INTRODUCTION: The lumbosacral transitional vertebra (LSTV) has been studied since 1876, with Castellvi developing a classification in 1984 based on its anatomy and laterality. It often goes unnoticed, or its diagnosis is...INTRODUCTION: The lumbosacral transitional vertebra (LSTV) has been studied since 1876, with Castellvi developing a classification in 1984 based on its anatomy and laterality. It often goes unnoticed, or its diagnosis is limited to a lumbar spine X-ray for confirmation. This has led to LSTV being underdiagnosed or even ignored. Our aim is to describe and evaluate radiological diagnostic techniques for LSTV and propose a diagnostic methodology to reduce errors in vertebral level identification, useful for percutaneous procedures and/or biomechanical measurement analysis. MATERIALS AND METHODS: A systematic literature review was conducted. The search terms included: "Castellvi," "Lumbosacral Transitional Vertebra," "Radiology." Logical connectors such as "and" and "or" were applied. The following databases were reviewed: Scopus, PubMed, Ovid, ScienceDirect, EBSCO, and Nature. The timeframe was limited from 2004 to December 2024. Inclusion and exclusion criteria were applied. A total of 419 articles were identified. The "Rayyan" program was used to compile information, and "PRISMA," "STROBE," and "CONSORT" were used to facilitate the analysis process. RESULTS: Forty-eight articles were included and analyzed (10 CT, 4 PET-CT, 2 bone scans, 9 MRI, 6 X-rays, 4 EOS, and 13 mixed). The most common findings highlighted CT as the gold standard for diagnosing LSTV, with spinopelvic parameters correlating with LSTV. Radiography is effective for vertebral numbering. MRI studies utilize anatomical landmarks to identify vertebral levels and LSTV, although they are less sensitive. EOS is also used for vertebral level identification. CONCLUSIONS: Our proposed diagnostic methodology for LSTV includes: first, using plain AP radiography for cranial-to-caudal vertebral numbering and evaluating morphological anomalies. Second, if LSTV is suspected, performing CT as the gold standard for diagnosis due to its high sensitivity and specificity, and measuring spinopelvic parameters to correlate with LSTV. Third, using MRI in special cases. Fourth, conducting a morphological analysis and using Jenkins' classification for LSTV categorization.
BACKGROUND: Upper airway stimulation (UAS) is an emerging neuromodulatory treatment for obstructive sleep apnea (OSA). It involves stimulating the motor fibers of the hypoglossal nerve to prevent airway collapse. Patient...BACKGROUND: Upper airway stimulation (UAS) is an emerging neuromodulatory treatment for obstructive sleep apnea (OSA). It involves stimulating the motor fibers of the hypoglossal nerve to prevent airway collapse. Patients with OSA and pain may require radiofrequency ablation (RFA) or electrocautery during surgery. Due to the proximity of UAS leads to cervical facet joints, careful procedural considerations are necessary to prevent complications. This report summarizes best practices for performing RFA or electrocautery in patients with UAS implants, guided by manufacturer safety recommendations and expert consensus statements. CASE PRESENTATION: An elderly patient with OSA, successfully treated with Inspire UAS, and chronic cervical facet-mediated pain presented for repeat cervical RFA. The procedure followed manufacturer safety recommendations, including turning off the UAS device prior to the intervention, positioning the grounding pad to avoid current passage through the implant, maintaining distance from the device leads, and using bipolar RFA. The RFA was performed without complications, and the patient experienced significant pain relief without adverse effects. CONCLUSION: This case underscores the importance of thorough preprocedural planning when performing RFA in patients with implanted neuromodulation devices. Adhering to manufacturer guidelines can reduce the risk of device interference and associated complications.
