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Third-Degree Burn from Cooled Radiofrequency Ablation of Medial Branch Nerves for Treatment of Thoracic Facet Syndrome.

Pain Pract. 2014 May 2;

Authors: Walega D, Roussis C

Radiofrequency ablation of medial branch nerves is considered a safe and effective treatment for chronic facet joint pain in the cervical, thoracic, and lumbosacral spine. Cooled radiofrequency ablation (C-RFA) is gaining popularity over conventional thermal radiofrequency ablation (RFA) in pain management. However, complications of C-RFA have not been reported in the literature. We present a first report of third-degree skin burn resulting from C-RFA electrode use for the treatment of facet syndrome. A 61-year-old woman (BMI of 21.8 kg/m(2) ) with thoracic facet syndrome underwent C-RFA of the T1-4 medial branch nerves (Thoracool System, Baylis Medical Company, Montreal, QC, Canada). Lesioning at the superior-lateral aspect of the thoracic transverse processes at each level was performed. During lesioning of the T2 MBN on the T3 transverse process, skin blanching 15 mm in diameter was noted around the introducer needle with patient complaints of severe, localized pain. Postprocedurally the skin injury at this level worsened in appearance, with a 20 mm × 4 mm skin defect, which took nearly 5 months to heal. With C-RFA, internally cooled electrodes are capable of creating large volume spherical lesions, a size advantage over conventional RFA. Although C-RFA lesion size may overcome the anatomic variability of target nerve location and potentially improve pain outcomes, added vigilance is required in thin patients and in anatomic regions of minimal subcutaneous tissue between the lesion target and the dermis. Skin burns at the site of the RF electrode are a potential risk under such conditions.

PMID: 24796394 [PubMed – as supplied by publisher]

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Sclerosing injections and ultrasound-guided arthroscopic shaving for patellar tendinopathy: good clinical results and decreased tendon thickness after surgery-a medium-term follow-up study.

Knee Surg Sports Traumatol Arthrosc. 2014 May 6;

Authors: Sunding K, Willberg L, Werner S, Alfredson H, Forssblad M, Fahlström M

PURPOSE: Treatment of patellar tendinopathy/jumper’s knee with ultrasound-guided sclerosing injections or ultrasound-guided arthroscopic shaving has shown good clinical short-term results. Former studies indicate that the tendon thickness and structure stays unaffected after successful treatment. The aim of this study was to evaluate the sonographic findings and clinical outcome 3-5 years after treatment of patellar tendinopathy with ultrasound-guided sclerosing injections or arthroscopic shaving.
METHODS: Fifty-seven patellar tendons (43 patients) with chronic patellar tendinopathy were evaluated, with ultrasound, colour Doppler (CD) and visual analogue scale (VAS) for pain and satisfaction with treatment, 3-5 years after treatment. Functional status was evaluated with a single question-“Back in full loading activity?” yes or no.
RESULTS: At endpoint (mean 46 months), there was a significant decrease in anteroposterior thickness of the proximal patellar tendon in patients treated with ultrasound-guided arthroscopic shaving but not after sclerosing injections. Tendon structure had improved, and CD local blood flow had diminished significantly in both groups. There were good clinical results with a significant decrease in VAS for pain after sclerosing injections (VAS 64 ± 18 → 17 ± 23) with 74 % satisfied patients and also after arthroscopic shaving (VAS 77 ± 16 → 13 ± 23) with 80 % satisfied patients. There were no significant differences in VAS between groups. A significant correlation between low local blood flow and high patient satisfaction was found.
CONCLUSIONS: Tendon thickness decreased over time after ultrasound-guided arthroscopic shaving, and tendon structure and local blood flow decreased after both treatments. There were good, and similar, clinical results with both methods. LEVEL OF EVIDENCE: III.

PMID: 24797812 [PubMed – as supplied by publisher]

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Infectious spondylodiscitis – A case series analysis.

Adv Med Sci. 2014 Mar;59(1):57-60

Authors: Garkowski A, Zajkowska A, Czupryna P, Lebkowski W, Letmanowski M, Gołębicki P, Moniuszko A, Ustymowicz A, Pancewicz S, Zajkowska J

PURPOSE: We aimed to describe the clinical and laboratory features as well as diagnostic difficulties in the case series of spondylodiscitis.
MATERIALS/METHODS: We retrospectively reviewed 11 cases of spondylodiscitis. The diagnosis of spondylodiscitis was based on clinical, radiological and microbiological evidence and by the response to antimicrobial therapy.
RESULTS: There were 7 men and 4 women, and the age ranged from 21 to 74 years. Risk factors of spondylodiscitis were observed in 7 patients. The approximate time from onset of symptoms to diagnosis was from 2 to 7 months (median 45 days). Back pain was the most common symptom. The most frequent location of spondylodiscitis was lumbar spine. Pathogens were isolated in 6 cases and were as follows: Staphylococcus aureus (4 cases), Staphylococcus warneri (1 case) and Escherichia coli (1 case). After therapy, all patients had rapid regression of symptoms and no permanent neurological impairments and recurrence of infection were observed.
CONCLUSIONS: Diagnosis of spondylodiscitis is frequently delayed. This disease should be taken into consideration in differential diagnosis in patients with root syndromes accompanied by back pain and usually fever as well as increased values of CRP and ESR.

PMID: 24797976 [PubMed – in process]

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Postsurgical Pathologies Associated with Intradural Electrical Stimulation in the Central Nervous System: Design Implications for a New Clinical Device.
Biomed Res Int. 2014;2014:989175
Authors: Gib…

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Clinical, Microbiologic, and Outcome Analysis of Mycotic Aortic Aneurysm: The Role of Endovascular Repair.

