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Back Pain: HELP
Articles from New York area
Based on 372 articles published since 2008

These are the 372 published articles about Back Pain that originated from New York area during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15
1 Guideline 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.

2 Guideline ACR Appropriateness Criteria 2017

Anonymous3930905 / Bernard, Stephanie A / Kransdorf, Mark J / Beaman, Francesca D / Adler, Ronald S / Amini, Behrang / Appel, Marc / Arnold, Erin / Cassidy, R Carter / Greenspan, Bennett S / Lee, Kenneth S / Tuite, Michael J / Walker, Eric A / Ward, Robert J / Wessell, Daniel E / Weissman, Barbara N. ·Principal Author, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Electronic address: sbernard@psu.edu. · Panel Chair, Mayo Clinic, Phoenix, Arizona. · Panel Vice-Chair, University of Kentucky, Lexington, Kentucky. · NYU Center for Musculoskeletal Care, New York, New York. · University of Texas MD Anderson Cancer Center, Houston, Texas. · James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons. · Orthopaedics and Rheumatology of the North Shore, Skokie, Illinois; American College of Rheumatology. · UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons. · Medical College of Georgia at Georgia Regents University, Augusta, Georgia. · University of Wisconsin Hospital & Clinics, Madison, Wisconsin. · Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. · Tufts Medical Center, Boston, Massachusetts. · Mayo Clinic, Jacksonville, Florida. · Specialty Chair, Brigham & Women's Hospital, Boston, Massachusetts. ·J Am Coll Radiol · Pubmed #28473095.

ABSTRACT: Inflammatory sacroiliitis or the seronegative axial spondyloarthropathies often presents as back pain or sacroiliac joint pain of more than 3-month duration with inflammatory symptoms and typically in patients younger than 45 years of age. Imaging plays an important role in diagnosis and disease monitoring. This article addresses the appropriate sequence of initial imaging for evaluation of a suspected spondyloarthropathy, the imaging follow-up of treatment response and the special considerations for imaging of trauma in patients with ankylosis of the spine. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

3 Guideline Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. 2017

Wong, J J / Côté, P / Sutton, D A / Randhawa, K / Yu, H / Varatharajan, S / Goldgrub, R / Nordin, M / Gross, D P / Shearer, H M / Carroll, L J / Stern, P J / Ameis, A / Southerst, D / Mior, S / Stupar, M / Varatharajan, T / Taylor-Vaisey, A. ·UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada. · Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada. · Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, ON, Canada. · Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada. · Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada. · Masters Program, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada. · Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, USA. · Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada. · Rehabilitation Research Centre, University of Alberta, Edmonton, AB, Canada. · Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada. · Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, ON, Canada. · Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, QC, Canada. · Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada. · Masters Program, University of Saskatchewan, Saskatoon, SK, Canada. ·Eur J Pain · Pubmed #27712027.

ABSTRACT: We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias. According to high-quality guidelines: (1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options; (2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation; (3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and (4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Ten guidelines were of high methodological quality, but updating and some methodological improvements are needed. Overall, most guidelines target nonspecific LBP and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments. The recommendation to use paracetamol for acute LBP is challenged by recent evidence and needs to be revisited. SIGNIFICANCE: Most high-quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/NSAIDs as first-line treatments for LBP. Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating.

4 Guideline ACR Appropriateness Criteria Low Back Pain. 2016

Patel, Nandini D / Broderick, Daniel F / Burns, Judah / Deshmukh, Tejaswini K / Fries, Ian Blair / Harvey, H Benjamin / Holly, Langston / Hunt, Christopher H / Jagadeesan, Bharathi D / Kennedy, Tabassum A / O'Toole, John E / Perlmutter, Joel S / Policeni, Bruno / Rosenow, Joshua M / Schroeder, Jason W / Whitehead, Matthew T / Cornelius, Rebecca S / Corey, Amanda S. ·Fairfax Radiology Consultants PC, Fairfax, Virginia. Electronic address: nandini416@gmail.com. · Mayo Clinic Jacksonville, Jacksonville, Florida. · Montefiore Medical Center, Bronx, New York. · Children's Hospital of Wisconsin, Milwaukee, Wisconsin. · Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons. · Massachusetts General Hospital, Boston, Massachusetts. · UCLA Medical Center, Los Angeles, California, neurosurgical consultant. · Mayo Clinic, Rochester, Minnesota. · University of Minnesota, Minneapolis, Minnesota. · University of Wisconsin Hospital and Clinic, Madison, Wisconsin. · Rush University, Chicago, Illinois, neurosurgical consultant. · Washington University School of Medicine, St Louis, Missouri, American Academy of Neurologists. · University of Iowa Hospitals and Clinics, Iowa City, Iowa. · Northwestern University Feinberg School of Medicine, Chicago, Illinois, neurosurgical consultant. · Walter Reed National Military Medical Center, Bethesda, Maryland. · Children's National Medical Center, Washington, District of Columbia. · University of Cincinnati, Cincinnati, Ohio. · Emory University, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #27496288.

