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Back Pain: HELP
Articles by Vanessa Gabrovsky Cuéllar
Based on 3 articles published since 2010
(Why 3 articles?)

Between 2010 and 2020, Vanessa G. Cuellar wrote the following 3 articles about Back Pain.
+ Citations + Abstracts
1 Review α 2016

Cuéllar, Jason M / Cuéllar, Vanessa Gabrovsky / Scuderi, Gaetano J. ·Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA. · 450 North Roxbury Boulevard, Suite 602, Beverly Hills, CA 90210, USA. · 210 Jupiter Lakes Boulevard, Suite 3102, Jupiter, FL 33458, USA. Electronic address: scuderimd@aol.com. ·Phys Med Rehabil Clin N Am · Pubmed #27788907.


2 Clinical Trial Cytokine evaluation in individuals with low back pain using discographic lavage. 2010

Cuellar, Jason M / Golish, S Raymond / Reuter, Merrill W / Cuellar, Vanessa G / Angst, Martin S / Carragee, Eugene J / Yeomans, David C / Scuderi, Gaetano J. ·New York University Hospital for Joint Diseases, New York, NY 10003, USA. ·Spine J · Pubmed #20207331.

ABSTRACT: BACKGROUND CONTEXT: The pathophysiology underlying degenerative disc disease and its implication in painful syndromes remain unclear. However, spine magnetic resonance imaging (MRI) can demonstrate changes in disc water content and the annulus; provocative discography purportedly identifies degenerate discs causing serious low back pain; and biochemical assays have identified local inflammatory markers. No study to date has correlated pain on disc injection during discography evaluation with relevant MRI findings and biochemical markers. PURPOSE: The purpose of this study was to correlate concordant pain on during discography to biochemical markers obtained by disc lavage and MRI findings. STUDY DESIGN: This is a Phase 1 Diagnostic Test Assessment Cohort Study (Sackett and Haynes). PATIENT SAMPLE: The patient sample included 21 symptomatic patients with suspected discogenic pain and three Phase 1 control subjects. OUTCOME MEASURES: The outcome measures included discography pain scores, MRI degenerative grades, and immunoreactivity to various inflammatory cytokine concentrations present in disc lavage samples. METHODS: Twenty-one symptomatic patients with lumbar degenerative disc disease and three control subjects underwent discography, MRI, and biochemical analysis of disc lavage fluid. Lumbar MRI was scored for Pfirrmann grading of the lumbar discs, and annular disruption was identified by nuclear disc lavage. Disc lavage samples were analyzed for biochemical markers by high-sensitivity immunoassay. RESULTS: Eighty-three discs from 24 patients were studied: 67 discs from 21 patients with axial back pain (suspected discogenic pain group) and 16 discs from 3 scoliosis patients without back pain (Phase 1 control subjects). Among the biochemical markers surveyed, interferon gamma (IFN-gamma) immunoreactivity was most consistently identified in patients with axial back pain. Discs with annular disruption and concordant pain reproduction at a visual analog scale of 7 to 10/10 had greater IFN-gamma immunoreactivity than those without this finding (p=.003); however, at least some IFN-gamma immunoreactivity was found in all but one disc in the symptomatic group. CONCLUSIONS: Among the potential inflammatory markers tested in this Phase 1 study, IFN-gamma immunoreactivity was most commonly elevated in discogram "positive" discs but absent in asymptomatic controls. However, this marker was also frequently elevated in degenerative but "negative" discography discs. From these findings, Phase 2 and Phase 3 validity studies are reasonable to pursue. Phase 4 utility studies may be performed concurrently to assess this method's predictive value in outcome studies.

3 Article Accelerated degeneration after failed cervical and lumbar nucleoplasty. 2010

Cuellar, Vanessa G / Cuellar, Jason M / Vaccaro, Alexander R / Carragee, Eugene J / Scuderi, Gaetano J. ·Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA. ·J Spinal Disord Tech · Pubmed #21131800.

ABSTRACT: STUDY DESIGN: Observational cohort study. SUMMARY OF BACKGROUND DATA: Studies evaluating the treatment of presumed discogenic spine pain using nucleoplasty have reported variable success rates. It has been suggested that these procedures lower the intradiscal pressure, reduce disk protrusion, improve disk hydration, and restore disk height. It is proposed that such structural changes in treated disks correspond to the clinical improvement in patients. Radiographic and clinical evidence showing the efficacy of nucleoplasty remains inadequate. OBJECTIVE: To document the comparative changes in magnetic resonance imaging (MRI) the appearance of disk morphology as reflected by Pfirrmann classification scores before and after the nucleoplasty treatment in patients with continued symptoms. METHODS: Twenty-eight consecutive patients with persistent symptoms after nucleoplasty within 1 year of treatment were evaluated. Prenucleoplasty and postnucleoplasty MRIs were evaluated and Pfirrmann scores of the symptomatic level were determined. RESULTS: In all the treated patients, comparison between the prenucleoplasty and the postnucleoplasty MRI of the targeted disks failed to show increased signal hydration, disk space height improvement, or shrinkage of the preoperative disk bulge at a mean time of 6 months after the procedure. Of the 17 cervical levels treated in 12 patients, 5 seemed to show progressive degeneration at treated levels (42% of the patients). Of the 17 lumbar procedures in 16 patients, 4 seemed to show progressive degeneration (25% of the patients) and 1 developed a new spondylolisthesis (6.3%). Thus, 32% of the patients in our cohort showed progressive degeneration at the treated level. The median Pfirrmann score in both prenucleoplasty and postnucleoplasty was 2, and the mean Pfirrmann classification prenucleoplasty and postnucleoplasty was 1.8 and 2.1, respectively (P<0.05, 2-tailed t test). CONCLUSION: This study failed to detect any morphologic improvement of disk abnormalities by MRI evaluation in patients with persistent pain, who then underwent nucleoplasty. Thirty-two percent showed progressive degeneration in less than 1 year after nucleoplasty, a rate greater than expected by natural progression during the interval of examination.