Pub Date : 2025-07-30DOI: 10.1016/j.inpm.2025.100613
Ben Marshall , Eric K. Holder , Christin Tiegs-Heiden , Kunj Amin , Alison Stout , Clark C. Smith , Benoy Benny , David O'Brien , Wade M. King , Andrew J. Engel , Mathew Saffarian , Zheyan Chen , Jaymin Patel , Adrian Popescu , Byron J. Schneider , Zachary L. McCormick , David Levi
{"title":"FactFinders for patient safety: Do epidural steroid injections increase the risk of fracture or lumbar surgical site infection?","authors":"Ben Marshall , Eric K. Holder , Christin Tiegs-Heiden , Kunj Amin , Alison Stout , Clark C. Smith , Benoy Benny , David O'Brien , Wade M. King , Andrew J. Engel , Mathew Saffarian , Zheyan Chen , Jaymin Patel , Adrian Popescu , Byron J. Schneider , Zachary L. McCormick , David Levi","doi":"10.1016/j.inpm.2025.100613","DOIUrl":"10.1016/j.inpm.2025.100613","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100613"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-30DOI: 10.1016/j.inpm.2025.100617
Sean Fox , Joshua Levin
Basivertebral nerve ablation (BVNA) has been shown to have significant and lasting effects on chronic vertebrogenic low back pain. Serious complications have been rare, including hematoma formation. However, given that the target lesion occurs at the basivertebral foramen, which not only houses the basivertebral nerve terminus but also the basivertebral vessels, hematoma formation is theoretically plausible. This case demonstrates a suspected hematoma in the extradural neural axis compartment following BVNA. The patient was treated conservatively and there were no significant lasting adverse effects.
{"title":"Hematoma formation after basivertebral nerve ablation","authors":"Sean Fox , Joshua Levin","doi":"10.1016/j.inpm.2025.100617","DOIUrl":"10.1016/j.inpm.2025.100617","url":null,"abstract":"<div><div>Basivertebral nerve ablation (BVNA) has been shown to have significant and lasting effects on chronic vertebrogenic low back pain. Serious complications have been rare, including hematoma formation. However, given that the target lesion occurs at the basivertebral foramen, which not only houses the basivertebral nerve terminus but also the basivertebral vessels, hematoma formation is theoretically plausible. This case demonstrates a suspected hematoma in the extradural neural axis compartment following BVNA. The patient was treated conservatively and there were no significant lasting adverse effects.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100617"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-29DOI: 10.1016/j.inpm.2025.100615
Charles J. Mazof , Derek H. Bui , Musa M. Aner
Horner's syndrome is a clinically significant condition caused by disruption of the oculosympathetic nerve pathway, typically presenting with ptosis, miosis, and facial anhidrosis. It can result from serious, life-threatening conditions such as trauma, carotid artery dissection, or malignancy; however, it may also arise from iatrogenic reasons, including stellate ganglion blocks, by other surgical interventions of the head and neck. While exceedingly rare, Horner's syndrome has been reported to occur after a cervical epidural steroid injection. Given the various potential etiologies of Horner's syndrome, prompt evaluation is required to rule out life-threatening conditions in the setting of an acute and unexpected presentation.
This case study describes a presentation of Horner's syndrome following a cervical epidural steroid injection (ESI) for a cervical radiculopathy. Due to the unusual nature, a serious cerebrovascular event was initially considered and urgent evaluation was advised. Fortunately, all symptoms resolved fully within two hours without medical intervention. It has been suggested that local anesthetic diffusion to the preganglionic neurons caused pharmacologic disruption of the sympathetic fibers. This case provides additional evidence to the limited reports of Horner's syndrome after cervical epidurals. It also highlights the importance of minimizing or forgoing local anesthetics, considering non-particulate steroids, and conducting emergent evaluation for new onset of neurological deficits during or after cervical ESIs.
