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https://www.readbyqxmd.com/read/28535567/radiation-dose-and-procedure-time-for-994-ct-guided-spine-pain-control-procedures
#1
Matthew S Lazarus, Rebecca B Forman, Alan L Brook, Todd S Miller
BACKGROUND: Image guidance for spine pain control procedures, including epidural steroid injection, nerve root block, and facet block, can be performed with either computed tomography (CT) or conventional fluoroscopy. CT has the advantage of improved anatomic localization and use of air for contrast; however, there are concerns that CT leads to higher radiation dose and longer procedure time. OBJECTIVE: To evaluate procedure time and radiation dose for multiple types of spine pain control procedures performed under CT guidance...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28535546/cost-utility-analysis-of-lumbar-interlaminar-epidural-injections-in-the-treatment-of-lumbar-disc-herniation-central-spinal-stenosis-and-axial-or-discogenic-low-back-pain
#2
Laxmaiah Manchikanti, Vidyasagar Pampati, Ramsin M Benyamin, Joshua A Hirsch
BACKGROUND: Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28514779/low-back-pain-in-pregnancy-investigations-management-and-role-of-neuraxial-analgesia-and-anaesthesia-a-systematic-review
#3
Herman Sehmbi, Rohan D'Souza, Anuj Bhatia
BACKGROUND: Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regarding investigations, management strategies and considerations around performing neuraxial blocks for pregnant women with LBP. METHODS: We searched 3 databases and reviewed literature concerning LBP in pregnancy with regards to diagnostic modalities, management strategies and use of neuraxial techniques for facilitating labour and delivery...
May 18, 2017: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/28504548/the-lumbar-neural-foramen-and-transforaminal-epidural-steroid-injections-an-anatomic-review-with-key-safety-considerations-in-planning-the-percutaneous-approach
#4
Jacob C Mandell, Gregory J Czuczman, Glenn C Gaviola, Varand Ghazikhanian, Charles H Cho
OBJECTIVE: The purpose of this article is to review the anatomy of the lumbar neural foramen and to describe techniques of transforaminal epidural steroid injections with emphasis on safety. Rare cases of paraplegia have been reported. CONCLUSION: Although no consensus currently exists about which approach is the safest, knowledge of the foraminal anatomy is a key consideration when choosing a needle approach for transforaminal epidural steroid injections.
May 15, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28490942/comparison-of-incidences-of-intravascular-injection-between-medial-and-lateral-side-approaches-during-traditional-s1-transforaminal-epidural-steroid-injection
#5
Sang Jun Park, Shin Hyung Kim, Seon Ju Kim, Duck Mi Yoon, Kyung Bong Yoon
Purpose. Intravascular injection rates are higher during traditional S1 transforaminal epidural steroid injection (TFESI) compared with lumbar transforaminal injection. We compared the incidences of intravascular injection between the medial and lateral approaches to the S1 foramen during S1 TFESI. Materials and Methods. A total of 139 patients underwent one or more TFESIs (170 total injections). The patients received S1 TFESI by either medial or lateral side of S1 foramen under fluoroscopic anteroposterior view using digital subtraction method...
2017: Pain Research & Management: the Journal of the Canadian Pain Society
https://www.readbyqxmd.com/read/28485773/curcumin-alleviates-lumbar-radiculopathy-by-reducing-neuroinflammation-oxidative-stress-and-nociceptive-factors
#6
L Xiao, M Ding, A Fernandez, P Zhao, L Jin, X Li
Current non-surgical treatments for lumbar radiculopathy [e.g. epidural steroids and Tumour necrosis factor-α (TNF-α) antagonists] are neither effective nor safe. As a non-toxic natural product, curcumin possesses an exceptional anti-inflammatory profile. We hypothesised that curcumin alleviates lumbar radiculopathy by attenuating neuroinflammation, oxidative stress and nociceptive factors. In a dorsal root ganglion (DRG) culture, curcumin effectively inhibited TNF-α-induced neuroinflammation, in a dose-dependent manner, as shown by mRNA and protein expression of IL-6 and COX-2...
May 9, 2017: European Cells & Materials
https://www.readbyqxmd.com/read/28483686/persistent-hiccups-after-an-epidural-steroid-injection-successfully-treated-with-baclofen-a-case-report
#7
Berdale Colorado, Gregory Decker
Persistent hiccups are an established adverse reaction to epidural steroid injections. Although oral baclofen has been used to treat hiccups in various clinical settings, none of the previously reported studies that used baclofen were related to hiccups occurring after spinal injections/procedures. We report a case of a man who developed persistent hiccups after a transforaminal epidural steroid injection that was treated successfully with oral baclofen. LEVEL OF EVIDENCE: To be determined...
