Epidural interlaminar injections in severe degenerative lumbar spine: fluoroscopy should not be a luxury

Preoperative Dyeing Technique for Decreasing Radiation Exposure in Unilateral Biportal Endoscopic Spine Surgery

BACKGROUND

Minimally invasive surgery has many advantages, including early recovery and cosmetic preservation. However, the higher radiation exposure to physicians and patients has drawbacks. Preoperative tissue dyeing techniques are feasible options for reducing radiation exposure and procedure time, but their efficacy has not yet been evaluated. Therefore, this study aimed to evaluate surgical outcomes and reduce radiation exposure during unilateral biportal endoscopy surgery.

METHODS

This was a prospective, case-controlled analysis in a tertiary hospital. Patients receiving experimental tissue dye and controls in the nondye group were compared from May 2020 to September 2021. The ipsilateral posterolateral approach (IPA) and the far lateral approach (FLA) were analyzed separately among all single-level spinal procedures without instrumentation. Operative details (operation time, improvement of back and leg pain, and length of hospital stay) and radiation exposure (dose and duration) were compared.

RESULTS

A total of 88 cases were included, consisting of 64 interlaminar approaches (experimental: 33, control: 31) and 24 FLAs (experimental: 13 and control: 11). In the IPA approach, the patient and physician radiation exposure doses and duration decreased significantly. Conversely, for the FLA, only the duration of the physician exposure decreased significantly.

CONCLUSIONS

Preoperative tissue dyeing techniques using IPA can reduce radiation exposure for physicians and patients. However, a decrease in the duration of radiation was observed only in physicians using the FLA. The dyeing technique is effective in IPA, but the efficacy of FLA is doubtful.

Update on Interventional Radiology of the Spine

Interventional radiologists now perform spinal interventions routinely for diagnostic and therapeutic purposes. New technologies for the management of spine pathologies have emerged with promising results in terms of safety and efficacy. Interventional radiology techniques in the spine include percutaneous biopsy and therapies for intervertebral disk herniation or spinal stenosis, facet and sacroiliac joint pathologies, vertebral and sacral fractures, and metastases. These techniques can also be easily combined one with the other or to further therapeutic approaches including systemic therapies, surgical approaches, and radiotherapy. This review provides a comprehensive overview of current percutaneous imaging-guided interventional radiology techniques in the spine. It will help readers become familiar with the most common indications, learn about different technical considerations during performance, and review the available evidence. Controversies concerning new products and technical approaches are also addressed.

Percutaneous imaging-guided techniques for the treatment of benign neuropathic pain

To date, conservative management including physical and/or systemic pharmacologic therapy is considered as the first line approach for the management of neuropathic pain syndromes. In the era of an opioid overdose crisis with an increased concern upon the risks and harms arising from the misuse of medicines for pain management, percutaneous minimally invasive techniques such as nerve infiltrations as well as neurolysis or neuromodulation techniques can be proposed to control pain and improve life quality. Computed tomography can serve as an ideal guiding technique due to its specific characteristics including precise anatomic delineation, high spatial resolution and good tissue contrast. The purpose of this review is to make the reader familiar with the most common indications for minimally invasive imaging-guided techniques in patients with neuralgia and provide current evidence regarding technical considerations.

Interventional pain management for chronic pain: a survey of physicians in Canada

PURPOSE

The use of interventional pain management (IPM) modalities to alleviate chronic pain is increasing despite the lack of high-quality evidence. We undertook this survey to explore patterns, training, and attributes of IPM practice.

METHODS

We administered a 32-item survey via seven Canadian physician member organizations, whose members were engaged in the management of chronic pain.

RESULTS

Of 777 physicians contacted, 256 (33%) responded: 45 (6%) declined to participate and 211 (27%) agreed to participate; the number of participants answering any given question varied. One hundred and sixty-nine of 194 (87%) practiced IPM and 103 of 194 (53%) managed only non-cancer pain. Pain management training of ≥ six months was associated with higher odds of IPM training (odds ratio [OR], 2.98; 95% confidence interval [CI], 1.32 to 6.7), but not necessarily ongoing IPM practice (OR, 1.97; 95% CI, 0.74 to 5.3). A substantial percentage of physicians (108 of 168 [64%]) practiced IPM based only on training received during either their base residency program or courses. Only 48 of 186 (26%) felt that there were adequate opportunities for IPM training, and 69 of 186 (37%) believed that their colleagues practiced IPM in accordance with the best current evidence.

CONCLUSIONS

Our survey indicates that IPM practice and training were not uniform, and that interventional therapies for chronic pain may not be performed in accordance with the best available evidence. Our survey highlights a lack of IPM training opportunities, which may result in substandard training. Concerted efforts involving physician organizations and regulators are needed to standardize IPM training and develop clinical guidelines to optimize evidence-based practice.