{"title":"A rare presentation of Horner's syndrome following cervical epidural steroid injection","authors":"Charles J. Mazof , Derek H. Bui , Musa M. Aner","doi":"10.1016/j.inpm.2025.100615","DOIUrl":"10.1016/j.inpm.2025.100615","url":null,"abstract":"<div><div>Horner's syndrome is a clinically significant condition caused by disruption of the oculosympathetic nerve pathway, typically presenting with ptosis, miosis, and facial anhidrosis. It can result from serious, life-threatening conditions such as trauma, carotid artery dissection, or malignancy; however, it may also arise from iatrogenic reasons, including stellate ganglion blocks, by other surgical interventions of the head and neck. While exceedingly rare, Horner's syndrome has been reported to occur after a cervical epidural steroid injection. Given the various potential etiologies of Horner's syndrome, prompt evaluation is required to rule out life-threatening conditions in the setting of an acute and unexpected presentation.</div><div>This case study describes a presentation of Horner's syndrome following a cervical epidural steroid injection (ESI) for a cervical radiculopathy. Due to the unusual nature, a serious cerebrovascular event was initially considered and urgent evaluation was advised. Fortunately, all symptoms resolved fully within two hours without medical intervention. It has been suggested that local anesthetic diffusion to the preganglionic neurons caused pharmacologic disruption of the sympathetic fibers. This case provides additional evidence to the limited reports of Horner's syndrome after cervical epidurals. It also highlights the importance of minimizing or forgoing local anesthetics, considering non-particulate steroids, and conducting emergent evaluation for new onset of neurological deficits during or after cervical ESIs.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100615"},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 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.
{"title":"No major complications seen in a retrospective review of 1,018 cervical transforaminal epidural steroid injections","authors":"Gabriella H. Wozniak, Anish A. Rana, Andrew R. Stephens, Ramzi El-Hassan, Ben L. Laplante, Rajeev K. Patel","doi":"10.1016/j.inpm.2025.100622","DOIUrl":"10.1016/j.inpm.2025.100622","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>The goal of this study is to demonstrate the safety of CTFESI in a large retrospective cohort study using non-particulate steroids.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>This study demonstrated no major complications after fluoroscopy guided CTFESI with use of non-particulate steroids and standard safety techniques.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100622"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-24DOI: 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.
{"title":"Could this atypical image be an unexpected combination? A visual vignette","authors":"Ridvan Isik , Sena Unver , Savas Sencan , Osman Hakan Gunduz , Serdar Kokar , Kemal Nas","doi":"10.1016/j.inpm.2025.100616","DOIUrl":"10.1016/j.inpm.2025.100616","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>We aimed to raise awareness of the importance of recognising atypical images in interventional pain procedures.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100616"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696461","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}
{"title":"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””","authors":"Timothy Olivier, Ankit Patel, Weibin Shi, Zilin Ma, Thiru M. Annaswamy","doi":"10.1016/j.inpm.2025.100621","DOIUrl":"10.1016/j.inpm.2025.100621","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100621"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-24DOI: 10.1016/j.inpm.2025.100618
David Levi , Dustin Randall , Scott Horn , Austin Russo , Josh Gabri , Morgan Durand , Joshua Levin
Summary of background data
The risk of a symptomatic epidural bleed in patients continuing anticoagulation during most types of spinal injection procedures is extremely low. Cervical epidural steroid injections involve a unique risk of a catastrophic complication if an epidural hematoma is to occur secondary to spinal cord compression due to the anatomic confines of the cervical spinal canal. There is minimal research on the risk of cervical transforaminal epidural steroid injections (CTFESI) with anticoagulation.
Objective
Evaluate the risk of performing CTFESI with patients continuing prescribed anticoagulation medication.
Methods
A retrospective review was performed at two practice settings, a community-based outpatient practice and an academic practice, to identify all CTFESI performed between June 2018 through November 2023. Patient medical records were reviewed for the presence of anticoagulation and NSAID medication the day of the CTFESI. Data analysis used descriptive statistics to summarize the distribution of anticoagulants, NSAIDs, and cervical levels across practices, along with medication frequencies and percentages.