May 5, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28482062/cervical-epidural-depth-correlation-between-cervical-mri-measurements-of-the-skin-to-cervical-epidural-space-and-the-actual-needle-depth-during-interlaminar-cervical-epidural-injections
#8
Haitham Algrain, Alison Liu, Sarabdeep Singh, To-Nhu Vu, Steven P Cohen
Objective. : The purpose of this study was to assess the correlation between skin-to-epidural space depth, as measured on cervical magnetic resonance imaging (MRI), and actual needle depth, as measured by Tuohy needle markings during cervical epidural steroid injections. Methods. : We conducted a retrospective review of cervical MRI images to determine estimated depth from skin to epidural space. Of the 121 reviewed patients who underwent cervical epidural steroid injections, 81 met inclusion criteria and were retained for data analysis...
May 8, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28480104/perioperative-steroids-for-lumbar-disc-surgery-a-meta-analysis-of-randomized-controlled-trials
#9
REVIEW
Muhammad Waqas, Hussain Shallwani, Muhammad S Shamim, Khabir Ahmad
BACKGROUND: Our review question was "Does perioperative steroids administration, in comparison with other treatments or placebo, improve either postoperative pain control, length of hospital stay, or return to work in patients undergoing lumbar disc surgery?" METHODS: We searched PubMed, CINAHL PLUS, and Cochrane databases for randomized control trials (RCTs) studying the role of steroids for lumbar disc surgery. Studies that compared perioperative steroids with other treatments or placebo were included...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28437329/metastatic-spinal-cord-compression-and-steroid-treatment-a-systematic-review
#10
Abhishek Kumar, Michael H Weber, Ziya Gokaslan, Jean-Paul Wolinsky, Meic Schmidt, Laurence Rhines, Michael G Fehlings, Ilya Laufer, Daniel M Sciubba, Michelle J Clarke, Narayan Sundaresan, Jorrit-Jan Verlaan, Arjun Sahgal, Dean Chou, Charles G Fisher
STUDY DESIGN: Systematic review. OBJECTIVES: We conducted a systematic review of the literature to answer the following questions regarding the use of steroid therapy in metastatic spinal cord compression (MSCC): 1. In cases of MSCC, what is the effect of steroid administration before definitive radiotherapy or surgery on ambulatory status, bowel and bladder function and survival? 2. What steroid dosing regimens are associated with the best outcomes concerning neurological symptoms and complication prevention in cases of MSCC? SUMMARY OF BACKGROUND DATA: Currently, there is significant variation in the initial bolus dose, daily maintenance dose and duration of treatment when steroids are used as a bridge to definitive therapy for MSCC...
May 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28409420/single-fraction-spine-stereotactic-ablative-body-radiotherapy-with-volumetric-modulated-arc-therapy
#11
Matthew M Gestaut, Nitika Thawani, Sangroh Kim, Veera R Gutti, Sameer Jhavar, Niloyjyoti Deb, Andrew Morrow, Russell A Ward, Jason H Huang, Mehul Patel
This study investigated a single institution's experience with volumetric modulated arc therapy (VMAT) directed stereotactic ablative body radiotherapy (SABR) for vertebral metastases. From 2010 to 2014, 95 lesions of spinal metastases in 73 patients were treated with SABR using VMAT. Clinical local control, pain level, and use of steroid medication were employed to evaluate treatment responses. The majority (79%) of patients were treated with a radiation dose of 20 Gy in a single fraction. However, when normal tissue constraints could not be achieved, the dose was reduced to 18 Gy (11%) or 16 Gy (8%) in 1 fraction...
April 13, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/28405034/a-multicentre-survey-of-the-current-acute-post-operative-pain-management-practices-in-tertiary-care-teaching-hospitals-in-maharashtra
#12
Samina Khaliloddin Khatib, Syed Shamim Razvi, Sadhana Sudhir Kulkarni, Swapnil Parab
BACKGROUND AND AIMS: Undertreated pain can have negative consequences on patients' health as well as the health-care system. The present study was aimed at identifying the current trends in post-operative pain management and availability of acute pain services (APS). In addition, it is also an attempt to assess the availability of analgesia for non-surgical cases, and the attitudes, beliefs, and perceptions of clinicians regarding acute pain management in the tertiary hospitals in the state of Maharashtra (India)...
