Evidence-informed management of chronic low back pain with minimally invasive nuclear decompression

Derby, Richard; Baker, Russell T.; Lee, Chang-Hyung

doi:10.1016/j.spinee.2007.10.019

Cited by 18 publications

(26 citation statements)

References 41 publications

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“…Although widely used to estimate median and mean particle sizes (i.e. diameter) of corticosteroid formulations , light microscopy is not optimal to determine the true particle size distribution in a suspension. A more accurate method would be laser light scattering .…”

Section: Discussionmentioning

confidence: 99%

Dilution and microfiltration of particulate corticosteroids for spinal epidural injections: impact on drug concentration and agglomerate formation

et al. 2019

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Particulate corticosteroids have been described to lead to greater pain improvement compared with their nonparticulate counterparts when used in epidural injections. It is hypothesised that filtering may significantly impact their concentration and long-term efficacy. We investigated if passing particulate suspensions through different commonly-used filters affects drug dosage. Two particulate corticosteroid formulations, triamcinolone acetonide and methylprednisolone acetate, were mixed at different concentrations with either bupivacaine hydrochloride or 0.9% sodium chloride. Solutions were passed through a 5-lm and a 0.2-lm filter. Mass spectroscopy results indicated a complete loss of corticosteroid from the solutions using both filters, and light microscopy imaging demonstrated agglomerate formation, suggesting that filtering interferes with drug dosage. The choice of diluents must also be considered to reduce large agglomerate formation. Clinicians should be aware of the consequences of filtering particulate suspensions and carefully consider the selection of diluent when considering treatment plans.

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Section: Discussionmentioning

confidence: 99%

Dilution and microfiltration of particulate corticosteroids for spinal epidural injections: impact on drug concentration and agglomerate formation

et al. 2019

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“…However, more proponents and clinical evidence supported nucleoplasty for individual with lumbar radicular pain, 26 , 27 because of decompression of nerve root through removing nucleus material, decreasing nucleus volume and lowering intradiscal pressure. 28 , 29 In contrast, the benefit of coblation nucleoplasty in treating discogenic low back pain is uncertain, because the scope of interruption of nerves hardly reached to the outer annulus, which was considered as the major origin of discogenic pain.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Coblation Annuloplasty in Discogenic Low Back Pain

Tang

et al. 2015

Medicine

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In degenerative disc, the innervated outer annulus is confirmed to the major origin resulted in discogenic pain. To alleviate the discogenic pain, annuloplasty with electrothermal technology was proved to be effective, which mainly involves the thermal heating of the annulus to denature collagen fibers and denervate posterior annular nerve fibers. However, little is known that efficacy of annuloplasty with coblation technology in treating discogenic pain through directly interrupting nerves in outer annulus.The purpose of this study was to evaluate the clinical outcomes of coblation annuloplasty for the treatment of discogenic low back pain.In a clinical prospective observational study, 17 consecutive patients with discogenic low back pain underwent coblation annuloplasty under local anesthesia. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, and modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 6 months of follow-up.The preoperative pain VAS score was 6.5 ± 0.8(95% confidence interval [CI] 6.1–6.9) and the pain VAS score decreased to 2.9 ± 1.6 (95% CI 2.1–3.8), 2.9 ± 1.7 (95% CI 2.1–3.8), 3.2 ± 1.6 (95% CI 2.4–4.1), 3.2 ± 1.7 (95% CI 2.4–4.2) at 1 week and 1, 3 and 6 month postoperatively, respectively. 12 (70.6%), 11 (64.7%), 10 (58.8%) and 10 (58.8%) of patients reported significant pain relief at 1 week and 1, 3 and 6 months postoperatively. At 1, 3, and 6 months postoperatively, the numbers of patients with “excellent” or “good” ratings were 13 (76.5%), 11 (64.7%), and 10 (58.8%) according to the modified MacNab criteria. No serious complications were observed.The finds show that coblation annuloplasty is an effective, safe, and less uncomfortable procedure in managing discogenic low back pain.

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“…Literatur [314][315][316][317][318][319][320][321][322] ⇓⇓ Operative Verfahren (siehe Tabelle 11) sind in jedem Fall an den Nachweis einer spezifischen Ursache der Kreuzschmerzen gebunden. Auch die ab einem bestimmten Lebensalter bei fast jedem Menschen nachweisbaren, vorwiegend degenerativen Veränderungen der Wirbelsäule sind nicht automatisch mit einer kausalen Diagnose gleichzusetzen [106].…”

Section: -2unclassified

“…Die in der Literaturrecherche gefundenen Übersichtsarbeiten zu operativen Verfahren schließen mehrheitlich Studien zu Patienten mit spezifischen Kreuzschmerzen bzw. einem gemischten Patientenklientel ein [314][315][316][317][318][319][320][321][322]. Gezielte Untersuchungen für Patienten mit nicht-spezifischen Kreuzschmerzen wurden nicht gefunden.…”

Section: -2unclassified

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Janssen¹,

Füssel²,

Hanisch³

et al. 2019

MMW - Fortschritte der Medizin

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Evidence-informed management of chronic low back pain with minimally invasive nuclear decompression

Cited by 18 publications

References 41 publications

Dilution and microfiltration of particulate corticosteroids for spinal epidural injections: impact on drug concentration and agglomerate formation

Dilution and microfiltration of particulate corticosteroids for spinal epidural injections: impact on drug concentration and agglomerate formation

Efficacy of Coblation Annuloplasty in Discogenic Low Back Pain

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