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Yuan H, Yi X. Lumbar Spinal Stenosis and Minimally Invasive Lumbar Decompression: A Narrative Review. J Pain Res 2023; 16:3707-3724. [PMID: 37954472 PMCID: PMC10637222 DOI: 10.2147/jpr.s428112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 11/14/2023] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a common pain condition that causes lumbar back pain, radiating leg pain, and possible functional impairment. MILD is an emerging minimally invasive treatment for LSS. It is an image-guided percutaneous procedure designed to debulk hypertrophied ligamentum flavum. However, the exact short- and long-term efficacy, safety profile, indication criteria, and certain procedure details reported in medical literature vary. Objective This narrative review was to elucidate efficacy, safety profile, certain procedure details, advantages, and limitations of MILD. Study Design This is a narrative review. Setting All included articles are clinic trials including analytic studies and descriptive studies. Methods PubMed, Cochrane Library, and Scopus were searched. Only clinical trials of MILD procedure were included. Information of indications, contraindications, VAS scores, ODI scores, effective rate, efficacy durations, and certain procedure details was focused on. Results According to the literature, for the MILD procedure, the VAS score could be reduced from a pre-treatment level of 6.3-9.6 to a post-treatment level of 2.3-5.8. The ODI score could be reduced from a pre-treatment level of 38.8-55.3 to a post-treatment level of 27.4-39.8. The effective rate of the MILD procedure was reported to be 57.1%-88%. A 2-year postoperative stability of efficacy was also supported. One RCT study testified superior efficacy of MILD over epidural steroid injection. Limitations There is few high-quality literature in the review. Moreover, the long-term efficacy of MILD cannot be revealed according to the current literature. Conclusion Based on the reviewed literature, MILD is an effective and safe procedure. MILD can reduce pain intensity and improve functional status significantly. Therefore, it is a preferable option for LSS patients who failed conservative treatments, but not for those who require immediate invasive decompression surgery.
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Affiliation(s)
- Hongjie Yuan
- Department of Pain Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaobin Yi
- Pain Division, Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA
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2
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Validity of outcome measures used in randomized clinical trials and observational studies in degenerative lumbar spinal stenosis. Sci Rep 2023; 13:1068. [PMID: 36658179 PMCID: PMC9852241 DOI: 10.1038/s41598-022-27218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
It is unclear whether outcome measures used in degenerative lumbar spinal stenosis (DLSS) have been validated for this condition. Cross-sectional analysis of studies for DLSS included in systematic reviews (SA) and meta-analyses (MA) indexed in the Cochrane Library. We extracted all outcome measures for pain and disability. We assessed whether the studies provided external references for the validity of the outcome measures and the quality of the validation studies. Out of 20 SA/MA, 95 primary studies used 242 outcome measures for pain and/or disability. Most commonly used were the VAS (n = 69), the Oswestry Disability Index (n = 53) and the Zurich Claudication Questionnaire (n = 22). Although validation references were provided in 45 (47.3%) primary studies, only 14 validation studies for 9 measures (disability n = 7, pain and disability combined n = 2) were specifically validated in a DLSS population. The quality of the validation studies was mainly poor. The Zurich Claudication Questionnaire was the only disease specific tool with adequate validation for assessing treatment response in DLSS. To compare results from clinical studies, outcome measures need to be validated in a disease specific population. The quality of validation studies need to be improved and the validity in studies adequately cited.
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3
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Sayed D, Grider J, Strand N, Hagedorn JM, Falowski S, Lam CM, Tieppo Francio V, Beall DP, Tomycz ND, Davanzo JR, Aiyer R, Lee DW, Kalia H, Sheen S, Malinowski MN, Verdolin M, Vodapally S, Carayannopoulos A, Jain S, Azeem N, Tolba R, Chang Chien GC, Ghosh P, Mazzola AJ, Amirdelfan K, Chakravarthy K, Petersen E, Schatman ME, Deer T. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. J Pain Res 2022; 15:3729-3832. [PMID: 36510616 PMCID: PMC9739111 DOI: 10.2147/jpr.s386879] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.
