Pub Date : 2025-07-09DOI: 10.1016/j.inpm.2025.100606
Andrew R. Stephens , Ashley Rogerson , Rajeev K. Patel , Ramzi El-Hassan
Background
Cervical transforaminal epidural steroid injections (CTFESI) are commonly used to treat cervical radiculopathy. Though major adverse events have been published in case reports, larger cohort studies have not demonstrated this concern.
Objective
The purpose of this study was to assess the risk of major and minor complications after CTFESIs using a large database.
Methods
TriNetX, a global health research network, was queried from January 01, 2004–May 20, 2025 for patients with cervical radiculopathy undergoing CTFESI. All diagnostic and surgical codes after CTFESI were analyzed. Specific major complications queried for were stroke, seizures, and paralysis. Nervous system, musculoskeletal, infectious, and procedural diagnoses were evaluated for complications. Complications were reported as number and percent.
Results
A total of 32,913 patients underwent CTFESI with available follow-up data. There were ≤10 (≤0.03 %) patients who had intraoperative/post-procedure complications, ≤10 (≤0.03 %) with CSF leak. There were 143 (0.4 %) patients that had cerebral vascular disease related codes. Of these, 50 (0.15 %) had cerebral infarction codes and ≤10 (≤0.03 %). There were 39 (0.12 %) patients with seizure codes, and 18 (0.5 %) patients that had paralysis codes. There were 0 (0 %) patients who had mortality related codes within a day after CTFESI.
Conclusion
This study demonstrates the risk of major complications after CTFESI in a large cohort to be low.
{"title":"Rates of complications after cervical transforaminal epidural steroid injections for patients with cervical radiculopathy utilizing a large national database","authors":"Andrew R. Stephens , Ashley Rogerson , Rajeev K. Patel , Ramzi El-Hassan","doi":"10.1016/j.inpm.2025.100606","DOIUrl":"10.1016/j.inpm.2025.100606","url":null,"abstract":"<div><h3>Background</h3><div>Cervical transforaminal epidural steroid injections (CTFESI) are commonly used to treat cervical radiculopathy. Though major adverse events have been published in case reports, larger cohort studies have not demonstrated this concern.</div></div><div><h3>Objective</h3><div>The purpose of this study was to assess the risk of major and minor complications after CTFESIs using a large database.</div></div><div><h3>Methods</h3><div>TriNetX, a global health research network, was queried from January 01, 2004–May 20, 2025 for patients with cervical radiculopathy undergoing CTFESI. All diagnostic and surgical codes after CTFESI were analyzed. Specific major complications queried for were stroke, seizures, and paralysis. Nervous system, musculoskeletal, infectious, and procedural diagnoses were evaluated for complications. Complications were reported as number and percent.</div></div><div><h3>Results</h3><div>A total of 32,913 patients underwent CTFESI with available follow-up data. There were ≤10 (≤0.03 %) patients who had intraoperative/post-procedure complications, ≤10 (≤0.03 %) with CSF leak. There were 143 (0.4 %) patients that had cerebral vascular disease related codes. Of these, 50 (0.15 %) had cerebral infarction codes and ≤10 (≤0.03 %). There were 39 (0.12 %) patients with seizure codes, and 18 (0.5 %) patients that had paralysis codes. There were 0 (0 %) patients who had mortality related codes within a day after CTFESI.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the risk of major complications after CTFESI in a large cohort to be low.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100606"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579694","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 : 2025-07-03DOI: 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.
{"title":"Optimal diagnosing and interventional treatment of the posterior ligamentous complex inflammatory syndrome","authors":"Bunty Shah, Yakov Vorobeychik","doi":"10.1016/j.inpm.2025.100609","DOIUrl":"10.1016/j.inpm.2025.100609","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Case</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100609"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535544","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 : 2025-07-02DOI: 10.1016/j.inpm.2025.100610
Sanjeet Narang , Jason Yong , David Hao
Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination. By reframing neuraxial analgesia not as an extraordinary measure, but as a legitimate and potentially transformative option, we advocate for broader, more equitable integration of these therapies.