Results
A total of 2792 CTFESIs were performed across both settings between June 2018 and November 2023. Of those, 1040 CTFESIs (37.2 %) were performed on patients taking some form of anticoagulant medication. 277 CTFESI were performed on patients taking anticoagulants or aspirin or a combination of anticoagulants and ASA. 763 were performed on patients taking NSAIDs. There were no reported cases of symptomatic epidural hematomas or other bleeding complications in the immediate post-procedural period or up to 1 week following the procedure.
Conclusion
It is likely that CTFESI can be safely performed in patients continuing anticoagulation, aspirin (ASA), or NSAIDs. Discontinuing anticoagulants or NSAIDs for CTFESIs may not be necessary. Further studies are warranted to confirm these results.
{"title":"Safety profile of cervical transforaminal epidural steroid injections performed while maintaining anticoagulation, aspirin, or NSAIDs","authors":"David Levi , Dustin Randall , Scott Horn , Austin Russo , Josh Gabri , Morgan Durand , Joshua Levin","doi":"10.1016/j.inpm.2025.100618","DOIUrl":"10.1016/j.inpm.2025.100618","url":null,"abstract":"<div><h3>Summary of background data</h3><div>The risk of a symptomatic epidural bleed in patients continuing anticoagulation during most types of spinal injection procedures is extremely low. Cervical epidural steroid injections involve a unique risk of a catastrophic complication if an epidural hematoma is to occur secondary to spinal cord compression due to the anatomic confines of the cervical spinal canal. There is minimal research on the risk of cervical transforaminal epidural steroid injections (CTFESI) with anticoagulation.</div></div><div><h3>Objective</h3><div>Evaluate the risk of performing CTFESI with patients continuing prescribed anticoagulation medication.</div></div><div><h3>Methods</h3><div>A retrospective review was performed at two practice settings, a community-based outpatient practice and an academic practice, to identify all CTFESI performed between June 2018 through November 2023. Patient medical records were reviewed for the presence of anticoagulation and NSAID medication the day of the CTFESI. Data analysis used descriptive statistics to summarize the distribution of anticoagulants, NSAIDs, and cervical levels across practices, along with medication frequencies and percentages.</div></div><div><h3>Results</h3><div>A total of 2792 CTFESIs were performed across both settings between June 2018 and November 2023. Of those, 1040 CTFESIs (37.2 %) were performed on patients taking some form of anticoagulant medication. 277 CTFESI were performed on patients taking anticoagulants or aspirin or a combination of anticoagulants and ASA. 763 were performed on patients taking NSAIDs. There were no reported cases of symptomatic epidural hematomas or other bleeding complications in the immediate post-procedural period or up to 1 week following the procedure.</div></div><div><h3>Conclusion</h3><div>It is likely that CTFESI can be safely performed in patients continuing anticoagulation, aspirin (ASA), or NSAIDs. Discontinuing anticoagulants or NSAIDs for CTFESIs may not be necessary. Further studies are warranted to confirm these results.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100618"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-17DOI: 10.1016/j.inpm.2025.100611
David Levi , Sara Tyszko , Scott Horn , Nicole Pham , Joshua Levin
Summary of background
The field of orthobiologics has attempted to address the challenge of discogenic low back pain (LBP). Research in areas such as stem cells, platelet-rich plasma, and specific growth factor injections has seen limited success.
Objective
The purpose of this trial was to determine the efficacy of a single intradiscal bone marrow concentrate (BMC) injection on pain and function for chronic discogenic LBP.
Methods
Patients with presumed discogenic LBP participated in a prospective, double-blind, randomized, sham controlled trial of a single intradiscal BMC injection compared to a sham procedure. Pain and function were assessed at baseline, 3, 6, and 12 months by Clinical Outcome Measurement Brief Instrument (COMBI) which includes the Numeric Rating Scale (NRS). Function was also assessed by the Oswestry Disability Index (ODI). The primary outcome was based upon clinical success, defined by at least 50 % pain relief from baseline to 3, 6, and 12 months.