ABSTRACT: Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

5 Editorial Single Versus Two-Level Transforaminal Epidural Steroid Injection for Treating Lumbosacral Radicular Pain: What is the Evidence? 2015

Cohen, Steven P / Furman, Michael B / Weber, Nicholas H / Singh, Jaspal Ricky. ·Johns Hopkins School of Medicine, Baltimore, MD. · Uniformed Services University of the Health Sciences, Bethesda, MD. · Interventional Spine Care, Musculoskeletal Ultrasound, Electrodiagnostics, OSS Health, York, PA. · Physical Medicine and Rehabilitation, Weill Cornell Medical College, 525 E 68th Street, Baker 16, New York, NY 10065. ·PM R · Pubmed #26319041.

ABSTRACT: -- No abstract --

6 Editorial Anterior lumbar interbody fusion using rhBMP-2. 2014

Heary, Robert F. ·Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey. ·J Neurosurg Spine · Pubmed #25279656.

ABSTRACT: -- No abstract --

7 Editorial Of low back pain and moxibustion. 2014

Dubois, Michel Y / Chen, Lucy. ·Midtown Pain Medicine, New York, New York, USA. ·Pain Med · Pubmed #25132305.

ABSTRACT: -- No abstract --

8 Editorial Ride 'em cowboy! The therapeutics of virtual reality technology and simulation. 2014

Citrome, L. ·New York Medical College, Valhalla, NY, USA. citrome@cnsconsultant.com. ·Int J Clin Pract · Pubmed #25074333.

ABSTRACT: -- No abstract --

9 Editorial Medical marijuana for failed back surgical syndrome: a viable option for pain control or an uncontrolled narcotic? 2014

Aggarwal, Sunil K / Pangarkar, Sanjog / Carter, Gregory T / Tribuzio, Bianca / Miedema, Mark / Kennedy, David J. ·Rusk Institute of Rehabilitation Medicine, New York, NY(∗). · Department of Physical Medicine and Rehabilitation, Inpatient Pain Service Veterans Health Service, Los Angeles, CA(†). · St Luke's Rehabilitation Institute, Spokane, WA(‡). · Department of Physical Medicine and Rehabilitation, UCLA-WLA VA, Los Angeles, CA(§). · Department of Physical Medicine and Rehabilitation, UCLA-WLA VA, Los Angeles, CA(‖). · Stanford University, Redwood City, CA(¶). Electronic address: djkenned@stanford.edu. ·PM R · Pubmed #24766854.

ABSTRACT: -- No abstract --

10 Editorial Expert's comment concerning Grand Rounds case entitled "L5-S1 disc replacement after two previous fusion surgeries for scoliosis" (by S. Jehan, S. Elsayed, J. Webb and B. Boszczyk). 2011

Bitan, Fabien D. ·Department of Spine Surgery, Lenox Hill Hospital, 130 East 77th Street, 7th Floor, New York, NY 10021, USA. bitanf@manhattanorthopaedics.com ·Eur Spine J · Pubmed #20878426.

ABSTRACT: The attempt to preserve motion below a long fusion is certainly praiseworthy even if it is clearly understood with the patient that the result might be only temporary, buying some good years in the most active part of life. The analysis of the case presented here suggests that such an approach could be recommended in the right patient, with the right team. More experience and reports are necessary to evolve from an anecdotal report to a new path in the treatment of adult scoliosis.

11 Review Nonopioid versus opioid agents for chronic neuropathic pain, rheumatoid arthritis pain, cancer pain and low back pain. 2019

Noori, Selaiman A / Aiyer, Rohit / Yu, James / White, Robert S / Mehta, Neel / Gulati, Amitabh. ·Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. · Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, 10065, USA. · Department of Anesthesiology, University of Illinois College of Medicine, Chicago, IL, 60612 USA. · Department of Anesthesia & Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. ·Pain Manag · Pubmed #30681031.

ABSTRACT: Chronic pain continues to be a major health issue throughout the world and a huge economic burden for nations around the world. While the use of opioids does have risks, they are still widely used by clinicians as a treatment option for various chronic pain conditions. This review explores and compares the efficacy and safety of opioid and nonopioid agents for the following commonly encountered chronic pain conditions: neuropathic pain, rheumatoid arthritis joint pain, cancer pain and low back pain. Our findings demonstrate that while there are several nonopioid pharmacologic options that are clinically effective, opioids maintain a role in the treatment of certain chronic pain conditions and should continue to have an important place in the armamentarium of clinicians.

