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Interventional spinal Injections

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https://www.readbyqxmd.com/read/28546769/treatment-of-chronic-low-back-pain-new-approaches-on-the-horizon
#1
REVIEW
Nebojsa Nick Knezevic, Shane Mandalia, Jennifer Raasch, Ivana Knezevic, Kenneth D Candido
Back pain is the second leading cause of disability among American adults and is currently treated either with conservative therapy or interventional pain procedures. However, the question that remains is whether we, as physicians, have adequate therapeutic options to offer to the patients who suffer from chronic low back pain but fail both conservative therapy and interventional pain procedures before they consider surgical options such as discectomy, disc arthroplasty, or spinal fusion. The purpose of this article is to review the potential novel therapies that are on the horizon for the treatment of chronic low back pain...
2017: Journal of Pain Research
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/28530017/mechanical-stress-by-spasticity-accelerates-fracture-healing-after-spinal-cord-injury
#3
Naoyoshi Sakitani, Hiroyuki Iwasawa, Masato Nomura, Yasushi Miura, Hiroshi Kuroki, Junya Ozawa, Hideki Moriyama
Accelerated fracture healing in patients with spinal cord injuries (SCI) is often encountered in clinical practice. However, there is no distinct evidence in the accelerated fracture healing, and the mechanisms of accelerated fracture healing in SCI are poorly understood. We aimed to determine whether SCI accelerated fracture healing in morphology and strength, to characterize the healing process with SCI, and to clarify the factors responsible for accelerated fracture healing. In total, 39 male Wistar rats were randomly divided into healthy control without intervention, SCI only, fracture with SCI, botulinum toxin (BTX) A-treated fracture with SCI, and propranolol-treated fracture with SCI groups...
May 22, 2017: Calcified Tissue International
https://www.readbyqxmd.com/read/28514309/a-randomized-controlled-trial-of-botulinum-toxin-a-for-treating-neuropathic-pain-in-patients-with-spinal-cord-injury
#4
Gang Li, Chang-An Lv, Li Tian, Lian-Jin Jin, Ping Sun, Wei Zhao
BACKGROUND: To assess the effect of botulinum toxin A (BTA) for treating neuropathic pain in patients with spinal cord injury (SCI). METHODS: A total of 44 patients with SCI with neuropathic pain were randomly divided into the intervention group and the placebo group, each group 21 patients. The subjects in the intervention group received BTA (200 U subcutaneous injection, once daily) at the painful area, whereas those in the placebo group were administered a saline placebo...
May 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28492440/diskitis-osteomyelitis-spinal-epidural-abscess-meningitis-and-endocarditis-following-sacroiliac-joint-injection-for-the-treatment-of-low-back-pain-in-a-patient-on-therapy-for-hepatitis-c-virus
#5
Geeta Nagpal, John P Flaherty, Honorio T Benzon
OBJECTIVE: Sacroiliac joint injections are frequently performed procedures in the management of acute and chronic low-back pain, including patients with various immunocompromised states. Infectious complications following these procedures along with other spinal injections are rarely reported, but the true incidence is unknown. The purpose of this report is to highlight the devastating neurologic sequela that can occur, and to discuss potential future management strategies. CASE REPORT: We present a patient who developed diskitis, osteomyelitis, spinal epidural abscess, meningitis, and endocarditis from Staphylococcus aureus, all of which developed shortly after a sacroiliac joint injection...
May 10, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28486278/interventional-approaches-to-low-back-pain
#6
Ariana M Nelson, Geeta Nagpal
Chronic low back pain (LBP) places a tremendous economic burden on society due to both direct and indirect costs. Health care costs for adults with chronic LBP have steadily increased over the past 20 years, coinciding with a large increase in the utilization of spinal injections, surgical interventions, opioid medications, and physical therapy. The treatment of LBP is best approached by a multimodal and even multidisciplinary approach with a combination of physical rehabilitation, pharmacologic management, psychological intervention, spinal injections, and surgical intervention with a goal of improving the functional status of the patient...
