Interventional Pain Medicine最新文献

{"title":"Validation of thoracolumbar injury classification and Severity Score in the management of acute and subacute Osteoporotic vertebral compression fractures – A pilot study and a suggested modification","authors":"Jatinder S. Gill ,&nbsp;Martina Stippler ,&nbsp;Qing Ruan ,&nbsp;Nasir Hussain ,&nbsp;Andrew P. White ,&nbsp;Vwaire Oruhurhu ,&nbsp;Obaid Malik ,&nbsp;Thomas Simopoulos ,&nbsp;Ivan Urits ,&nbsp;Ryan S. D'Souza ,&nbsp;Sanjeet Narang ,&nbsp;Joshua A. Hirsch","doi":"10.1016/j.inpm.2024.100438","DOIUrl":"10.1016/j.inpm.2024.100438","url":null,"abstract":"<div><h3>Objective</h3><p>To retrospectively assess the Thoracolumbar Injury Classification and Severity Score (TLICS) in patients with osteoporotic vertebral compression fractures (OVCF) and compare the treatment given with that predicted by the TLICS score.</p></div><div><h3>Methods</h3><p>All medical records of patients presenting from January 2014 to November 2017 for acute atraumatic or low impact OVCF were screened, and eligible patients were retrospectively reviewed. The TLICS score was determined based upon magnetic resonance imaging (MRI) findings and clinical records. Clinical records (including pain score data), imaging data, operative procedures, and stability of neurological examination were tracked over three months for each patient.</p></div><div><h3>Results</h3><p>Of the 56 patients included, 36 patients had a TLICS score of 1, 18 had a TLICS score of 2, and two had a TLICS score of 4. Only one patient with a TLICS score of 4 underwent surgical stabilization, while the rest of the cohort was managed non-operatively, with or without kyphoplasty. TLICS score 1 corresponded to simple compression and TLICS score 2 corresponded to burst morphology with retropulsion and without neurological deficits. Of the patients with a TLICS score of 1 and 2 who underwent kyphoplasty, there was a statistically significant improvement in pain scores in both groups; however no significant difference was observed, between each TLICS score (i.e., 1 or 2). None of the patients developed instability or neurological decline.</p></div><div><h3>Conclusion</h3><p>TLICS score correctly predicted operative versus non-operative management in all patients with OVCF. TLICS may be used in making management decisions, and in the triage of these patients for operative versus non-operative evaluations. Our study suggests that patients with TLICS score of 4 or higher require surgical evaluation, while those with TLICS of 1 or 2 are likely to have satisfactory non-surgical management with augmentation or conservative care. In general, patients with OVCF typically present with low TLICS score. Kyphoplasty appears to be similarly beneficial in patients with a TLICS score of 1 or a TLICS score of 2. A modification of the TLICS score by adding TLICS Zero to include uncompressed OVCF with edema is suggested. The limitations of this study include a small size; a larger study is needed to confirm these findings.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100438"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000591/pdfft?md5=b3fa2b819ef7085c2d1f78d37506e340&pid=1-s2.0-S2772594424000591-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164558","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}

{"title":"Superior Cluneal neuralgia—An underappreciated cause of low back pain?","authors":"Einar Ottestad,&nbsp;Anthony Machi","doi":"10.1016/j.inpm.2024.100436","DOIUrl":"10.1016/j.inpm.2024.100436","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100436"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000578/pdfft?md5=94d891c4e85067ea9fe697c006efeff3&pid=1-s2.0-S2772594424000578-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239143","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}

{"title":"Clinical history correlates with lateral atlantoaxial (C1-2) joint edema. A pilot study","authors":"Joshua Levin ,&nbsp;Matthew Kaufman ,&nbsp;Gerald Yeung","doi":"10.1016/j.inpm.2024.100434","DOIUrl":"10.1016/j.inpm.2024.100434","url":null,"abstract":"<div><h3>Background</h3><p>Clinical evaluation in the determination of the etiology of axial spine pain is limited.</p></div><div><h3>Objective</h3><p>To determine if a set of three features of the clinical history are indicative of C1-2 joint edema on MRI.</p></div><div><h3>Methods</h3><p>All patients from one physician's practice who had axial cervical spine pain from 2021 to 2023 were evaluated. Cases were defined as those with all 3 of the ASL criteria, defined as Age &gt;65, Superior cervical/suboccipital pain, and exacerbation of pain primarily by Lateral cervical spine rotation. Age-matched controls had axial cervical spine pain without meeting the ASL criteria. Edema around the atlantoaxial joint and/or odontoid was evaluated by STIR MR sequences.</p></div><div><h3>Results</h3><p>The ASL criteria had a sensitivity of 82 % [95 % CI: 64–100 %], specificity of 79 %, [95 % CI: 63–95 %], positive predictive value of 74 % [95 % CI: 54–94 %], and negative predictive value of 86 % [95 % CI: 72–100 %] in diagnosing C1-2 joint edema.</p></div><div><h3>Conclusion</h3><p>A positive ASL criteria is sensitive and specific in the diagnosis of C1-2 joint edema, which may have clinical implications.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100434"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000554/pdfft?md5=90617d7673e089d7c967112fcefd2684&pid=1-s2.0-S2772594424000554-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136684","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}

