Interventional Pain Medicine最新文献

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Authors' response to the letter to the editor on “Tendon modification with percutaneous ultrasound-guided tenotomy using TENEX®: A histological and macroscopic analysis of a bovine cadaveric model.” 作者对“使用TENEX®经皮超声引导肌腱切开术的肌腱修复：牛尸体模型的组织学和宏观分析”致编辑的信的回复。

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-08-15 DOI: 10.1016/j.inpm.2025.100626

Sayed E. Wahezi , Ugur Yener , Suwannika Palee

引用次数: 0

In response to “Letter to the editor regarding “Assessing ChatGPT responses to patient questions on epidural steroid injections: A comparative study of general vs specific queries”” 关于“评估ChatGPT对患者硬膜外类固醇注射问题的反应：一般与特殊问题的比较研究”的致编辑的回复

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-24 DOI: 10.1016/j.inpm.2025.100621

Timothy Olivier, Ankit Patel, Weibin Shi, Zilin Ma, Thiru M. Annaswamy

引用次数: 0

Could this atypical image be an unexpected combination? A visual vignette 这个非典型的图像会是一个意想不到的组合吗？一个视觉小插曲

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-24 DOI: 10.1016/j.inpm.2025.100616

Ridvan Isik , Sena Unver , Savas Sencan , Osman Hakan Gunduz , Serdar Kokar , Kemal Nas

Background

We report the case of a patient who underwent transforaminal epidural steroid injection (TFESI), and a combination of intradural contrast media spread and dural pulsation during the procedure.

Objective

We aimed to raise awareness of the importance of recognising atypical images in interventional pain procedures.

Methods

A 67-year-old woman presented with low back and right leg pain due to spinal stenosis. We performed right L3 TFESI with a Quincke spinal needle under the guidance of C-arm fluoroscopy. The needle placement on imaging consistent with the epidural region, but contrast distribution suggested subdural spread. When we administered contrast material again, the contrast extended and widened a little more in the cranio-caudal direction in the same region but did not disperse. Therefore, we obtained a live fluoroscopic image. The contrast media was accumulated in the same region and showed pulsatile properties in the images. We speculated that this image may be a combination of intradural spread and dural pulsation or may be due to the impact of an artery in the restricted epidural space.

Results

We terminated the procedure.The patient exhibited no neurological deficits, and lumbar MRI and CT angiography were conducted to exclude other causes The neuroradiologist evaluated the examinations and found no abnormalities. To alleviate the persistent pain of the patient, we prescribed medical treatment.

Conclusion

Atypical contrast media distributions may be seen during procedures. To avoid possible complications, it is vital for physicians to have a thorough knowledge of the contrast media distribution pattern.

我们报告了一例接受椎间孔硬膜外类固醇注射（TFESI）的患者，在手术过程中，硬膜内造影剂扩散和硬膜搏动相结合。目的提高人们对介入性疼痛手术中非典型图像识别重要性的认识。方法一名67岁女性，因椎管狭窄导致腰背部和右腿疼痛。在c臂透视引导下用Quincke脊髓针行右L3 TFESI。影像学上针的位置与硬膜外区域一致，但对比分布提示硬膜下扩散。当我们再次使用造影剂时，在同一区域，造影剂在颅尾方向上延伸和变宽了一点，但没有分散。因此，我们获得了实时透视图像。造影剂聚集在同一区域，在图像中表现出脉动性。我们推测该图像可能是硬膜内扩散和硬膜搏动的结合，或者可能是由于动脉在受限的硬膜外空间的影响。结果终止手术。患者未表现出神经功能障碍，并进行腰椎MRI和CT血管造影以排除其他原因。神经放射学家评估检查结果，未发现异常。为了减轻病人持续的疼痛，我们给他开了药方。结论术中可见非典型造影剂分布。为了避免可能的并发症，对医生来说，全面了解造影剂的分布模式是至关重要的。

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引用次数: 0

No major complications seen in a retrospective review of 1,018 cervical transforaminal epidural steroid injections 回顾性分析1018例经椎间孔硬膜外类固醇注射未见重大并发症

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-28 DOI: 10.1016/j.inpm.2025.100622

Gabriella H. Wozniak, Anish A. Rana, Andrew R. Stephens, Ramzi El-Hassan, Ben L. Laplante, Rajeev K. Patel

Background

Cervical transforaminal epidural steroid injections (CTFESI) are commonly used to treat cervical radicular pain, but concerns remain about their safety due to case reports of complications such as stroke, spinal cord injury and death. These complications have been associated with use of particulate steroids causing embolic infarcts from inadvertent intra-arterial injection. With the use of non-particulate steroids these complications have never been reported. Additionally, recent cohort studies have demonstrated safety. Yet many providers still consider these procedures to be unsafe. Additional work is needed to further elucidate the risk of complications after CTFESI.

