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Park D, Chang MC. Ultrasound-guided interventions for controlling the thoracic spine and chest wall pain: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 39:190-199. [PMID: 35468715 PMCID: PMC9273134 DOI: 10.12701/jyms.2022.00192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 01/07/2023]
Abstract
Ultrasound-guided injection is useful for managing thoracic spine and chest wall pain. With ultrasound, pain physicians perform the injection with real-time viewing of major structures, such as the pleura, vasculature, and nerves. Therefore, the ultrasound-guided injection procedure not only prevents procedure-related adverse events but also increases the accuracy of the procedure. Here, ultrasound-guided interventions that could be applied for thoracic spine and chest wall pain were described. We presented ultrasound-guided thoracic facet joint and costotransverse joint injections and thoracic paravertebral, intercostal nerve, erector spinae plane, and pectoralis and serratus plane blocks. The indication, anatomy, Sonoanatomy, and technique for each procedure were also described. We believe that our article is helpful for clinicians to conduct ultrasound-guided injections for controlling thoracic spine and chest wall pain precisely and safely.
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Affiliation(s)
- Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
- Corresponding author: Min Cheol Chang, MD Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-4682 • Fax: +0504-231-8694 • E-mail:
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Derby R, Vorobeychik Y, Schneider BJ, McCormick ZL. Comparison of two needle versus one needle lesioning techniques for thoracic medial branch neurotomy. INTERVENTIONAL PAIN MEDICINE 2022; 1:100085. [PMID: 39239368 PMCID: PMC11373022 DOI: 10.1016/j.inpm.2022.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 09/07/2024]
Abstract
Background and objectives No prior studies have investigated an assumed advantage of creating a radiofrequency strip lesion for posterior element spinal axial pain using a two-needle technique (TNT) compared to a one-needle technique (ONT) that creates a single ovoid lesion. We explore the relationship of TNT compared to ONT on the magnitude and duration of pain relief following thoracic medial branch neurotomy (TMBN). Methods This study is a retrospective audit of consecutive patients treated with TMBN at a single site and interventionalist over ten years (2007-2017). All patients had undergone TMBN after failed conservative care and, with few exceptions, patient-reported ≥ 70% pain relief after thoracic medial branch block (TMBB). All patients had TMBN performed with a medial to lateral (MLA) radiofrequency cannula approach using either an ONT or TNT technique. We used parametric and nonparametric statistics and three levels of case analysis to assess for intergroup differences. Results Thirty-five consecutive patients underwent their primary TMBN, and two underwent both on a subsequent repeat using the MLA approach, 19 using the ONT, 18 using the TNT. The TNT group had clinically and statistically greater pain relief magnitude and duration than the ONT subgroup. The difference resulted in non-overlapping 95% confidence intervals for both percent pain relief and duration of pain relief using three levels of case analysis. Conclusion The comparison of TMBN techniques demonstrates a statistically significant separation of TNT to ONT sample mean values for magnitude and duration of pain relief when using TNT compared to ONT for TMBN using an MLA.
