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Back Pain: HELP
Articles from Lousiana
Based on 46 articles published since 2008
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These are the 46 published articles about Back Pain that originated from Lousiana during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Tuberculous Spondylolisthesis: A Reappraisal of the Clinicoradiologic Spectrum and Surgical Treatment Paradigm. 2018

Narayan, Vinayak / Mohammed, Nasser / Savardekar, Amey R / Patra, Devi Prasad / Nanda, Anil. ·Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. · Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. Electronic address: ananda@lsuhsc.edu. ·World Neurosurg · Pubmed #29526779.

ABSTRACT: INTRODUCTION: Spinal tuberculosis (TB) is a common infectious disease prevalent in developing countries and an increasing issue in developed countries. The association of tuberculosis with spondylolisthesis is rarely reported in literature. The aim of our review is to analyze the clinical features and radiologic characteristics of TB spondylolisthesis and to provide a concise update on its surgical management, based on the literature. METHODS: A systematic review was performed after conducting a thorough search of the PubMed database. Articles were selected systematically and reviewed completely and relevant data were summarized and discussed. RESULTS: Nineteen articles were selected for the review. The most common clinical manifestation was focal back pain, followed by motor deficit. Most patients had grade 2 listhesis and associated tubercular abscess. The anterior as well as the posterior surgical approach have their own advantages and the choice of approach depends on the location of disease, ease of access, achievement of spinal stability, and avoidance of spread of contiguous infection. Although a posterior approach and fixation using pedicular screws and rods along with debridement of pus or granulation tissue is the favored approach in dorsolumbar TB, an anterior approach, corpectomy, and fusion are preferred in cervical TB. CONCLUSIONS: Treatment of TB spondylolisthesis encompasses a wide spectrum of surgical options. However, the mainstay of treatment is chemotherapy. The indications for which surgical management may have an upper hand over medical management are spinal cord compression, significant instability, large tubercular abscess, painful vertebral lesions, kyphosis, and infection by multidrug-resistant TB or extreme drug-resistant TB, when medical management alone does not help. Surgery is effective in these situations by achieving radical debridement, permanent stability, prevention of further neurologic deterioration, and early recovery. Even although conservative management may help in certain cases, a posterior approach, decompression, and fusion are preferred for unstable dorsolumbar disease, whereas an anterior approach is preferred for cervical disease. Combined approaches can be considered in pediatric spinal TB for the correction of kyphotic deformity and its consequent maintenance.

2 Review An Analysis of New Approaches and Drug Formulations for Treatment of Chronic Low Back Pain. 2017

Bhangare, Karishma Patel / Kaye, Alan D / Knezevic, Nebojsa Nick / Candido, Kenneth D / Urman, Richard D. ·Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. · Department of Anesthesiology and Pain Medicine, Louisiana State University School of Medicine, LSU Health Science Center, 1542 Tulane Avenue, Room 659, New Orleans, LA 70112, USA. · Department of Anesthesiology and Pain Medicine, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA. · Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: urmanr@gmail.com. ·Anesthesiol Clin · Pubmed #28526154.

ABSTRACT: The prevalence of chronic low back pain (CLBP) is increasing. Treatment is effective in less than 50% of patients after 1 year. This review investigates new treatments for CLBP. An extensive literature review focuses on new treatments for CLBP. Their safety and efficacy were evaluated and are described in detail in this review. The investigation identified new treatments for CLBP including chemonucleolysis, platelet-rich plasma injections, artemin, tanezumab, and stem cells. Further research and innovation are needed to implement these methods into practice and assess clinical significance. The current evidence suggests that there are promising new agents for the treatment of CLBP.

3 Review A critical overview of the current myofascial pain literature - July 2016. 2016

Dommerholt, Jan / Grieve, Rob / Finnegan, Michelle / Hooks, Todd. ·Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: jan@myopain4u.com. · Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of the West of England, Blackberry Hill, Bristol, United Kingdom. Electronic address: Rob.Grieve@uwe.ac.uk. · Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA. Electronic address: mbfpt77@gmail.com. · New Orleans Pelicans, New Orleans, LA, USA. Electronic address: trhooks@hotmail.com. ·J Bodyw Mov Ther · Pubmed #27634092.

ABSTRACT: The overview of the myofascial pain literature includes a wide variety of basic and clinical studies, ranging from assessing muscle activation patterns to the impact of platelet-rich plasma injections. Contributions to the literature once again came from all corners of the world, such as Australia, Belgium, Brazil, Germany, Greece, Iran, Italy, Japan, Korea, the Netherlands, Norway, Poland, Spain, Taiwan, Turkey, and the USA. A total of 30 papers are included in this overview.

4 Review A Systematic Review and Best Evidence Synthesis of the Effectiveness of Therapeutic Facet Joint Interventions in Managing Chronic Spinal Pain. 2015

Manchikanti, Laxmaiah / Kaye, Alan D / Boswell, Mark V / Bakshi, Sanjay / Gharibo, Christopher G / Grami, Vahid / Grider, Jay S / Gupta, Sanjeeva / Jha, Sachin Sunny / Mann, Dharam P / Nampiaparampil, Devi E / Sharma, Manohar Lal / Shroyer, Lindsay N / Singh, Vijay / Soin, Amol / Vallejo, Ricardo / Wargo, Bradley W / Hirsch, Joshua A. ·Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; LSU Health Science Center, New Orleans, LA; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; Manhattan Spine an. ·Pain Physician · Pubmed #26218948.

ABSTRACT: BACKGROUND: The therapeutic spinal facet joint interventions generally used for the treatment of axial spinal pain of facet joint origin are intraarticular facet joint injections, facet joint nerve blocks, and radiofrequency neurotomy. Despite interventional procedures being common as treatment strategies for facet joint pathology, there is a paucity of literature investigating these therapeutic approaches. Systematic reviews assessing the effectiveness of various therapeutic facet joint interventions have shown there to be variable evidence based on the region and the modality of treatment utilized. Overall, the evidence ranges from limited to moderate. OBJECTIVE: To evaluate and update the clinical utility of therapeutic lumbar, cervical, and thoracic facet joint interventions in managing chronic spinal pain. STUDY DESIGN: A systematic review of therapeutic lumbar, cervical, and thoracic facet joint interventions for the treatment of chronic spinal pain. METHODS: The available literature on lumbar, cervical, and thoracic facet joint interventions in managing chronic spinal pain was reviewed. The quality assessment criteria utilized were the Cochrane Musculoskeletal Review Group criteria and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized trials and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for observational studies. The level of evidence was classified at 5 levels from Level I to Level V. Data sources included relevant literature identified through searches on PubMed and EMBASE from 1966 through March 2015, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake consumption. RESULTS: A total of 21 randomized controlled trials meeting appropriate inclusion criteria were assessed in this evaluation. A total of 5 observational studies were assessed. In the lumbar spine, for long-term effectiveness, there is Level II evidence for radiofrequency neurotomy and lumbar facet joint nerve blocks, whereas the evidence is Level III for lumbosacral intraarticular injections. In the cervical spine, for long-term improvement, there is Level II evidence for cervical radiofrequency neurotomy and cervical facet joint nerve blocks, and Level IV evidence for cervical intraarticular injections. In the thoracic spine there is Level II evidence for thoracic facet joint nerve blocks and Level IV evidence for radiofrequency neurotomy for long-term improvement. LIMITATIONS: The limitations of this systematic review include an overall paucity of high quality studies and more specifically the lack of investigations related to thoracic facet joint injections. CONCLUSION: Based on the present assessment for the management of spinal facet joint pain, the evidence for long-term improvement is Level II for lumbar and cervical radiofrequency neurotomy, and therapeutic facet joint nerve blocks in the cervical, thoracic, and lumbar spine; Level III for lumbar intraarticular injections; and Level IV for cervical intraarticular injections and thoracic radiofrequency neurotomy.