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Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA,Correspondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email
| | - Jay Grider
- University of Kentucky, Lexington, KY, USA
| | - Natalie Strand
- Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Steven Falowski
- Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nestor D Tomycz
- AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Rohit Aiyer
- Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - David W Lee
- Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Hemant Kalia
- Rochester Regional Health System, Rochester, NY, USA,Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Soun Sheen
- Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Mark N Malinowski
- Adena Spine Center, Adena Health System, Chillicothe, OH, USA,Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Michael Verdolin
- Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA
| | - Shashank Vodapally
- Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - Alexios Carayannopoulos
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA,Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA,Neurosurgery, Brown University, Providence, RI, USA
| | - Sameer Jain
- Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA
| | - Nomen Azeem
- Department of Neurology, University of South Florida, Tampa, FL, USA,Florida Spine & Pain Specialists, Riverview, FL, USA
| | - Reda Tolba
- Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates,Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA,Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA
| | | | | | | | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA,Va San Diego Healthcare, San Diego, CA, USA
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA,Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Deer TR, Grider JS, Pope JE, Lamer TJ, Wahezi SE, Hagedorn JM, Falowski S, Tolba R, Shah JM, Strand N, Escobar A, Malinowski M, Bux A, Jassal N, Hah J, Weisbein J, Tomycz ND, Jameson J, Petersen EA, Sayed D. Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN). J Pain Res 2022; 15:1325-1354. [PMID: 35546905 PMCID: PMC9084394 DOI: 10.2147/jpr.s355285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Discussion Conclusion
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Affiliation(s)
- Timothy R Deer
- Centers for Pain Relief, Charleston, WV, USA
- Correspondence: Timothy R Deer, The Spine and Nerve Centers of the Virginias, 400 Court Street, Suite 100, Charleston, WV, 25301, USA, Tel +1 304 347-6141, Email
| | - Jay S Grider
- UK HealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Sayed E Wahezi
- Montefiore Medical Center, SUNY-Buffalo, Buffalo, NY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Steven Falowski
- Director Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Reda Tolba
- Pain Management Department, Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Jay M Shah
- SamWell Institute for Pain Management, Colonia, NJ, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Alex Escobar
- Department of Anesthesiology and Pain Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Anjum Bux
- Bux Pain Management, Lexington, KY, USA
| | | | - Jennifer Hah
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | | | - Nestor D Tomycz
- Department of Neurological Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Dawood Sayed
- Pain Medicine, Multidisciplinary Pain Fellowship, The University of Kansas Health System, Kansas City, KS, USA
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5
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Pryzbylkowski P, Bux A, Chandwani K, Khemlani V, Puri S, Rosenberg J, Sukumaran H. Minimally invasive direct decompression for lumbar spinal stenosis: impact of multiple prior epidural steroid injections. Pain Manag 2021; 12:149-158. [PMID: 34344197 DOI: 10.2217/pmt-2021-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: A modified algorithm for the treatment of lumbar spinal stenosis with hypertrophic ligamentum flavum using minimally-invasive lumbar decompression (mild®)was assessed, with a focus on earlier intervention. Patients & methods: Records of 145 patients treated with mild after receiving 0-1 epidural steroid injections (ESIs) or 2+ ESIs were retrospectively reviewed. Pain assessments as measured by visual analog scale (VAS) scores were recorded at baseline and 1-week and 3-month follow-ups. Results: Improvements in VAS scores at follow-ups compared with baseline were significant in both groups. No statistically significant differences were found between the two groups. Conclusion: Multiple ESIs prior to mild showed no benefit. A modified algorithm to perform mild immediately upon diagnosis or after the failure of the first ESI is recommended.