Objective

The goal of this study is to demonstrate the safety of CTFESI in a large retrospective cohort study using non-particulate steroids.

Methods

Medical records of all consecutive patients who underwent CFTESI within a tertiary academic multidisciplinary spine center from December 2002 through September 2024 were retrospectively reviewed. Data collected included vertebral level of injection, major (stroke, seizure, spinal cord injury, and death) and minor (headache, diaphoresis, syncope) complications, ED/urgent care visits within 2 weeks of procedure, and length of follow up within the performing PM&R department.

Results

A total of 1018 CTFESI procedures involving 558 patients were reviewed. There were no major complications in our study and no patients necessitated an ED or urgent care visit. Of 1018 total procedures, 16 (1.57 %) were attempted and aborted mid-procedure. Of these, 3 procedures were aborted due to inability to access the neuroforamen, 6 procedures were aborted due to signs of vascular uptake and/or subjective symptoms of vascular uptake, 3 procedures were aborted due to patient inability to tolerate the procedure, and 4 procedures were aborted due to vasovagal response. Only 1 (0.01 %) procedure resulted in a vasovagal response (hypotension, bradycardia, dizziness) following completion of the procedure.

Conclusion

This study demonstrated no major complications after fluoroscopy guided CTFESI with use of non-particulate steroids and standard safety techniques.

背景颈椎经椎间孔硬膜外类固醇注射（CTFESI）通常用于治疗颈椎神经根性疼痛，但由于卒中、脊髓损伤和死亡等并发症的病例报道，人们对其安全性仍然存在担忧。这些并发症与使用颗粒类固醇引起的动脉内意外注射栓塞性梗死有关。使用非颗粒类固醇后，这些并发症从未报道过。此外，最近的队列研究已经证明了安全性。然而，许多提供者仍然认为这些程序是不安全的。需要进一步的工作来进一步阐明CTFESI后并发症的风险。本研究的目的是在一项大型回顾性队列研究中证明CTFESI使用非颗粒类固醇的安全性。方法回顾性分析2002年12月至2024年9月在某三级学术多学科脊柱中心连续接受CFTESI治疗的所有患者的病历。收集的数据包括椎体注射水平、主要（中风、癫痫、脊髓损伤和死亡）和次要（头痛、出汗、晕厥）并发症、2周内急诊科/急诊就诊情况以及在执行pm&r科的随访时间。结果共回顾了1018例CTFESI手术，涉及558例患者。在我们的研究中没有重大并发症，没有患者需要急诊科或紧急护理。在总共1018例手术中，有16例（1.57%）尝试并中途流产。其中，3例手术因无法进入神经孔而流产，6例手术因血管摄取的迹象和/或血管摄取的主观症状而流产，3例手术因患者无法耐受手术而流产，4例手术因血管迷走神经反应而流产。只有1例（0.01%）手术后出现血管迷走神经反应（低血压、心动过缓、头晕）。结论：本研究显示，在使用非颗粒类固醇和标准安全技术的情况下，透视引导CTFESI无重大并发症。

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引用次数: 0

Letter to the editor: Challenging epidural catheterization in a patient with vertebral metastases 致编辑：对椎骨转移患者硬膜外置管的挑战

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-06-24 DOI: 10.1016/j.inpm.2025.100603

Nurbanu Hindioglu Dogan, Serdar Kokar, Savas Sencan, Osman Hakan Gunduz

Epidural analgesia is a valuable modality in managing cancer-related pain, particularly when systemic therapies are insufficient or poorly tolerated. This letter presents a case of technically challenging epidural catheterization in a patient with vertebral metastases, emphasizing the procedural difficulties posed by altered spinal anatomy and prior neuraxial interventions.

