Pain physician
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To evaluate radiation exposure to the spinal interventionalist performing lumbar discography. A prospective study on four spinal interventionalists who performed 106 consecutive lumbar discograms (levels) on 37 patients with low back pain. Radiation exposure was monitored with the assistance of a radiological technologist (RT) who allocated four (4) dosimetry badges to all spinal interventionalists performing Discograms on consecutive patients being referred for evaluation of possible discogenic pain. ⋯ The mean/cumulative exposure per procedure was 3.66(-/+0.915)/390(-/+9.750) mREM at the "ring" badge, 2.35(-/+0.635)/251(-/+6.275) mREM at the "outside apron" badge, 1.49(-/+0.373)/159(-/+3.975) mREM at the "glasses" badge. A statistically significant higher radiation exposure was found on discograms at the L5/S1 level compared to the L4/5 and L3/4 levels. Our study illustrates that radiation exposure to the spinal interventionalist performing lumbar discography is well within safety limits.
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Lumbar zygapophyseal joints have long been considered a source of low back pain with or without leg pain. The objective of this prospective study was to investigate the therapeutic effectiveness of lumbar zygapophyseal joint radiofrequency denervation (RFD) followed by physical therapy, for the treatment of refractory lumbar zygapophyseal joint mediated low back pain secondary to lumbar zygapophyseal joint synovitis, in baseball pitchers. Participants included twelve male baseball pitchers with a diagnosis of lumbar zygapophyseal joint synovitis mediated low back pain and a subsequent difficulty in pitching. ⋯ Ten out of 12 (83%) athletes were able to return to pitching at a level attained prior to RFD. All 12 patients, experienced statistically significant low back pain relief, with a mean pre-RFD VAS of 8.4; mean post-RFD VAS of 1.7; mean pre-RFD R-M score of 12.3; and mean post-RFD R-M score of 22.3. In conclusion, athletes, experiencing lumbar zygapophyseal joint mediated low back pain secondary to zygapophyseal joint synovitis and have failed more conservative management may benefit from radiofrequency zygapophyseal joint denervation followed by a formal rehabilitation program.
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Complications of unintended intravascular penetration and subsequent injection of local anesthetics and/or other drugs occasionally are devastating. Multiple reports have related to unrecognized intravascular placement of the needle. The generally accepted technique during interventional techniques is intermittent fluoroscopy. ⋯ This case report involves description of digital subtraction to enhance visualization of contrast distribution during injection. Three series of images are included from atlanto-occipital joint, caudal epidural catheterization, and a cervical transforaminal injection. The case reports demonstrate that digital subtraction fluoroscopic imaging is superior to intermittent or live fluoroscopy in detecting intravascular injections with interventional techniques.
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Controlled substance abuse has increased at an alarming rate. However, available evidence suggests a wide variance in the use of controlled substances, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration. The primary objective of controlled substance guidelines by American Society of Interventional Pain Physicians (ASIPP) is to provide guidance for the use of controlled substances for the treatment of chronic pain. ⋯ It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, controlled substance prescribing and treatment different from that outlined here may be warranted. These guidelines do not represent "standard of care."
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It is estimated that over 50% of approximately 4 million interventional procedures performed annually in the United States are performed utilizing fluoroscopy. Fluoroscopy offers validity to interventional techniques by providing precise localization of anatomic target areas and facilitating accurate delivery of injectate. Exposure to ionizing radiation is an unavoidable consequence while performing fluoroscopic procedures. ⋯ Results of this study showed an average exposure per patient of 8.9 -/+ 0.4 seconds and per procedure of 4.9 -/+ 0.11 seconds. Scatter radiation exposure was higher outside the lead aprons compared to inside the lead aprons. Scatter radiation exposure at groin level was similar with or without lead shielding from the table to the floor.