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Affiliation(s)
- Richard Derby
- Spinal Diagnostics and Treatment Center, Daily City, Ca, USA
| | - Yakov Vorobeychik
- Penn State Milton S. Hershey Medical Center, Penn State College of Medicine. Department of Anesthesiology & Perioperative Medicine, Hershey, PA, USA
| | - Byron J Schneider
- Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, USA
| | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
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Del Chiaro A, Ciampi B, Franzoni F, Miccoli M, Galletti S, Stella SM. Inflammatory disease of the costotransverse joints: US evaluation in 15 symptomatic patients. J Ultrasound 2021; 25:167-175. [PMID: 34118056 PMCID: PMC9148345 DOI: 10.1007/s40477-021-00589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022] Open
Abstract
The costotransverse joints (CTJs) are small arthrodial joints which articulate with the costal tuberosity on the transverse process of the thoracic vertebrae. CTJs are composed of oval-shaped facets with a major axis, vertical at the upper vertebrae and almost horizontal at the lower vertebrae. This position explains the different movements of the ribs: the cranial ribs move on the sagittal plane and the caudal ribs on the transverse plane. Movements in directions other than these usual CTJ spatial planes can cause inflammation resulting in a stinging pain in the space between the scapula and thoracic spine. We studied 15 subjects with paravertebral pain compatible with CTJ pathology. Mean age was 29 years, 11 females/4 males. In 12 patients, the non-dominant limb was affected. US imaging was carried out using linear 12 MHz and 9 MHz probes. Scanning was performed following the long axis of the rib (transverse plane) and the short axis (sagittal plane). Sagittal scanning is the method of choice for detection of possible joint effusion and comparison with undamaged joints above and below. US identified joint effusion correlating with the site of pain in all patients. Thickening of the posterior costotransverse capsular ligament was detected in six patients mainly affecting the first thoracic vertebrae. Power Doppler showed intraarticular hypervascularization in four patients. US imaging should be performed as a first-line examination in the evaluation of patients with stinging pain in the paravertebral region. US evidence of effusion within the joints is a sure sign of involvement of these structures.
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Affiliation(s)
- A Del Chiaro
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy. .,Orthopedic and Trauma Operating Unit, University of Pisa, Pisa, Italy.
| | - B Ciampi
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy.,Advanced Musculoskeletal Ultrasound SIUMB School of Bologna, Maggiore Hospital, Bologna, Italy
| | - F Franzoni
- School of Specialization in Sports Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Santa Chiara Hospital of Pisa, Pisa, Italy
| | - M Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Galletti
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy.,Advanced Musculoskeletal Ultrasound SIUMB School of Bologna, Maggiore Hospital, Bologna, Italy
| | - S M Stella
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy.,School of Specialization in Sports Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Santa Chiara Hospital of Pisa, Pisa, Italy
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Sagir A, Bolash R. COMBINED BIPOLAR AND V-SHAPED LESIONS FOR LUMBAR FACET RADIOFREQUENCY ABLATION: A TECHNICAL REPORT. PAIN MEDICINE 2021; 23:862-866. [PMID: 33830202 DOI: 10.1093/pm/pnab136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/23/2021] [Accepted: 04/07/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) is a demonstrated safe and effective treatment for chronic low back pain. RFA delivers high density electrical current near lumbar medial branch nerve. The success of RFA is contingent upon creating a lesion that overlaps the sensory nerve supplying the affected facet joint(s). Both bipolar-RFA and V-shaped active tip cannulas increase lesion size in experimental models. We describe successful application of concomitant bipolar and V-shaped lesions in a single patient with chronic low back pain caused by lumbar spondylosis. CASE PRESENTATION An 81-year-old male with atrial fibrillation on chronic warfarin anticoagulation was previously treated with conventional monopolar lumbar facet RFA resulting in a 75% decrement in pain intensity exceeding eight months. Nine months after the procedure, his pain returned with similar pretreatment character and was unresponsive to additional physical therapy and acetaminophen. We elected to use a V-shaped cannula to maximize lesion diameter and lengthen intervals between anticoagulant abstinence to minimize the risk. Intraoperatively, a grounding-pad malfunction compelled us to convert to bipolar-RFA by placing a second adjacent V-shaped cannula, eliminating grounding-pad requirement. Bilateral bipolar medial branch RFA of L3-L4, L4-L5, L5-S1 nerves was performed between these two cannulas without further incident. The patient had sustained analgesia that lasted over twelve months resultant from treatment. CONCLUSION We herein describe a technique of combined bipolar-RFA utilizing proximally adjacent V-shaped cannulas. Both bipolar and V-shaped cannulas create larger lesions in experiments. While both techniques purport theoretical advantages, the clinical superiority of a combined technique warrants continued clinical investigation.