5 Review A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain. 2015

Boswell, Mark V / Manchikanti, Laxmaiah / Kaye, Alan D / Bakshi, Sanjay / Gharibo, Christopher G / Gupta, Sanjeeva / Jha, Sachin Sunny / Nampiaparampil, Devi E / Simopoulos, Thomas T / Hirsch, Joshua A. ·Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; LSU Health Science Center, New Orleans, LA; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; Manhattan Spine an. ·Pain Physician · Pubmed #26218947.

ABSTRACT: BACKGROUND: Spinal zygapophysial, or facet, joints are a source of axial spinal pain and referred pain in the extremities. Conventional clinical features and other noninvasive diagnostic modalities are unreliable in diagnosing zygapophysial joint pain. STUDY DESIGN: A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks. OBJECTIVE: To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain. METHODS: A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. The level of evidence was classified as Level I to V based on the grading of evidence utilizing best evidence synthesis. Data sources included relevant literature identified through searches of PubMed and other electronic searches published from 1966 through March 2015, Cochrane reviews, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES: Studies must have been performed utilizing controlled local anesthetic blocks. The criterion standard must have been at least 50% pain relief from baseline scores and the ability to perform previously painful movements. RESULTS: The available evidence is Level I for lumbar facet joint nerve blocks with the inclusion of a total of 17 studies with dual diagnostic blocks, with at least 75% pain relief with an average prevalence of 16% to 41% and false-positive rates of 25% to 44%. The evidence for diagnosis of cervical facet joint pain with cervical facet joint nerve blocks is Level II based on a total of 11 controlled diagnostic accuracy studies, with significant variability among the prevalence in a heterogenous population with internal inconsistency. The prevalence rates ranged from 36% to 67% with at least 80% pain relief as the criterion standard and a false-positive rate of 27% to 63%. The level of evidence for the diagnostic accuracy of thoracic facet joint nerve blocks is Level II with 80% or higher pain relief as the criterion standard with a prevalence ranging from 34% to 48% and false-positive rates ranging from 42% to 48%. LIMITATIONS: The shortcomings of this systematic review include a paucity of literature related to the thoracic spine, continued debate on an appropriate gold standard, appropriateness of diagnostic blocks, and utility. CONCLUSION: The evidence is Level I for the diagnostic accuracy of lumbar facet joint nerve blocks, Level II for cervical facet joint nerve blocks, and Level II for thoracic facet joint nerve blocks in assessment of chronic spinal pain.

6 Review Using the International Classification of Functioning, Disability and Health in Physiotherapy in Multidisciplinary Vocational Rehabilitation: A Case Study of Low Back Pain. 2015

Finger, Monika E / Selb, Melissa / De Bie, Robert / Escorpizo, Reuben. ·Swiss Paraplegic Research (SPF), Nottwil, Switzerland. · ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Nottwil, Switzerland. · CAPHRI Research School, Maastricht University, Maastricht, The Netherlands. · Department of Epidemiology and Institute for Education, Maastricht University, Maastricht, The Netherlands. · Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, USA. · Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland. ·Physiother Res Int · Pubmed #24733817.

ABSTRACT: OBJECTIVES: Multidisciplinary teamwork is increasingly recognized as a critical factor of success in vocational rehabilitation. Although its clinical implementation is still challenging, the International Classification of Functioning, Disability and Health (ICF) has shown to be a useful framework to facilitate communication between stakeholders, to help structure rehabilitation plans and for setting goals and clarifying team roles. With this in mind, the objective of this teaching case study is to illustrate an application of ICF-based tools in a multidisciplinary return to work (RTW) program for patients with non-specific low back pain (NLBP) from the perspective of the physiotherapist. PARTICIPANT: The participant is a 42-year-old kindergarten teacher, who was on sick leave for 10 weeks due to NLBP. METHODS: This case study describes the use of ICF-based tools such as the Rehabilitation Management Sheet (RehabManagement-Sheet) to guide the rehabilitation process and facilitate team-based and physiotherapist goal setting and documentation in a multidisciplinary RTW program for NLBP. RESULTS: Utilizing ICF tools, we defined long-term and short-term goals, documented improvements in the patient's impairments, activity limitations, and participation restrictions and formulated action steps. CONCLUSION: The use of ICF-based tools in multidisciplinary rehabilitation allows for a comprehensive assessment, common goal setting and coordinated intervention planning. ICF-based tools like the RehabManagement-Sheet support the physiotherapist's role within the rehabilitation team by enhancing transparency in goal setting and intervention planning across disciplines.

7 Review Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. 2012

Parr, Allan T / Manchikanti, Laxmaiah / Hameed, Haroon / Conn, Ann / Manchikanti, Kavita N / Benyamin, Ramsin M / Diwan, Sudhir / Singh, Vijay / Abdi, Salahadin. ·Premier Pain Center, Covington, LA, USA. alparr@alparr.com ·Pain Physician · Pubmed #22622911.