12 Review Case-based roundtable on treatment approach for young, fit, newly diagnosed multiple myeloma patients. 2018

Giralt, Sergio / Seifter, Eric. ·Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and. · Johns Hopkins University School of Medicine, Baltimore, MD. ·Hematology Am Soc Hematol Educ Program · Pubmed #30504298.

ABSTRACT: With the advent new proteasome inhibitors (carfilzomib, ixazomib), new immune-modulatory drugs (pomalidomide), and new monoclonal antibodies (elotuzimab, daratumumab) as approved treatments for myeloma, the therapeutic landscape for this disease has changed. In this chapter, using a case-based approach, I will provide a personal guide of how I approach myeloma therapy in a transplant eligible patient in 2018.

13 Review Biologic Annulus Fibrosus Repair: A Review of Preclinical In Vivo Investigations. 2018

Sloan, Stephen R / Lintz, Marianne / Hussain, Ibrahim / Hartl, Roger / Bonassar, Lawrence J. ·1 Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York. · 2 Department of Neurological Surgery, Weill Cornell Brain and Spine Center , New York-Presbyterian Hospital, New York, New York. · 3 Sibley School of Mechanical and Aerospace Engineering, Cornell University , Ithaca, New York. ·Tissue Eng Part B Rev · Pubmed #29105592.

ABSTRACT: Lower back pain, the leading cause of workplace absences and disability, is often attributed to intervertebral disc degeneration, in which nucleus pulposus (NP) herniates through lesions in the annulus fibrosus (AF) and impinges on the spinal cord and surrounding nerves. Surgeons remove extruded NP via discectomy when indicated by local/radicular pain supported by radiographic evidence; however, current interventions do not alter the underlying disease or seal the AF. The reported rates of recurrent herniation or pain following discectomy cases range from 5% to 25%, which has pushed spine research in recent years toward annular repair and closure strategies. Synthetic implants designed to mechanically seal the AF have been subject to large animal and clinical trials, with limited success in preventing recurrent herniation. Like gold standard interventions, purely mechanical devices fail to promote tissue integration, long-term healing, or restore native biomechanical function to the spine. Biological repair strategies utilizing principles of tissue engineering have demonstrated success in overcoming the inadequacies of current interventions and mechanical implants, yet, none has reached clinical or proof-of-concept trials in humans. In this review, we will discuss annular repair strategies promoting biological healing that have been implemented in small and large animal models in vivo, and ways to enhance the efficacy of these treatments.

14 Review Animal models for studying the etiology and treatment of low back pain. 2018

Shi, Changgui / Qiu, Sujun / Riester, Scott M / Das, Vaskar / Zhu, Bingqian / Wallace, Atiyayein A / van Wijnen, Andre J / Mwale, Fackson / Iatridis, James C / Sakai, Daisuke / Votta-Velis, Gina / Yuan, Wen / Im, Hee-Jeong. ·Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University of China, Shanghai, China. · Department of Orthopedic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China. · Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. · Department of Biochemistry, Rush University Medical Center, Chicago, Illinois. · Departments of Biobehavioral Health Science, University of Illinois at Chicago (UIC), Chicago, Illinois. · Department of Surgery, McGill University and Orthopaedic Research Laboratory, Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, Montreal, Canada. · Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York. · Department of Orthopaedic Surgery, Tokai University School of Medicine, Kanagawa, Japan. · Department of Anesthesiology, University of Illinois at Chicago (UIC), Chicago, Illinois. · Jesse Brown Veterans Affairs Medical Center (JBVAMC) at Chicago, Chicago, Illinois. · Department of Bioengineering, University of Illinois at Chicago (UIC), Chicago, Illinois. ·J Orthop Res · Pubmed #28921656.

ABSTRACT: Chronic low back pain is a major cause of disability and health care costs. Effective treatments are inadequate for many patients. Animal models are essential to further understanding of the pain mechanism and testing potential therapies. Currently, a number of preclinical models have been developed attempting to mimic aspects of clinical conditions that contribute to low back pain (LBP). This review focused on describing these animal models and the main behavioral tests for assessing pain in each model. Animal models of LBP can be divided into the following five categories: Discogenic LBP, radicular back pain, facet joint osteoarthritis back pain, muscle-induced LBP, and spontaneous occurring LBP models. These models are important not only for enhancing our knowledge of how LBP is generated, but also for the development of novel therapeutic regimens to treat LBP in patients. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1305-1312, 2018.