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Affiliation(s)
- Afrin Sagir
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Robert Bolash
- Department of Pain Management, Cleveland Clinic, Cleveland, OH
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Rispoli L, Rakesh N, Shah R, Gulati A. Interventional Pain Treatments in the Management of Oncologic Patients With Thoracic Spinal Tumor-Related Pain: A Case Series. Pain Pract 2019; 19:866-874. [PMID: 31273928 DOI: 10.1111/papr.12813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Advanced tumors of the thoracic spine are difficult to treat and can lead to complex pain syndromes. Following conventional oncologic treatments, pharmacologic therapy may be insufficient to manage pain. Minimally invasive interventional procedures offer alternatives to treat malignant thoracic spinal pain. METHODS Thirteen patients with metastatic disease and poorly controlled thoracic axial and/or radicular pain were identified via a retrospective chart review. Patients were either treated with radiation, surgery, chemotherapy, or a combination of these. Then, the patients were organized into groups based on their diagnoses, anatomical disease locations, symptoms, prior treatments, and interventional pain procedures offered. RESULTS All cases of intercostal nerve, costotransverse junction, erector spinae plane, and paravertebral blocks resulted in pain relief without any reported complications. A patient who received a thoracic epidural injection had a complete resolution of pain when combined with radiation therapy 2 weeks after the injection. One patient who underwent repeat thoracic epidural injections eventually had an intrathecal pump placement, resulting in reduced opioid usage. Finally, 1 patient who received a thoracic medial branch block with a relief of thoracic axial pain reported greater pain relief with a medial branch nerve cryoablation. CONCLUSION We propose a treatment algorithm to manage patients with thoracic spinal tumor-related pain. Interventional thoracic axial procedures may be safe and efficacious pain treatments for patients with cancer.
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Affiliation(s)
- Leia Rispoli
- Weill Cornell Tri-Institutional Pain Medicine Program, Department of Anesthesiology, Weill Cornell Medicine, New York, New York, U.S.A
| | - Neal Rakesh
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital-University Hospital of Columbia and Cornell, New York, New York, U.S.A
| | - Rita Shah
- Weill Cornell Tri-Institutional Pain Medicine Program, Department of Anesthesiology, Weill Cornell Medicine, New York, New York, U.S.A
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
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Kvarstein G, Lundeland B. Bipolar radiofrequency neurotomy for spinal pain - a promising technique but still some steps to go. Scand J Pain 2018; 18:565-566. [PMID: 30281515 DOI: 10.1515/sjpain-2018-0305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gunnvald Kvarstein
- Department of Clinical Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway, Phone: +47 92295309
| | - Bård Lundeland
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
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Rohof O, Chen CK. The response to radiofrequency neurotomy of medial branches including a bipolar system for thoracic facet joints. Scand J Pain 2018; 18:747-753. [PMID: 30001215 DOI: 10.1515/sjpain-2018-0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/20/2018] [Indexed: 01/01/2023]
Abstract
Background and aims The evidence for interventional treatment of thoracic facet joint pain remains limited. This is partly due to inconsistency of the path of thoracic medial branches and a lower incidence of thoracic facet pain among spine pain patients. The purpose of this study is to evaluate the efficacy of bipolar radiofrequency (RF) neurotomy of medial branches for treating chronic thoracic facet joint pain. Methods This is a retrospective record review of all patients diagnosed to have thoracic facet pain with diagnostic block and subsequently treated with bipolar RF neurotomy of medial branch between January 2012 and December 2015. The outcome measures were mean changes in Numeral Rating Scale (NRS) and Pain Disability Index (PDI). Results There were 71 patients with complete data available for analysis. The mean age of the patients was 57.9±11.2 years. The mean duration of pain was 23±10.5 months. The majority of patients (82%) had pain reduction of more than 50% at 12 months after bipolar RF neurotomy. The NRS decreased significantly from baseline of 7.75±1.25 to 2.86±1.53 at 3 months and 2.82±1.29 at 12 months post-procedure (p<0.001. p<0.001, respectively). The PDI improved significantly from 40.92±12.22 to 24.15±9.79, p<0.05). There were no serious adverse effects or complications of the procedure reported in this study. Conclusions Bipolar RF neurotomy of thoracic medial branch is associated with a significant reduction in thoracic facet joint pain. The promising findings from this case series merit further assessment with prospective, randomized controlled trial which will produce a more reliable and accurate finding for its clinical applications.