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Affiliation(s)
- Peter Pryzbylkowski
- Relievus Pain Management, 3100 Hingston Ave. Suite 104, Egg Harbor Township, NJ 08234, USA
| | - Anjum Bux
- Ephraim McDowell Regional Medical Center, 230 West Main St., Danville, KY 40422, USA
| | - Kailash Chandwani
- UNC Health Southeastern, 4901 Dawn Dr. Suite 3300, Lumberton, NC 28358, USA
| | - Vishal Khemlani
- Columbia Pain Management, PC, 3601 Klindt Dr. Suite 200, The Dalles, OR 97058, USA
| | - Shawn Puri
- Relievus Pain Management, 9815 Roosevelt Blvd Suite J, Philadelphia, PA 19114, USA
| | - Jason Rosenberg
- SC Pain & Spine Specialists, 4731 Hwy 17 Bypass South, Murrells Inlet, SC 29576, USA
| | - Harry Sukumaran
- The Detroit Medical Center, 3990 John R, Box 162, Detroit, MI 48201, USA
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Jain S, Deer T, Sayed D, Chopra P, Wahezi S, Jassal N, Weisbein J, Jameson J, Malinowski M, Golovac S. Minimally invasive lumbar decompression: a review of indications, techniques, efficacy and safety. Pain Manag 2020; 10:331-348. [DOI: 10.2217/pmt-2020-0037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Lumbar spinal stenosis is a common degenerative spine condition. In properly selected patients, minimally invasive lumbar decompression ( mild®) may be an option to improve outcomes. This review provides an in-depth description of the mild procedure and a comprehensive examination of safety and efficacy. Two randomized controlled trials, together with 11 other controlled clinical studies, have established the efficacy of mild, which is a minimally invasive procedure that does not involve implants and has demonstrated excellent efficacy and safety. With an established safety profile equivalent to epidural steroid injections, and efficacy that has been shown to be superior to such injections, mild can reasonably be positioned early in the treatment algorithm for these patients. Based on extensive review of the literature, robust safety and efficacy through 2 years, and in accordance with minimally invasive spine treatment guidelines, mild is recommended as the first intervention after failure of conservative measures for lumbar spinal stenosis patients with neurogenic claudication and ligamentum flavum hypertrophy.
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Affiliation(s)
- Sameer Jain
- Pain Treatment Centers of America, Little Rock, AR 72211, USA
| | - Timothy Deer
- The Spine & Nerve Center of The Virginias, Charleston, WV 25301, USA
| | - Dawood Sayed
- University of Kansas Hospital, Kansas City, KS 66160, USA
| | - Pooja Chopra
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sayed Wahezi
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Navdeep Jassal
- Spine & Pain Institute of Florida, Lakeland, FL 33805, USA
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7
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Deer TR, Grider JS, Pope JE, Falowski S, Lamer TJ, Calodney A, Provenzano DA, Sayed D, Lee E, Wahezi SE, Kim C, Hunter C, Gupta M, Benyamin R, Chopko B, Demesmin D, Diwan S, Gharibo C, Kapural L, Kloth D, Klagges BD, Harned M, Simopoulos T, McJunkin T, Carlson JD, Rosenquist RW, Lubenow TR, Mekhail N. The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment. Pain Pract 2018; 19:250-274. [PMID: 30369003 DOI: 10.1111/papr.12744] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. METHODS The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer-reviewed literature as the basis for making minimally invasive spine treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [RCTs]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. RESULTS The LSS treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image-guided lumbar decompression as superior to lumbar epidural steroid injection, and 1 RCT supported spacer use in a noninferiority study comparing 2 spacer products currently available. CONCLUSIONS MISTs should be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer-reviewed literature. The MIST Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence-based decision algorithm.