Results
Sixty-three patients were included in the trial (45 BMC, 18 sham). There were no significant differences in the primary outcome (>50 % relief in NRS) at 3 months (40 % BMC group [95 %CI: 27–50 %] vs 33 % sham group [95 %CI: 15–56 %]), 6 months (40 % BMC [95 %CI: 27–50 %] vs 39 % sham [95 %CI: 20–61 %]), or 12 months (44 % BMC [95 %CI: 31–59 %] vs 56 % sham [95 %CI: 34–75 %]). There were no significant differences in the proportion of patients achieving at least a 30 % improvement on the ODI at 3 months (51 % BMC group [95 %CI: 37–65 %] vs 33 % sham group [95 %CI: 16–56 %]), 6 months (53 % BMC [95 %CI: 39–67 %] vs 44 % sham [95 %CI: 25–65 %]), or 12 months (56 % BMC [95 %CI: 41–69 %] vs 61 % sham [95 %CI: 39–80 %]).
Conclusions
Intradiscal BMC was equivalent to a sham procedure for chronic discogenic LBP. Both groups had a high, but statistically equivalent success rate. Unfortunately, the significant limitations of this trial, including lack of quality cell analysis, limit the ability to draw conclusions on the effectiveness of intradiscal BMC.
{"title":"Bone marrow concentrate intradiscal injection for chronic discogenic low back pain: A double-blind randomized sham-controlled trial","authors":"David Levi , Sara Tyszko , Scott Horn , Nicole Pham , Joshua Levin","doi":"10.1016/j.inpm.2025.100611","DOIUrl":"10.1016/j.inpm.2025.100611","url":null,"abstract":"<div><h3>Summary of background</h3><div>The field of orthobiologics has attempted to address the challenge of discogenic low back pain (LBP). Research in areas such as stem cells, platelet-rich plasma, and specific growth factor injections has seen limited success.</div></div><div><h3>Objective</h3><div>The purpose of this trial was to determine the efficacy of a single intradiscal bone marrow concentrate (BMC) injection on pain and function for chronic discogenic LBP.</div></div><div><h3>Methods</h3><div>Patients with presumed discogenic LBP participated in a prospective, double-blind, randomized, sham controlled trial of a single intradiscal BMC injection compared to a sham procedure. Pain and function were assessed at baseline, 3, 6, and 12 months by Clinical Outcome Measurement Brief Instrument (COMBI) which includes the Numeric Rating Scale (NRS). Function was also assessed by the Oswestry Disability Index (ODI). The primary outcome was based upon clinical success, defined by at least 50 % pain relief from baseline to 3, 6, and 12 months.</div></div><div><h3>Results</h3><div>Sixty-three patients were included in the trial (45 BMC, 18 sham). There were no significant differences in the primary outcome (>50 % relief in NRS) at 3 months (40 % BMC group [95 %CI: 27–50 %] vs 33 % sham group [95 %CI: 15–56 %]), 6 months (40 % BMC [95 %CI: 27–50 %] vs 39 % sham [95 %CI: 20–61 %]), or 12 months (44 % BMC [95 %CI: 31–59 %] vs 56 % sham [95 %CI: 34–75 %]). There were no significant differences in the proportion of patients achieving at least a 30 % improvement on the ODI at 3 months (51 % BMC group [95 %CI: 37–65 %] vs 33 % sham group [95 %CI: 16–56 %]), 6 months (53 % BMC [95 %CI: 39–67 %] vs 44 % sham [95 %CI: 25–65 %]), or 12 months (56 % BMC [95 %CI: 41–69 %] vs 61 % sham [95 %CI: 39–80 %]).</div></div><div><h3>Conclusions</h3><div>Intradiscal BMC was equivalent to a sham procedure for chronic discogenic LBP. Both groups had a high, but statistically equivalent success rate. Unfortunately, the significant limitations of this trial, including lack of quality cell analysis, limit the ability to draw conclusions on the effectiveness of intradiscal BMC.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100611"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-16DOI: 10.1016/j.inpm.2025.100614
Hasan Sen, Amanda Cooper, Aaron Conger, Zachary L. McCormick, Allison Glinka Przybysz
Background
Dorsal root ganglion (DRG) stimulation has emerged as an effective, targeted neuromodulation therapy for refractory pain of the lower extremities, particularly in the setting of complex regional pain syndrome. However, preliminary evidence supporting DRG for other applications, such as peripheral neuropathy or refractory nociceptive pain, is currently limited to patient populations with discrete pain sources. We report a case of chronic, multifactorial foot pain successfully treated with a right S1 DRG stimulation after failure of multiple prior interventions including physical therapy, corticosteroid injections, and surgeries.