15 Review Inflammatory biomarkers of low back pain and disc degeneration: a review. 2017

Khan, Aysha N / Jacobsen, Hayley E / Khan, Jansher / Filippi, Christopher G / Levine, Mitchell / Lehman, Ronald A / Riew, K Daniel / Lenke, Lawrence G / Chahine, Nadeen O. ·The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York. · Department of Orthopedic Surgery, Columbia University, New York, New York. · Lenox Hill Hospital, Northwell Health, New York, New York. · New York-Presbyterian-Spine Hospital, New York, New York. · Department of Biomedical Engineering, Columbia University, New York, New York. ·Ann N Y Acad Sci · Pubmed #29265416.

ABSTRACT: Biomarkers are biological characteristics that can be used to indicate health or disease. This paper reviews studies on biomarkers of low back pain (LBP) in human subjects. LBP is the leading cause of disability, caused by various spine-related disorders, including intervertebral disc degeneration, disc herniation, spinal stenosis, and facet arthritis. The focus of these studies is inflammatory mediators, because inflammation contributes to the pathogenesis of disc degeneration and associated pain mechanisms. Increasingly, studies suggest that the presence of inflammatory mediators can be measured systemically in the blood. These biomarkers may serve as novel tools for directing patient care. Currently, patient response to treatment is unpredictable with a significant rate of recurrence, and, while surgical treatments may provide anatomical correction and pain relief, they are invasive and costly. The review covers studies performed on populations with specific diagnoses and undefined origins of LBP. Since the natural history of LBP is progressive, the temporal nature of studies is categorized by duration of symptomology/disease. Related studies on changes in biomarkers with treatment are also reviewed. Ultimately, diagnostic biomarkers of LBP and spinal degeneration have the potential to shepherd an era of individualized spine medicine for personalized therapeutics in the treatment of LBP.

16 Review Leiomyosarcoma of the Inferior Vena Cava in an HIV-Positive Adult Patient: A Case Report and Review of the Literature. 2017

Xu, Jing / Velayati, Arash / Berger, Barbara J / Liu, Ming / Cheedella, Naga K Sucharita / Gotlieb, Vladimir. ·Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA. · Department of Infectious Disease, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA. · Department of Pathology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA. · Department of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA. ·Am J Case Rep · Pubmed #29097650.

ABSTRACT: BACKGROUND Leiomyosarcoma is the most common primary malignancy of the inferior vena cava (IVC), and represents approximately 10% of primary retroperitoneal sarcomas. Leiomyosarcoma presents with non-specific symptoms, including abdominal pain or back pain. There is an increased incidence in immunosuppressed individuals. CASE REPORT An unusual presentation of IVC leiomyosarcoma is reported in a 46-year-old female patient infected with human immunodeficiency virus (HIV) who was on highly active antiretroviral therapy (HAART) and who had a normal CD4 count of 934, who presented with back pain. Magnetic resonance imaging (MRI) of the lumbar spine showed a mass of the IVC. Initial computed tomography (CT)-guided biopsy of the IVC mass was non-diagnostic. An IVC filter was inserted, and the patient was discharged home, but 20 days later, she returned to the hospital with worsening right flank pain. Laboratory tests showed acute renal failure, and a repeat CT scan showed IVC thrombus extending 5 cm superiorly. When compared with the previous CT, there was an extension of thrombus into both renal veins. Histopathology of a transjugular needle core biopsy showed a moderately differentiated leiomyosarcoma. The patient was transferred to a multidisciplinary sarcoma center for surgical resection, chemotherapy, and radiation therapy. CONCLUSIONS This report is of a rare case of IVC leiomyosarcoma in a middle-aged HIV-positive woman with a normal CD4 count. Leiomyosarcoma of the IVC is extremely rare, is often detected when advanced, and has a poor prognosis. This case report describes the clinical, imaging, surgical and histopathological findings of leiomyosarcoma of the IVC.

17 Review Looking beyond the intervertebral disc: the need for behavioral assays in models of discogenic pain. 2017

Mosley, Grace E / Evashwick-Rogler, Thomas W / Lai, Alon / Iatridis, James C. ·Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York. ·Ann N Y Acad Sci · Pubmed #28797134.