{"title":"Reconsidering neuraxial analgesia at end of life: Clinical, ethical, and socioeconomic perspectives","authors":"Sanjeet Narang , Jason Yong , David Hao","doi":"10.1016/j.inpm.2025.100610","DOIUrl":"10.1016/j.inpm.2025.100610","url":null,"abstract":"<div><div>Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination. By reframing neuraxial analgesia not as an extraordinary measure, but as a legitimate and potentially transformative option, we advocate for broader, more equitable integration of these therapies.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100610"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535545","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 : 2025-06-29DOI: 10.1016/j.inpm.2025.100607
Ryan Triglia , Andrew Walrond , Jesse Wagner , Paul M. Kitei , Jeffrey Boyd , Jeremy I. Simon
<div><h3>Background</h3><div>Lumbar radiculopathy is estimated to affect approximately 3–5 % of the population. Among the leading causes of radiculopathy are degenerative or congenital spinal stenosis and lumbar disc herniations, which can contribute to compression and narrowing in various regions of the spine including the neural foramen, subarticular recess, or central canal. When patients do not respond to typical conservative treatment such as medications and physical therapy, epidural steroid injections can be considered as a next step in management. There are three approaches available for accessing the lumbar epidural space: caudal, interlaminar, and transforaminal. There is no clear consensus regarding the selected approach for an epidural injection based on a patient's history, physical examination, and imaging findings, however.</div></div><div><h3>Objective</h3><div>The purpose of this study was to explore how factors such as primary residency training, fellowship training, practice setting, adherence to IPSIS guidelines, geographic location, and years of experience may influence epidural approach preferences.</div></div><div><h3>Methods</h3><div>A survey was created utilizing the Survey Monkey™ platform which was then administered by the International Pain and Spine Intervention Society (IPSIS) to all active members via email. The survey consisted of seven questions asking for demographic information including residency specialty, fellowship training, if the fellowship emphasized IPSIS guidelines, years in practice, country of practice, and practice setting. There were questions that described hypothetical clinical scenarios that provided the respondent with the pain distribution and the associated pertinent magnetic resonance imaging (MRI) findings. For each scenario, the responder was given options for type of therapeutic injection the practitioner would choose. The final two questions then asked which steroid the responder would utilize for an interlaminar and transforaminal epidural steroid injection. The survey was open for completion during a three-month period. A total of 202 IPSIS members responded, with an average of 196 responses to each question with a completion rate of 74 %.</div></div><div><h3>Results</h3><div>Most respondents completed residency in Physical Medicine and Rehabilitation (63.1 %) or Anesthesiology (29.9 %), with 67.7 % reporting fellowship training aligned with IPSIS guidelines. The most common fellowship type was ACGME-accredited pain (38.6 %), and respondents were primarily based in the U.S. (84.8 %), practicing in private multi-specialty groups (35.5 %). Experience levels were well distributed, with most in either early (<5 years, 32.1 %) or late-career (>15 years, 34.7 %) stages. Across all six clinical scenarios, the transforaminal supraneural approach was most frequently selected, especially at L4-L5 and L5-S1. Respondents selecting the most common techniques were primarily PM&R-trained and
{"title":"Trends in lumbar epidural injection selection: A survey of practitioner preferences and practice patterns","authors":"Ryan Triglia , Andrew Walrond , Jesse Wagner , Paul M. Kitei , Jeffrey Boyd , Jeremy I. Simon","doi":"10.1016/j.inpm.2025.100607","DOIUrl":"10.1016/j.inpm.2025.100607","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar radiculopathy is estimated to affect approximately 3–5 % of the population. Among the leading causes of radiculopathy are degenerative or congenital spinal stenosis and lumbar disc herniations, which can contribute to compression and narrowing in various regions of the spine including the neural foramen, subarticular recess, or central canal. When patients do not respond to typical conservative treatment such as medications and physical therapy, epidural steroid injections can be considered as a next step in management. There are three approaches available for accessing the lumbar epidural space: caudal, interlaminar, and transforaminal. There is no clear consensus regarding the selected approach for an epidural injection based on a patient's history, physical examination, and imaging findings, however.</div></div><div><h3>Objective</h3><div>The purpose of this study was to explore how factors such as primary residency training, fellowship training, practice setting, adherence to IPSIS guidelines, geographic location, and years of experience may influence epidural approach preferences.