Pain physician
-
Recurrent or persistent low back pain (LBP) after surgical discectomy (SD) for intervertebral disc herniation has been well documented. The source of low back pain in these patients has not been examined. ⋯ This is the first published investigation of the tissue source of chronic LBP after SD. It appears that DP is the most common reason for chronic LBP after SD. If more rigorous study confirms our findings, future biologic treatments may hold value in repairing symptomatic annular fissures after SD.
-
Randomized Controlled Trial
Fluoroscopic cervical interlaminar epidural injections in managing chronic pain of cervical postsurgery syndrome: preliminary results of a randomized, double-blind, active control trial.
Cervical postsurgery syndrome is common with increasing cervical surgical interventions. Cervical spine surgery may fail in a certain proportion of patients with continued pain secondary to pseudoarthrosis, adjacent segment degeneration, inadequate decompression, iatrogenic instability, facet joint arthritis, deformity, and spinal stenosis. Among the various treatments available for managing cervical postsurgery syndrome, epidural steroid injections are one of the most common nonsurgical interventions. However there have not been any systematic evaluations regarding the effectiveness of cervical epidural injections in cervical postsurgery syndrome. ⋯ NCT01071369.
-
Randomized Controlled Trial
Fluoroscopic epidural injections in cervical spinal stenosis: preliminary results of a randomized, double-blind, active control trial.
Cervical spinal stenosis is a common disease that results in considerable morbidity and disability. There are multiple modalities of treatments, including surgical interventions and multiple interventional techniques including epidural injections. The literature on the effectiveness of cervical epidural steroids is sporadic. Emerging evidence for cervical interlaminar epidurals for various conditions in the cervical spine is positive; however, the effect of fluoroscopic epidural injections in cervical spinal stenosis has not been studied. ⋯ NCT01071369.
-
Vertebroplasty is a minimally invasive procedure demonstrated to be safe and effective in the treatment of painful osteoporotic and malignancy related fractures when performed in the thoracolumbar spine. Multiple randomized and nonrandomized reports have demonstrated its effectiveness. Conversely, transoral vertebroplasty (TOV) to treat the second cervical vertebra (C2) has been described in only a few case reports. ⋯ TOV is safe, effective, and long-lasting in the treatment of cervical pain resulting from malignant involvement of C2.
-
In 2000 the intradiscal electrothermal therapy (IDET) procedure for the treatment of discogenic pain was introduced. The technique involves the positioning of an intradiscal catheter with a temperature-controlled thermal resistive heating coil at the inner posterior annulus. The therapeutic mechanism of IDET combines the thermo-coagulation of native nociceptors and in-grown nonmyelinated nerve fibers with collagen shrinkage, stabilizing annular fissures. Thermal nerve root injuries were described with IDET. The temperature in relation to the distance from the catheter tip was investigated. The intradiscal temperature distribution during treatment with IDET was also described. ⋯ This study shows that temperatures generated within the spinal canal during IDET do not appear to be high enough to cause nerve damage.