ABSTRACT: Orthopedic research into chronic discogenic back pain has commonly focused on aging- and degeneration-related changes in intervertebral disc structure, biomechanics, and biology. However, the primary spine-related reason for physician office visits is pain. The ambiguous nature of the human condition of discogenic low back pain motivates the use of animal models to better understand the pathophysiology. Discogenic back pain models must consider both emergent behavioral changes following pain induction and changes in the nervous system that mediate such behavior. Looking beyond the intervertebral disc, we describe the different ways to classify pain in human patients and animal models. We describe several behavioral assays that can be used in rodent models to augment disc degeneration measurements and characterize different types of pain. We review rodent models of discogenic pain that employed behavioral pain assays and highlight a need to better integrate neuroscience and orthopedic science methods to extend current understanding of the complex and multifactorial pathophysiology of discogenic back pain.

18 Review A commentary review of the cost effectiveness of manual therapies for neck and low back pain. 2017

Harper, Brent / Jagger, Kristen / Aron, Adrian / Steinbeck, Larry / Stecco, Antonio. ·Department of Physical Therapy, Radford University, VA, USA. · Private Clinic, Kennesaw, GA, USA. · RUSK Rehabilitation Department, New York City, NY, USA. Electronic address: antonio.stecco@nyumc.org. ·J Bodyw Mov Ther · Pubmed #28750984.

ABSTRACT: BACKGROUND & PURPOSE: Neck and low back pain (NLBP) are global health problems, which diminish quality of life and consume vast economic resources. Cost effectiveness in healthcare is the minimal amount spent to obtain acceptable outcomes. Studies on manual therapies often fail to identify which manual therapy intervention or combinations with other interventions is the most cost effective. The purpose of this commentary is to sample the dialogue within the literature on the cost effectiveness of evidence-based manual therapies with a particular focus on the neck and low back regions. METHODS: This commentary identifies and presents the available literature on the cost effectiveness of manual therapies for NLBP. Key words searched were neck and low back pain, cost effectiveness, and manual therapy to select evidence-based articles. Eight articles were identified and presented for discussion. RESULTS: The lack of homogeneity, in the available literature, makes difficult any valid comparison among the various cost effectiveness studies. DISCUSSION: Potential outcome bias in each study is dependent upon the lens through which it is evaluated. If evaluated from a societal perspective, the conclusion slants toward "adequate" interventions in an effort to decrease costs rather than toward the most efficacious interventions with the best outcomes. When cost data are assessed according to a healthcare (or individual) perspective, greater value is placed on quality of life, the patient's beliefs, and the "willingness to pay."

19 Review Coccydynia: Tailbone Pain. 2017

Foye, Patrick M. ·Physical Medicine and Rehabilitation, Coccyx Pain Center, Rutgers New Jersey Medical School, 90 Bergen Street, DOC Suite 3100, Newark, NJ 07103-2425, USA. Electronic address: Doctor.Foye@gmail.com. ·Phys Med Rehabil Clin N Am · Pubmed #28676363.

ABSTRACT: Coccyx (tailbone) pain substantially decreases the quality of life for patients who suffer with this condition. Classic symptoms include midline pain located below the sacrum and above the anus. Symptoms are worse while sitting or during transitions from sitting to standing. Physical examination typically reveals focal tenderness during palpation of the coccyx. Diagnostic tests include radiographs. Advanced studies may include MRI, computerized tomography scans, or nuclear medicine bone scans. Treatments may include the use of cushions, medications by mouth, topical medications, local pain management injections, pelvic floor physical therapy, and (in rare cases) surgical removal of the coccyx (coccygectomy).

20 Review Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. 2017

Paige, Neil M / Miake-Lye, Isomi M / Booth, Marika Suttorp / Beroes, Jessica M / Mardian, Aram S / Dougherty, Paul / Branson, Richard / Tang, Baron / Morton, Sally C / Shekelle, Paul G. ·West Los Angeles Veterans Affairs Medical Center, Los Angeles, California. · University of California, Los Angeles Fielding School of Public Health, Los Angeles. · RAND Corporation, Southern California Evidence-based Practice Center, Santa Monica. · Phoenix Veterans Affairs Healthcare System, Phoenix, Arizona. · Canandaigua Veterans Affairs Medical Center, Rochester, New York. · Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota. · White River Junction Veterans Affairs Medical Center, White River Junction, Vermont. · Virginia Tech, Blacksburg. ·JAMA · Pubmed #28399251.