</div></div><div><h3>Methods</h3><div>A survey was created utilizing the Survey Monkey™ platform which was then administered by the International Pain and Spine Intervention Society (IPSIS) to all active members via email. The survey consisted of seven questions asking for demographic information including residency specialty, fellowship training, if the fellowship emphasized IPSIS guidelines, years in practice, country of practice, and practice setting. There were questions that described hypothetical clinical scenarios that provided the respondent with the pain distribution and the associated pertinent magnetic resonance imaging (MRI) findings. For each scenario, the responder was given options for type of therapeutic injection the practitioner would choose. The final two questions then asked which steroid the responder would utilize for an interlaminar and transforaminal epidural steroid injection. The survey was open for completion during a three-month period. A total of 202 IPSIS members responded, with an average of 196 responses to each question with a completion rate of 74 %.</div></div><div><h3>Results</h3><div>Most respondents completed residency in Physical Medicine and Rehabilitation (63.1 %) or Anesthesiology (29.9 %), with 67.7 % reporting fellowship training aligned with IPSIS guidelines. The most common fellowship type was ACGME-accredited pain (38.6 %), and respondents were primarily based in the U.S. (84.8 %), practicing in private multi-specialty groups (35.5 %). Experience levels were well distributed, with most in either early (<5 years, 32.1 %) or late-career (>15 years, 34.7 %) stages. Across all six clinical scenarios, the transforaminal supraneural approach was most frequently selected, especially at L4-L5 and L5-S1. Respondents selecting the most common techniques were primarily PM&R-trained and","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100607"},"PeriodicalIF":0.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510752","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 : 2025-06-28DOI: 10.1016/j.inpm.2025.100608
Tomás Caroço , Eva Kubrova , Sahil Gupta , Mark Friedrich B. Hurdle
{"title":"Letter to the Editor regarding \"Lumbar facet joint denervation targeting the medial branch in the sub-mammillary fossa: An anatomical optimization study\"","authors":"Tomás Caroço , Eva Kubrova , Sahil Gupta , Mark Friedrich B. Hurdle","doi":"10.1016/j.inpm.2025.100608","DOIUrl":"10.1016/j.inpm.2025.100608","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100608"},"PeriodicalIF":0.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502166","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 : 2025-06-25DOI: 10.1016/j.inpm.2025.100602
Mingda Chen , Sercan Tosun , Nicolas R. Thompson , Kush K. Goyal
{"title":"Corrigendum to “Genicular nerve block with corticosteroid for chronic knee Pain: Patient-Reported outcomes across 9-years of practice” [Intervent Pain Med 4 (2025) 100601]","authors":"Mingda Chen , Sercan Tosun , Nicolas R. Thompson , Kush K. Goyal","doi":"10.1016/j.inpm.2025.100602","DOIUrl":"10.1016/j.inpm.2025.100602","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100602"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471009","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 : 2025-06-24DOI: 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.
{"title":"Letter to the editor: Challenging epidural catheterization in a patient with vertebral metastases","authors":"Nurbanu Hindioglu Dogan, Serdar Kokar, Savas Sencan, Osman Hakan Gunduz","doi":"10.1016/j.inpm.2025.100603","DOIUrl":"10.1016/j.inpm.2025.100603","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100603"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366640","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 : 2025-06-21DOI: 10.1016/j.inpm.2025.100604
Alexandre J. Bourcier MD, MSc , Christina Im BA , Jane Phan BA , Michelle Nwufo MSc , Miad Hadaegh MD , Colton M. Malesovas MD , Jae Jung MD , Kyle Yang MD , Jonathan Droessler MD
{"title":"Spinal cord stimulation for Tarlov cyst-related pain: Initial success and subsequent explantation in an elderly patient","authors":"Alexandre J. Bourcier MD, MSc , Christina Im BA , Jane Phan BA , Michelle Nwufo MSc , Miad Hadaegh MD , Colton M. Malesovas MD , Jae Jung MD , Kyle Yang MD , Jonathan Droessler MD","doi":"10.1016/j.inpm.2025.100604","DOIUrl":"10.1016/j.inpm.2025.100604","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 3","pages":"Article 100604"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335875","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 : 2025-06-01DOI: 10.1016/j.inpm.2025.100599
Katharine A. Smolinski , Christopher Radlicz , Hasan Sen , Amanda N. Cooper , Brook Martin , Alycia Amatto , Allison Glinka Przybysz , Robert Burnham , Aaron M. Conger , Zachary L. McCormick , Taylor R. Burnham
Background
Outcomes following sacral lateral branch radiofrequency neurotomy (SLBRFN) likely depend on patient selection criteria; however, commonly used criteria vary considerably. Refinement of selection criteria for SLBRFN may improve treatment outcomes. This study investigated common prognostic block-based selection criteria and treatment success following SLBRFN.