AIM: This study was conducted to determine how watching comedy movies affects vital signs and postoperative pain in patients during transurethral prostate resection. METHODS: A randomized controlled trial model study was...AIM: This study was conducted to determine how watching comedy movies affects vital signs and postoperative pain in patients during transurethral prostate resection. METHODS: A randomized controlled trial model study was conducted at a hospital in Turkey. Ninety patients were included in the study (comedy: 30, documentary: 30, control: 30). Pain was assessed using the Visual Analog Pain Scale, while patient monitors recorded vital signs. RESULTS: At the first measurement, the mean pain score in the comedy group was 2.0. Although this value was numerically the lowest among the groups, it was not statistically significant (p > 0.05). Across the three groups, baseline VAS values demonstrated similar ranges (95% CI: 2.73-3.41). In the 24th and 48th hour measurements, the pain was again at the lowest level in the comedy group (VAS 24 h 95% CI: 2.12-2.84; VAS 48 h 95% CI: 0.94-1.52; p < 0.001). Although a decrease was observed in the pulse rate of vital signs in all three groups in the postoperative measurements, it was determined that the lowest value was in the comedy group (pulse at operation start 95% CI: 79.92-84.47, 15th minute 95% CI: 73.79-87.69, 30th minute 95% CI: 46.03-68.70, end of surgery 95% CI: 71.75-76.14; p < 0.001). While a decrease in systolic blood pressure was observed in all three groups during and after surgery compared to the preoperative period, it was determined that the most significant decrease was in the comedy group (15th minute 95% CI: 117.12-124.82, 30th minute 95% CI: 74.46-94.95, end of surgery 95% CI: 116.54-123.46; p < 0.05). CONCLUSIONS: The study's results determined that comedy films significantly affected pain management and perioperative vital signs such as pulse and systolic blood pressure.
INTRODUCTION: Glossopharyngeal neuralgia (GPN) is a rare neuropathy characterized by paroxysmal, unilateral, and severe pain episodes affecting the throat, tonsils, base of the tongue, and pharynx. Its management remains...INTRODUCTION: Glossopharyngeal neuralgia (GPN) is a rare neuropathy characterized by paroxysmal, unilateral, and severe pain episodes affecting the throat, tonsils, base of the tongue, and pharynx. Its management remains challenging due to the absence of standardized treatment protocols and the limited availability of high-quality comparative studies. OBJECTIVE: To review and compare the effectiveness and safety of available treatments for GPN. METHODS: A systematic review was conducted, analyzing studies published in the last decade that evaluated GPN treatments. Searches were performed in PubMed, SCIELO, and the Regional Portal of BVS. Studies were assessed for quality, risk of bias, and key outcomes, including pain relief and adverse effects. RESULTS: Twenty-six studies, comprising 973 patients, were included. Seven treatment modalities were analyzed. Microvascular decompression (MVD) demonstrated the highest efficacy and durability, with an immediate pain relief rate exceeding 86.7% and exhibiting the lowest recurrence rates. Alternative treatments, including gamma knife radiosurgery, radiofrequency thermocoagulation, and pulsed radiofrequency, showed initial pain relief but had higher recurrence rates over time. The posterior inferior cerebellar artery was the most frequently involved vessel in cases with vascular compression. CONCLUSION: MVD is the preferred first-line surgical treatment when pharmacological therapy fails, vascular compression is present, and the patient is a suitable candidate for surgery. In cases where MVD is contraindicated or vascular compression is absent, alternative treatments should be considered based on individual patient factors, balancing efficacy and long-term outcomes. Further high-quality studies are needed to refine treatment strategies for GPN.
