Two-Needle Technique for Lumbar Radiofrequency Medial Branch Denervation: A Technical Note.

Background: Radiofrequency ablation (RFA) of the medial branches of the dorsal rami has been reported to relieve facet joint-related back pain for 6 months to 1 year in 60% of patients. Although providing benefit in a significant proportion of patients, there remains a group of patients who do not experience any pain relief from RFA or experience only benefit from the ablation for a short period. Failure of RFA has been attributed to technical failure of coagulating the nerve or coagulation of a minimal section of the nerve, allowing for early reinnervation.

Lumbar Transgrade Dorsal Root Ganglion Stimulation Lead Placement in Patients with Post-Surgical Anatomical Changes: A Technical Note.

Background: Stimulation of the dorsal root ganglion (DRG-S) has been shown to be an efficacious treatment option for refractory neuropathic pain syndromes. However, placement of the percutaneous leads for trial implantation can be challenging in patients with prior spinal surgical interventions resulting in anatomical changes and adhesions.

Methods: This technical report describes the transgrade placement of DRG-S leads in 4 patients with back pain surgery histories in whom secondary to specific anatomical pathologies the traditional anterograde placement of DRG-S leads was not feasible.

Filum Terminale Needle Placement During Caudal Epidural Steroid Injection.

Objective: Caudal epidural steroid injections (ESIs) are commonly used to treat lumbar radicular pain. Touhy needles are placed under live fluoroscopic guidance to ensure epidural administration of medication. This is a case report of direct needle and catheter placements into and through the filum terminale during a caudal approach to the epidural space.

Ultrasound-Guided Cryoablation of a Traumatic Hip Disarticulation Neuroma.

Objective: Traumatic amputation at the pelvic level is a rare procedure with few studies addressing long-term complications. Painful neuroma formation may form at the site of nerve transection and cause significant impairments in daily living. Ultrasound-guided cryoablation therapy has grown in popularity and should be considered in patients with painful neuromas.

Timing of Platelet Rich Plasma Injections During Antithrombotic Therapy.

The use of platelet rich plasma (PRP) spans across many fields owing to its role in healing and as a natural alternative to surgery. PRP continues to grow however much of the literature is anecdotal or case report based and there is a lack of controlled trials to evaluate standards for PRP. The International Cellular Medical Society (ICMS) has developed guidelines to help with the safe advancement of PRP; however there remains a gap in literature concerning the timing of PRP injections in patients who are on antithrombotic therapy.

Myofascial low back pain.

Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle.