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Jerome Schofferman

Publications and source records attributed to Jerome Schofferman.

13 recordsLinked to original sources
PubMed2004

Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To determine the success rate and duration of relief of repeat radiofrequency neurotomy for lumbar facet joint pain. SUMMARY OF BACKGROUND DATA: Radiofrequency neurotomy is an effective but temporary management of lumbar facet pain. When pain recurs, radiofrequency neurotomy is usually repeated, but the outcome and duration of relief for repeat radiofrequency neurotomies are unknown. METHODS: Record review of consecutive patients who had an initial successful radiofrequency neurotomy, subsequent recurrence of pain, and then repeat radiofrequency neurotomy. Responses of repeat radiofrequency neurotomies were compared with initial radiofrequency neurotomy for success rates and duration of relief. RESULTS: There were 16 women and 4 men. Mean age was 48 years (range, 26-63). Radiofrequency neurotomy denervated one segment in two patients, two segments in 16 patients, and three or more in two patients. There were 10 bilateral and 10 unilateral radiofrequency neurotomies. Mean duration of relief after initial radiofrequency neurotomy was 10.5 months (range, 4-19). To date, two patients had a series of two radiofrequency neurotomies performed, six had three, five had four, three had five, and four had seven or more. Twenty patients had a second radiofrequency neurotomy, which was successful in 17 (85%) but unsuccessful in two. The mean duration of relief in 16 of these 17 patients was 11.6 months (range, 6-19), and relief is continuing in one. Sixteen patients had a third radiofrequency neurotomy, of which 15 were successful and one was unsuccessful. The mean duration of relief in nine of the 15 was 11.2 months (range, 5-23), and relief is continuing in the other six. Eight patients had a fourth radiofrequency neurotomy, which was successful in seven but unsuccessful in one. The mean duration of relief was 9 months (range, 5-14) in three patients, and relief is continuing in the other four. None of these differences is significant. The frequency of success and durations of relief remained consistent after each subsequent radiofrequency neurotomy. CONCLUSIONS: Repeated radiofrequency neurotomies are an effective long-term palliative management of lumbar facet pain. Each radiofrequency neurotomy had a mean duration of relief of 10.5 months and was successful more than 85% of the time.

Adult↗
PubMed2003

Chronic Neck Pain and Cervicogenic Headaches.

Chronic axial neck pain and cervicogenic headache are common problems, and there have been significant advances in the understanding of the etiology and treatment of each. The severity and duration of pain drives the process. For patients who have had slight to moderate pain that has been present for less than 6 months and have no significant motor loss, strength training of anterior, posterior, and interscapular muscle groups coupled with body mechanics training is prescribed. After 8 weeks, if the patient is better, exercises are continued at home or in a gym. If the patient is not better, physical therapy is continued for up to 8 more weeks. In patients with motor loss or severe pain, radiographs and magnetic resonance imaging (MRI) should be ordered at the initial visit. In patients with slight to moderate pain who are not better by 4 to 6 months, plain radiographs of the neck and MRI should be ordered. Based on the results, a spinal injection is usually prescribed. If MRI reveals spinal stenosis of the central or lateral canal, or a disc herniation, an epidural corticosteroid injection should be ordered. If the epidural provides good relief, the patient can be referred for more aggressive physical therapy and repeat the epidural as needed up to a maximum of three times. If there is no pathology within the canal, medial branch blocks and intra-articular steroid injections can be ordered based on the joints that are most tender or where disc space narrowing is greatest, or MRI or radiographs are recommended. If there is excellent relief from the medial branch block and joint injections, repeat when the steroids wear off. If there is good relief again, but pain recurs, medial branch radiofrequency neurotomy is recommended. For patients with one or two level disc degeneration that has not responded, a psychologic evaluation and discography is recommended. If there are no significant psychologic abnormalities, and one or two (rarely three) painful discs, surgical consultation is recommended. Adjunctive low-dose opioid analgesics, nonsteroidal anti-inflammatory drugs, and perhaps tricyclic antidepressants are used to supplement the program at mid- and late stages.