May 8, 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28433438/analgesic-effects-of-transcutaneous-ultrasound-nerve-stimulation-in-a-rat-model-of-oxaliplatin-induced-mechanical-hyperalgesia-and-cold-allodynia
#7
Yueh-Ling Hsieh, Han-Yu Chen, Ching-Hsiang Yang, Chen-Chia Yang
This study investigated the effects and underlying mechanisms of therapeutic ultrasound (TUS) in a rat model of oxaliplatin-induced peripheral neuropathy. Animals received a total of eight injections with oxaliplatin (4 mg/kg), administered at 3-d intervals. TUS intervention (1 MHz, 0.5 W/cm(2)) started on the fifth oxaliplatin administration and continued for 10 consecutive d. Sensory behavioral examinations, protein levels of transient receptor potential channels (TRPM8 and TRPV1) in dorsal root ganglia (DRG) and substance P (SP) in spinal dorsal horn were examined...
April 19, 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/28431283/zika-virus-infection-of-adult-and-fetal-stat2-knock-out-hamsters
#8
Venkatraman Siddharthan, Arnaud J Van Wettere, Rong Li, Jinxin Miao, Zhongde Wang, John D Morrey, Justin G Julander
Zika virus (ZIKV) infection was investigated in adult and fetal STAT2 knock-out (KO) hamsters. Subcutaneous injection of ZIKV of adults resulted in morbidity, mortality, and infection of the uterus, placenta, brain, spinal cord, and testicles, thus providing an opportunity to evaluate congenital ZIKV infection in a second rodent species besides mice. ZIKV-infected cells with morphologies of Sertoli cells and spermatogonia were observed in the testes, which may have implications for sexual transmission and male sterility...
April 18, 2017: Virology
https://www.readbyqxmd.com/read/28431040/prospective-assessment-of-pain-and-comfort-in-chronic-pain-patients-undergoing-interventional-pain-management-procedures
#9
Thomas Simopoulos, Daniel Leffler, Sheila Barnett, Devon Campbell, Shu Jing Lian, Jatinder S Gill
Objective.:  Interventional pain management procedures have an important role in the management of chronic pain. The present study seeks to identify the proportion of patients who experience severe pain during pain procedures either with or without sedation. There is then an attempt to identify any association of high pain levels with factors such as age, gender, ethnicity, preprocedure pain level, procedure type, tobacco use, and baseline pharmaceuticals taken for both pain and/or mood disorder management...
April 18, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28420598/1-5-t-augmented-reality-navigated-interventional-mri-paravertebral-sympathetic-plexus-injections
#10
David R Marker, Paweena U Thainual, Tamas Ungi, Aaron J Flammang, Gabor Fichtinger, Iulian I Iordachita, John A Carrino, Jan Fritz
PURPOSE: The high contrast resolution and absent ionizing radiation of interventional magnetic resonance imaging (MRI) can be advantageous for paravertebral sympathetic nerve plexus injections. We assessed the feasibility and technical performance of MRI-guided paravertebral sympathetic injections utilizing augmented reality navigation and 1.5 T MRI scanner. METHODS: A total of 23 bilateral injections of the thoracic (8/23, 35%), lumbar (8/23, 35%), and hypogastric (7/23, 30%) paravertebral sympathetic plexus were prospectively planned in twelve human cadavers using a 1...