ABSTRACT: Importance: Acute low back pain is common and spinal manipulative therapy (SMT) is a treatment option. Randomized clinical trials (RCTs) and meta-analyses have reported different conclusions about the effectiveness of SMT. Objective: To systematically review studies of the effectiveness and harms of SMT for acute (≤6 weeks) low back pain. Data Sources: Search of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature from January 1, 2011, through February 6, 2017, as well as identified systematic reviews and RCTs, for RCTs of adults with low back pain treated in ambulatory settings with SMT compared with sham or alternative treatments, and that measured pain or function outcomes for up to 6 weeks. Observational studies were included to assess harms. Data Extraction and Synthesis: Data extraction was done in duplicate. Study quality was assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool. This tool has 11 items in the following domains: randomization, concealment, baseline differences, blinding (patient), blinding (care provider [care provider is a specific quality metric used by the CBN Risk of Bias tool]), blinding (outcome), co-interventions, compliance, dropouts, timing, and intention to treat. Prior research has shown the CBN Risk of Bias tool identifies studies at an increased risk of bias using a threshold of 5 or 6 as a summary score. The evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Main Outcomes and Measures: Pain (measured by either the 100-mm visual analog scale, 11-point numeric rating scale, or other numeric pain scale), function (measured by the 24-point Roland Morris Disability Questionnaire or Oswestry Disability Index [range, 0-100]), or any harms measured within 6 weeks. Findings: Of 26 eligible RCTs identified, 15 RCTs (1711 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in pain (pooled mean improvement in the 100-mm visual analog pain scale, -9.95 [95% CI, -15.6 to -4.3]). Twelve RCTs (1381 patients) produced moderate-quality evidence that SMT has a statistically significant association with improvements in function (pooled mean effect size, -0.39 [95% CI, -0.71 to -0.07]). Heterogeneity was not explained by type of clinician performing SMT, type of manipulation, study quality, or whether SMT was given alone or as part of a package of therapies. No RCT reported any serious adverse event. Minor transient adverse events such as increased pain, muscle stiffness, and headache were reported 50% to 67% of the time in large case series of patients treated with SMT. Conclusions and Relevance: Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.

21 Review Intervertebral Disk Degeneration and Repair. 2017

Dowdell, James / Erwin, Mark / Choma, Theodoe / Vaccaro, Alexander / Iatridis, James / Cho, Samuel K. ·Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York. · Department of Orthopedics, University of Toronto, Toronto, Ontario, Canada. · Department of Orthopedics, University of Missouri, Columbia, Missouri. · Department of Orthopedics, Rothman Institute, Philadel-phia, Pennsylvania. ·Neurosurgery · Pubmed #28350945.

ABSTRACT: Intervertebral disk (IVD) degeneration is a natural progression of the aging process. Degenerative disk disease (DDD) is a pathologic condition associated with IVD that has been associated with chronic back pain. There are a variety of different mechanisms of DDD (genetic, mechanical, exposure). Each of these pathways leads to a final common result of unbalancing the anabolic and catabolic environment of the extracellular matrix in favor of catabolism. Attempts have been made to gain an understanding of the process of IVD degeneration with in Vitro studies. These models help our understanding of the disease process, but are limited as they do not come close to replicating the complexities that exist with an in Vivo model. Animal models have been developed to help us gain further understanding of the degenerative cascade of IVD degeneration In Vivo and test experimental treatment modalities to either prevent or reverse the process of DDD. Many modalities for treatment of DDD have been developed including therapeutic protein injections, stem cell injections, gene therapy, and tissue engineering. These interventions have had promising outcomes in animal models. Several of these modalities have been attempted in human trials, with early outcomes having promising results. Further, increasing our understanding of the degenerative process is essential to the development of new therapeutic interventions and the optimization of existing treatment protocols. Despite limited data, biological therapies are a promising treatment modality for DDD that could impact our future management of low back pain.

22 Review Assessment of Patient-Reported Outcome Instruments to Assess Chronic Low Back Pain. 2017

Ramasamy, Abhilasha / Martin, Mona L / Blum, Steven I / Liedgens, Hiltrud / Argoff, Charles / Freynhagen, Rainer / Wallace, Mark / McCarrier, Kelly P / Bushnell, Donald M / Hatley, Noël V / Patrick, Donald L. ·Forest Research Institute, Jersey City, New Jersey. · Health Research Associates, Mountlake Terrace, Washington. · GlaxoSmithKline, Collegeville, Pennsylvania. · Grunenthal, GermanyGmbH, Aachen, Germany. · Albany Medical College, Albany, New York, USA. · Benedictus Krankenhaus Tutzing and Technische Universität, München, Germany. · University of California San Diego, San Diego, California. · University of Washington, Seattle, Washington, USA. ·Pain Med · Pubmed #28340111.