ABSTRACT: BACKGROUND: Epidural injections with local anesthetics and steroids are one of the most commonly used interventions in managing chronic low back pain and lower extremity pain of various causes. However, despite their extensive use, debate continues on their effectiveness due to the lack of well-designed, randomized, controlled studies to determine the effectiveness of epidural injections in general, and caudal epidural injections in particular. STUDY DESIGN: A systematic review of caudal epidural injections with or without steroids in managing chronic pain secondary to lumbar disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and discogenic pain without disc herniation or radiculitis. OBJECTIVE: To evaluate the effect of caudal epidural injections with or without steroids in managing various types of chronic low back pain with or without lower extremity pain emanating as a result of disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and chronic discogenic pain. METHODS: The available literature on caudal epidural injections with or without steroids in managing various types of chronic low back pain with or without lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for fluoroscopic observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. RESULTS: For this systematic review, 73 studies were identified. Of these, 51 were excluded and a total of 16 studies met inclusion criteria for methodological quality assessment with 11 randomized trials and 5 non-randomized studies. For lumbar disc herniation, the evidence is good for short- and long-term relief of chronic pain secondary to disc herniation or radiculitis with local anesthetic and steroids and fair relief with local anesthetic only. In managing chronic axial or discogenic pain, spinal stenosis, and post surgery syndrome, the indicated evidence is fair. LIMITATIONS: The limitations of this study include the paucity of literature, specifically for chronic pain without disc herniation. CONCLUSION: There was good evidence for short- and long-term relief of chronic pain secondary to disc herniation or radiculitis with local anesthetic and steroids and fair relief with local anesthetic only. Further, this systematic review also provided indicated evidence of fair for caudal epidural injections in managing chronic axial or discogenic pain, spinal stenosis, and post surgery syndrome.

8 Review Undifferentiated spondyloarthritis: recent clinical and therapeutic advances. 2010

Cruzat, Vanesa / Cuchacovich, Raquel / Espinoza, Luis R. ·Section of Rheumatology, Department of Medicine, LSU Health Sciences Center at New Orleans, 1542 Tulane Avenue, New Orleans, LA 70112-2822, USA. ·Curr Rheumatol Rep · Pubmed #20632136.

ABSTRACT: The spondyloarthropathies comprise a large clinical spectrum of disorders that include well-defined clinical disorders such as ankylosing spondylitis and less well-defined disorders such as undifferentiated spondyloarthritis, which refers to patients with inflammatory back pain not fulfilling classification criteria for ankylosing spondylitis and without radiologic evidence of sacroillitis. These disorders share clinical and genetic features and are linked by their association with HLA-B27 and by the presence of enthesitis as the basic pathologic lesion. The prevalence of the entire group ranges between 0.6% and 1.9%. This article reviews the recent advances in our understanding of the clinical spectrum, pathogenesis, genetics, and management of undifferentiated spondyloarthritis.

9 Review Musculoskeletal disorders. 2010

LeBlanc, Kim Edward / LeBlanc, Leanne L. ·Department of Family Medicine, Louisiana State University Health Sciences Center School of Medicine, 1542 Tulane Avenue, Room 123, T1-8, New Orleans, LA 70112, USA. klebla@lsuhsc.edu ·Prim Care · Pubmed #20493342.

ABSTRACT: Musculoskeletal system complaints are one of the most common reasons that patients seek medical care. A significant number of these patients use complementary and alternative medicine. This article discusses the most common musculoskeletal problems for which patients present to a physician's office. These include osteoarthritis, rheumatoid arthritis, low back pain, neck pain, and myofascial pain syndrome.

10 Review Axial gouty arthropathy. 2009

Saketkoo, Lesley Ann / Robertson, Hugh J / Dyer, Herbert R / Virk, Zia-Ullah / Ferreyro, Humberto Roque / Espinoza, Luis R. ·Section of Rheumatology, Department of Internal Medicine, Louisiana State University Health Sciences Center, 820 Napoleon Avenue, Suite 890, New Orleans, LA 70115, USA. saketkoo.md@gmail.com ·Am J Med Sci · Pubmed #19680018.

ABSTRACT: Gouty involvement of the spinal column is not as rare as generally perceived. Tophaceous gout involving the spinal column is a well-documented cause of myelopathy and frank cord compression. It takes several years of gout before bony destruction is radiologically apparent. If erosive or tophaceous gout is present, magnetic resonance imaging signal enhancement offers diagnostic guidance. Non-tophaceous gout of the spine may also show signal enhancement consistent with inflammation. The sequelae of cord compression can be reversed with timely surgical intervention and maintenance of uric acid-lowering therapy; in some cases, medical therapy alone can reverse the findings of radiculopathy. Growing evidence suggests that the tangled web of hypertension, diabetes, and atherosclerotic disease are risk factors for gout and hyperuricemia and may, in fact, be the result of higher than physiologically tolerable levels of uric acid in humans. Here, 52 additional cases to the 73 collated by Hou et al (Surg Neurol. 2007;67:65-73), reinforce that gout is a major contender on the differential diagnosis of back-related presentations in patients at high risk for gout. The pervasiveness of cardiovascular disease and chronic back pain warrants a closer look into a possible occult contributor to the prevalence of chronic back pain: gout.

11 Review Lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain: a systematic review. 2009

Parr, Allan T / Diwan, Sudhir / Abdi, Salahadin. ·Premier Pain Center, Covington, LA 70433, USA. alparr@alparr.com ·Pain Physician · Pubmed #19165302.

ABSTRACT: BACKGROUND: Low back pain with or without lower extremity pain is the most common problem among chronic pain disorders with significant economic, societal, and health impact. Epidural injections are one of the most commonly performed interventions in the United States in managing chronic low back pain. However the evidence is highly variable among different techniques utilized - namely interlaminar, caudal, transforaminal - and for various conditions, namely - intervertebral disc herniation, spinal stenosis, and discogenic pain without disc herniation or radiculitis. STUDY DESIGN: A systematic review of lumbar interlaminar epidural injections with or without steroids. OBJECTIVE: To evaluate the effect of lumbar interlaminar epidural injections with or without steroids in managing various types of chronic low back and lower extremity pain emanating as a result of disc herniation or radiculitis, spinal stenosis, and chronic discogenic pain. METHODS: Review of the literature and methodologic quality assessment were performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF) for therapeutic interventions. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles. Results of analysis were performed for multiple conditions separately. OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. RESULTS: The available literature included only blind epidural injections without fluoroscopy. The indicated evidence is positive (Level II-2) for short-term relief of pain of disc herniation or radiculitis utilizing blind interlaminar epidural steroid injections with lacking of evidence with Level III for long-term relief for disc herniation and radiculitis. The evidence is lacking with Level III for short and long-term relief for spinal stenosis and discogenic pain without radiculitis or disc herniation utilizing blind epidural injections. LIMITATIONS: The limitations of this study include paucity of literature, lack of quality evidence, lack of fluoroscopic procedures, and lack of applicable evidence in contemporary interventional pain management practices. CONCLUSION: The evidence based on this systematic review is limited for blind interlaminar epidurals in managing all types of pain except for short-term relief of pain secondary to disc herniation and radiculitis. This evidence does not represent contemporary interventional pain management practices and also the evidence may not be extrapolated to fluoroscopically directed lumbar interlaminar epidural injections.

12 Review Systematic review of caudal epidural injections in the management of chronic low back pain. 2009

Conn, Ann / Buenaventura, Ricardo M / Datta, Sukdeb / Abdi, Salahadin / Diwan, Sudhir. ·Premier Pain Center, Covington, LA, USA. annconn@gmail.com ·Pain Physician · Pubmed #19165299.