May 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/28396242/long-term-effects-of-repeated-injections-of-local-anesthetic-with-or-without-corticosteroid-for-lumbar-spinal-stenosis-a-randomized-trial
#11
Janna L Friedly, Bryan A Comstock, Judith A Turner, Patrick J Heagerty, Richard A Deyo, Zoya Bauer, Andrew L Avins, Srdjan S Nedeljkovic, David R Nerenz, Xu Rita Shi, Thiru Annaswamy, Christopher J Standaert, Matthew Smuck, David J Kennedy, Venu Akuthota, David Sibell, Ajay D Wasan, Felix Diehn, Pradeep Suri, Sean D Rundell, Larry Kessler, Allen S Chen, Jeffrey G Jarvik
OBJECTIVE: To determine the overall long term effectiveness of treatment with epidural corticosteroid injections for lumbar central spinal stenosis and the impact of repeat injections, including crossover injections, on outcomes through 12 months. DESIGN: Multicenter, double-blind, randomized trial comparing epidural injections of corticosteroid plus lidocaine versus lidocaine alone SETTING: 16 U.S. clinical sites PARTICIPANTS: 400 participants with imaging-confirmed lumbar central spinal stenosis INTERVENTIONS: Participants were randomized to receive either epidural injections with corticosteroid plus lidocaine or lidocaine alone with the option of blinded crossover after 6 weeks to receive the alternate treatment...
April 7, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28382238/evaluation-and-interventional-management-of-pain-after-vertebral-augmentation-procedures
#12
Jesse Hatgis, Michelle Granville, Robert E Jacobson
INTRODUCTION: A small subset of patients who underwent successful vertebral compression fracture (VCF) augmentation procedures may develop subsequent pain requiring spinal injections. In a retrospective analysis, we determined whether the pain was related to the original fracture site or to another area within the lumbar or thoracic spine. The pain occurred either at the same/adjacent level and/or non-adjacent level as the VCF. Interventional treatments primarily targeted the facet joints, specifically in the form of facet joint blocks and/or radiofrequency ablation to the medial branches...
February 28, 2017: Curēus
https://www.readbyqxmd.com/read/28375916/neuropathic-pain
#13
Lindsay A Zilliox
PURPOSE OF REVIEW: Neuropathic pain is a frequently encountered condition that is often resistant to treatment and is associated with poor patient satisfaction of their treatment. Several medications have been shown to be effective in treating neuropathic pain associated with diabetic neuropathy and postherpetic neuralgia, and these medications are often used to treat neuropathic pain associated with other conditions as well. This article summarizes the diagnosis and assessment of patients with neuropathic pain as well as available pharmacologic and interventional treatment options...
April 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28339551/anticoagulant-and-antiplatelet-management-for-spinal-procedures-a-prospective-descriptive-study-and-interpretation-of-guidelines
#14
Bradly S Goodman, L McLean House, Sridhar Vallabhaneni, Srinivas Mallempati, Matthew R Willey, Matthew Thomas Smith
Setting.:  Epidural hematoma rarely complicates interventional spine procedures. While anticoagulant and antiplatelet drugs increase bleeding risk, cessation may precipitate serious thromboembolic events. The Spine Intervention Society (SIS) and American Society of Regional Anesthesia and Pain Medicine (ASRA) put forth guidelines that dissent with regard to management of hemostatically active agents during commonly performed spinal injections. Objective.:  To validate an antiplatelet/anticoagulant management table based on modifications of the SIS 2013 and ASRA 2015 guidelines...
October 6, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28264437/transplantation-of-embryonic-spinal-cord-derived-cells-helps-to-prevent-muscle-atrophy-after-peripheral-nerve-injury
#15
Carolin Ruven, Wen Li, Heng Li, Wai-Man Wong, Wutian Wu
Injuries to peripheral nerves are frequent in serious traumas and spinal cord injuries. In addition to surgical approaches, other interventions, such as cell transplantation, should be considered to keep the muscles in good condition until the axons regenerate. In this study, E14.5 rat embryonic spinal cord fetal cells and cultured neural progenitor cells from different spinal cord segments were injected into transected musculocutaneous nerve of 200-300 g female Sprague Dawley (SD) rats, and atrophy in biceps brachii was assessed...
