Persistent air leak treated by autologous blood patch pleurodesis: the role of CT-guided small-bore chest tube insertion.

Autologous blood patch pleurodesis (ABPP) offers an alternative to surgery when conservative management is ineffective for treating a persistent air leak (PAL). In the traditional technique, autologous venous blood is introduced into the affected pleural cavity via a blindly inserted large-bore surgical chest tube. Herein, we present a case of an 18 year old male with a PAL following video assisted thorascopic bleb resection and talc pleurodesis who underwent successful ABPP using a small-bore pigtail catheter placed under computed tomography (CT) guidance.

Low-Intensity Pulsed Ultrasound Therapy for a Symptomatic Persistent Olecranon Physis in an Adolescent Baseball Pitcher.

A 15-year-old competitive right-handed high school baseball pitcher experienced an acute onset of right elbow pain when throwing. He initially treated it conservatively with rest alone for 3 months, but on return to throwing, he was still experiencing pain. Radiographs revealed that he had a persistent olecranon physis.

Ultrasound-guided trigger point injections in the cervicothoracic musculature: a new and unreported technique.

Background: Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under diagnosed and under treated medical problems encountered in clinical practice.

Electromyographically guided trigger point injections in the cervicothoracic musculature of obese patients: a new and unreported technique.

Background: Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under-diagnosed and under-treated medical problems encountered in clinical practice.

Fluoroscopically guided caudal epidural steroid injections in degenerative lumbar spine stenosis.

Background: Caudal epidural steroid injections are commonly utilized to help reduce radicular pain in lumbar spinal stenosis. There have been studies done to evaluate the effectiveness of this procedure non-fluoroscopically guided. Search revealed no prospective studies evaluating the effectiveness of fluoroscopically guided caudal epidural injections on patients with bilateral radicular pain from degenerative lumbar spinal stenosis.

Radiation exposure to the physician performing fluoroscopically guided caudal epidural steroid injections.

This study was designed to investigate radiation exposure to a physician performing fluoroscopically guided caudal epidural steroid injections. The prospective study design included 100 consecutive fluoroscopically guided caudal epidural steroid injections performed on patients with radiculitis from either herniated nucleus pulposus or lumbar spinal stenosis. Radiation exposure was monitored with the assistance of a radiological technologist (RT) who allocated four dosimetry badges to all physicians performing fluoroscopically guided caudal epidural steroid injections on consecutive patients being treated for radicular pain.

Radiation exposure to the spinal interventionalist performing lumbar discography.

To evaluate radiation exposure to the spinal interventionalist performing lumbar discography. A prospective study on four spinal interventionalists who performed 106 consecutive lumbar discograms (levels) on 37 patients with low back pain. Radiation exposure was monitored with the assistance of a radiological technologist (RT) who allocated four (4) dosimetry badges to all spinal interventionalists performing Discograms on consecutive patients being referred for evaluation of possible discogenic pain.

Fluoroscopic guided lumbar interlaminar epidural injections: a prospective evaluation of epidurography contrast patterns and anatomical review of the epidural space.

Objective: To evaluate the pattern and flow of epidural contrast in fluoroscopically guided lumbar interlaminar steroid injections.

Design And Methods: A prospective case series of 25 (twenty-five) consecutive patients receiving 25 (twenty-five) injections. Patients had either lumbar spinal stenosis (LSS) or herniated nucleus pulposus (HNP).

Candida spondylodiscitis: an unusual case of thoracolumbar pain with review of imaging findings and description of the clinical condition.

Spondylodiscitis is an unusual but important cause of back pain. Patients with spinal infections typically present with severe sharp aching pain, malaise, fever, and percussion tenderness over the affected area. Early identification of the responsible organism is essential for adequate and prompt treatment.

Epidurography contrast patterns with fluoroscopic guided lumbar transforaminal epidural injections:a prospective evaluation.

Background: Lumbar transforaminal epidural injections have been utilized in the treatment of radicular pain with proven success. It was postulated that interlaminar epidural injections result in a dorsal flow of contrast while transforaminal epidural steroid injections showed good ventral flow limited to one single spinal motion segment. There have been no published studies evaluating epidurography/contrast patterns utilizing fluoroscopy.

Adverse effects of fluoroscopically guided interlaminar thoracic epidural steroid injections.

Objectives: To assess the prevalence of adverse effects or complications from fluoroscopically guided thoracic interlaminar epidural steroid injections.

Design: A retrospective study with independent observer review. Patients presenting with thoracic radicular pain, caused by either herniated nucleus pulposus or thoracic spondylosis as confirmed by magnetic resonance imaging, received an interlaminar thoracic epidural steroid injection as part of a conservative-care treatment plan.

Epidural steroid injections in the treatment of symptomatic lumbar spinal stenosis associated with epidural lipomatosis.

Epidural lipomatosis has been implicated as a cause or contributor of symptomatic lumbar spinal stenosis. Although epidural steroid injections have been very successful for symptomatic treatment of spinal stenosis; their role in treatment of symptomatic stenosis secondary to epidural lipomatosis is unclear. A review literature (MEDLINE, PubMed) found no reports justifying the use of steroids.

