Neuroimaging clinics of North America
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The use of biomarkers of microvascular structure and function from perfusion and permeability imaging is now well established in neuro-oncological research. There remain significant challenges to be overcome before these techniques and related biomarkers can find general clinical acceptance. ⋯ The potential clinical benefits of these approaches are already becoming clear, particularly in the setting of novel antiangiogenic therapies. With an increasing body of evidence in the scientific literature, and with a steadily falling barrier to entry, the coming decade should see rapid developments in imaging biomarkers, and facilitate their transition into routine clinical practice.
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Spinal cord stimulation has been used successfully for more than 40 years. The application of an electrical impulse field on to the spinal cord is used with a battery generator source and a variety of either cylindrical or paddle/plate leads. ⋯ Many clinical conditions such as complex regional pain syndrome, failed back spinal syndrome, and extremity neuropathic pain involving the trunk and limbs are approved for its use. This device allows patients to live a successful life without pain.
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Epidural steroid injections have been used for decades as part of a rehabilitation program to relieve back or neck pain and the associated radicular nerve component that often accompanies these problems. These injections are minimally invasive and offer many patients substantial relief without the need for more invasive procedures. Although effective and generally simple, they must be performed accurately and properly for maximum benefit and complication avoidance. This article discusses the various technical aspects of the procedure that must be observed by the operator to accomplish these ends.
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Pain that develops in the cervical, thoracic, lumbar, and sacral spine is typically initiated from a clinical condition called spondylosis. Radiofrequency ablation is a key element in the treatment protocol of patients with spondylosis of the cervical, thoracic, lumbar, and sacroiliac joint pain. ⋯ Radiofrequency neurolysis is a common technique used in the treatment of chronic pain, particularly facet (zygapophyseal joint) arthralgia. The technique involves an insulated needlelike cannula; x-rays passing through the patient show the projected relative radioopaque bony landmarks and the metallic cannula.