Pain physician
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The Hartel anterior approach is a commonly used puncture method in percutaneous balloon compression (PBC) surgery. However, anatomical variations along the puncture path, and visual errors on x-ray 2-dimensional imaging, may increase the difficulty of a successful first attempt. Our clinical practice has shown that employing the quadrant localization technique to plan puncture points and angles can enhance the puncture success rate. ⋯ In PBC surgery, the quadrant localization technique improves efficiency and reduces hospital stay compared with the conventional Hartel anterior approach, without increasing the risk of complications.
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Dorsal root ganglion stimulation (DRGS) is an established method for treating persistent and severe pain conditions. However, performing DRGS has significant challenges. Current DRGS systems are expensive, hindering accessibility for many patients and health care systems. Additionally, placing DRGS devices requires specialized training in epidural techniques and lead anchoring methods. Technical and financial requirements also limit the clinical applicability and availability of DRGS. ⋯ To our knowledge, this feasibility cadaver study is the first of its kind to examine the accuracy and efficiency of a fluoroscopy-guided transforaminal approach to place injectable electrodes near the DRG. These promising results suggest that this method could be a viable alternative to existing DRGS techniques, warranting further investigation into its clinical potential.
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Kümmell disease (KD)-a rare and relatively complex spinal condition-is a type of posttraumatic osteoporotic vertebral compression fracture manifesting as a delayed collapse of a vertebral body. Although most patients with KD present with pain in the fracture area, some present with pain in the rib region or distal lumbosacral region, without pain in the fracture area, which poses challenges for diagnosing and treating KD. ⋯ Patients with Stage I or Stage II KD may experience pain distal to the fracture area, which may effectively be alleviated by percutaneous kyphoplasty.
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The neurolytic celiac plexus block (NCPB) can be introduced through the posterior para-aortic, anterior para-aortic, posterior transaortic, or endoscopic anterior para-aortic puncture approach, as well as the posterior approach via the intervertebral disc. To reduce the complications of puncture, this block's original manual blind puncture technique can be improved upon by using a C-arm fluoroscope, computed tomography (CT), or an ultrasound, the last of which may be endoscopic. ⋯ An NCPB that uses CT-guided double-needle puncture through the anterior and posterior diaphragmatic crura can improve absolute alcohol's ability to surround the corresponding segment of the abdominal aorta and block the greater and lesser splanchnic nerves and celiac plexus when injected. This approach to the NCPB has a better analgesic effect on patients with intractable visceral cancer pain in the upper abdominal area.