Journal Article↗
PubMed2003

The sacroiliac joint: a potential cause of pain after lumbar fusion to the sacrum.

The sacroiliac joint (SIJ) can cause pain after lumbosacral fusion. Diagnosis requires >75% relief after local anesthetic SIJ injection. This study is a retrospective review of patients with low back pain after lumbosacral fusion who had SIJ injections. Percentage and duration of pain relief were noted. Results are as follows: there were 34 patients; 8 fused at L5-S1, 14 fused at L4-S1, and 12 had multilevel fusions. Twenty had >75% relief within 45 minutes, and 11 had prolonged relief. Six had relief >20% but <75%, and one had prolonged relief. Eight never improved. Eight had posterior iliac crest bone harvested, and there was no correlation between donor side and pain side. In 34 patients with low back pain after lumbosacral fusion, SIJ was the cause of pain in 32% and possibly the cause in 29%. This is the first detailed description of this problem.

Adult↗
PubMed2003

Coccygectomy for severe refractory sacrococcygeal joint pain.

Severe refractory coccydynia occasionally requires coccygectomy. Methods involved a retrospective chart review plus telephone follow-up of 15 patients who had coccygectomy. Pain was assessed by the numerical rating scale and function by Oswestry Low Back Disability Score. There were 13 (87%) patients (four men, nine women) available for follow-up at a mean of 43 months (range 19-74 months). Mean age was 45 years (range 24-72 years). All patients had coccygeal pain arising from the sacrococcygeal joint, but there were other lumbar disorders in 10 patients. There were two complications. The numerical rating scale improved from 7.3 to 3.6 (p < 0.001), and the Oswestry Low Back Disability Score improved from 55 to 36 (p < 0.001). Twelve patients would have the same surgery for the same result. Coccygectomy provides statistically and clinically significant improvement in patients with severe refractory sacrococcygeal joint pain. Many patients have other lumbar spine pathology.

Adult↗
PubMed2002

Upper cervical anterior diskectomy and fusion improves discogenic cervical headaches.

STUDY DESIGN: Retrospective patient identification and prospective data collection were performed. OBJECTIVE: To evaluate the outcome of anterior cervical diskectomy and fusion for discogenic cervical headaches. SUMMARY OF BACKGROUND DATA: Cervicogenic headaches affect up to 2.5% of the population. One cause is discogenic pain. Because anterior cervical diskectomy and fusion may improve neck pain, the effect of this procedure on discogenic cervical headaches was evaluated. METHODS: Nine patients with severe refractory cervicogenic headaches who underwent anterior cervical diskectomy and fusion of the upper cervical discs were retrospectively identified on the basis of clinical, radiographic, and diskography findings. Pain was measured by a numerical rating scale, and function by the Oswestry Disability Index. RESULTS: The study involved six women and three men with a mean age of 52 (range, 35-72 years) and a mean follow-up period of 37 months (range, 24-49 months). Anterior cervical diskectomy and fusion was performed at both C2-C3 and C3-C4 in seven patients, at C2-C3 in one patient, and at C2-C3, C3-C4, and C4-C5 in one patient. Associated symptoms included nausea, arm pain, dizziness, and visual disturbances. All the patients improved. All stated that they would have the same surgery again for the same outcome. The mean numerical rating score improved from 8 (range, 5-10) to 2.7 (range, 0-7) ( < 0.001), and five patients (56%) had total headache relief. The mean Oswestry Disability Index improved from 62 (range, 42-87) to 35 (range, 2-82) ( < 0.009). The associated symptoms resolved in all the patients. There was early moderate to severe dysphagia in three patients, and mild dysphagia in four patients. At the final follow-up assessment, five patients evidenced mild dysphagia. CONCLUSIONS: Anterior cervical diskectomy and fusion appears to be quite effective for discogenic cervical headache, but should be reserved for patients who are extremely impaired and refractory to all other treatments.

