Nonsurgical Interventional Spine Pain Procedures

Whitaker, Colin D; Stone, Benjamin; Gregorczyk, Jerzy A.; Alsoof, Daniel; Hardacker, Kyle; Diebo, Bassel G.; Daniels, Alan H.; Basques, Bryce A.

doi:10.2106/jbjs.rvw.22.00235

Cited by 2 publications

(1 citation statement)

References 129 publications

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“…As with SCSs, a higher preinsertion oral opioid dose correlates with a lower likelihood of long-term pain reduction with the IDDD 64 . A downside is that IDDDs are associated with a high complication rate (most commonly lead migration and infection), and some complications, including pump malfunction, catheter occlusion, septum rupture resulting in potentially life-threatening overdose, ulceration of the IDDD through surrounding tissue, and granuloma formation are severe enough to require explantation 67,68 .…”

Section: Idddsmentioning

confidence: 99%

Optimizing Preoperative Chronic Pain Management in Elective Spine Surgery Patients

Arciero,

Coury,

Dionne

et al. 2023

JBJS Reviews

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» Chronic preoperative opioid use negatively affects outcomes after spine surgery, with increased complications and reoperations, longer hospital stays, decreased return-to-work rates, worse patient-reported outcomes, and a higher risk of continued opioid use postoperatively.» The definition of chronic opioid use is not consistent across studies, and a more specific and consistent definition will aid in stratifying patients and understanding their risk of inferior outcomes.» Preoperative weaning periods and maximum dose thresholds are being established, which may increase the likelihood of achieving a meaningful improvement after surgery, although higher level evidence studies are needed.» Spinal cord stimulators and intrathecal drug delivery devices are increasingly used to manage chronic back pain and are equivalent or perhaps even superior to opioid treatment, although few studies exist examining how patients with these devices do after subsequent spine surgery.» Further investigation is needed to determine whether a true mechanistic explanation exists for spine-related analgesia related to spinal cord stimulators and intrathecal drug delivery devices.

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Section: Idddsmentioning

confidence: 99%

Optimizing Preoperative Chronic Pain Management in Elective Spine Surgery Patients

Arciero,

Coury,

Dionne

et al. 2023

JBJS Reviews

View full text Add to dashboard Cite

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Prevalence, clinical predictors, and mechanisms of resorption in lumbar disc herniation: a systematic review

Xie,

Dong,

Fang

et al. 2024

Orthopedic Reviews

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Study design Systematic review Background Conservative treatment is clinically preferred for lumbar disc herniation (LDH), and surgery is considered when patients’ life quality is still affected by LDH symptoms after three months’ conservative treatment. Spontaneous resorption of nucleus pulposus (NP) is common during conservative treatment. However, the current understanding for the mechanism of NP spontaneous resorption is lacking. Purpose The aim of this study was to elucidate the rate of NP spontaneous resorption, the evidence of predicting spontaneous resorption, and the pathophysiologic mechanisms of spontaneous resorption in the conservative management of LDH based on existing evidence from literature. Methods Studies related to NP spontaneous resorption of LDH were retried from PubMed, Embase, and Cochrane databases. Based on the studies conforming to inclusion criteria, a systematic review was generated for describing the proportion of NP spontaneous resorption, evidence of predicted resorption, and pathophysiologic mechanisms of spontaneous resorption. Results We reviewed a total of 34 articles dealing with the percentage of LDH resorption. The percentage of NP spontaneous resorption after conservative treatment was 76.6% (1684/2199), ranging from 20% to 96.2%. A total of 25 papers were reviewed, involving evidence of predicting resorption using predictors including NP size, inflammatory response to NP herniation, NP prolapse, the percentages edge-enhancing area and posterior longitudinal ligament coverage of the herniation measured by enhanced MRI. Moreover, we analyzed a total of 22 papers describing the pathophysiologic mechanisms of NP spontaneous resorption, where main mechanisms include inflammatory response, neovascular growth, macrophage infiltration, immune intervention, and matrix degradation. Conclusions A percentage of 76.6% in LDH patients undergo NP resorption. Prolapsed NP has a greater contact surface with blood system, which is easily to trigger immune response and thus promote spontaneous resorption. The mechanism of NP spontaneous resorption is mainly due to macrophage infiltration leading to immune response.

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Nonsurgical Interventional Spine Pain Procedures

Cited by 2 publications

References 129 publications

Optimizing Preoperative Chronic Pain Management in Elective Spine Surgery Patients

Optimizing Preoperative Chronic Pain Management in Elective Spine Surgery Patients

Prevalence, clinical predictors, and mechanisms of resorption in lumbar disc herniation: a systematic review

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