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Affiliation(s)
- Timothy R Deer
- Center for Pain Relief, Charleston, West Virginia, U.S.A
| | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A
| | - Jason E Pope
- Evolve Restorative Clinic, Santa Rosa, California, U.S.A
| | - Steven Falowski
- Functional Neurosurgery, St. Lukes University Health Network, Bethlehem, Pennsylvania, U.S.A
| | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - David A Provenzano
- Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, U.S.A
| | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Eric Lee
- Summit Pain Alliance, Sonoma, California, U.S.A
| | - Sayed E Wahezi
- Montefiore Medical Center, SUNY-Buffalo, Buffalo, New York, U.S.A
| | - Chong Kim
- Center for Pain Relief, Charleston, West Virginia, U.S.A
| | - Corey Hunter
- Ainsworth Institute of Pain Management, New York, New York, U.S.A
| | - Mayank Gupta
- Anesthesiology and Pain Medicine, HCA Midwest Health, Overland Park, Kansas, U.S.A
| | - Rasmin Benyamin
- Millennium Pain Center, Bloomington, Illinois, U.S.A.,College of Medicine, University of Illinois, Urbana-Champaign, Illinois, U.S.A
| | | | - Didier Demesmin
- Rutgers Robert Wood Johnson Medical School, Department of Pain Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, U.S.A
| | - Sudhir Diwan
- Manhattan Spine and Pain Medicine, Lenox Hill Hospital, New York, New York, U.S.A
| | - Christopher Gharibo
- Pain Medicine and Orthopedics, NYU Langone Hospitals Center, New York, New York, U.S.A
| | - Leo Kapural
- Carolina's Pain Institute at Brookstown, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - David Kloth
- Department of Anesthesiology, Danbury Hospital, Danbury, Connecticut, U.S.A
| | - Brian D Klagges
- Anesthesiology and Pain Medicine, Amoskeag Anesthesiology, Manchester, New Hampshire, U.S.A
| | - Michael Harned
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Tom Simopoulos
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | | | | | | | | | - Nagy Mekhail
- Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, Ohio, U.S.A
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Ehrhardt KP, Mothersele SM, Brunk AJ, Green JB, Jones MR, Billeaud CB, Kaye AD. Spinal Cord Stimulation, MILD Procedure, and Regenerative Medicine, Novel Interventional Nonopioid Therapies in Chronic Pain. Curr Pain Headache Rep 2018; 22:26. [PMID: 29556832 DOI: 10.1007/s11916-018-0680-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Chronic pain is a highly prevalent condition affecting millions of individuals. RECENT FINDINGS In recent years, newer treatments have emerged that are changing the way clinicians treat pain pathogenesis, including novel nonopioid strategies. In this regard, spinal cord stimulation, the MILD procedure, and regenerative medicine have shown promise. This review summarizes recent literature on these three emerging treatment strategies. The results of this review suggest that under certain conditions, spinal cord stimulation, the MILD procedure, and regenerative medicine can be effective treatment modalities.
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Affiliation(s)
- Ken P Ehrhardt
- Department of Anesthesiology and Pain Medicine, LSU Health Science Center, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 659, New Orleans, LA, USA
| | - Susan M Mothersele
- Department of Anesthesiology and Pain Medicine, LSU Health Science Center, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 659, New Orleans, LA, USA
| | - Andrew J Brunk
- Department of Anesthesiology and Pain Medicine, LSU Health Science Center, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 659, New Orleans, LA, USA
| | - Jeremy B Green
- Department of Anesthesiology and Pain Medicine, LSU Health Science Center, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 659, New Orleans, LA, USA
| | - Mark R Jones
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Craig B Billeaud
- Department of Anesthesiology and Pain Medicine, LSU Health Science Center, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 659, New Orleans, LA, USA
| | - Alan David Kaye
- Department of Anesthesiology and Pain Medicine, LSU Health Science Center, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 659, New Orleans, LA, USA. .,Department of Pharmacology, LSU School of Medicine, New Orleans, LA, USA.
