Pain physician
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Review Meta Analysis
Effectiveness of thermal annular procedures in treating discogenic low back pain.
Persistent low back pain refractory to conservative treatment is a common problem that leads to widespread impairment, resulting in significant costs to society. The intervertebral disc is a major source of persistent low back pain. Technologies developed to treat this problem, including various surgical instrumentation and fusion techniques, have not reliably provided satisfactory results in terms of either pain relief or increased function. Thermal annular procedures (TAPs) were first developed in the late 1990s in an attempt to treat discogenic pain. The hope was that they would provide greater value than fusion in terms of efficacy, morbidity, and cost. Three technologies have been developed to apply heat to the annulus: intradiscal electrothermal therapy (IDET), discTRODE, and biacuplasty. Since nerve ingrowth and tissue regeneration in the annulus is felt to be the source of pain in discogenic low back pain, when describing the 3 above techniques we use the term "thermal annular procedures" rather than "thermal intradiscal procedures." We have specifically excluded studies treating the nucleus. TAPs have been the subject of significant controversy. Multiple reviews have been conducted resulting in varying conclusions. ⋯ In summary, the evidence is fair for IDET and poor for discTRODE and biacuplasty is being evaluated in 2 ongoing randomized controlled trials.
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Randomized Controlled Trial
Occipital nerve stimulation for chronic migraine: a randomized trial.
Chronic migraine (CM) and medication overuse headache (MOH) are disabling conditions that may be only partially managed with conservative treatments. Occipital nerve stimulation (ONS) is an innovative treatment for headache disorders. ⋯ According to the results obtained, ONS appears to be a safe and effective treatment for carefully selected CM and MOH patients.
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The major complications arising from vertebroplasty or kyphoplasty are related to leakage of cement beyond the confines of the collapsed vertebral body. Traditionally, a liquid (low viscosity) cement is used in most vertebroplasty systems available on the market, coupled with mechanical injection devices or one mL syringes. ⋯ Percutaneous cement augmentation in osteoporotic and malignant compression fractures using a highly viscous cement that can be safely controlled and injected via a hydraulic system can be performed safely without significant complications. The leakage rate and patterns were similar in both benign and malignant compression fractures. The use of highly viscous cement may decrease the complication rate in malignant lesions that has been traditionally described to exhibit more cement leakage with low viscosity cement.