Pain physician
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Randomized Controlled Trial
Whitacre Needle Reduces the Incidence of Intravascular Uptake in Lumbar Transforaminal Epidural Steroid Injections.
Transforaminal epidural steroid injection (TFESI) is a commonly used interventional pain management procedures to treat radicular leg pain. Although most reported complications of TFESI are minor, serious morbidity has also been demonstrated including spinal cord infarction, paraplegia, and quadriparesis. Suggested mechanisms include direct vascular injury or intravascular injection of particulate steroid. ⋯ The Whitacre needle had the benefit of reducing the incidence of intravascular injection with minimal differences in technical difficulties and the amount of radiation exposure during lumbar TFESI.
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Comparative Study
Full-Endoscopic Technique Discectomy Versus Microendoscopic Discectomy for the Surgical Treatment of Lumbar Disc Herniation.
Full-endoscopic technique discectomy (FED) or microendoscopic discectomy (MED) are 2 widely used minimally invasive procedures for the treatment of lumbar disc herniation. However, there is insufficient literature regarding the differences between these 2 surgical procedures. ⋯ Although the clinical outcomes of the 2 surgical techniques were similar, the FED had the advantages of quicker postoperative recovery and more immediate effect.
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An 80-year-old woman presented with chronic lumbosacral pain since her laminectomy and instrumentation 10 years ago. Examination was consistent with left sacroiliitis, and the patient underwent an elective left sacroiliac joint injection. Two days following her procedure she fell and landed on her left hip and on the next day, she presented to the emergency room with acutely worsening left gluteal pain. ⋯ The only effective methods to eliminate the spores is to heat them at a temperature greater than 100 degrees Celsius for 10 minutes or with use of a 10% potassium hydroxide (KOH) solution. We hypothesize that clostridium spores were present on the patient's skin from previous stool soiling, and that these were introduced directly into the soft tissue by needle trauma. Rare complications such as this one are scarcely reported in the literature and thus it becomes difficult to adequately identify risk factors or to formulate strategies to improve practice management.
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Review Meta Analysis
A Systematic Review and Best Evidence Synthesis of the Effectiveness of Therapeutic Facet Joint Interventions in Managing Chronic Spinal Pain.
The therapeutic spinal facet joint interventions generally used for the treatment of axial spinal pain of facet joint origin are intraarticular facet joint injections, facet joint nerve blocks, and radiofrequency neurotomy. Despite interventional procedures being common as treatment strategies for facet joint pathology, there is a paucity of literature investigating these therapeutic approaches. Systematic reviews assessing the effectiveness of various therapeutic facet joint interventions have shown there to be variable evidence based on the region and the modality of treatment utilized. Overall, the evidence ranges from limited to moderate. ⋯ Based on the present assessment for the management of spinal facet joint pain, the evidence for long-term improvement is Level II for lumbar and cervical radiofrequency neurotomy, and therapeutic facet joint nerve blocks in the cervical, thoracic, and lumbar spine; Level III for lumbar intraarticular injections; and Level IV for cervical intraarticular injections and thoracic radiofrequency neurotomy.
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Review Meta Analysis
A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain.
Spinal zygapophysial, or facet, joints are a source of axial spinal pain and referred pain in the extremities. Conventional clinical features and other noninvasive diagnostic modalities are unreliable in diagnosing zygapophysial joint pain. ⋯ The evidence is Level I for the diagnostic accuracy of lumbar facet joint nerve blocks, Level II for cervical facet joint nerve blocks, and Level II for thoracic facet joint nerve blocks in assessment of chronic spinal pain.