March 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28403104/effect-of-bipolar-pulsed-radiofrequency-on-refractory-chronic-cervical-radicular-pain-a-report-of-two-cases
#13
Min Cheol Chang
RATIONALE: Despite undergoing transforaminal epidural steroid injection (TFESI), many patients complain of persisting cervical radicular pain. For the management of chronic cervical radicular pain, clinicians are widely applying pulsed radiofrequency (PRF) stimulation to dorsal root ganglions (DRGs). To enhance the effect of PRF stimulation, we conducted bipolar PRF stimulation in 2 patients with chronic cervical radicular pain that was refractory to monopolar PRF and repeated TFESIs...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28392945/pitfalls-in-interventional-pain-medicine-hyponatremia-after-ddavp-for-a-patient-with-von-willebrand-disease-undergoing-an-epidural-steroid-injection
#14
Talal W Khan, Abdulraheem Yacoub
Desmopressin (DDAVP), a synthetic analog of vasopressin, has been used in patients with von Willebrand disease (VWD), mild hemophilia A, and platelet dysfunction to reduce the risk of bleeding associated with surgical and interventional procedures. We report the case of a patient with VWD presenting with a bulging disc and radicular pain that underwent transforaminal epidural steroid injections. Her course was complicated with the interval development of headaches and dizziness symptomatic of moderate hyponatremia, likely due to excessive fluid intake...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28384946/a-randomized-controlled-clinical-trial-to-determine-the-effectiveness-of-caudal-epidural-steroid-injection-in-lumbosacral-sciatica
#15
Jaydeep Nandi, Abhishek Chowdhery
INTRODUCTION: Caudal epidural steroid injection have been a part of nonsurgical management of lumbosacral sciatica since last half a century but various randomized controlled trials fail to provide convincing evidence in favour of its effectiveness. AIM: To assess the efficacy of caudal epidural steroid injection in patients of lumbosacral sciatica in comparison to placebo. MATERIALS AND METHODS: The study consisted of patients of sciatica caused by lumbosacral disc prolapse (observed on Magnetic Resonance Imaging (MRI) scan)...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28379464/filum-terminale-needle-placement-during-caudal-epidural-steroid-injection
#16
Ryan R Ramsook, David Spinner, Rajiv R Doshi
Objective. : Caudal epidural steroid injections (ESIs) are commonly used to treat lumbar radicular pain. Touhy needles are placed under live fluoroscopic guidance to ensure epidural administration of medication. This is a case report of direct needle and catheter placements into and through the filum terminale during a caudal approach to the epidural space. Design. : Single case report. Setting. : Beth Israel Deaconess Medical Center...
March 30, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28375914/low-back-pain
#17
Jinny O Tavee, Kerry H Levin
PURPOSE OF REVIEW: This article provides an overview of evaluating and treating low back pain in the outpatient setting. RECENT FINDINGS: As most cases of acute low back pain have a favorable prognosis, current guidelines on imaging studies recommend conservative treatment for 6 weeks prior to obtaining an MRI if no red flags are present. Of these red flags, a prior history of cancer is the strongest risk factor for a malignant etiology and requires urgent evaluation with MRI...
April 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28349269/successful-outcomes-following-transforaminal-epidural-steroid-injections-for-c4-5-cervical-disc-prolapse-associated-with-profound-neurological-deficit
#18
Adam Meir, Keith Bush
PURPOSE: To show that with C5 radiculopathy and profound neurological deficit, good outcomes can be obtained with injection therapy. METHOD: We present two cases of cervical radiculopathy secondary to disc prolapse associated with profound neurological deficit. In both cases, cervical injection therapy was used as the primary management. RESULTS: The two cases presented were both male, 59 and 36 years, and were diagnosed on MRI imaging with C4/5 disc prolapses...
March 27, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28340495/residents-learning-curve-of-lumbar-transforaminal-epidural-steroid-injections
#19
Holger Joswig, Sarah Roberta Haile, Gerhard Hildebrandt, Martin Nikolaus Stienen
Background and Study Aims There is a paucity of literature on beginners' training and on its connection with patient safety for transforaminal epidural steroid injections (TFESIs). This study retrospectively assessed the learning curves and associated complications of neurosurgery residents never previously exposed to TFESI and compared them with experienced board-certified faculty neurosurgeons (BCFNs). Material and Methods Procedure time in minutes, dose-area product (DAP) in cGy*cm(2), periprocedural observations, and complications in 354 TFESIs for radicular pain secondary to lumbar disk herniation or lumbar spinal stenosis were extracted from operative notes and the electronic infiltration logbook in the per-injection format...
March 24, 2017: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/28340251/thermal-qst-phenotypes-associated-with-response-to-lumbar-epidural-steroid-injections-a-pilot-study
#20
Dermot P Maher, Weihua Ding, Sarabdeep Singh, Arissa Opalacz, Claire Fishman, Mary Houghton, Shihab Ahmed, Lucy Chen, Jianren Mao, Yi Zhang
Objective.:  Response to lumbar epidural steroid injection in lumbar radicular pain varies. The purpose of this study is to characterize the changes in quantitative sensory testing (QST) phenotypes of subjects and compare the QST characteristics in patients who do respond to treatment of radicular pain with a lumbar epidural steroid injection (ESI). Design.:  Prospective, observational pilot study. Setting.:  Outpatient pain center. Methods...
March 13, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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