ABSTRACT: BACKGROUND: Caudal epidural injection of local anesthetics with or without steroids is one of the most commonly used interventions in managing chronic low back and lower extremity pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of caudal epidural injections in various conditions - disc herniation and radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic low back pain of disc origin without disc herniation or radiculitis. STUDY DESIGN: A systematic review of caudal epidural injections with or without steroids in managing chronic pain secondary to lumbar disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and discogenic pain without disc herniation or radiculitis. OBJECTIVE: To evaluate the effect of caudal epidural injections with or without steroids in managing various types of chronic low back and lower extremity pain emanating as a result of disc herniation or radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic discogenic pain. METHODS: A review of the literature was performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles. OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > or = 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. RESULTS: The evidence showed Level I for short- and long-term relief in managing chronic low back and lower extremity pain secondary to lumbar disc herniation and/or radiculitis and discogenic pain without disc herniation or radiculitis. The indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing low back pain of post-lumbar laminectomy syndrome and spinal stenosis. LIMITATIONS: The limitations of this study include the paucity of literature, specifically for chronic pain without disc herniation. CONCLUSION: This systematic review shows Level I evidence for relief of chronic pain secondary to disc herniation or radiculitis and discogenic pain without disc herniation or radiculitis. Further, the indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing chronic pain of post lumbar laminectomy syndrome and spinal stenosis.

13 Article Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. 2019

Navani, Annu / Manchikanti, Laxmaiah / Albers, Sheri L / Latchaw, Richard E / Sanapati, Jaya / Kaye, Alan D / Atluri, Sairam / Jordan, Sheldon / Gupta, Ashim / Cedeno, David / Vallejo, Alejandro / Fellows, Bert / Knezevic, Nebojsa Nick / Pappolla, Miguel / Diwan, Sudhir / Trescot, Andrea M / Soin, Amol / Kaye, Adam M / Aydin, Steve M / Calodney, Aaron K / Candido, Kenneth D / Bakshi, Sanjay / Benyamin, Ramsin M / Vallejo, Ricardo / Watanabe, Art / Beall, Douglas / Stitik, Todd P / Foye, Patrick M / Helander, Erik M / Hirsch, Joshua A. ·Comprehensive Pain Management Center, Campbell, CA. · Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY. · University Pain Medicine and Rehabilitation Center, Newark, NJ. · LSU Health Science Center, New Orleans. · Tri State Spine Care Institute. · Associate Director of Research at Millennium Pain Center, Bloomington, IL; Chief Science Officer at South Texas Orthopaedic Research Institute, Laredo, TX; and Adjunct Researcher at Illinois Wesleyan University, Bloomington, IL. · Millennium Pain Center, Bloomington, IL; Illinois Wesleyan University, Bloomington, Illinois. · Millennium Pain Center, Bloomington, Illinois; University of Illinois at Urbana-Champaign, Champaign, Illinois. · Vice Chair for Research and Education, Department of Anesthesiology and Pain Management, Advocate Illinois Masonic Medical Center, Clinical Associate Professor of Anesthesiology and Surgery at University of Illinois, Chicago, IL. · St. Michael's Pain and Spine Clinics, Houston, TX, and Univeristy of Texas Medical Branch, Galveston, TX. · Pain and Headache Center, Eagle River, Alaska. · Ohio Pain Clinic. · Manhattan Spine and Pain Medicine, New York, NY, and Hofstra-North Shore/LIJ School of Medicine, New York, NY. · Texas Spine and Joint Hospital, Tyler, TX. · SurgiCare of Manhattan and Lenox Hill Hospital. · Millennium Pain Center, Bloomington, IN. · Mt. Baker Pain Center, Bellingham, WA. · Clinical Radiology of Oklahoma, Edmond, OK. · Department of Anesthesiology, LSU School of Medicine, New Orleans, LA. · Massachusetts General Hospital and Harvard Medical School, Boston, MA. ·Pain Physician · Pubmed #30717500.

ABSTRACT: BACKGROUND: Regenerative medicine is a medical subspecialty that seeks to recruit and enhance the body's own inherent healing armamentarium in the treatment of patient pathology. This therapy's intention is to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous or allogenic biologics. This field is rising like a Phoenix from the ashes of underperforming conventional therapy midst the hopes and high expectations of patients and medical personnel alike. But, because this is a relatively new area of medicine that has yet to substantiate its outcomes, care must be taken in its public presentation and promises as well as in its use. OBJECTIVE: To provide guidance for the responsible, safe, and effective use of biologic therapy in the lumbar spine. To present a template on which to build standardized therapies using biologics. To ground potential administrators of biologics in the knowledge of the current outcome statistics and to stimulate those interested in providing biologic therapy to participate in high quality research that will ultimately promote and further advance this area of medicine. METHODS: The methodology used has included the development of objectives and key questions. A panel of experts from various medical specialties and subspecialties as well as differing regions collaborated in the formation of these guidelines and submitted (if any) their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these guidelines. The literature pertaining to regenerative medicine, its effectiveness, and adverse consequences was thoroughly reviewed using a best evidence synthesis of the available literature. The grading for recommendation was provided as described by the Agency for Healthcare Research and Quality (AHRQ). SUMMARY OF EVIDENCE: Lumbar Disc Injections: Based on the available evidence regarding the use of platelet-rich plasma (PRP), including one high-quality randomized controlled trial (RCT), multiple moderate-quality observational studies, a single-arm meta-analysis and evidence from a systematic review, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best-evidence synthesis. Based on the available evidence regarding the use of medicinal signaling/ mesenchymal stem cell (MSCs) with a high-quality RCT, multiple moderate-quality observational studies, a single-arm meta-analysis, and 2 systematic reviews, the qualitative evidence has been assessed as Level III (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Epidural Injections Based on one high-quality RCT, multiple relevant moderate-quality observational studies and a single-arm meta-analysis, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Lumbar Facet Joint Injections Based on one high-quality RCT and 2 moderate-quality observational studies, the qualitative evidence for facet joint injections with PRP has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. Sacroiliac Joint Injection Based on one high-quality RCT, one moderate-quality observational study, and one low-quality case report, the qualitative evidence has been assessed as Level IV (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis. CONCLUSION: Based on the evidence synthesis summarized above, there is Level III evidence for intradiscal injections of PRP and MSCs, whereas the evidence is considered Level IV for lumbar facet joint, lumbar epidural, and sacroiliac joint injections of PRP, (on a scale of Level I through V) using a qualitative modified approach to the grading of evidence based on best evidence synthesis.Regenerative therapy should be provided to patients following diagnostic evidence of a need for biologic therapy, following a thorough discussion of the patient's needs and expectations, after properly educating the patient on the use and administration of biologics and in full light of the patient's medical history. Regenerative therapy may be provided independently or in conjunction with other modalities of treatment including a structured exercise program, physical therapy, behavioral therapy, and along with the appropriate conventional medical therapy as necessary. Appropriate precautions should be taken into consideration and followed prior to performing biologic therapy. Multiple guidelines from the Food and Drug Administration (FDA), potential limitations in the use of biologic therapy and the appropriate requirements for compliance with the FDA have been detailed in these guidelines. KEY WORDS: Regenerative medicine, platelet-rich plasma, medicinal signaling cells, mesenchymal stem cells, stromal vascular fraction, bone marrow concentrate, chronic low back pain, discogenic pain, facet joint pain, Food and Drug Administration, minimal manipulation, evidence synthesis.

