫米和 80 毫米的模具制成。结果与直套管相比,在深度为 40 毫米的 18、20 和 22 号套管中,弧形射频消融套管的偏转增加。对于深度为 80 毫米的 20 号和 22 号插管,弧形 RFA 插管与直插管相比偏转更大。总体而言,与直套管相比,20 号套管的弧形套管的平均偏转增加了 1.9 倍,22 号套管的平均偏转增加了 2.5 倍。当手术需要额外的可转向性时,应考虑通过在针头或套管顶端设置弯曲来获得额外的偏转,最高可达 2.5 倍。
{"title":"Comparison of curved and straight tip radiofrequency cannula deflection in a ballistic model","authors":"Allen Chen ,&nbsp;Udai Nanda ,&nbsp;Joseph Solberg ,&nbsp;Ethan Rand ,&nbsp;George Christolias ,&nbsp;Jaspal Ricky Singh","doi":"10.1016/j.inpm.2024.100429","DOIUrl":"10.1016/j.inpm.2024.100429","url":null,"abstract":"<div><h3>Background</h3><p>Percutaneous pain and spine procedures play an important diagnostic and therapeutic role in the treatment of various pain diagnoses. Accurate placement of needles or cannulae during these procedures is paramount to the success of these procedures.</p></div><div><h3>Objective</h3><p>The purpose of this study is to examine and quantify the amount of deflection of radiofrequency cannulae based on curved tip versus no curved tip, using a ballistic gel tissue simulant.</p></div><div><h3>Materials and methods</h3><p>Six different types of cannulae commonly used for spinal and peripheral nerve ablations were selected, including 18, 20, and 22 gauge curved and straight radiofrequency cannulae. Ballistic gel samples were made in molds of 40 mm and 80 mm. Each cannula was mounted in a drill press to ensure accurate trajectory.</p></div><div><h3>Results</h3><p>Curved RFA cannula had increased deflection when compared to straight cannula for 18-, 20-, and 22-gauge cannulae at a depth of 40 mm. Curved RFA cannula had increased deflection when compared to straight cannula for 20- and 22-gauge cannulae at a depth of 80 mm. Overall, the mean deflection for a curved cannula increased 1.9x for 20-gauge cannulae and 2.5x for 22-gauge cannulae when compared to a straight cannula.</p></div><div><h3>Conclusions</h3><p>For interventionalists, understanding the effects of needle or cannula shape is crucial for accurate placement. When a procedure requires additional steerability, additional deflection up to 2.5x obtained by placing a bend in the needle or cannula tip should be considered.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100429"},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000505/pdfft?md5=b88f037b6b9a7dc41a9333b499ff6967&pid=1-s2.0-S2772594424000505-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961713","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}
引用次数: 0
Collecting patient-reported outcomes for the assessment of interventions for pain conditions: Development, accuracy and usability of a customizable mobile app 收集患者报告的结果以评估疼痛状况的干预措施:可定制移动应用程序的开发、准确性和可用性
Pub Date : 2024-07-30 DOI: 10.1016/j.inpm.2024.100427
Brook I. Martin, Aaron Conger, Taylor Burnham, Daniel Finch, Zachary L. McCormick
{"title":"Collecting patient-reported outcomes for the assessment of interventions for pain conditions: Development, accuracy and usability of a customizable mobile app","authors":"Brook I. Martin,&nbsp;Aaron Conger,&nbsp;Taylor Burnham,&nbsp;Daniel Finch,&nbsp;Zachary L. McCormick","doi":"10.1016/j.inpm.2024.100427","DOIUrl":"10.1016/j.inpm.2024.100427","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100427"},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000487/pdfft?md5=20df5b3580e2bf407e7cc375dd6f25ca&pid=1-s2.0-S2772594424000487-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961712","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}
引用次数: 0
Superior cluneal nerves radiofrequency in the management of chronic low back pain 上锁骨神经射频治疗慢性腰背痛
Pub Date : 2024-07-23 DOI: 10.1016/j.inpm.2024.100428
Leonado Arce Gálvez , Jesús Daes Mora , Rafael Enrico Valencia Gómez , José Luis Cuervo Pulgarín , David Hernández Abuchaibe , Christian Vladimir Guauque Marcelo

Introduction

Chronic low back pain is a highly prevalent condition with multiple etiologies. Cluneal nerve neuropathy is an increasingly relevant condition in the management of this condition, and radiofrequency is an alternative management option.