Methods
In this retrospective cohort study, consecutive patients from two Canadian musculoskeletal pain management clinics who underwent SLBRFN over a 6-year period (2016–2022) were identified by electronic medical record. Patients were categorized according to several prognostic block paradigms based on number of blocks (single vs. dual), block type (lateral branch block [LBB] vs. intra-articular block [IAB]), and subsequent percentage of pain relief. Six block criteria were established: 1 = LBB/LBB≥80 %; 2 = IAB/LBB≥80 %; 3 = LBB/LBB 50–79 %; 4 = IAB/LBB 50–79 %; 5 = LBB≥80 %; 6 = LBB 50–79 %. Treatment success was assessed at three months post-SLBRFN using two criteria: (1) the primary study outcome of ≥50 % numerical rating scale (NRS) pain reduction and (2) a secondary outcome of Pain Disability Quality-of-Life Questionnaire (PDQQ) score improvement by the minimal clinically important difference (MCID). Logistic regression analyses evaluated the association between block criteria and treatment success following SLBRFN.
Results
281 consecutive patients (75.1 % female, 61.8 ± 14.2 years of age, BMI 29.4 ± 6.6 kg/m2) were included. Cohort success rates for pain and functional improvement were 43.4 % (95 % CI: 37.8–49.3) and 46.6 % (95 % CI: 40.9–52.5), respectively. After adjusting for demographics and cannula type/SLBRFN technique, none of the odds ratios for the six prognostic block paradigms showed statistical significance.
Conclusion
Nearly 50 % of patients who underwent SLBRFN reported clinically significant improvement in pain and disability at three months post-procedure, regardless of prognostic block selection criteria. These results suggest that multiple block strategies may determine eligibility for SLBRFN.
{"title":"What is the optimal block selection paradigm for predicting a successful treatment outcome following sacral lateral branch radiofrequency neurotomy? A real-world cohort study","authors":"Katharine A. Smolinski , Christopher Radlicz , Hasan Sen , Amanda N. Cooper , Brook Martin , Alycia Amatto , Allison Glinka Przybysz , Robert Burnham , Aaron M. Conger , Zachary L. McCormick , Taylor R. Burnham","doi":"10.1016/j.inpm.2025.100599","DOIUrl":"10.1016/j.inpm.2025.100599","url":null,"abstract":"<div><h3>Background</h3><div>Outcomes following sacral lateral branch radiofrequency neurotomy (SLBRFN) likely depend on patient selection criteria; however, commonly used criteria vary considerably. Refinement of selection criteria for SLBRFN may improve treatment outcomes. This study investigated common prognostic block-based selection criteria and treatment success following SLBRFN.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, consecutive patients from two Canadian musculoskeletal pain management clinics who underwent SLBRFN over a 6-year period (2016–2022) were identified by electronic medical record. Patients were categorized according to several prognostic block paradigms based on number of blocks (single vs. dual), block type (lateral branch block [LBB] vs. intra-articular block [IAB]), and subsequent percentage of pain relief. Six block criteria were established: 1 = LBB/LBB≥80 %; 2 = IAB/LBB≥80 %; 3 = LBB/LBB 50–79 %; 4 = IAB/LBB 50–79 %; 5 = LBB≥80 %; 6 = LBB 50–79 %. Treatment success was assessed at three months post-SLBRFN using two criteria: (1) the primary study outcome of ≥50 % numerical rating scale (NRS) pain reduction and (2) a secondary outcome of Pain Disability Quality-of-Life Questionnaire (PDQQ) score improvement by the minimal clinically important difference (MCID). Logistic regression analyses evaluated the association between block criteria and treatment success following SLBRFN.</div></div><div><h3>Results</h3><div>281 consecutive patients (75.1 % female, 61.8 ± 14.2 years of age, BMI 29.4 ± 6.6 kg/m<sup>2</sup>) were included. Cohort success rates for pain and functional improvement were 43.4 % (95 % CI: 37.8–49.3) and 46.6 % (95 % CI: 40.9–52.5), respectively. After adjusting for demographics and cannula type/SLBRFN technique, none of the odds ratios for the six prognostic block paradigms showed statistical significance.</div></div><div><h3>Conclusion</h3><div>Nearly 50 % of patients who underwent SLBRFN reported clinically significant improvement in pain and disability at three months post-procedure, regardless of prognostic block selection criteria. These results suggest that multiple block strategies may determine eligibility for SLBRFN.</div></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"4 2","pages":"Article 100599"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189478","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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