Biochemical and immunological properties of cytokines conjugated to dendritic polymers.

Here we describe a post-translational modification of SC-63032, a variant of the species restricted, multi-lineage hematopoeitic factor human interleukin-3 (hIL-3). We have made two new dendritic polymer (polyamidoamine or PAMAM dendrimers, generation 5)-SC-63032 bioconjugates. Using two distinct chemistries (one of which is novel to this work), we achieved site-specific conjugation with respect to the amino acid in the proteins ligated to the dendrimers.

Complications of fluoroscopically guided interlaminar cervical epidural injections.

Objectives: To assess the incidence of complications of fluoroscopically guided interlaminar cervical epidural injections.

Design: A retrospective cohort design study.

Setting: A multidisciplinary spine care center.

Epidemiology of spine tumors presenting to musculoskeletal physiatrists.

Objective: To report the incidence and epidemiologic formation of previously undetected primary and secondary spine tumors presenting as spinal and/or extremity pain to a physiatrist practicing in an academic or private practice multidisciplinary spine center.

Design: Multicenter retrospective chart review.

Setting: Three multidisciplinary spine settings (1 academic, 2 private).

Lumbar epidural steroid injections in the patient with lumbar spinal stenosis.

Epidural steroid injections seem to be a useful component of a comprehensive and functionally oriented rehabilitation program for the patient with LSS. Review of the literature indicates the injections seem to be effective and are safe when performed with proper technique.

Lumbar spinal stenosis: anatomy and pathogenesis.

This article reviews the history, classification, and pathoanatomy of lumbar spinal stenosis. An understanding of the pathoanatomy of lumbar spinal stenosis is essential for the clinician to treat the patient with clinically symptomatic lumbar spinal stenosis more effectively.

Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study.

Objective: To identify the short- and long-term therapeutic benefit of fluoroscopically guided lumbar transforaminal epidural steroid injections in patients with radicular leg pain from degenerative lumbar stenosis.

Design: This prospective cohort study performed at a multidisciplinary spine center. There were a total of 34 patients who met our inclusion criteria for the treatment of unilateral radicular pain from degenerative lumbar spinal stenosis who underwent fluoroscopically guided lumbar transforaminal epidural injections.

Radiation exposure of the spinal interventionalist performing fluoroscopically guided lumbar transforaminal epidural steroid injections.

Objective: To evaluate radiation exposure to spinal interventionalists while performing transforaminal epidural steroid injections (TFESIs).

Design: Prospective study.

Setting: Multidisciplinary spine center.

Sciatic neuropathy secondary to infiltrating intermuscular lipoma of the thigh.

Sciatic neuropathy is a rare mononeuropathy of the lower limbs that is commonly misdiagnosed as spinal stenosis or herniated nucleus pulposus. We describe an unusual case in which a patient underwent surgical excision of a large soft-tissue mass on his right side that involved the posterior and medial compartment of the thigh with displacement of the sciatic nerve posteriorly. The patient had full resolution of his pain and restoration of his neurologic function.

Complications of fluoroscopically guided caudal epidural injections.

Objectives: To assess the incidence of complications of fluoroscopically guided caudal epidural injections.

Design: A retrospective cohort design study in which chart review was performed on patients, who presented with radiculopathy and received fluoroscopically guided caudal epidural steroid injections. All injections were performed consecutively over a 12-mo period.

Role of weight-bearing flexion and extension myelography in evaluating the intervertebral disc.

Magnetic resonance imaging has many advantages compared with myelography and/or computed tomography in evaluating the lumbar spine for herniated nucleus pulposus. The authors have included a series of three patients whose histories and physical examinations were clinically suggestive of herniated nucleus pulposus but whose magnetic resonance imaging scans were interpreted by a radiologist as a disc bulge without nerve root compression. Because all patients had not responded to a conservative care treatment program and surgical intervention was to be considered, subsequent testing with lumbar myelography with weight-bearing flexion and extension views demonstrated more clearly the presence of herniated nucleus pulposus along with compression of the nerve root; it also revealed that a positional change in the disc occurred with flexion and extension.

Complications of fluoroscopically guided transforaminal lumbar epidural injections.

Objectives: To assess the incidence of complications of fluoroscopically guided lumbar transforaminal epidural injections.

Design: A retrospective cohort design study. Patients presenting with radiculopathy, caused by either lumbar spinal stenosis or herniated nucleus pulposus confirmed by magnetic resonance imaging or computed tomography scanning, received transforaminal epidural steroid injections as part of a conservative care treatment plan.

Lumbosacral radiculopathy secondary to metastatic uterine leiomyosarcoma: a case report.

Study Design: A retrospective case report.

Objectives: To increase awareness of the fact that very serious and potentially devastating conditions can be associated with lumbosacral radiculopathy. To reinforce the need to have a definitive diagnosis before performing epidural injections in patients with radicular pain who are not responsive to conservative treatment.