ABSTRACT: Objective: To identify patient-reported outcome (PRO) instruments that assess chronic low back pain (cLBP) symptoms (specifically pain qualities) and/or impacts for potential use in cLBP clinical trials to demonstrate treatment benefit and support labeling claims. Design: Literature review of existing PRO measures. Methods: Publications detailing existing PRO measures for cLBP were identified, reviewed, and summarized. As recommended by the US Food & Drug Administration (FDA) PRO development guidance, standard measurement characteristics were reviewed, including development history, psychometric properties (validity and reliability), ability to detect change, and interpretation of observed changes. Results: Thirteen instruments were selected and reviewed: Low Back Pain Bothersomeness Scale, Neuropathic Pain Symptom Inventory, PainDETECT, Pain Quality Assessment Scale Revised, Revised Short Form McGill Pain Questionnaire, Low Back Pain Impact Questionnaire, Oswestry Disability Index, Pain Disability Index, Roland-Morris Disability Questionnaire, Brief Pain Inventory and Brief Pain Inventory Short Form, Musculoskeletal Outcomes Data Evaluation and Management System Spine Module, Orebro Musculoskeletal Pain Questionnaire, and the West Haven-Yale Multidimensional Pain Inventory Interference Scale. The instruments varied in the aspects of pain and/or impacts that they assessed, and none of the instruments fulfilled all criteria for use in clinical trials to support labeling claims based on recommendations outlined in the FDA PRO guidance. Conclusions: There is an unmet need for a validated PRO instrument to evaluate cLBP-related symptoms and impacts for use in clinical trials.

23 Review Can screening instruments accurately determine poor outcome risk in adults with recent onset low back pain? A systematic review and meta-analysis. 2017

Karran, Emma L / McAuley, James H / Traeger, Adrian C / Hillier, Susan L / Grabherr, Luzia / Russek, Leslie N / Moseley, G Lorimer. ·Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. · Neuroscience Research Australia, Barker Street, Randwick, Sydney, New South Wales, 2031, Australia. · Prince of Wales Clinical School, University of New South Wales, High Street, Kensington, New South Wales, 2052, Australia. · Clarkson University, 41 Elm Street, Potsdam, New York, USA. · Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. lorimer.moseley@unisa.edu.au. · Neuroscience Research Australia, Barker Street, Randwick, Sydney, New South Wales, 2031, Australia. lorimer.moseley@unisa.edu.au. ·BMC Med · Pubmed #28100231.

ABSTRACT: BACKGROUND: Delivering efficient and effective healthcare is crucial for a condition as burdensome as low back pain (LBP). Stratified care strategies may be worthwhile, but rely on early and accurate patient screening using a valid and reliable instrument. The purpose of this study was to evaluate the performance of LBP screening instruments for determining risk of poor outcome in adults with LBP of less than 3 months duration. METHODS: Medline, Embase, CINAHL, PsycINFO, PEDro, Web of Science, SciVerse SCOPUS, and Cochrane Central Register of Controlled Trials were searched from June 2014 to March 2016. Prospective cohort studies involving patients with acute and subacute LBP were included. Studies administered a prognostic screening instrument at inception and reported outcomes at least 12 weeks after screening. Two independent reviewers extracted relevant data using a standardised spreadsheet. We defined poor outcome for pain to be ≥ 3 on an 11-point numeric rating scale and poor outcome for disability to be scores of ≥ 30% disabled (on the study authors' chosen disability outcome measure). RESULTS: We identified 18 eligible studies investigating seven instruments. Five studies investigated the STarT Back Tool: performance for discriminating pain outcomes at follow-up was 'non-informative' (pooled AUC = 0.59 (0.55-0.63), n = 1153) and 'acceptable' for discriminating disability outcomes (pooled AUC = 0.74 (0.66-0.82), n = 821). Seven studies investigated the Orebro Musculoskeletal Pain Screening Questionnaire: performance was 'poor' for discriminating pain outcomes (pooled AUC = 0.69 (0.62-0.76), n = 360), 'acceptable' for disability outcomes (pooled AUC = 0.75 (0.69-0.82), n = 512), and 'excellent' for absenteeism outcomes (pooled AUC = 0.83 (0.75-0.90), n = 243). Two studies investigated the Vermont Disability Prediction Questionnaire and four further instruments were investigated in single studies only. CONCLUSIONS: LBP screening instruments administered in primary care perform poorly at assigning higher risk scores to individuals who develop chronic pain than to those who do not. Risks of a poor disability outcome and prolonged absenteeism are likely to be estimated with greater accuracy. It is important that clinicians who use screening tools to obtain prognostic information consider the potential for misclassification of patient risk and its consequences for care decisions based on screening. However, it needs to be acknowledged that the outcomes on which we evaluated these screening instruments in some cases had a different threshold, outcome, and time period than those they were designed to predict. SYSTEMATIC REVIEW REGISTRATION: PROSPERO international prospective register of systematic reviews registration number CRD42015015778 .

