Pain physician
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Lumbar radiculopathy secondary to L5-S1 degenerative changes adjacent to a lumbar fusion usually requires extending the fusion to include the degenerative L5-S1 level; this revision surgery can often be a very invasive procedure. ⋯ Endoscopic spine surgery offers patients with fusions that terminate at L5 a safe and effective option for treatment of lumbar degenerative spine disease at L5-S1 below their fusion constructs. A longer follow-up and a larger prospective study would be necessary to consider the utility of endoscopic compression versus extending the fusion construct.
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Pudendal neuralgia (PN) is one of the most common forms of genital pain. Only 42.2% of PN patients respond to the first-line treatment. Novel neuromodulation techniques in the treatment of refractory PN patients are urgently required. ⋯ These data imply that SNS can have beneficial effects on patients with refractory PN.
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Ultrasound-guided (ULSD-g) genicular nerve blocks (GNB) using pharmacological agents for pain control in chronic knee osteoarthritis (OA) are gaining in popularity. There lacks a systematic review to evaluate the ULSD techniques and pharmacological agents used during the intervention, and to assess the knee's function postintervention. ⋯ There is fair evidence to at least target the superior medial genicular nerve, inferior medial genicular nerve, and Inferior medial genicular nerve using local anesthetics, corticosteroids, or alcohol to reduce pain and to improve knee function in patients with chronic knee OA under ULSD guidance. The procedure is safe but more research is needed to determine the optimal interventional approach.