Methods

A case series, which included four patients who underwent ultrasound-guided conventional radiofrequency intervention of the superior cluneal nerves, using a previously undescribed technique and direction of intervention.

Results

Patients reported a 50–90 % improvement in pain and a functional benefit for their daily activities of more than 40 % at 4- and 10-week follow-up, with no adverse events following the intervention.

Conclusions

Continuous radiofrequency of the cluneal nerves is an interesting alternative in the management of this pathology of low back pain. The ultrasound technique described may be a management proposal with lower risk and adequate effectiveness.

简介:慢性腰背痛是一种发病率很高的疾病,有多种病因。方法该系列病例包括四名患者,他们在超声引导下接受了上锁骨神经的常规射频介入治疗,采用了一种之前未曾描述过的技术和介入方向。结果患者在 4 周和 10 周的随访中,疼痛改善了 50%-90%,日常活动功能改善了 40%以上,干预后未出现不良反应。所述超声波技术可能是一种风险较低、效果显著的治疗方案。
{"title":"Superior cluneal nerves radiofrequency in the management of chronic low back pain","authors":"Leonado Arce Gálvez ,&nbsp;Jesús Daes Mora ,&nbsp;Rafael Enrico Valencia Gómez ,&nbsp;José Luis Cuervo Pulgarín ,&nbsp;David Hernández Abuchaibe ,&nbsp;Christian Vladimir Guauque Marcelo","doi":"10.1016/j.inpm.2024.100428","DOIUrl":"10.1016/j.inpm.2024.100428","url":null,"abstract":"<div><h3>Introduction</h3><p>Chronic low back pain is a highly prevalent condition with multiple etiologies. Cluneal nerve neuropathy is an increasingly relevant condition in the management of this condition, and radiofrequency is an alternative management option.</p></div><div><h3>Methods</h3><p>A case series, which included four patients who underwent ultrasound-guided conventional radiofrequency intervention of the superior cluneal nerves, using a previously undescribed technique and direction of intervention.</p></div><div><h3>Results</h3><p>Patients reported a 50–90 % improvement in pain and a functional benefit for their daily activities of more than 40 % at 4- and 10-week follow-up, with no adverse events following the intervention.</p></div><div><h3>Conclusions</h3><p>Continuous radiofrequency of the cluneal nerves is an interesting alternative in the management of this pathology of low back pain. The ultrasound technique described may be a management proposal with lower risk and adequate effectiveness.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100428"},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000499/pdfft?md5=159602cf8424797a4ac23e323f7e815a&pid=1-s2.0-S2772594424000499-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141960408","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}
引用次数: 0
Rates of positive vs negative studies in the spine literature 脊柱文献中阳性研究与阴性研究的比率
Pub Date : 2024-07-17 DOI: 10.1016/j.inpm.2024.100423
Samantha Levin , Joshua Levin

Background

Accuracy in the interpretation of data, and publication of studies regardless of outcomes are vital to the development of the scientific literature.

Objective

To determine the proportion of studies in the spine literature that report positive results.

Study design

Review article of studies published in nine major spine, pain, and physical medicine and rehabilitation (PM&R) journals from January 1, 2018–December 31, 2022.

Patient sample

Not applicable.

Methods

Articles that reported on pain and/or function from 2018 to 2022 in nine major journals were reviewed by two independent evaluators. The articles were graded as either positive or negative based on the authors’ own conclusions about their work.