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Abstract
PURPOSE OF REVIEW Percutaneous lumbar decompression is a minimally invasive procedure for the treatment of symptomatic lumbar spinal stenosis (LSS). The purpose of this article is to review the current literature on percutaneous lumbar decompression as well as review the safety and outcomes associated with the procedure. RECENT FINDINGS LSS is a significant cause of chronic pain and a common indication for invasive spine surgery. The recent literature shows that percutaneous lumbar decompression is a minimally invasive treatment option that affords a high level of safety, improved function, decreased pain scores, and is cost-effective. SUMMARY This minimally invasive procedure is an option for patients with central canal LSS who have continued pain-following conservative treatment such as physical therapy, oral medications, and lumbar spine injections. Percutaneous lumbar decompression is a procedure that bridges the gap between invasive surgery and more conservative treatment for LSS. This percutaneous technique provides increasing options to those patients with central canal lumbar stenosis who may not be candidates for an invasive decompression procedure. Overall, this procedure has been found to be well tolerated and effective in reducing pain while generally improving function.
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10
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Costandi S, Chopko B, Mekhail M, Dews T, Mekhail N. Lumbar spinal stenosis: therapeutic options review. Pain Pract 2014; 15:68-81. [PMID: 24725422 DOI: 10.1111/papr.12188] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/27/2014] [Indexed: 01/15/2023]
Abstract
Lumbar spinal stenosis (LSS) functionally impacts significant numbers of Americans per year. Current estimates place the number of Americans suffering from senescent lumbar spinal stenosis at 400,000. The prevalence of this disorder in patients ranging from 60 to 69 years of age is very high. Forty-seven percent of this age group have mild to moderate stenosis, and 19.7% have severe stenosis. As the baby boomer generation gets older, 10,000 individuals attain the age of 65 years every day in United States. LSS is becoming very common and will be a major healthcare issue as the population ages. Although LSS is not life threatening, it can cause substantial disability with limitations to performing daily activities, and thus, the associated negative impact on quality of life (QOL). This article reviews the pathophysiology and current treatment options for LSS, focusing on evidence-based treatment options.
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Affiliation(s)
- Shrif Costandi
- Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A
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11
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Kreiner DS, MacVicar J, Duszynski B, Nampiaparampil DE. The mild® procedure: a systematic review of the current literature. PAIN MEDICINE 2013; 15:196-205. [PMID: 24308292 DOI: 10.1111/pme.12305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study's objective was to determine if the literature supports use of the Minimally Invasive Lumbar Decompression (mild®) procedure (Vertos Medical, Aliso Viejo, CA, USA) to reduce pain and improve function in patients with symptomatic degenerative lumbar spinal stenosis. DESIGN/SETTINGS The study was designed as an evidence-based review of available data. Studies were identified from PubMed, Embase, and the Cochrane Library. Articles were evaluated using the Grading of Recommendations Assessment, Development and Evaluation Working Group system. Results were compiled assessing short- (4-6 weeks), medium- (3-6 months), and long-term (>1 year) outcomes. The primary outcomes evaluated were pain, measured by the visual analog scale (VAS), and function, measured by the Oswestry Disability Index (ODI). Secondary outcomes included pain and patient satisfaction, measured by the Zurich Claudication Questionnaire, adverse effects/complications, and changes in utilization of co-interventions. RESULTS The literature search revealed one randomized controlled trial (RCT) and 12 other studies (seven prospective cohort, four retrospective, and one case series) that provided information on the use of mild® in patients with degenerative lumbar spinal stenosis. All studies showed statistically significant improvements in VAS and ODI scores at all time frames compared with preprocedure levels; the RCT showed improvement over controls. Categorical data were not provided; thus, the proportion of patients who experienced minimal clinically meaningful outcomes is unknown. CONCLUSION The current body of evidence addressing mild® is of low quality. High-quality studies that are independent of industry funding and provide categorical data are needed to clarify the proportions of patients who benefit from mild® and the degree to which these patients benefit. Additional data at up to 2 years are needed to determine the overall utility of the procedure.