硬膜外镇痛是治疗癌症相关疼痛的一种有价值的方式，特别是当全身治疗不足或耐受性差时。这封信介绍了一个技术上具有挑战性的硬膜外置管在椎体转移患者的病例，强调了脊柱解剖结构改变和先前的神经轴干预所带来的手术困难。

引用次数: 0

Reassessing the risks of Cervical Transforaminal Epidural Steroid Injections (CTFESI) 宫颈经椎间孔硬膜外类固醇注射（CTFESI）的风险评估

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-08-15 DOI: 10.1016/j.inpm.2025.100625

Clark C. Smith MD, MPH

引用次数: 0

Optimal diagnosing and interventional treatment of the posterior ligamentous complex inflammatory syndrome 后韧带复合体炎症综合征的最佳诊断与介入治疗

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-07-03 DOI: 10.1016/j.inpm.2025.100609

Bunty Shah, Yakov Vorobeychik

Introduction

The previously described posterior ligamentous complex inflammatory syndrome can result in chronic axial low back pain. This condition can be identified through MRI findings that demonstrate inflammatory changes in the compartments of the posterior ligamentous complex region, with the space of Okada serving as a connection between them. However, an effective interventional treatment for this syndrome has not yet been proposed.

Case

We present the case of a patient suffering from persistent axial low back pain who did not respond to medication or physical therapy. A SPECT scan revealed significant radiotracer uptake in the bilateral L4-L5 facet joints and the L4-L5 interspinous ligament. Given that bilateral L3-L4 diagnostic medial branch blocks yielded negative results, posterior ligamentous complex inflammatory syndrome was suspected. Injection of contrast dye into the L4-L5 interspinous adventitial bursa demonstrated the spread of contrast material from the injection site to the space of Okada and the bilateral L4-L5 facet joints. Subsequent steroid injection provided the patient with over 80 % pain relief at the five-week follow-up.

Conclusion

Patients experiencing axial low back pain, particularly those with negative diagnostic medial branch blocks, should consider undergoing a SPECT scan. This recommendation is particularly relevant in cases involving Baastrup disease or pars defects, as these conditions are often associated with the presence of the space of Okada, which is crucial for the development of PLCIS. If this diagnosis is confirmed through imaging, a steroid injection into the adventitial interspinous bursa may offer an effective treatment for PLCIS by facilitating medication distribution throughout the compartments of the posterior ligamentous complex region.

前面描述的后韧带复合体炎症综合征可导致慢性轴性腰痛。这种情况可以通过MRI检查发现后韧带复合体区室室的炎症改变来识别，冈田间隙是它们之间的连接。然而，对这种综合征的有效介入治疗尚未提出。我们提出的情况下，患者遭受持续轴向腰痛谁没有响应药物或物理治疗。SPECT扫描显示双侧L4-L5小关节和L4-L5棘间韧带有明显的放射性示踪剂摄取。鉴于双侧L3-L4诊断性内支阻滞结果为阴性，怀疑为后韧带复合体炎症综合征。在L4-L5棘间囊内注射造影剂显示造影剂从注射部位扩散到冈田间隙和双侧L4-L5小关节。随后的类固醇注射在五周的随访中为患者提供了超过80%的疼痛缓解。结论：轴向性腰痛患者，特别是诊断为内侧支阻滞阴性的患者，应考虑进行SPECT扫描。这一建议尤其适用于Baastrup病或pars缺陷的病例，因为这些情况通常与冈田间隙的存在有关，而冈田间隙对于PLCIS的发展至关重要。如果这种诊断通过影像学证实，通过促进药物在整个后韧带复合体区域的分布，向棘间囊外注射类固醇可能是一种有效的治疗PLCIS的方法。

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引用次数: 0

Letter to the Editor regarding “Assessing ChatGPT responses to patient questions on epidural steroid injections” 致编辑关于“评估ChatGPT对患者硬膜外类固醇注射问题的反应”的信

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-08-02 DOI: 10.1016/j.inpm.2025.100620

Hinpetch Daungsupawong , Viroj Wiwanitkit

引用次数: 0

Long term management of refractory angina due to cardiac syndrome X with peripheral nerve field stimulation (PNfS) 外周神经野刺激对心脏X综合征难治性心绞痛的长期治疗

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-08-27 DOI: 10.1016/j.inpm.2025.100639

Andrea Perera , Teo Goroszeniuk , Keyoumars Ashkan

引用次数: 0

Letter to the Editor regarding "Lumbar facet joint denervation targeting the medial branch in the sub-mammillary fossa: An anatomical optimization study" 致编辑关于“针对乳腺下窝内侧支的腰椎小关节去神经支配：解剖学优化研究”的信

Interventional Pain Medicine

Pub Date : 2025-09-01 Epub Date: 2025-06-28 DOI: 10.1016/j.inpm.2025.100608

Tomás Caroço , Eva Kubrova , Sahil Gupta , Mark Friedrich B. Hurdle

引用次数: 0

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