Articles: back-pain.
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Introduction. Spinal cord stimulation is a widely used treatment modality for chronic pain, especially failed back surgery syndrome. However, migration of the lead or leads, coverage of axial pain, and the selection of an optimal system configuration continue to be subjects for serious debate. Materials and Methods. A retrospective study of the use of the method of "midline anchoring" of a single Octrode® lead, in 54 patients with low back and/or lower extremity pain, was done to assess the efficacy of this technique. ⋯ A "guarded cathode" array was used in the vast majority of the cases, with a relatively low position of the lead. Conclusions. "Midline anchoring" of the spinal cord stimulation lead is an effective implantation technique, allowing the use of a single, percutaneous, Octrode® lead, while preventing lead migration and allowing capture of axial and lower extremity pain, unilateral as well as bilateral. This study revives the idea of a single lead as a possible optimal configuration.
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Minim Invas Neurosur · Oct 2008
Minimally invasive vertebroplasty in the treatment of pain induced by spinal metastatic tumor.
Spinal metastatic tumor is a common problem and represents a challenging problem in oncology practice. Patients with osteolytic metastases often suffer from intractable local and/or radicular pain. Percutaneous vertebroplasty is a minimally invasive, radiologically guided procedure whereby bone cement is injected into structurally weakened vertebrae to provide immediate biomechanical stability. ⋯ The complication rate is about 21.8%, bone cement extravasation without neurological deficit is the most common complication. No new or adjacent vertebral fracture has occurred in more than 2 years follow-up. Percutaneous vertebroplasty is a minimally invasive procedure that offers a remarkable advantage of effective and immediate pain relief with few complications.
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There are currently 6 reviews on (pulsed) radiofrequency (RF) for the management of spinal pain. Two reviews on interventional pain management techniques in general also discuss RF. The outcomes of those reviews depend on the type of studies included and the opinion of the reviewers, which may result in different evidence levels. ⋯ Future research to confirm or deny the efficacy of (P)RF should be conducted in carefully selected patient populations. The tests used for patient inclusion in such a trial could potentially help the clinician in selecting patients for this type of treatment. The value of PRF treatment of the peripheral nerves also needs to be confirmed in well-designed trials.
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The aims of this study were: (1) to describe and compare pain intensity, disability, cognitive, physical, behavioral, and environmental variables in 4 predefined categories, on the basis of duration and recurrence of nonspecific spinal pain; and (2) to compare disability, cognitive, physical, behavioral, and environmental variables in these 4 predefined categories, after controlling for pain intensity. ⋯ After controlling for pain intensity, categories based on pain duration/recurrence differed in 3 cognitive variables and perceived social support. Pain expectations, catastrophizing and perceived social support were related to longer duration of pain. Between-group differences were small and pain duration/recurrence was not an important explanatory factor.
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Review Case Reports Comparative Study
Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity.
Minimally invasive and interbody and instrumented fusion techniques are increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar spine. Advocates of minimal access spinal approaches list certain advantages over open procedures, including decreased postoperative pain and narcotic requirements, shorter hospital stays, less blood loss, and smaller incisions. The minimally invasive anterolateral approach allows access to the lumbar spine through the retroperitoneal space. ⋯ One patient had additional posterior segmental instrumentation placed. Mean Cobb angles in the coronal plane were 28.5 degrees preoperatively and 18.3 degrees postoperatively (P < 0.05). We also present a historical perspective on retroperitoneal spine surgery, a regional anatomic description of the lumbosacral plexus and surrounding structures, and a description of the surgical technique as related to treatment of lumbar deformity.