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12
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Durkin B, Romeiser J, Shroyer ALW, Schiller R, Bae J, Davis RP, Peyster R, Benveniste H. Report From a Quality Assurance Program on Patients Undergoing the MILD Procedure. PAIN MEDICINE 2013; 14:650-6. [DOI: 10.1111/pme.12079] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levy RM, Deer TR. Systematic Safety Review and Meta-Analysis of Procedural Experience Using Percutaneous Access to Treat Symptomatic Lumbar Spinal Stenosis. PAIN MEDICINE 2012; 13:1554-61. [DOI: 10.1111/j.1526-4637.2012.01504.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Deer T. Minimally invasive lumbar decompression for the treatment of spinal stenosis of the lumbar spine. Pain Manag 2012; 2:457-65. [PMID: 24645862 DOI: 10.2217/pmt.12.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
SUMMARY Lumbar spinal stenosis is one of the most common degenerative diseases of the elderly population, and a major cause of debilitating pain and decreased function. Lumbar spinal stenosis is almost always associated with neurogenic claudication characterized as pain worsened by standing or walking and relieved by lumbar flexion or sitting. While initial treatment of lumbar spinal stenosis may involve conservative therapies, as patients become more symptomatic the traditional treatment path has generally led to open laminectomy and other invasive, potentially destabilizing, procedures. More recently, less invasive alternatives to wide laminectomy have been developed. This article describes a new method of percutaneous lumbar decompression for treatment of neurogenic claudication secondary to lumbar spinal stenosis, the minimally invasive lumbar decompression procedure. We review the steps of successfully decompressing the hypertrophic ligamentum flavum and lamina, thereby alleviating pressure on neural structures. This is a major innovation in patient care and a step to reduce risks while minimizing costs.
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Affiliation(s)
- Timothy Deer
- West Virginia University School of Medicine, 400 Court Street, Suite 100, Charleston, WV 25301, USA and The Center for Pain Relief, Inc., 400 Court Street, Suite 100, Charleston, WV 25301, USA.
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Chopko BW. Regarding Failure of Percutaneous Remodeling of the Ligamentum Flavum and Lamina for Neurogenic Claudication. Neurosurgery 2012; 71:E525-6; author reply E526-8. [DOI: 10.1227/neu.0b013e31825ca146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Benyamin RM, Vallejo R. Regarding: Dr. Tumialán et al. in response to "Long-term results of percutaneous lumbar decompression mild® for spinal stenosis". Pain Pract 2012; 12:498. [PMID: 22758601 DOI: 10.1111/j.1533-2500.2012.00566.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Lumbar spinal stenosis (LSS) is characterized by narrowing of the spinal canal with impingement of the spinal cord by surrounding tissues of bones. Current management options for LSS include rest, medications, physical therapy, epidural steroid injections, alternative medicine, and surgical decompression. Because each modality of treatment has its own set of limitations, there is a need for a safe, effective, and cost-saving treatment for LSS. mild is a minimally invasive procedure for treatment of degenerative LSS with ligamentum flavum hypertrophy through percutaneous decompression of the hypertrophic ligamentum flavum. The effect is debulking of tissue that is a contributor to lumbar canal narrowing with minimal trauma to surrounding tissue. This literature review presents a brief review of the pathophysiology, clinical presentation, and current treatment options for LSS and reviews the current literature regarding the efficacy, safety, and cost-effectiveness of the mild procedure.
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Affiliation(s)
- Hamilton Chen
- University of California, Irvine, California 92868, USA.
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Mekhail N, Costandi S, Abraham B, Wadie Samuel S. Functional and Patient-Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression. Pain Pract 2012; 12:417-25. [DOI: 10.1111/j.1533-2500.2012.00565.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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