24 Review Society of Interventional Radiology: Occupational Back and Neck Pain and the Interventional Radiologist. 2017

Dixon, Robert G / Khiatani, Vishal / Statler, John D / Walser, Eric M / Midia, Mehran / Miller, Donald L / Bartal, Gabriel / Collins, Jeremy D / Gross, Kathleen A / Stecker, Michael S / Nikolic, Boris / Anonymous990891. ·Department of Radiology, University of North Carolina, Chapel Hill, North Carolina. Electronic address: bob_dixon@med.unc.edu. · Department of Radiology, University of North Carolina, Chapel Hill, North Carolina. · Virginia Interventional and Vascular Associates, Fredericksburg, Virginia. · Department of Radiology, University of Texas Medical Branch, Galveston, Texas. · Department of Interventional Radiology, McMaster University, Hamilton, Ontario, Canada. · Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring. · Department of Radiology, Meir Medical Center, Kfar Saba, Israel. · Department of Radiology, Northwestern University, Chicago, Illinois. · Department of Interventional Radiology, Greater Baltimore Medical Center, Baltimore, Maryland. · Division of Angiography Interventional Radiology, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Radiology, Stratton Medical Center, Albany, New York. ·J Vasc Interv Radiol · Pubmed #27993508.

ABSTRACT: -- No abstract --

25 Review Systematic Review of the Efficacy of Particulate Versus Nonparticulate Corticosteroids in Epidural Injections. 2017

Mehta, Priyesh / Syrop, Isaac / Singh, Jaspal Ricky / Kirschner, Jonathan. ·Hospital for Special Surgery, 535 East 70th St, New York, NY 10021(∗). Electronic address: Priyesh.Mehta@gmail.com. · Weill Cornell Medical College, New York, NY(†). · Weill Cornell Medical College, New York, NY(‡). · Hospital for Special Surgery, New York, NY(§). ·PM R · Pubmed #27915069.

ABSTRACT: OBJECTIVE: To systematically analyze published studies in regard to the comparative efficacy of particulate versus nonparticulate corticosteroids for cervical and lumbosacral epidural steroid injections (ESI) in reducing pain and improving function. TYPE: Systematic review. LITERATURE SURVEY: MEDLINE (Ovid), EMBASE, and Cochrane databases were searched from the period of 1950 to December 2015. METHODOLOGY: Criteria for inclusion in this review were (1) randomized controlled trials and (2) retrospective studies that compared particulate versus nonparticulate medication in fluoroscopically guided injections via a transforaminal (TF) or interlaminar (IL) approach. Each study was assigned a level of evidence (I-V) based on criteria for therapeutic studies. A grade of recommendation (A, B, C, or I) was assigned to each statement. Categorical analysis of the data was reported when available, with success defined by the minimal clinically important difference for appendicular radicular pain-a reduction of at least 2 on the visual analog scale. When data were available, additional categorical analysis included the proportion of individuals with a reduction in pain of at least 50%, 70%, or 75%. Follow-up was included at all reported intervals from 2 weeks to 6 months. SYNTHESIS: Three cervical ESI and 6 lumbar ESI studies were found to be suitable for review. Of the 3 cervical ESI studies, 2 were retrospective studies with grade III level of evidence and 1 was a randomized controlled trial with grade II evidence. Of 4 lumbar ESI studies that used a TF approach, the 2 randomized double-blinded controlled trials were grade I evidence and 2 retrospective studies were grade II and III level of evidence. One randomized controlled trial using the lumbar IL approach was level II evidence. One retrospective cohort study using the lumbar TF, IL and caudal approach was level III evidence. CONCLUSIONS: There is no statistically significant difference in terms of pain reduction or improved functional outcome between particulate and nonparticulate preparations in cervical ESI and, therefore, the authors recommend using nonparticulate steroid when performing cervical TFESI (Grade of Recommendation: B). In patients with lumbar radiculopathy due to stenosis or disk herniation, TFESI using particulate versus non-particulate is equivocal in reducing pain (Grade of Recommendation: B) and improving function (Grade of Recommendation: C) and therefore the authors recommend the use of nonparticulate steroids for lumbar TFESI in patients with lumbar radicular pain (Grade of Recommendation: B). There is insufficient information to make a recommendation of one steroid preparation over the other in lumbar ILESI (Grade of Recommendation: I). Given the lack of strong data favoring the efficacy of one steroid preparation over the other, and the potential risk of catastrophic complications, all of which have been reported with particulate steroids, nonparticulate steroids should be considered as first line agents when performing ESIs. LEVEL OF EVIDENCE: III.