Pain physician
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Comparative Study
Comparison of balloon kyphoplasty with the new Kiva® VCF system for the treatment of vertebral compression fractures.
Vertebral compression fractures are common among the elderly, which is conditioned by osteoporosis. They cause back pain and limit the patient's activities. The Kiva® VCF Treatment System is a new device to treat vertebral compression fractures. Compared to other methods, the utilization of the Kiva System reduces the risk for complications and delivers improvements in back pain reduction and functionality. ⋯ The Kiva System appears to be a safe and effective procedure for the treatment of vertebral compression fractures. Six months after treatment with the Kiva System, better VAS values than the values after the treatment with balloon kyphoplasty were recorded. Reduction in functional impairment was as successful as it was after balloon kyphoplasty. Vertebral height restoration was observed in both groups, which was sustained for 6 months. The risk of cement extravasation during the Kiva Treatment is nearly the same as in balloon kyphoplasty; however, it requires a shorter operation time and produces less new fractures.
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Comparative Study
Vertebral augmentation versus conservative therapy for emergently admitted vertebral compression deformities: an economic analysis.
Vertebral augmentation (VA) performed on inpatients with painful osteoporotic vertebral compression fractures (VCFs) has been shown to facilitate discharge, decrease analgesic requirements, and improve pain. ⋯ Inpatient VA can be cost effective as demonstrated by the same daily cost between the VA and medically managed groups. Early identification and consultation can facilitate VA and rapid discharge. Anticoagulation issues and medical comorbidities can delay VA and lengthen hospital stays. Hospital admitted patients with painful osteoporotic VCF who are managed conservatively and discharged are at risk for readmission.
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Pulsed radiofrequency (PRF) therapy is a clinical treatment utilizing electromagnetic energy aimed to relieve neuropathic pain. This is the first study examining the modulated expression of pain regulatory genes following the induction of the spared nerve injury (SNI) pain model and subsequently treated with PRF therapy. ⋯ These results indicate that the electromagnetic energy applied via PRF therapy influences the reversal of behavioral and molecular effects of hypersensitivity developed from a peripheral nerve injury.
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Intermittent claudication is a typical symptom of lumbar spinal stenosis (LSS) and peripheral arterial obstructive disease (PAD). Because both LSS and PAD are predominantly associated with degenerative conditions, concomitant conditions are not uncommon. However, few reports of the demographic, clinical, and radiological characteristics of concomitant LSS and PAD (LSSPAD) have been published. ⋯ We found that concomitant PAD in patients with LSS is associated with old age, DM, the presence of aortic calcification, and ABI < 0.9. When these risk factors exist, further work up is needed to exclude the concomitant PAD.
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Case Reports
False positive radiographical evidence of pump catheter migration into the spinal cord.
Intrathecal drug delivery systems are becoming an increasingly common modality used by physicians to treat patients. Specifically, chronic spasticity secondary to multiple sclerosis (MS) may be treated with intrathecal baclofen (ITB) therapy when oral antispasmodics do not provide adequate relief. ITB therapy is effective, localizes drug delivery, and does not have the same degree of intolerable systemic effects often seen with oral and parenteral medications. ⋯ We present a case of an intrathecal baclofen pump catheter that was initially believed to have migrated into the spinal cord and the innovative use of cinefluoroscopy and digital subtraction used to identify catheter placement. Moreover, after confirmation of the catheter position within the spinal cord on magnetic resonance imaging (MRI) our team elected to perform a laminectomy, which demonstrated that the catheter was not in the spinal cord but was surrounded by arachnoid adhesions. We hope our efforts will provide the clinician insight into the common difficulties that arise and how best to troubleshoot them to serve this specific patient population and prevent potentially life-threatening complications.