14 Article Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain: A Systematic Review and Metaanalysis. 2018

Sanapati, Jaya / Manchikanti, Laxmaiah / Atluri, Sairam / Jordan, Sheldon / Albers, Sheri L / Pappolla, Miguel A / Kaye, Alan D / Candido, Kenneth D / Pampati, Vidyasagar / Hirsch, Joshua A. ·University Pain Medicine and Rehabilitation Center, Newark, NJ. · Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY. · Tri State Spine Care Institute. · St. Michael's Pain and Spine Clinics, Houston, TX, and Univeristy of Texas Medical Branch, Galveston, TX. · LSU Health Science Center, New Orleans. · Pain Management Center of Paducah. · Massachusetts General Hospital and Harvard Medical School, Boston, MA. ·Pain Physician · Pubmed #30508983.

ABSTRACT: BACKGROUND: Several cell-based therapies have been proposed in recent years the management of low back pain, including the injection of medicinal signaling cells or mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP). However, there is only emerging clinical evidence to support their use at this time. OBJECTIVE: To assess the effectiveness of MSCs or PRP injections in the treatment of low back and lower extremity pain. STUDY DESIGN: A systematic review and metaanalysis of the effectiveness of PRP and MSCs injections in managing low back and lower extremity pain. DATA SOURCES: PubMed, Cochrane Library, US National Guideline Clearinghouse, prior systematic reviews, and reference lists. The literature search was performed from 1966 through June 2018. STUDY SELECTION: Randomized trials, observational studies, and case reports of injections of biologics into the disc, epidural space, facet joints, or sacroiliac joints. DATA EXTRACTION: Data extraction and methodological quality assessment were performed utilizing Cochrane review methodologic quality assessment and Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) and Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR). The evidence was summarized utilizing principles of best evidence synthesis on a scale of 1 to 5. DATA SYNTHESIS: Twenty-one injection studies met inclusion criteria. There were 12 lumbar disc injections, 5 epidural, 3 lumbar facet joint, and 3 sacroiliac joint studies RESULTS: Evidence synthesis based on a single-arm metaanalysis, randomized controlled trials (RCTs), and observational studies, disc injections of PRP and MSCs showed Level 3 evidence (on a scale of Level I through V). Evidence for epidural injections based on single-arm metaanalysis, a single randomized controlled trial and other available studies demonstrated Level 4 (on a scale of Level I through V) evidence. Similarly, evidence for lumbar facet joint injections and sacroiliac joint injections without metaanalysis demonstrated Level 4 evidence (on a scale of Level I through V). LIMITATIONS: Lack of high quality RCTs. CONCLUSION: The findings of this systematic review and single-arm metaanalysis shows that MSCs and PRP may be effective in managing discogenic low back pain, radicular pain, facet joint pain, and sacroiliac joint pain, with variable levels of evidence in favor of these techniques. KEY WORDS: Chronic low back pain, regenerative therapy, medicinal signaling or mesenchymal stem cells, platelet-rich plasma, disc injection, lumbar facet joint injections, sacroiliac joint injections.

15 Article Musculoskeletal Injuries Affecting Radiologists According to the 2017 ACR Human Resources Commission Workforce Survey. 2018

Parikh, Jay R / Bender, Claire / Bluth, Edward. ·Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: jrparikh@mdanderson.org. · Department of Radiology, Mayo Clinic, Rochester, Minnesota. · Department of Radiology, Ochsner Clinic Foundation and The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana. ·J Am Coll Radiol · Pubmed #29571645.

ABSTRACT: Practice leaders surveyed in the 2017 ACR Human Resources Commission workforce survey reported that 25% of the radiologists or radiation oncologists they supervised had neck pain, 32% had low back pain, and 16% were dealing with a repetitive stress injury. The prevalence rates of these musculoskeletal ailments among radiologists and radiation oncologists were consistent with those reported in the literature in other populations. However, these prevalence rates may be underestimated because practice leaders, not the radiologists themselves, were surveyed, and the leaders may not be aware of all injuries.

16 Article Exercise intervention for unilateral amputees with low back pain: study protocol for a randomised, controlled trial. 2017

Wasser, Joseph G / Herman, Daniel C / Horodyski, MaryBeth / Zaremski, Jason L / Tripp, Brady / Page, Phillip / Vincent, Kevin R / Vincent, Heather K. ·Department of Orthopaedics and Rehabilitation, UF Health Orthopaedics and Sports Medicine Institute (OSMI), University of Florida, Gainesville, FL, 32611, USA. wassejg@ortho.ufl.edu. · Department of Orthopaedics and Rehabilitation, UF Health Orthopaedics and Sports Medicine Institute (OSMI), University of Florida, Gainesville, FL, 32611, USA. · Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, 32608, USA. · Performance Health, Baton Rouge, Louisiana, USA. ·Trials · Pubmed #29284521.

ABSTRACT: BACKGROUND: Atraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP). Resistance training interventions that focus on core stabilization, lumbar strength and dynamic stability during loading have strong potential to reduce LBP and address amputation-related changes to the musculoskeletal system. Home-based resistance exercise programs may be attractive to patients to minimize travel and financial burdens. METHODS/DESIGN: This study will be a single-assessor-blinded, pre-post-test randomised controlled trial involving 40 men and women aged 18-60 years with traumatic, unilateral transtibial amputation. Participants will be randomised to a home-based, resistance exercise group (HBRX) or a wait-list control group (CON). The HBRX will consist of 12 weeks of elastic resistance band and bodyweight training to improve core and lumbopelvic strength. Participants will be monitored via Skype or Facetime on a weekly basis. The primary outcome will be pain severity (11-point Numerical Pain Rating Scale; NRS DISCUSSION: The study findings will determine whether a HBRX program can decrease pain severity and positively impact several physiological and mechanical factors that contribute to back pain in unilateral transtibial amputees with chronic LBP. We will determine the relative contribution of the exercise-induced changes in these factors on pain responsiveness in this population. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03300375 . Registered on 2 October 2017.

