PILD, at present either MILD® or Totalis®, requires familiarization with the technique and instru... more PILD, at present either MILD® or Totalis®, requires familiarization with the technique and instrumentation through formal training. This chapter highlights the key components of the procedures themselves to increase safety and likelihood of good patient outcome. Discussed includes anesthesia, technique, and radiographic analysis.
Interspinous process spacers fill a significant gap in the treatment algorithm for lumbar spinal ... more Interspinous process spacers fill a significant gap in the treatment algorithm for lumbar spinal stenosis between conservative treatment options, such as physical therapy, injections, and medications, and, at the other end of the spectrum, surgical treatments (e.g., open laminectomy). There is strong clinical evidence that, for properly selected patients with neurogenic intermittent claudication secondary to moderate lumbar spinal stenosis, such spacers can provide significant relief of pain and reductions in physical disability. Interspinous process spacers can be implanted in a minimally invasive procedure, reducing the risk of complications.
Background: Chronic back and leg pain is a leading cause of disability and results in a significa... more Background: Chronic back and leg pain is a leading cause of disability and results in a significant health care expenditure. Options such as physical therapy, corticosteroids Epidural Injections (ESI) or spine surgery have limited long term benefit and may cause significant morbidity. Clonidine has anti-neuropathic pain and anti-inflammatory properties. A novel, slow-release biodegradable polymer (Poly (D, L-lactide) clonidine micropellets deliver sustained, high clonidine levels and may provide prolonged pain relief with minimal systemic side effects. Methods: A pilot multicenter investigation of the safety, pharmacokinetics (PK) and effectiveness of clonidine micropellets in patients with chronic lumbosacral radiculopathy. Three sequential cohorts of 18 subjects each received a single epidural injection of clonidine 0.325 mg, 0.975 mg or 1.95 mg (1, 3 or 6 micropellets, respectively) at the interlaminar epidural level that corresponds to the painful dermatomes. Clonidine PK was ev...
PILD allows access to the posterior central canal via ultra-minimally invasive approaches without... more PILD allows access to the posterior central canal via ultra-minimally invasive approaches without the need for general anesthesia. Three critical criteria for patient selection portend success: (1) the patient has neurogenic claudication and leg pain with walking or standing, (2) the patient has central canal lumbar spinal stenosis which is a function of ligamentum flavum hypertrophy, and (3) there exists no other rational cause of the patient’s pain, e.g., far lateral recess stenosis, foraminal stenosis, or vascular claudication. This chapter details the indications for success with PILD.
The facet joints are well-documented, common sources of spinal pain. The medial branch (MB) block... more The facet joints are well-documented, common sources of spinal pain. The medial branch (MB) block of the dorsal primary ramus subserves the facet joints, and a chemical or steroidal block of the nerve serves both as a diagnostic predicate to facet joint denervation as well as a potentially therapeutic intervention. Facet medial branch block (MBB) can safely be performed in the cervical, thoracic, and lumbar spine, but varying levels of evidence support MBB possibly because there exists low variability in MB anatomy in the cervical and lumbar spines and more inconsistency the thoracic spine.
Denervation is typically performed via radiofrequency (RF) ablation but can also be performed wit... more Denervation is typically performed via radiofrequency (RF) ablation but can also be performed with either cryoneurolysis or chemoneurolysis. Thermal ablation can provide significant relief for the better part of a year for most patients. Lesion size is directly proportional to nerve injury likelihood, and significant industry energy is aimed at increasing lesion size safely. With typical radiofrequency ablation, very little tissue destruction occurs distal to the spindle-shaped lesion, making needle placement and understanding of lesion shape critical to success. This chapter guides you toward safety and good outcomes.
The facet joints are well-documented, common sources of spinal pain. The medial branch (MB) block... more The facet joints are well-documented, common sources of spinal pain. The medial branch (MB) block of the dorsal primary ramus subserves the facet joints, and a chemical or steroidal block of the nerve serves both as a diagnostic predicate to facet joint denervation as well as a potentially therapeutic intervention. Facet medial branch block (MBB) can safely be performed in the cervical, thoracic, and lumbar spine, but varying levels of evidence support MBB possibly because there exists low variability in MB anatomy in the cervical and lumbar spines and more inconsistency the thoracic spine.
Fluoroscopy is primary tool for pain procedure imaging. With its use comes significant risk of ra... more Fluoroscopy is primary tool for pain procedure imaging. With its use comes significant risk of radiation injury. Understanding several basic radiation principles and then reviewing with your OR staff will yield enormous benefit. Lastly, by reducing exposure to the patient, the physician and staff will also benefit from exposure diminution. This chapter examines risk and associated strategy to reduce dose and thus risk for yourself, your patients and your staff.
PILD, at present either MILD® or Totalis®, requires familiarization with the technique and instru... more PILD, at present either MILD® or Totalis®, requires familiarization with the technique and instrumentation through formal training. This chapter highlights the key components of the procedures themselves to increase safety and likelihood of good patient outcome. Discussed includes anesthesia, technique, and radiographic analysis.
