Pain physician
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The utilization of spinal interventional pain techniques has grown rapidly over the last decade. However, practitioners use widely different techniques in these procedures, particularly in the use of image guidance. The importance of image guidance was highlighted by the fact that in recent systematic reviews on therapeutic effectiveness of epidural steroid injections and facet joint interventions, only studies that used image guidance were included. ⋯ The goals of this narrative review are to provide a basic overview of CT techniques available for spinal interventional pain procedures, to discuss the potential advantages and disadvantages of CT guidance, to provide a simple step-by-step approach to use of CT guidance, to share technical pearls, and to discuss methods to avoid potential pitfalls. This review will provide interventional pain physicians with knowledge of relevant CT image acquisition techniques and appropriate radiation dose reduction strategies. This will contribute to increased technical success rates while reducing radiation dose to the patient and staff.
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Discogenic pain is an important cause of low back pain (LBP). We have developed a pulsed radiofrequency (PRF) technique, using Diskit II needles (NeuroTherm, Middleton, MA, USA) placed centrally in the disk, for applying radiofrequency current in the disc (Intradiscal PRF method). ⋯ This intradiscal PRF method with consecutive PRF 5/5/60V, 15 min (with Diskit needle) appears to be a safe, minimally invasive treatment option for patients with chronic discogenic LBP.
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Review
Vertebral augmentation: update on safety, efficacy, cost effectiveness and increased survival?
Although over 300 articles have been published annually on vertebral augmentation in the last 5 years, there remains much debate about a fundamental question - is vertebral augmentation a safe and effective treatment to achieve analgesia, reduce disability, and improve quality of life in patients with a vertebral fracture? In this modern era of evidence-based clinical practice and public health care policy and funding, an evidentiary basis is needed to continue to perform vertebral augmentation. The aim of this narrative review is to summarize the latest and highest quality evidence for efficacy, safety, cost effectiveness, and potential survival benefit after vertebroplasty and kyphoplasty. The design, major inclusion criteria, primary outcome measures, relevant primary baseline characteristics, primary outcomes, relevant secondary outcomes, and limitations of prospective multicenter randomized sham-controlled and conservative management-controlled trials are summarized. ⋯ Finally, emerging literature assessing the potential cost-effectiveness of vertebral augmentation is considered. This narrative review will provide interventional pain physicians a summary of the latest and highest quality data published on vertebral augmentation. This will allow integration of the best available evidence with clinical expertise and patient wishes to make the most appropriate evidence-based clinical decisions for patients with symptomatic vertebral fracture.
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Comparative Study
The use of advanced imaging and representation of workers compensation in vertebral augmentation: a single-center comparison with the INVEST Trial.
Vertebral augmentation (VA) techniques have changed the paradigm of treatment during the past decade and involve injection of polymethylmethacrylate (PMMA) cement directly into a compressed vertebral body. During the summer of 2009, the INVEST trial was one of 2 randomized controlled studies that reported equivalence between vertebroplasty and a control procedure. ⋯ We reviewed our time-matched database in terms of 2 variables we thought curious in the INVEST trial. In comparison to our practice, where advanced imaging is essentially required and Workers compensation largely not seen, these aspects of the INVEST trial's population stood out.
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Case Reports
Vertebroplasty for the compression of the dorsal root ganglion due to spinal metastasis.
Radicular pain has been considered to be a relative contraindication to vertebroplasty. It was reported by some authors in the literature that percutaneous vertebroplasty (PV) in these conditions were performed without complications. ⋯ We suggest that carefully performed PV is an option for terminally ill patients with epidural and dorsal root ganglion involvement who do not respond to conservative treatment or cannot undergo radiation therapy and surgery. PV is minimally invasive compared to open surgery and may merit serious consideration in patients with limited physiologic reserves.