17 Article Multicenter Retrospective Study of Neurostimulation With Exit of Therapy by Explant. 2017

Pope, Jason E / Deer, Timothy R / Falowski, Steven / Provenzano, David / Hanes, Michael / Hayek, Salim M / Amrani, Jacob / Carlson, Jonathan / Skaribas, Ioannis / Parchuri, Kris / McRoberts, W Porter / Bolash, Robert / Haider, Nameer / Hamza, Maged / Amirdelfan, Kasra / Graham, Sean / Hunter, Corey / Lee, Eric / Li, Sean / Yang, Michael / Campos, Lucas / Costandi, Shrif / Levy, Robert / Mekhail, Nagy. ·Summit Pain Alliance, Santa Rosa, CA, USA. · Center for Pain Relief, Charleston, WV, USA. · St. Luke's University Health Network, Bethlehem, PA, USA. · Pain Diagnostics and Interventional Care, Sewickley, PA, USA. · University Hospitals, Cleveland, OH, USA. · Arizona Pain, Chandler, AZ, USA. · Pain Doctor, Houston, TX, USA. · Spine & Orthopedic Specialists, Tulsa, OK, USA. · Holy Cross Hospital, Fort Lauderdale, FL, USA. · Cleveland Clinic, Cleveland, OH, USA. · Spinal & Skeletal Pain Medicine, Utica, NY, USA. · Midatlantic Spine Specialists, Richmond, VA, USA. · IPM Medical Group, Walnut Creek, CA, USA. · Spine Diagnostic and Treatment, Baton Rouge, LA, USA. · Ainsworth Institute of Pain Management, New York, NY, USA. · Premier Pain Centers, East Brunswick, NJ, USA. · Boca Raton Regional Hospital, Boca Raton, FL, USA. ·Neuromodulation · Pubmed #28714533.

ABSTRACT: INTRODUCTION: Spinal cord stimulation (SCS) devices are cost effective and improve function as well as quality of life. Despite the demonstrated benefits of SCS, some patients have the device explanted. We are interested in exploring the patient characteristics of those explanted. METHODS: This is a retrospective chart review of neurostimulation patients who underwent explantation at 18 centers across the United States within the previous five years. RESULTS: Data from 352 patients were collected and compiled. Failed Back Surgery syndrome was the most common diagnosis (38.9%; n = 136/350) and over half of the patients reported numerical rating scale (NRS) scores ≥8 prior to implant (64.3%; n = 207/322). All patients reported changes in NRS scores across time, with an initial decrease after implant followed by a pre-explant increase (F (2, 961) = 121.7, p < 0.001). The most common reason for device explant was lack or loss of efficacy (43.9%; 152/346) followed by complications (20.2%; 70/346). Eighteen percent (18%; 62/343) of patients were explanted by a different physician than the implanting one. Rechargeable devices were explanted at a median of 15 months, whereas primary cell device explants occurred at a median of 36 months (CI 01.434, 2.373; median endpoint time ratio = 2.40). DISCUSSION: Loss or lack of efficacy and complications with therapy represent the most frequent reasons for neurostimulation explantation. Of the devices that were explanted, therapy was terminated earlier when devices were rechargeable, when complications occurred, or when pain relief was not achieved or maintained. Furthermore, in nearly 20% of the cases, a different provider than the implanting physician performed device removal. CONCLUSIONS: SCS is largely a safe and efficacious strategy for treating select chronic refractory pain syndromes. Further prospective data and innovation are needed to improve patient selection, maintain SCS therapeutic efficacy and reduce the reasons that lead to device explant.

18 Article Primary pain generator identification by CT-SPECT in a patient with low back pain: a case report. 2017

Tender, Gabriel / Constantinescu, Adriana / Conger, Andrew / DiGiorgio, Anthony. ·Department of Neurosurgery, Louisiana State University, 2020 Gravier Street, Suite 744, New Orleans, LA, USA. gtende@lsuhsc.edu. · Department of Oncology, University of Craiova, Str. Alexandru Ioan Cuza, 200585, Craiova, Romania. · Department of Neurosurgery, Louisiana State University, 2020 Gravier Street, Suite 744, New Orleans, LA, USA. ·BMC Res Notes · Pubmed #28327190.

ABSTRACT: BACKGROUND: Chronic low back pain is one of the most common conditions encountered in the middle-age population. Identifying the primary pain generator is notoriously difficult. The computed tomography-single-photon emission computed tomography (CT-SPECT) is emerging as a new diagnostic modality for this purpose. CASE PRESENTATION: This 68-year-old Caucasian male presented with intractable low back pain refractory to maximal conservative treatment, including medication and extensive physical therapy. The lumbar computed tomography, magnetic resonance imaging, and flexion-extension X-rays showed advanced degenerative changes throughout the lumbar spine, but no single level significantly worse than the others. The CT-SPECT showed markedly increased uptake at the L1-2 disc level and only minimal uptake at the other levels. The patient underwent a minimally invasive lateral L1-2 fusion with near-complete resolution of his low back pain. CONCLUSIONS: The CT-SPECT may provide a unique tool in establishing the primary pain generator in patients with degenerative spine disease.

19 Article Periprosthetic UHMWPE Wear Debris Induces Inflammation, Vascularization, and Innervation After Total Disc Replacement in the Lumbar Spine. 2017

Veruva, Sai Y / Lanman, Todd H / Isaza, Jorge E / Freeman, Theresa A / Kurtz, Steven M / Steinbeck, Marla J. ·Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA. · Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA. · Tulane University, Baton Rouge, LA, USA. · Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA. · Exponent, Inc, Philadelphia, PA, USA. · Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA. mjs348@drexel.edu. · Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA. mjs348@drexel.edu. ·Clin Orthop Relat Res · Pubmed #27488379.