BACKGROUND/IMPORTANCE: Selective nerve root blocks (SNRBs) are frequently used in clinical algorithms for managing chronic radicular pain. However, their prognostic value in identifying patients likely to benefit from pu...BACKGROUND/IMPORTANCE: Selective nerve root blocks (SNRBs) are frequently used in clinical algorithms for managing chronic radicular pain. However, their prognostic value in identifying patients likely to benefit from pulsed radiofrequency (PRF) treatment remains uncertain. OBJECTIVE: This systematic review evaluates whether a positive response to an SNRB predicts improved clinical outcomes following PRF in patients with chronic radicular pain. EVIDENCE REVIEW: A systematic search was conducted in PubMed, Embase, and Cochrane databases, along with reference lists of relevant articles. Eligible studies included patients with chronic radicular pain and assessed the prognostic role of SNRBs administered prior to PRF. Risk of bias was assessed using the ROBINS-I V2 tool. RESULTS: Only one prospective observational study met inclusion criteria. In patients with chronic lumbosacral radicular pain, a positive SNRB response was associated with a higher likelihood of treatment success at 6-week follow-up (odds ratio: 3.26; 95% CI: 0.97-11.00; p = 0.06). Multivariate analysis identified limited baseline disability, age > 55 years, and a positive SNRB response as predictors of success at 6 months, with an area under the receiver operating characteristic curve of 0.73. CONCLUSIONS: This review identified a lack of published studies-aside from one prospective observational study-examining the prognostic value of SNRBs in the context of PRF for chronic radicular pain. The findings underscore not only a lack of high-quality evidence but a broader gap in the literature. Further robust research is warranted to clarify the clinical utility of SNRBs in guiding PRF treatment decisions.
INTRODUCTION: Ultrasound-guided neuraxial injections are less accurate than fluoroscopy-guided techniques due to limited needle visualization, particularly in out-of-plane approaches. A novel dual-array ultrasound probe...INTRODUCTION: Ultrasound-guided neuraxial injections are less accurate than fluoroscopy-guided techniques due to limited needle visualization, particularly in out-of-plane approaches. A novel dual-array ultrasound probe developed by Rivanna Medical Inc., enables in-plane visualization of needle trajectory even when inserted perpendicularly. This study evaluates the accuracy of this novel technology in thoracic and lumbar facet joint injections. METHODS: A prevalidation study was conducted using one cadaver. One interventional pain physician independently performed facet joint injections using the dual-array ultrasound system. The system integrates two rotated 64-element curvilinear arrays configured to transmit and receive at 2.5 MHz with multiangle electronic beam steering (three angles per array) and real-time dual-array image blending/compounding, enabling visualization of both anatomy and the full in-plane needle trajectory. Injection accuracy was confirmed via fluoroscopy. RESULTS: All six injections successfully targeted the intended region. Two injections were classified as Grade 1, three as Grade 2, one as Grade 3, and zero as Grade 4. CONCLUSIONS: The dual-array ultrasound system shows promise in enhancing the accuracy of thoracic and lumbar facet joint injections by enabling in-plane needle visualization even at steep angles. Our findings highlight the potential of this technology to improve procedural precision, while also underscoring the learning curve associated with its use. These feasibility results support further validation for spine interventions requiring steep needle trajectories, and future studies should evaluate true neuraxial applications (e.g., epidural/intrathecal) with quantitative needle-tip localization metrics.
