Pain physician
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Comparative Study
Comparative assessment of different percutaneous endoscopic interlaminar lumbar discectomy (PEID) techniques.
Percutaneous endoscopic lumbar discectomy is a common surgical treatment for lumbar disc herniation, and percutaneous endoscopic interlaminar lumbar discectomy (PEID) is commonly used for direct decompression of L5-S1. Like microdiscectomy, recurrence of herniation after endoscopic discectomy is an important problem. In this study, we aimed to decrease the recurrence after PEID using a new surgical technique. ⋯ Though a learning curve is needed in order to become familiar with PEID, recurrence after PEID was associated with advanced age, and PEID with annular sealing resulted in lower early recurrence rates than without annular sealing. Thus, PEID with annular sealing may be a useful technique for reducing early recurrence.
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Case Reports
Vertebroplasty for the compression of the dorsal root ganglion due to spinal metastasis.
Radicular pain has been considered to be a relative contraindication to vertebroplasty. It was reported by some authors in the literature that percutaneous vertebroplasty (PV) in these conditions were performed without complications. ⋯ We suggest that carefully performed PV is an option for terminally ill patients with epidural and dorsal root ganglion involvement who do not respond to conservative treatment or cannot undergo radiation therapy and surgery. PV is minimally invasive compared to open surgery and may merit serious consideration in patients with limited physiologic reserves.
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The clinical management of osteolytic metastases involving C2 is unique, because it is challenging to approach these lesions. Symptoms may vary from local pain to progressive neurological deficit. Surgery or radiotherapy have been the treatments of choice for several years; however, surgery may not bean option for patients with multiple metastases and poor general medical status, and radiotherapy carries the risk of vertebral collapse and consequent neural compression due to delayed bone reconstruction. Through different approaches, vertebroplasty has been introduced into clinical practice as an alternative to traditional surgical and radiotherapy treatments of osteolytic metastases at C2. ⋯ Vertebroplasty via an anterolateral approach is an effective technique to treat osteolytic metastases involving C2. It is a valuable, minimally invasive, and efficient method that allows quick and lasting resolution of painful symptoms.
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Comparative Study
The use of advanced imaging and representation of workers compensation in vertebral augmentation: a single-center comparison with the INVEST Trial.
Vertebral augmentation (VA) techniques have changed the paradigm of treatment during the past decade and involve injection of polymethylmethacrylate (PMMA) cement directly into a compressed vertebral body. During the summer of 2009, the INVEST trial was one of 2 randomized controlled studies that reported equivalence between vertebroplasty and a control procedure. ⋯ We reviewed our time-matched database in terms of 2 variables we thought curious in the INVEST trial. In comparison to our practice, where advanced imaging is essentially required and Workers compensation largely not seen, these aspects of the INVEST trial's population stood out.
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Cervical central stenosis (CCS) is a narrowing of the spinal canal that can cause mechanical compression of the spinal nerve and roots, leading to neck pain and/or radicular pain. Cervical epidural steroid injections are commonly used in the treatment of CCS. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis with a targeted drug delivery. ⋯ Percutaneous adhesiolysis utilizing local anesthetic steroids and hypertonic sodium chloride solution may be an effective management strategy in patients with chronic posterior neck and upper extremity pain due to cervical central spinal stenosis, although there is no correlation between therapeutic response and the grade of CCS.