Results

Overall, 91 % [95 % CI 88–94 %] of all articles were reported to have positive results. No significant differences were found between the broad categories of spine, pain, and PM&R journals. When comparing different categories of treatments, there were lower rates of positive results from medication/supplement studies (54 % [95 % CI 27–81 %]) compared to studies of spine injections/interventions (95 % [95 % CI 91–99 %]) and those of surgery (100 % [95 % CI 96–100 %]), and a lower rate of positive results from studies on physical treatments (85 % [95 % CI 75–95 %]) compared to those of surgery (100 % [95 % CI 96–100 %]). Studies with placebo controls were less likely to report positive results (60 % [95 % CI 44–76 %]) compared to those that did not use placebo controls (96 % [95 % CI 94–98 %]).

Conclusions

Despite the vast majority of studies in the spine literature concluding positive results, the high disease prevalence of spine conditions and the enormous burden on the healthcare system remain.

背景数据解读的准确性以及无论结果如何都发表研究报告对科学文献的发展至关重要。目的确定脊柱文献中报告阳性结果的研究比例。研究设计对2018年1月1日至2022年12月31日期间在九种主要脊柱、疼痛、物理医学和康复(PM&R)期刊上发表的研究文章进行回顾性研究。患者样本不适用。方法由两名独立评估员对2018年至2022年期间九种主要期刊上报告疼痛和/或功能的文章进行回顾性研究。根据作者自己对其工作的结论,文章被评为阳性或阴性。结果总体而言,所有文章中有 91% [95 % CI 88-94%]报告了阳性结果。脊柱、疼痛和 PM&R 期刊大类之间没有发现明显差异。在比较不同类别的治疗方法时,药物/补充剂研究的阳性结果率(54 % [95 % CI 27-81%])低于脊柱注射/干预研究(95 % [95 % CI 91-99%])和手术研究(100 % [95 % CI 96-100%]),物理治疗研究的阳性结果率(85 % [95 % CI 75-95%])低于手术研究(100 % [95 % CI 96-100%])。与不使用安慰剂对照的研究(96 % [95 % CI 94-98%])相比,使用安慰剂对照的研究报告阳性结果的可能性较低(60 % [95 % CI 44-76%])。结论尽管脊柱文献中的绝大多数研究都得出了阳性结果,但脊柱疾病的高发病率和对医疗系统造成的巨大负担依然存在。
{"title":"Rates of positive vs negative studies in the spine literature","authors":"Samantha Levin ,&nbsp;Joshua Levin","doi":"10.1016/j.inpm.2024.100423","DOIUrl":"10.1016/j.inpm.2024.100423","url":null,"abstract":"<div><h3>Background</h3><p>Accuracy in the interpretation of data, and publication of studies regardless of outcomes are vital to the development of the scientific literature.</p></div><div><h3>Objective</h3><p>To determine the proportion of studies in the spine literature that report positive results.</p></div><div><h3>Study design</h3><p>Review article of studies published in nine major spine, pain, and physical medicine and rehabilitation (PM&amp;R) journals from January 1, 2018–December 31, 2022.</p></div><div><h3>Patient sample</h3><p>Not applicable.</p></div><div><h3>Methods</h3><p>Articles that reported on pain and/or function from 2018 to 2022 in nine major journals were reviewed by two independent evaluators. The articles were graded as either positive or negative based on the authors’ own conclusions about their work.</p></div><div><h3>Results</h3><p>Overall, 91 % [95 % CI 88–94 %] of all articles were reported to have positive results. No significant differences were found between the broad categories of spine, pain, and PM&amp;R journals. When comparing different categories of treatments, there were lower rates of positive results from medication/supplement studies (54 % [95 % CI 27–81 %]) compared to studies of spine injections/interventions (95 % [95 % CI 91–99 %]) and those of surgery (100 % [95 % CI 96–100 %]), and a lower rate of positive results from studies on physical treatments (85 % [95 % CI 75–95 %]) compared to those of surgery (100 % [95 % CI 96–100 %]). Studies with placebo controls were less likely to report positive results (60 % [95 % CI 44–76 %]) compared to those that did not use placebo controls (96 % [95 % CI 94–98 %]).</p></div><div><h3>Conclusions</h3><p>Despite the vast majority of studies in the spine literature concluding positive results, the high disease prevalence of spine conditions and the enormous burden on the healthcare system remain.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100423"},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000438/pdfft?md5=c8ca4929b810a826b0d680b9f057a306&pid=1-s2.0-S2772594424000438-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636992","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}
引用次数: 0
Early epidural lead migration in spinal cord stimulator trials: A case series 脊髓刺激器试验中的早期硬膜外导线移位:病例系列
Pub Date : 2024-07-16 DOI: 10.1016/j.inpm.2024.100426
Wendy Han Cong Song , Tim Ting Han Jen , Jill Alison Osborn , Vishal Varshney

