Pain physician
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The Affordable Care Act (ACA), signature legislation of President Obama, was arguably the most consequential and comprehensive health care reform since Medicare was introduced as part of President Lyndon B. Johnson's great society. It has been claimed that many of the law's reforms are now so integrated in the health system that full repeal would be impractical, while others including President Elect Trump have rejected that idea and called for full repeal and replacement claiming ACA law cannot be fixed. ⋯ The President-elect has described the problems he perceives with the ACA; rapidly rising premiums and deductibles, narrow networks, and limits of coverage imposed by health insurance companies. The President-elect has indicated that his goal will be to create a patient-centered health care system that promotes choice, quality, and affordability with health insurance and health care, and take any needed action to alleviate the burdens imposed on American families and businesses by law. Key words: Affordable Care Act, ObamaCare, Medicaid, exchanges, Trump plan, repeal, replace.
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Percutaneous access to the vertebral bodies is commonly done via the transpedicular approach for both diagnoses and treatment of spinal pathology. While this approach is effective in most cases, it is difficult in certain situations such as a patient with obstructing hardware from prior surgery. ⋯ The thoracic and lumbar vertebral bodies may be accessed using a percutaneous extrapedicular access technique which represents a relatively avascular and aneural approach to the vertebral body. The technique presented allows access to the vertebral body around existing hardware and can accommodate the placement of large instruments. This technique was not associated with any known complications in our series of patients.Key words: Vertebral body, spine, extrapedicular, kyphoplasty, vertebroplasty, paraspinal, thoracic, lumbar.
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Review Meta Analysis
Comparative Effectiveness of Suprascapular Nerve Block in the Relief of Acute Post-Operative Shoulder Pain: A Systematic Review and Meta-analysis.
The suprascapular nerve accounts for 70% of shoulder sensory innervations, and suprascapular nerve block (SSNB) has been shown to be effective in the relief of chronic shoulder pain including rotator cuff tendinitis, subdeltoid impingement syndrome, and adhesive capsulitis. However, this remains inconclusive for patients undergoing surgery. The present meta-analysis aimed to explore the effectiveness of SSNB for relieving acute post-operative shoulder pain. ⋯ Suprascapular nerve, shoulder surgery, thoracotomy, laparoscopic surgery.