INTRODUCTION: Invasive motor cortex stimulation (iMCS) can be a last-resort treatment of chronic neuropathic pain syndromes. There is evidence that iMCS was found to influence pain intensity, quality of life scores, and...INTRODUCTION: Invasive motor cortex stimulation (iMCS) can be a last-resort treatment of chronic neuropathic pain syndromes. There is evidence that iMCS was found to influence pain intensity, quality of life scores, and pain medication intake in clinical practice. Albeit, qualitative studies published over the last years showed that the expectations and experiences of patients have a significant impact on treatment outcomes. This paper focus on these experiences of chronic neuropathic pain patients treated with iMCS. OBJECTIVES: The aim of this interview study was to map the experiences of patients treated with iMCS in order to evaluate the multidimensional effects of iMCS. MATERIALS AND METHODS: Twenty-eight patients with chronic neuropathic pain treated with iMCS between 2005 and 2018 were interviewed individually. All interviews were semi-structured using a predefined topic list. An inductive iterative process was performed during the interviews using the constant comparative method. All interviews were audio-recorded and transcribed verbatim afterwards. Transcripts were coded using direct content analysis. The derived codes were structured into categories and themes. Basic quantitative demographic data were collected, and the decrease in pain intensity after 2 years iMCS was calculated. RESULTS: Content analysis of the interviews revealed ten relevant categories, which could be structured into three themes: 1. Influence of the iMCS procedure on patients' live; 2. Effects of iMCS on quality of life and participation and 3. Acceptance and satisfaction. In total, 32% (8/25) were identified as responders, and 68% (17/25) as non-responders. Most patients (71%, 20/28) indicated they would undergo iMCS again. Three patients deceased before the end of the study. CONCLUSION: This study suggests that the effects of iMCS should be assessed in a more multidimensional way compared to only the effect on pain as patients confided that the true treatment effect and patient satisfaction were based more on improvements of their quality of life, enabling patients to participate again in society in a meaningful way. In clinical practice, this study emphasizes the need for thorough patient education and realistic expectation management prior to implantation, highlighting both potential benefits and limitations to support informed decision-making.
OBJECTIVES: Artificial intelligence (AI) applications are being increasingly explored in pain medicine due to AI's ability to handle multidimensional data and analyze complex, nonlinear relationships. There is a need to...OBJECTIVES: Artificial intelligence (AI) applications are being increasingly explored in pain medicine due to AI's ability to handle multidimensional data and analyze complex, nonlinear relationships. There is a need to identify and understand the advances that have been made in developing AI-based clinical prediction models in interventional pain medicine for spine disorders. Therefore, the purpose of this study is to conduct a systematic review of AI-based prediction models for clinical outcomes in interventional spine medicine with a focus on model field of application, performance, and generalizability. METHODS: A systematic review evaluating AI-based clinical prediction models in interventional pain medicine for spine disorders was conducted using the PubMed/MEDLINE and Scopus databases in February of 2025. Articles meeting eligibility criteria had standardized data extracted and were assessed for their application, performance (primarily based on area under the receiver operating characteristic curve [AUROC] and accuracy), and generalizability (internal and/or external validation). RESULTS: A final total of nine studies were included in this systematic review. Of these nine, four of the studies were pertaining to epidural steroid injections and five of the studies were pertaining to spinal cord stimulators. Two studies (22.2%) out of nine achieved an excellent (> 0.90) AUROC or accuracy for their AI-based prediction models. One study (11.1%) externally validated their AI-based prediction model. DISCUSSION: AI-based clinical prediction models are limited to epidural steroid injections and spinal cord stimulators. Additionally, there is a need to improve model performance and generalizability through external validation prior to clinical translation.
OBJECTIVE: This questionnaire study aims to analyze the current clinical practice of the minimally invasive treatment of chronic lumbosacral radicular pain among accredited pain specialists in the Netherlands. METHODS: P...OBJECTIVE: This questionnaire study aims to analyze the current clinical practice of the minimally invasive treatment of chronic lumbosacral radicular pain among accredited pain specialists in the Netherlands. METHODS: Participants received an online questionnaire regarding differences in clinical practice comprising definitions and clinical criteria for diagnosis; indications for interventional treatment; technical approaches to treatment; and outcome evaluation in the management of chronic lumbosacral radicular pain. RESULTS AND CONCLUSION: A total of 125 pain specialists (response rate: 29%) completed the questionnaire. The most notable finding was that only 27% reported routinely performing prognostic selective nerve root blocks with local anesthetics prior to pulsed radiofrequency (PRF) treatment in patients with chronic lumbosacral radicular pain. Lidocaine was the preferred local anesthetic (n = 72, 63%). PRF was identified as the cornerstone of therapeutic interventional treatment by 81% of respondents (n = 93), and 40% (n = 46) reported combining PRF with corticosteroid administration.