ABSTRACT: BACKGROUND: The pathophysiology and mechanisms driving the generation of unintended pain after total disc replacement (TDR) remain unexplored. Ultrahigh-molecular-weight polyethylene (UHMWPE) wear debris from TDRs is known to induce inflammation, which may result in pain. QUESTIONS/PURPOSES: The purpose of this study was to determine whether (1) periprosthetic UHMWPE wear debris induces immune responses that lead to the production of tumor necrosis factor-α (TNFα) and interleukin (IL)-1ß, the vascularization factors, vascular endothelial growth factor (VEGF) and platelet-derived growth factor-bb (PDGFbb), and the innervation/pain factors, nerve growth factor (NGF) and substance P; (2) the number of macrophages is associated with the production of the aforementioned factors; (3) the wear debris-induced inflammatory pathogenesis involves an increase in vascularization and associated innervation. METHODS: Periprosthetic tissues from our collection of 11 patients with contemporary TDRs were evaluated using polarized light microscopy to quantify UHMWPE wear particles. The major reason for revision (mean implantation time of 3 years [range, 1-6 years]) was pain. For control subjects, biopsy samples from four patients with degenerative disc disease with severe pain and autopsy samples from three normal patients with no history of back pain were also investigated. Immunohistochemistry and histology were used to identify secretory factors, macrophages, and blood vessels. Immunostained serial sections were imaged at ×200 magnification and using MATLAB and NIH ImageJ, a threshold was determined for each factor and used to quantify positive staining normalized to tissue sectional area. The Mann-Whitney U test was used to compare results from different patient groups, whereas the Spearman Rho test was used to determine correlations. Significance was based on p < 0.05. RESULTS: The mean percent area of all six inflammatory, vascularization, and innervation factors was higher in TDR tissues when compared with normal disc tissues. Based on nonparametric data analysis, those factors showing the most significant increase included TNFα (5.17 ± 1.76 versus 0.05 ± 0.03, p = 0.02), VEGF (3.02 ± 1.01 versus 0.02 ± 0.002, p = 0.02), and substance P (4.15 ± 1.01 versus 0.08 ± 0.04, p = 0.02). The mean percent area for IL-1ß (2.41 ± 0.66 versus 0.13 ± 0.13, p = 0.01), VEGF (3.02 ± 1.01 versus 0.34 ± 0.29, p = 0.04), and substance P (4.15 ± 1.01 versus 1.05 ± 0.46, p = 0.01) was also higher in TDR tissues when compared with disc tissues from patients with painful degenerative disc disease. Five of the factors, TNFα, IL-1ß, VEGF, NGF, and substance P, strongly correlated with the number of wear particles, macrophages, and blood vessels. The most notable correlations included TNFα with wear particles (p < 0.001, ρ = 0.63), VEGF with macrophages (p = 0.001, ρ = 0.71), and NGF with blood vessels (p < 0.001, ρ = 0.70). Of particular significance, the expression of PDGFbb, NGF, and substance P was predominantly localized to blood vessels/nerve fibers. CONCLUSIONS: These findings indicate wear debris-induced inflammatory reactions can be linked to enhanced vascularization and associated innervation/pain factor production at periprosthetic sites around TDRs. Elucidating the pathogenesis of inflammatory particle disease will provide information needed to identify potential therapeutic targets and treatment strategies to mitigate pain and potentially avoid revision surgery. LEVEL OF EVIDENCE: Level III, therapeutic study.

20 Article Interspinous Process Decompression: Expanding Treatment Options for Lumbar Spinal Stenosis. 2016

Nunley, Pierce D / Shamie, A Nick / Blumenthal, Scott L / Orndorff, Douglas / Block, Jon E / Geisler, Fred H. ·Spine Institute of Louisiana, Shreveport, LA 71101, USA. · Ronald Reagan UCLA Medical Center, Westwood, CA 90095, USA. · Texas Back Institute, Plano, TX 75093, USA. · Spine Colorado, Durango, CO 81301, USA. · 2210 Jackson Street, Suite 401, San Francisco, CA 94115, USA. · 401 N. Wabash Avenue, Suite 62F, Chicago, IL 60611, USA. ·Biomed Res Int · Pubmed #27819001.

ABSTRACT: Interspinous process decompression is a minimally invasive implantation procedure employing a stand-alone interspinous spacer that functions as an extension blocker to prevent compression of neural elements without direct surgical removal of tissue adjacent to the nerves. The Superion® spacer is the only FDA approved stand-alone device available in the US. It is also the only spacer approved by the CMS to be implanted in an ambulatory surgery center. We computed the within-group effect sizes from the Superion IDE trial and compared them to results extrapolated from two randomized trials of decompressive laminectomy. For the ODI, effect sizes were all

21 Article Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal. 2016

Dickerson, David M / Dai, Ran / Scavone, Barbara M / McDade, William. ·From the *Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL; and †Ochsner Health System, New Orleans, LA. ·Reg Anesth Pain Med · Pubmed #27685350.

ABSTRACT: Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a congenitally narrowed spinal canal because of short pedicle syndrome. Epidural injectate occupies and compresses a percentage of the spinal canal and its neuronal contents. This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis. We believe a similar mechanism may explain the pain that patients sometimes experience after administration of large epidural volumes.

22 Article The Windowpane Squat. 2016

Liebenson, Craig. ·L.A. Sports & Spine, LA, USA. Electronic address: craigliebensondc@gmail.com. ·J Bodyw Mov Ther · Pubmed #26891658.

ABSTRACT: -- No abstract --

23 Article Comparison of Complications and Clinical and Radiographic Outcomes Between Nonobese and Obese Patients with Adult Spinal Deformity Undergoing Minimally Invasive Surgery. 2016

Park, Paul / Wang, Michael Y / Nguyen, Stacie / Mundis, Gregory M / La Marca, Frank / Uribe, Juan S / Anand, Neel / Okonkwo, David O / Kanter, Adam S / Fessler, Richard / Eastlack, Robert K / Chou, Dean / Deviren, Vedat / Nunley, Pierce D / Shaffrey, Christopher I / Mummaneni, Praveen V / Anonymous5740853. ·Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA. Electronic address: ppark@umich.edu. · Department of Neurological Surgery, University of Miami, Miami, Florida, USA. · San Diego Center for Spinal Disorders, La Jolla, California, USA. · Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA. · Department of Neurosurgery, University of South Florida, Tampa, Florida, USA. · Cedars-Sinai Spine Center, Los Angeles, California, USA. · Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. · Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. · Department of Orthopaedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California, USA. · Department of Neurosurgery, University of California, San Francisco, California, USA. · Department of Orthopaedic Surgery, University of California, San Francisco, California, USA. · Spine Institute of Louisiana, Shreveport, Louisiana, USA. · Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. ·World Neurosurg · Pubmed #26724613.

ABSTRACT: OBJECTIVE: Obesity can be associated with increased complications and potentially worse outcomes. We aimed to evaluate the impact of obesity on complications and outcomes in patients with adult spinal deformity (ASD) who underwent minimally invasive surgery (MIS). METHODS: A multicenter database of patients with ASD treated via MIS was queried. Of 190 patients in the database, 77 fit the inclusion criteria of 3 or more spinal levels treated minimally invasively. Patients were divided by body mass index (BMI) <30 (nonobese; n = 59) and BMI ≥ 30 (obese; n = 18). RESULTS: Mean BMI was 24.6 nonobese and 35.0 obese (P < 0.001). There were mean 3.8 interbody fusions nonobese and 4.7 obese (P = 0.065). Levels treated posteriorly averaged 5.8 nonobese and 5.9 obese (P = 0.502). Mean follow-up was 34.4 months nonobese and 35.3 months obese (P = 0.976). Baseline radiographic parameters were similar between groups. Postoperatively, SVA averaged 83.9 mm obese and 20.4 mm nonobese (P = 0.002). Postoperative lumbar lordosis-pelvic incidence mismatch averaged 17.9° obese and 9.9° nonobese (P = 0.028). Both groups had improvement in Oswestry Disability Index (ODI) scores with no difference in postoperative ODI scores between groups (P = 0.090). Similarly, both groups had decreased VAS scores for back and leg pain with no difference between groups postoperatively. Twenty (33.9%) nonobese patients versus 7 (38.9%) obese patients had complications (P = 0.452). CONCLUSIONS: Our results suggest that obesity does not negatively impact complication rate or clinical outcomes in patients with ASD treated via MIS approaches.