Surg Infect (Larchmt). 2014 May 6;

Authors: Huang YK, Chen CL, Lu MS, Tsai FC, Lin PL, Wu CH, Chiu CH

Abstract Background: Mycotic aortic aneurysm (MAA) is an infrequent but devastating form of vascular disease. Methods: We conducted a retrospective cohort study at a major medical center to identify independent risk factors for MAA and to provide opinions about treating it. The study population consisted of 43 patients who had had 44 MAAs over a period of 15 y. Results: All of the patients had positive blood cultures, radiologic findings typical of MAA, and clinical signs of infection (leukocytosis, fever, and elevated C-reactive protein). The mean age of the patients was 63.8±10.6 y and the mean period of their follow up was 35.7±39.3 mo. Twenty-nine patients with MAAs underwent traditional open surgery, 11 others received endovascular stent grafts, and four MAAs were managed conservatively. The most frequent causative pathogens were Salmonella (36/44 patients [81.8%]), in whom organisms of Salmonella serogroup C (consisting mainly of S. choleraesuis) were identified in 14 patients, organisms of Salmonella serogroup D were identified in 13 patients, and species without serogroup information were identified in nine patients. The overall mortality in the study population was 43.2% (with an aneurysm-related mortality of 18.2%, surgically related mortality of 13.6%, and in-hospital mortality of 22.7%). Conclusions: Shock is a risk factor for operative mortality. Misdiagnosis and treatment of MAA as low back pain, co-existing connective-tissue disease such as systemic lupus erythematosus and rheumatoid arthritis, and Salmonella serogroup C-associated bacteremia are risk factors for aneurysm-related death. Endovascular repair should be considered as an alternative option to the open repair of MAA.

PMID: 24800865 [PubMed – as supplied by publisher]

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A Case of Severe Low Back Pain After Surgery.

J Pain Palliat Care Pharmacother. 2014 May 7;

Authors: Rhodin A

ABSTRACT The etiology of chronic back pain is often unknown but can include failed spinal surgery. Pain can often be of mixed type and it is important to evaluate pain mechanisms. Comorbid factors often contribute to pain chronicity. Multimodal treatment, including opioid rotation where indicated, may offer a successful management approach. Other rehabilitative procedures such as physiotherapy, exercise therapy, and good sleep hygiene may have a profound impact on patient quality of life. Spinal cord stimulation may be an effective option for some patients with failed spinal surgery syndrome. A case of severe low back pain after surgery in a 45-year-old man is presented to illustrate this. This report is adapted from paineurope 2013; Issue 4, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: , at which European health professionals can register online to receive copies of the quarterly publication.

PMID: 24801975 [PubMed – as supplied by publisher]

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Baseline sacroiliac joint magnetic resonance imaging abnormalities and male sex predict the development of radiographic sacroiliitis.
Clin Rheumatol. 2013 Oct;32(10):1511-7
Authors: Akar S, Isik S,…

Diagnostic uncertainty and recall bias in chronic low back pain.
Pain. 2014 Apr 29;
Authors: Serbic D, Pincus T
Patients’ beliefs about the origin of their pain and their cognitive processi…

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Care related pain and functional restoration for chronic low back pain: a prospective study.

Ann Phys Rehabil Med. 2013 Sep;56(6):455-64

Authors: Beaudreuil J, Zerkak D, Métivier JC, Fouquet B

OBJECTIVE: To assess care related pain during a program of functional restoration for chronic low back pain.
PATIENTS AND METHODS: Chronic low back pain patients were prospectively included in a program of functional restoration. Low back pain was recorded before and after each morning and afternoon sessions, all over the program of functional restoration, for equivalence study. Equivalence was admitted if 95% confidence interval of the difference in pain falled wholly in the interval ± 10/100mm. Medication was recorded during the program. Progression of the patients during the program and 3-month effectiveness were also recorded for internal validity.
RESULTS: Thirty-seven patients were included. They underwent a progression in load and spent energy during the program. Follow-up also indicated improvement of functional ability and quality of life. There was no variation in pain during the program however medication intake increased.
CONCLUSION: There was no significant care related pain during our program of functional restoration for chronic low back pain. This may be due to adaptation of the medication and suggests the importance of close medical management of patients during functional restoration.

PMID: 23896221 [PubMed – indexed for MEDLINE]

A late presentation of isolated lymph node tuberculosis postintravesical BCG therapy for superficial bladder cancer: a novel case.

BMJ Case Rep. 2014;2014

Authors: Tasleem AM, Varga B, Mahmalji W, Madaan S

Intravesical BCG immunotherapy is commonly used in the treatment of superficial bladder cancer. We recount the case of an 82-year-old British man who completed a course of BCG immunotherapy in 2011 for superficial bladder cancer, and presented in January 2013 with a loss of appetite, loss of weight and severe back pain. CT scanning, followed by MRI displayed a 5.7cm×5 cm conglomerated necrotic, haemorrhagic mass of lymph nodes in the para-aortic region. A CT-guided biopsy revealed granulomatous inflammation, focal fibrosis and acid-fast bacilli consistent with Mycobacterium tuberculosis (TB). The patient was treated with combination antituberculous medication, and is recovering. To our knowledge, this is the only reported case of lymph node TB secondary to intravesical BCG immunotherapy. We suggest that in patients treated with postintravesical BCG with enlarged lymph nodes, a diagnosis of secondary TB should be considered.

PMID: 24792024 [PubMed – in process]

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