Background

Spinal cord stimulation (SCS) devices are routinely trialed to assess pain and functional improvement before permanent lead implantation. Lead migration is a common complication that may cause a loss of therapeutic effect in patients who may otherwise benefit from SCS. The timing of lead migration during the trial period is currently unknown.

Objectives

We hypothesize that significant lead migration may occur early in the SCS trial period, such as postoperative day 1 or 2, which may allow for contact stimulation adjustment to prevent false negative trial results. As such, in this study, we aim to evaluate the incidence and distance of lead migration in early thoracic SCS trial period.

Methods

We performed a case series of 27 patients ≥19 years of age who received differential target multiplexed thoracic SCS trials for chronic neuropathic pain from July 1, 2020 to July 1, 2023. Patients with a neuropathic pain diagnosis failing medical treatment, without structural pathology limiting epidural access, and with psychiatric clearance for suitability are eligible for SCS trials at our center. Pre- and post-flexion radiographs taken immediately after implantation and on postoperative day 1 or 2 were examined to assess the distance of lead migration. Clinically significant lead migration was pre-defined as ≥ 10 mm.

Results

The mean (SD) distances of epidural lead migration on postoperative day 1 or 2 were 18.2 (12.9) mm and 19.1 (13.3) mm for the cephalic and caudal leads, respectively. All migrations were caudad except for one trial. Clinically significant lead migration occurred in 20/27 (74 %) patients.

Conclusion

Clinically significant epidural lead migration occurs in the early SCS trial period.

背景脊髓刺激(SCS)装置在永久性导线植入前会进行常规试用,以评估疼痛和功能改善情况。导线移位是一种常见的并发症,可能会导致原本可从 SCS 中获益的患者失去治疗效果。我们假设,在 SCS 试验早期(如术后第 1 或第 2 天)可能会出现明显的导线移位,这样就可以对接触刺激进行调整,避免出现假阴性试验结果。因此,在本研究中,我们旨在评估胸椎 SCS 试验早期导联迁移的发生率和距离。方法我们对 2020 年 7 月 1 日至 2023 年 7 月 1 日期间因慢性神经病理性疼痛而接受不同靶点多路胸椎 SCS 试验的 27 名年龄≥19 岁的患者进行了病例系列研究。经诊断为神经病理性疼痛且无法接受药物治疗的患者、无限制硬膜外通路的结构性病变的患者,以及经精神科检查适合接受 SCS 试验的患者,均可在本中心接受 SCS 试验。在植入后立即和术后第 1 或第 2 天拍摄的屈曲前和屈曲后 X 光片用于评估导线移位的距离。结果术后第1天或第2天硬膜外导线移位的平均距离(标度)分别为18.2 (12.9)毫米和19.1 (13.3)毫米,头侧和尾侧导线移位的平均距离(标度)分别为18.2 (12.9)毫米和19.1 (13.3)毫米。除一次试验外,所有移位均发生在尾部。20/27(74%)例患者发生了有临床意义的导联移位。
{"title":"Early epidural lead migration in spinal cord stimulator trials: A case series","authors":"Wendy Han Cong Song ,&nbsp;Tim Ting Han Jen ,&nbsp;Jill Alison Osborn ,&nbsp;Vishal Varshney","doi":"10.1016/j.inpm.2024.100426","DOIUrl":"10.1016/j.inpm.2024.100426","url":null,"abstract":"<div><h3>Background</h3><p>Spinal cord stimulation (SCS) devices are routinely trialed to assess pain and functional improvement before permanent lead implantation. Lead migration is a common complication that may cause a loss of therapeutic effect in patients who may otherwise benefit from SCS. The timing of lead migration during the trial period is currently unknown.</p></div><div><h3>Objectives</h3><p>We hypothesize that significant lead migration may occur early in the SCS trial period, such as postoperative day 1 or 2, which may allow for contact stimulation adjustment to prevent false negative trial results. As such, in this study, we aim to evaluate the incidence and distance of lead migration in early thoracic SCS trial period.</p></div><div><h3>Methods</h3><p>We performed a case series of 27 patients ≥19 years of age who received differential target multiplexed thoracic SCS trials for chronic neuropathic pain from July 1, 2020 to July 1, 2023. Patients with a neuropathic pain diagnosis failing medical treatment, without structural pathology limiting epidural access, and with psychiatric clearance for suitability are eligible for SCS trials at our center. Pre- and post-flexion radiographs taken immediately after implantation and on postoperative day 1 or 2 were examined to assess the distance of lead migration. Clinically significant lead migration was pre-defined as ≥ 10 mm.</p></div><div><h3>Results</h3><p>The mean (SD) distances of epidural lead migration on postoperative day 1 or 2 were 18.2 (12.9) mm and 19.1 (13.3) mm for the cephalic and caudal leads, respectively. All migrations were caudad except for one trial. Clinically significant lead migration occurred in 20/27 (74 %) patients.</p></div><div><h3>Conclusion</h3><p>Clinically significant epidural lead migration occurs in the early SCS trial period.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100426"},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000475/pdfft?md5=b7a5291a3aca7e7fb4b53e6f1d09b48a&pid=1-s2.0-S2772594424000475-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141622201","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}
引用次数: 0
Sustained pain relief from radiofrequency ablation of the superior cluneal nerves using a bipolar palisade technique: A case report 使用双极帕利塞德技术对上锁骨神经进行射频消融可持续缓解疼痛:病例报告
Pub Date : 2024-07-16 DOI: 10.1016/j.inpm.2024.100425
Theodore Cohen

Previous authors have described the anatomy of the superior cluneal nerves with medial, intermediate, and lateral branches as they pass over the iliac crest. Prior authors describe a technique for radiofrequency of the superior cluneal nerves with needle placement walking off of the superior border of the iliac crest with needle redirection by sensory testing and a monopolar radiofrequency lesion. This is a case report of a patient with sustained pain relief after performing a radiofrequency ablation of the superior cluneal nerves utilizing a bipolar palisade technique.

之前的作者描述了楔上神经的解剖结构,包括穿过髂嵴的内侧、中间和外侧分支。之前的作者描述了一种对楔上神经进行射频治疗的技术,将针头放置在髂嵴上缘,通过感觉测试和单极射频病变对针头进行重新定向。这是一份利用双极帕利塞德技术对楔上神经进行射频消融后患者疼痛持续缓解的病例报告。
{"title":"Sustained pain relief from radiofrequency ablation of the superior cluneal nerves using a bipolar palisade technique: A case report","authors":"Theodore Cohen","doi":"10.1016/j.inpm.2024.100425","DOIUrl":"10.1016/j.inpm.2024.100425","url":null,"abstract":"<div><p>Previous authors have described the anatomy of the superior cluneal nerves with medial, intermediate, and lateral branches as they pass over the iliac crest. Prior authors describe a technique for radiofrequency of the superior cluneal nerves with needle placement walking off of the superior border of the iliac crest with needle redirection by sensory testing and a monopolar radiofrequency lesion. This is a case report of a patient with sustained pain relief after performing a radiofrequency ablation of the superior cluneal nerves utilizing a bipolar palisade technique.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100425"},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000463/pdfft?md5=57bca8fb4eef706e15dea28b2b41961a&pid=1-s2.0-S2772594424000463-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141630001","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}
引用次数: 0
期刊
Interventional Pain Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1