24 Article Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery? 2016

Park, Paul / Okonkwo, David O / Nguyen, Stacie / Mundis, Gregory M / Than, Khoi D / Deviren, Vedat / La Marca, Frank / Fu, Kai-Ming / Wang, Michael Y / Uribe, Juan S / Anand, Neel / Fessler, Richard / Nunley, Pierce D / Chou, Dean / Kanter, Adam S / Shaffrey, Christopher I / Akbarnia, Behrooz A / Passias, Peter G / Eastlack, Robert K / Mummaneni, Praveen V / Anonymous5030844. ·Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. Electronic address: ppark@umich.edu. · Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania. · San Diego Center for Spinal Disorders, La Jolla, California. · Department of Neurosurgery, University of California, San Francisco, California. · Department of Orthopaedic Surgery, University of California, San Francisco, California. · Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. · Weill Cornell Brain and Spine Center, New York, New York. · Department of Neurological Surgery, University of Miami, Miami, Florida. · Department of Neurosurgery, University of South Florida, Tampa, Florida. · Cedars-Sinai Spine Center, Los Angeles, California. · Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois. · Spine Institute of Louisiana, Shreveport, Louisiana. · Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. · Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, New York. · Department of Orthopaedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California, USA. ·World Neurosurg · Pubmed #26431736.

ABSTRACT: BACKGROUND: Older age has been considered a relative contraindication to complex spinal procedures. Minimally invasive surgery (MIS) techniques to treat patients with adult spinal deformity (ASD) have emerged with the potential benefit of decreased approach-related morbidity. OBJECTIVE: To determine whether a minimal clinically important difference (MCID) could be achieved in patients ages ≥ 65 years with ASD who underwent MIS. METHODS: Multicenter database of patients who underwent MIS for ASD was queried. Outcome metrics assessed were Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain. On the basis of published reports, MCID was defined as a positive change of 12.8 ODI, 1.2 VAS back pain, and 1.6 VAS leg pain. RESULTS: Forty-two patients were identified. Mean age was 70.3 years; 31 (73.8%) were women. Preoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis mismatch, and sagittal vertical axis were 35°, 24.6°, 14.2°, and 4.7 cm, respectively. Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis, and sagittal vertical axis were 18°, 25.4°, 11.9°, and 4.9 cm, respectively. A mean of 5.0 levels was treated posteriorly, and a mean of 4.0 interbody fusions was performed. Mean ODI improved from 47.1 to 25.1. Mean VAS back and leg pain scores improved from 6.8 and 5.9 to 2.7 and 2.7, respectively. Mean follow-up was 32.1 months. For ODI, 64.3% of patients achieved MCID. For VAS back and leg pain, 82.9% and 72.2%, respectively, reached MCID. CONCLUSIONS: MCID represents the threshold at which patients feel a meaningful clinical improvement has occurred. Our study results suggest that the majority of elderly patients with modest ASD can achieve MCID with MIS.

25 Article National Perioperative Outcomes for Intrathecal Pump, Spinal Cord Stimulator, and Peripheral Nerve Stimulator Procedures. 2015

Abrecht, Christopher R / Gabriel, Rodney A / Dutton, Richard P / Kaye, Alan D / Michna, Edward / Urman, Richard D. ·Brigham and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, MA. · Anesthesia Quality Institute, Executive Director, American Society of Anesthesiologists, Chief Quality Officer. · LSU Health Science Center, New Orleans. · righam and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, MA. ·Pain Physician · Pubmed #26606006.

ABSTRACT: BACKGROUND: There is abundant literature on the long-term complications of intrathecal pumps (ITP), spinal cord stimulators (SCS), and peripheral nerve stimulators (PNS) used in the treatment of chronic pain. There is less information, however, on the perioperative complications of these procedures. OBJECTIVE: Exploration of the perioperative outcomes of implantable pain devices. STUDY DESIGN: Observational study. SETTING: University hospitals, community hospitals, specialty hospitals, attached surgery centers, and freestanding surgery centers METHODS: Data were obtained from the National Anesthesia Clinical Outcomes Registry (NACOR) of the Anesthesia Quality Institute (AQI). Information was collected on patient demographics, procedure information, anesthetic administered, diagnosis linked to the procedure, and perioperative outcomes. RESULTS: The search yielded 12,611 ITP, 19,276 SCS, and 15,184 PNS cases from 2010 to 2014. In this sample, the majority of procedures were performed at community hospitals, not university medical centers. The most common diagnosis cited for an ITP was an implant complication (n = 2,570), followed by spasticity, and non-malignant back pain. For SCS, the most common diagnoses were lower back pain (n = 5,515) or radiculopathy (n = 2,398). For PNS, by far the most common diagnosis related to urinary dysfunction (n = 8,745), with painful bladder syndrome a small minority (n = 133). General anesthetics were more often performed for ITP than for SCS and PNS procedures (60.6% vs. 31.8% and 32.2%, respectively). Hemodynamic instability was a common outcome (13.9% for ITP procedures); other common outcomes for all the procedures included case delays, inadequate pain control, and extended PACU stays. LIMITATIONS: Despite the large sample size in this study, not all medical centers transmit their outcome data to NACOR. Furthermore, some institutions do not report clinical outcomes for every case to NACOR, making the sample size of assessing complications smaller and potentially more biased. Finally, procedures identified in the NACOR database using CPT may be similar but not identical and therefore potentially influence outcomes. CONCLUSIONS: Databases such as NACOR can provide rich information on ITP, SCS, and PNS for physicians performing these procedures. In this sample, ITP procedures, performed on the patients with the most severe cormobidities and often-requiring general anesthesia, were the most likely to be associated with hemodynamic instability, inadequate pain control, and extended PACU stays. Complications relating to the ITP are also the most common reason for an operation. These findings underscore the importance of proper patient selection for ITP and other implantable pain devices, in particular for patients with malignant pain or multiple co-morbidities. To identify the root causes of complications, additional information is needed on the procedure performed (e.g., an implant vs a revision), the surgical technique used, and the device implanted, as well as on specific patient comorbidities. Such information will likely become more available as resources like NACOR expand and as electronic medical record systems and coding become more integrated.

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