PILD, at present either MILD® or Totalis®, requires familiarization with the technique and instru... more PILD, at present either MILD® or Totalis®, requires familiarization with the technique and instrumentation through formal training. This chapter highlights the key components of the procedures themselves to increase safety and likelihood of good patient outcome. Discussed includes anesthesia, technique, and radiographic analysis.
Interspinous process spacers fill a significant gap in the treatment algorithm for lumbar spinal ... more Interspinous process spacers fill a significant gap in the treatment algorithm for lumbar spinal stenosis between conservative treatment options, such as physical therapy, injections, and medications, and, at the other end of the spectrum, surgical treatments (e.g., open laminectomy). There is strong clinical evidence that, for properly selected patients with neurogenic intermittent claudication secondary to moderate lumbar spinal stenosis, such spacers can provide significant relief of pain and reductions in physical disability. Interspinous process spacers can be implanted in a minimally invasive procedure, reducing the risk of complications.
Background: Chronic back and leg pain is a leading cause of disability and results in a significa... more Background: Chronic back and leg pain is a leading cause of disability and results in a significant health care expenditure. Options such as physical therapy, corticosteroids Epidural Injections (ESI) or spine surgery have limited long term benefit and may cause significant morbidity. Clonidine has anti-neuropathic pain and anti-inflammatory properties. A novel, slow-release biodegradable polymer (Poly (D, L-lactide) clonidine micropellets deliver sustained, high clonidine levels and may provide prolonged pain relief with minimal systemic side effects. Methods: A pilot multicenter investigation of the safety, pharmacokinetics (PK) and effectiveness of clonidine micropellets in patients with chronic lumbosacral radiculopathy. Three sequential cohorts of 18 subjects each received a single epidural injection of clonidine 0.325 mg, 0.975 mg or 1.95 mg (1, 3 or 6 micropellets, respectively) at the interlaminar epidural level that corresponds to the painful dermatomes. Clonidine PK was ev...
PILD allows access to the posterior central canal via ultra-minimally invasive approaches without... more PILD allows access to the posterior central canal via ultra-minimally invasive approaches without the need for general anesthesia. Three critical criteria for patient selection portend success: (1) the patient has neurogenic claudication and leg pain with walking or standing, (2) the patient has central canal lumbar spinal stenosis which is a function of ligamentum flavum hypertrophy, and (3) there exists no other rational cause of the patient’s pain, e.g., far lateral recess stenosis, foraminal stenosis, or vascular claudication. This chapter details the indications for success with PILD.
The facet joints are well-documented, common sources of spinal pain. The medial branch (MB) block... more The facet joints are well-documented, common sources of spinal pain. The medial branch (MB) block of the dorsal primary ramus subserves the facet joints, and a chemical or steroidal block of the nerve serves both as a diagnostic predicate to facet joint denervation as well as a potentially therapeutic intervention. Facet medial branch block (MBB) can safely be performed in the cervical, thoracic, and lumbar spine, but varying levels of evidence support MBB possibly because there exists low variability in MB anatomy in the cervical and lumbar spines and more inconsistency the thoracic spine.
Denervation is typically performed via radiofrequency (RF) ablation but can also be performed wit... more Denervation is typically performed via radiofrequency (RF) ablation but can also be performed with either cryoneurolysis or chemoneurolysis. Thermal ablation can provide significant relief for the better part of a year for most patients. Lesion size is directly proportional to nerve injury likelihood, and significant industry energy is aimed at increasing lesion size safely. With typical radiofrequency ablation, very little tissue destruction occurs distal to the spindle-shaped lesion, making needle placement and understanding of lesion shape critical to success. This chapter guides you toward safety and good outcomes.
The facet joints are well-documented, common sources of spinal pain. The medial branch (MB) block... more The facet joints are well-documented, common sources of spinal pain. The medial branch (MB) block of the dorsal primary ramus subserves the facet joints, and a chemical or steroidal block of the nerve serves both as a diagnostic predicate to facet joint denervation as well as a potentially therapeutic intervention. Facet medial branch block (MBB) can safely be performed in the cervical, thoracic, and lumbar spine, but varying levels of evidence support MBB possibly because there exists low variability in MB anatomy in the cervical and lumbar spines and more inconsistency the thoracic spine.
Fluoroscopy is primary tool for pain procedure imaging. With its use comes significant risk of ra... more Fluoroscopy is primary tool for pain procedure imaging. With its use comes significant risk of radiation injury. Understanding several basic radiation principles and then reviewing with your OR staff will yield enormous benefit. Lastly, by reducing exposure to the patient, the physician and staff will also benefit from exposure diminution. This chapter examines risk and associated strategy to reduce dose and thus risk for yourself, your patients and your staff.
PILD, at present either MILD® or Totalis®, requires familiarization with the technique and instru... more PILD, at present either MILD® or Totalis®, requires familiarization with the technique and instrumentation through formal training. This chapter highlights the key components of the procedures themselves to increase safety and likelihood of good patient outcome. Discussed includes anesthesia, technique, and radiographic analysis.
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