February 27, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28235527/a-patient-with-postpolio-syndrome-developed-cauda-equina-syndrome-after-neuraxial-anesthesia-a-case-report
#16
Wei-Cheng Tseng, Zhi-Fu Wu, Wen-Jinn Liaw, Su-Yang Hwa, Nan-Kai Hung
Combined spinal anesthesia and postoperative epidural analgesia is widely used in orthopedic surgery. Uncommon but serious neurologic complications of neuraxial anesthesia (NA) include direct trauma during needle or catheter insertion, central nervous system infections, and neurotoxicity of local anesthetics. Cauda equina syndrome (CES) is a rare complication after NA but can result in severe neurologic deterioration that may require surgical intervention. We present a case of a 69-year-old woman with postpolio syndrome who developed CES after combined spinal anesthesia and postoperative epidural analgesia...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28209505/botulinum-toxin-treatment-for-nocturnal-calf-cramps-in-patients-with-lumbar-spinal-stenosis-a-randomized-clinical-trial
#17
Sang Jun Park, Kyung Bong Yoon, Duck Mi Yoon, Shin Hyung Kim
OBJECTIVES: To evaluate the clinical effectiveness of botulinum toxin (BTX) injection into the gastrocnemius muscles in patients with lumbar spinal stenosis (LSS) who have frequent nocturnal calf cramps (NCCs). DESIGN: Prospective, randomized clinical trial. SETTING: Outpatient department for interventional pain management. PARTICIPANTS: Patients (N=50) with LSS who have NCCs at least once per week were enrolled. INTERVENTION: Patients were randomly allocated to receive either conservative treatments plus gabapentin (group GPN) or BTX injection (group BTX)...
May 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28207664/descriptive-analysis-of-spinal-neuroaxial-injections-surgical-interventions-and-physical-therapy-utilization-for-degenerative-lumbar-spondylolisthesis-within-medicare-beneficiaries-from-2000-to-2011
#18
Joseph A Sclafani, Alexandra Constantin, Pei-Shu Ho, Venu Akuthota, Leighton Chan
STUDY DESIGN: A retrospective, observational study. OBJECTIVE: The aim of this study was to determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries. SUMMARY OF BACKGROUND DATA: Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of treatment algorithms including physical therapy and interventional techniques can be used to manage clinically significant degenerative spondylolisthesis...
February 15, 2017: Spine
https://www.readbyqxmd.com/read/28176970/percutaneous-vertebroplasty-and-interventional-tumor-removal-for-malignant-vertebral-compression-fractures-and-or-spinal-metastatic-tumor-with-epidural-involvement-a-prospective-pilot-study
#19
Yi-Feng Gu, Qing-Hua Tian, Yong-Dong Li, Chun-Gen Wu, Yan Su, Hong-Mei Song, Cheng-Jian He, Dong Chen
OBJECTIVE: The aim of this study was to compare the efficacy of percutaneous vertebroplasty (PVP) and interventional tumor removal (ITR), with PVP alone for malignant vertebral compression fractures and/or spinal metastatic tumor with epidural involvement. PATIENTS AND METHODS: A total of 124 patients were selected for PVP and ITR (n = 71, group A) and PVP alone (n = 53, group B). A 14 G needle and guide wire were inserted into the vertebral body, followed by sequential dilatation of the tract until the last cannula reached the anterior portion of the pedicle...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28154344/importance-of-recognizing-carpal-tunnel-syndrome-for-neurosurgeons-a-review
#20
Masatoshi Yunoki, Takahiro Kanda, Kenta Suzuki, Atsuhito Uneda, Koji Hirashita, Kimihiro Yoshino
Idiopathic carpal tunnel syndrome (CTS) is a common complaint, reflecting entrapment neuropathy of the upper extremity. CTS produces symptoms similar to those of other conditions, such as cervical spondylosis or ischemic or neoplastic intracranial disease. Because of these overlaps, patients with CTS are often referred to a neurosurgeon. Surgical treatment of CTS was started recently in our department. Through this experience, we realized that neurosurgeons should have an increased awareness of this condition so they can knowledgeably assess patients with a differential diagnosis that includes CTS and cervical spinal and cerebral disease...
April 15, 2017: Neurologia Medico-chirurgica
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