Case report
A 74-year-old male presented with chronic refractory right foot pain, diagnosed with L5-S1 radiculopathy, peripheral neuropathy, persistent post-surgical pain following multiple procedures, including partial toe pain, which significantly impaired his mobility and quality of life. DRG stimulation was pursued after multiple prior interventions, including physical therapy, corticosteroid injections, surgeries, and a trial of peripheral nerve stimulation (PNS) that provided only temporary relief. Following a successful stimulation trial, a permanent DRG device was implanted at the S1 level, resulting in meaningful, sustained pain relief and functional improvement.
Conclusion
DRG stimulation represents a promising treatment for refractory lower extremity pain, especially in cases where traditional therapies have failed. This case illustrates its therapeutic potential in patients with complex refractory neuropathic pain of mixed etiologies.
{"title":"Dorsal root ganglion stimulation for multifactorial refractory foot pain: A case report","authors":"Hasan Sen, Amanda Cooper, Aaron Conger, Zachary L. McCormick, Allison Glinka Przybysz","doi":"10.1016/j.inpm.2025.100614","DOIUrl":"10.1016/j.inpm.2025.100614","url":null,"abstract":"<div><h3>Background</h3><div>Dorsal root ganglion (DRG) stimulation has emerged as an effective, targeted neuromodulation therapy for refractory pain of the lower extremities, particularly in the setting of complex regional pain syndrome. However, preliminary evidence supporting DRG for other applications, such as peripheral neuropathy or refractory nociceptive pain, is currently limited to patient populations with discrete pain sources. We report a case of chronic, multifactorial foot pain successfully treated with a right S1 DRG stimulation after failure of multiple prior interventions including physical therapy, corticosteroid injections, and surgeries.</div></div><div><h3>Case report</h3><div>A 74-year-old male presented with chronic refractory right foot pain, diagnosed with L5-S1 radiculopathy, peripheral neuropathy, persistent post-surgical pain following multiple procedures, including partial toe pain, which significantly impaired his mobility and quality of life. DRG stimulation was pursued after multiple prior interventions, including physical therapy, corticosteroid injections, surgeries, and a trial of peripheral nerve stimulation (PNS) that provided only temporary relief. Following a successful stimulation trial, a permanent DRG device was implanted at the S1 level, resulting in meaningful, sustained pain relief and functional improvement.</div></div><div><h3>Conclusion</h3><div>DRG stimulation represents a promising treatment for refractory lower extremity pain, especially in cases where traditional therapies have failed. This case illustrates its therapeutic potential in patients with complex refractory neuropathic pain of mixed etiologies.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100614"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-12DOI: 10.1016/j.inpm.2025.100612
Ameet Nagpal , Fred DeFrancesch , Kevin Martinez , George Rappard , D. Scott Kreiner , Jatinder S. Gill , Yakov Vorobeychik , International Pain and Spine Intervention Society
{"title":"Safety practices for interventional pain procedures: Disc access/provocation discography, vertebral augmentation, and neurostimulation procedures","authors":"Ameet Nagpal , Fred DeFrancesch , Kevin Martinez , George Rappard , D. Scott Kreiner , Jatinder S. Gill , Yakov Vorobeychik , International Pain and Spine Intervention Society","doi":"10.1016/j.inpm.2025.100612","DOIUrl":"10.1016/j.inpm.2025.100612","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100612"},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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