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Affiliation(s)
- Olav Rohof
- Orbis Medical Center (Zuyderland Hospital), Sittard Geleen Heerlen, The Netherlands
| | - Chee Kean Chen
- Department of Anesthesiology and Intensive Care, KPJ Kuching Specialist Hospital, Lot 10420, Block 11, Tabuan Stutong Commercial Centre, Jalan Setia Raja, 93350 Kuching, Sarawak, Malaysia, Phone: +6-082-365777, Fax: +6-082-364666
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Zhang L, Ding XL, Zhao XL, Wang JN, Li YP, Tian M. Fluoroscopy-guided Bipolar Radiofrequency Thermocoagulation Treatment for Discogenic Low Back Pain. Chin Med J (Engl) 2016; 129:2313-8. [PMID: 27647190 PMCID: PMC5040017 DOI: 10.4103/0366-6999.190682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The efficacy of percutaneous intradiscal radiofrequency thermocoagulation (PIRFT) for the treatment of discogenic low back pain (LBP) remains controversial. However, all the PIRFT studies utilized monopolar radiofrequency thermocoagulation (RFTC). The aim of this study was to investigate the safety and efficacy of bipolar RFTC for the treatment of discogenic LBP. Methods: A total of 23 patients with discogenic LBP were treated with single-level bipolar RFTC. The patients were assessed before the procedure and at 1 week, 1 month, 3 months, 6 months, and 1 year after the procedure. The primary outcome included the visual analog scale (VAS) score and the Oswestry Disability Index (ODI) score. The secondary outcome included pain relief, reduction of analgesic dose, and patient satisfaction. Results: The VAS and ODI scores were significantly decreased after bipolar RFTC treatment at all time points of follow-up (P < 0.05). Bipolar RFTC treatment also resulted in a significant change in all secondary measures, such as pain relief, reduction of analgesic dose, and patient satisfaction. No serious complications or neurological sequelae were observed in any of the patients. Conclusions: Bipolar RFTC treatment can significantly attenuate pain and improve the function of patients with discogenic LBP.
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Affiliation(s)
- Li Zhang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xin-Li Ding
- Department of Rehabilitation Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Xu-Li Zhao
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Jun-Nan Wang
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Yan-Ping Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Ming Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Yoon KB, Kim SH, Park SJ, Moon JA, Yoon DM. Clinical Effectiveness of Ultrasound-guided Costotransverse Joint Injection in Thoracic Back Pain Patients. Korean J Pain 2016; 29:197-201. [PMID: 27413487 PMCID: PMC4942650 DOI: 10.3344/kjp.2016.29.3.197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 01/10/2023] Open
Abstract
Because of its anatomical location and function, the costotransverse (CTRV) joint can be a source of thoracic back pain. In this retrospective observational study, we evaluated the clinical effectiveness of the CTRV joint injection in thoracic back pain patients with suspected CTRV joint problems. We enrolled 20 thoracic back pain patients with localized tenderness that was provoked by the application of pressure on the affected CTRV joints. We injected it with 0.5 ml of a ropivacaine and triamcinolone mixture at each level. The mean pre-injection pain score decreased by 37.9% (7.2 ± 1.5 to 4.5 ± 1.7, P < 0.001) two weeks after CTRV joint injection. In addition, 70% of patients reported an excellent or good level of satisfaction. We demonstrated that an ultrasound-guided injection of the CTRV joint reduced patients' pain scores and led to a high level of satisfaction at short-term follow-ups in patients with suspected CTRV joint problems.
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Affiliation(s)
- Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Jun Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ae Moon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Duck Mi Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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