Adult↗
PubMed2002

Etiology of long-term failures of lumbar spine surgery.

BACKGROUND CONTEXT: Patients who do not improve after lumbar surgery may be given the nonspecific label of "failed back surgery syndrome (FBSS)." Since 1981, there has not been a quantitative assessment of the etiologies of FBSS despite major improvements in surgical techniques and diagnostic testing. PURPOSE: To define the causes of FBSS seen in a referral-based spine center. STUDY DESIGN AND METHODS: Retrospective review of 181 consecutive charts of patients seen at a single spine center because of continued pain after lumbar surgery performed elsewhere. Evaluation was individualized based on history and physical examination and included x-rays, CT scans, MRI, selective nerve root injections, discography, and psychiatric evaluation. PATIENT SAMPLE: There were 101 men and 80 women; mean age was 47 years. There were 118 patients with one prior surgery, 52 with two, 6 with three, and 5 with four. Mean interval from the last prior surgery to the first clinic visit was 33 months. RESULTS: A predominant diagnosis could be established in 170 of 181 (94%) patients, and included foraminal stenosis (29%), painful disc(s) (17%), pseudarthrosis (14%), neuropathic pain (9%), instability (5%), and psychological problems (3%). CONCLUSION: We were able to establish a predominant diagnosis in 94% of our patients. Foraminal stenosis remains the leading cause of FBSS, but painful discs are also common. Recurrent disc herniation is seen less often than in the past, and there is increased recognition of neuropathic pain. Knowledge of the potential causes of FBSS leads to a more efficient and cost-effective evaluation of these patients.

Journal Article↗
PubMedDate not supplied

Failed back surgery: etiology and diagnostic evaluation.

BACKGROUND CONTEXT: This is a synopsis of a symposium presented to the North American Spine Society Annual Meeting in Montreal, Canada, 2002. PURPOSE: To provide the reader with a distillation of the material presented regarding the diagnosis of failed back surgery syndrome (FBSS). METHODS: Panel presentation. RESULTS: The proper treatment of patients with FBSS depends on a precise and accurate diagnosis. With a careful history, examination, imaging studies, psychological evaluation and diagnostic injections, a diagnosis can be reached in over 90% of patients. The most common diagnoses are foraminal stenosis (25% to 29%), painful disc (20% to 22%), pseudarthrosis (14%), neuropathic pain (10%), recurrent disc herniation (7% to 12%), facet joint pain (3%) and sacroiliac joint (SIJ) pain (2%). Psychological factors are always present and may help or hinder. Common psychological diagnoses include depression, anxiety disorder and substance abuse disorder. Diagnostic injections are very useful for facet joint pain, SIJ pain and discogenic pain; they may also be used to confirm a putative neural compression as a cause of pain. CONCLUSIONS: Spine surgeons must be aware of the common causes of FBSS in order to be able to thoroughly evaluate their patients and to minimize the occurrence of this problem.

Back Pain↗
PubMedDate not supplied

Web-based touch-screen computer assessment of chronic low back pain: a pilot study.

The objective of this study was to evaluate the acceptability and feasibility of a Web-based touch-screen computer questionnaire as a data collection method for patients experiencing chronic low back pain in a tertiary spine clinic. Participants completed the Oswestry Low Back Pain Disability Index, SF-36, and Beck Depression Inventory using a touch-screen computer. The time taken to complete the questionnaire was recorded electronically (M = 27.4 minutes; SD = 13.8). Prior computer experience and perceptions of computer use were also assessed. Low back pain was evaluated before and after completing the touch-screen computer questionnaire. Observations of sitting and standing tolerances were made. Participants completed a nine-item paper-and-pencil satisfaction survey after completing the computer questionnaire. Overall satisfaction level with this mode of data collection was high, supporting a larger study using touch-screen technology in patients with chronic low back pain. Important factors influencing satisfaction were the computer environment, ease of use, security, and the ability to interrupt the questionnaire process to allow for changes in sitting or standing posture.

Activities of Daily Living↗