{"title":"How soon after an epidural steroid injection can you predict the patient's response?","authors":"Byron J. Schneider,&nbsp;Valentine U. Chukwuma,&nbsp;Blake M. Fechtel,&nbsp;David J. Kennedy","doi":"10.1016/j.inpm.2024.100435","DOIUrl":"10.1016/j.inpm.2024.100435","url":null,"abstract":"<div><h3>Background</h3><p>Epidural steroid injections (ESI) are utilized for the management of radicular pain, but there are no previous published studies that detail the specific timeline of patient response to an ESI.</p></div><div><h3>Purpose</h3><p>To describe patients’ temporal response in pain relief following an ESI.</p></div><div><h3>Study design/setting</h3><p>Prospective in vivo study of consecutive patients at an outpatient physical medicine and rehabilitation clinic at a single academic spine center.</p></div><div><h3>Patient sample</h3><p>134 consecutive patients who received an ESI between January 2020 through June 2020.</p></div><div><h3>Methods</h3><p>Patients were contacted every 3 days ± 1 day for 21 days post ESI to assess pain as measured via 11-point numeric pain score and subjective percentage pain relief question.</p></div><div><h3>Results</h3><p>134 consecutive patients were enrolled, with 108 (80.6 %) having follow-up data through 3 weeks post ESI. At 3 weeks, 51/108 patients (47.2 %) had reported a successful response as defined by at least 50 % reduction of their pain index. Of these 51 patients, 37 (72.5 %) reported &gt;50 % relief on day 1, a further 11 (21.6 %) first reported &gt;50 % relief on day 4, and the remaining 3 (5.9 %) successes first reported &gt;50 % relief on days 13, 16, and 22. 57/108 patients (52.8 %) were non-responders, most of whom never reached the 50 % threshold at any time point. Of these non-responders, 19/57 (33.3 %) did report &gt;50 % relief on day 1. Those patient's pain relief fell below 50 % on day 4 (12/19 patients, 63.2 %), day 7 (5/19 patients, 26.3 %), day 13 (1 patient, 5.3 %), and day 16 (1 patient, 5.3 %). A positive response or negative response at each follow up point was looked at as a predictor of a concordant three-week outcome for the population. The positive likelihood ratio at follow-up day 1, day 4, day 7, and day 10, was 2.14, 6.12, 7.97, and 40 respectively. The negative likelihood ratio at follow-up day 1, day 4, day 7, and day 10 was 0.42, 0.15, 0.16, and 0.24 respectively.</p></div><div><h3>Discussion/conclusion</h3><p>This is the first study to meticulously follow up patients every 72 h after ESI. A patient's response on day 4, either positive or negative, is predictive of their 3-week outcome. Sustained relief at day 7 or 10 further increases the likelihood of a positive 3-week outcome.</p></div>","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100435"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772594424000566/pdfft?md5=ffc2602657847a0a2edffbfd98051934&pid=1-s2.0-S2772594424000566-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150255","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}

{"title":"Posterior internal vertebral venous plexus, the “Black Ice” of epidural hematoma: A letter to the editor","authors":"Christopher Amen,&nbsp;Zirong Zhao","doi":"10.1016/j.inpm.2024.100437","DOIUrl":"10.1016/j.inpm.2024.100437","url":null,"abstract":"","PeriodicalId":100727,"journal":{"name":"Interventional Pain Medicine","volume":"3 3","pages":"Article 100437"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277259442400058X/pdfft?md5=782d5830c3f339a106588fec99f39ee5&pid=1-s2.0-S277259442400058X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142130023","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}

{"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}

{"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}

{"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}

{"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}

{"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}