PubMed Health⌕ Search

Biomedical subjects

Paul Dreyfuss

Publications and source records attributed to Paul Dreyfuss.

8 recordsLinked to original sources
PubMed2003

Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus.

STUDY DESIGN: A retrospective audit and examination of anatomic findings. OBJECTIVE: To examine the effectiveness of sensory stimulation-guided radiofrequency neurotomy for the treatment of recalcitrant sacroiliac joint pain. SUMMARY OF BACKGROUND DATA: Sacroiliac joint-mediated pain is a distinct clinical entity. The prevalence of intra-articular pain arising from the sacroiliac joint in patients with low back pain has been estimated at 15% to 30%. Unfortunately, the clinical success of current treatment methods for chronic sacroiliac pain is discouraging. Based on the anatomy of the sacral posterior primary rami and their lateral branch nerves, an anatomically based sensory stimulation-guided radiofrequency technique was developed to overcome the inherent challenge posed by the variable topography of the sacral lateral branch nerves. MATERIALS AND METHODS ANATOMIC STUDY: Meticulous dissection exposing the dorsal sacral plexus and lateral branch nerves entering the sacroiliac joint complex was performed on three cadaveric specimens. Small-gauge wires were placed adjacent to the lateral branch nerves entering the joint and over the dorsal sacrum to the dorsal sacral foramina. Fluoroscopic images were obtained correlating the location and number of these branches arising from the posterior primary rami of S1-S3 to identifiable bony landmarks. CLINICAL STUDY: A retrospective chart review was performed selecting patients who underwent sensory stimulation-guided sacral lateral branch radiofrequency neurotomy after dual analgesic sacroiliac joint deep interosseous ligament analgesic testing between February 17, 1998 and March 15, 1999. RESULTS: A total of 14 patients met inclusion criteria for this retrospective study. Success was defined as greater than 60% consistent subjective relief and greater than a 50% consistent decrease in visual integer pain score, maintained for at least 6 months after the procedure. Sixty-four percent of patients experienced a successful outcome, with 36% experiencing complete relief. Fourteen percent of patients did not achieve any improvement. No patients experienced a complication or worsening of their pain from the procedure. CONCLUSIONS: A sensory stimulation-guided approach toward the identification and subsequent radiofrequency thermocoagulation of symptomatic sacral lateral branch nerves appears to offer significant therapeutic advantages over existing therapies for the treatment of chronic sacroiliac joint complex pain.

Adult↗
PubMed2003

Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury.

Spinal cord injury has been recognized as a complication of cervical transforaminal injections, but the mechanism of injury is uncertain. In the course of a transforaminal injection, an observation was made after the initial injection of contrast medium. The contrast medium filled a radicular artery that passed to the spinal cord. The procedure was summarily abandoned, and the patient suffered no ill effects. This case demonstrates that despite using careful and accurate technique, it is possible for material to be injected into a radicular artery. Consequently, inadvertent injection of corticosteroids into a radicular artery may be the mechanism for spinal cord injury following transforaminal injections. This observation warns operators to always perform a test injection of contrast medium, and carefully check for arterial filling using real-time fluoroscopy with digital subtraction.

Adrenal Cortex Hormones↗
PubMedDate not supplied

A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain.

BACKGROUND: Intradiscal electrothermal therapy (IDET) is a treatment for discogenic low back pain the efficacy of which has not been rigorously tested. PURPOSE: To compare the efficacy of IDET with that of a placebo treatment. STUDY DESIGN/SETTING: Randomized, placebo-controlled, prospective trial. PATIENT SAMPLE: Patients were recruited by referral and the media. No inducements were provided to any patient in order to have them participate. Of 1,360 individuals who were prepared to submit to randomization, 260 were found potentially eligible after clinical examination and 64 became eligible after discography. All had discogenic low back pain lasting longer than 6 months, with no comorbidity. Thirty-seven were allocated to IDET and 27 to sham treatment. Both groups were satisfactorily matched for demographic and clinical features. METHODS: IDET was performed using a standard protocol, in which the posterior annulus of the painful disc was heated to 90 C. Sham therapy consisted of introducing a needle onto the disc and exposing the patient to the same visual and auditory environment as for a real procedure. Thirty-two (85%) of the patients randomized to the IDET group and 24 (89%) of those assigned to the sham group complied fully with the protocol of the study, and complete follow-up data are available for all of these patients. OUTCOME MEASURES: The principal outcome measures were pain and disability, assessed using a visual analog scale for pain, the Short Form (SF)-36, and the Oswestry disability scale. RESULTS: Patients in both groups exhibited improvements, but mean improvements in pain, disability and depression were significantly greater in the group treated with IDET. More patients deteriorated when subjected to sham treatment, whereas a greater proportion showed improvements in pain when treated with IDET. The number needed to treat, to achieve 75% relief of pain, was five. Whereas approximately 40% of the patients achieved greater than 50% relief of their pain, approximately 50% of the patients experienced no appreciable benefit. CONCLUSIONS: Nonspecific factors associated with the procedure account for a proportion of the apparent efficacy of IDET, but its efficacy cannot be attributed wholly to a placebo effect. The results of this trial cannot be generalized to patients who do not fit the strict inclusion criteria of this study, but IDET appears to provide worthwhile relief in a small proportion of strictly defined patients undergoing this treatment for intractable low back pain.

Adult↗
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

Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain.

OBJECTIVES: Cervical transforaminal epidural injections of corticosteroids have been used in the treatment of radicular pain. Particulate agents have been associated with rare adverse neurological outcomes. It is unknown whether nonparticulate preparations are any less effective than particulate preparations. Therefore, a study was designed to determine whether there is a basis for promoting a theoretically safer nonparticulate corticosteroid preparation. DESIGN: Volunteer patients were randomized to receive a single cervical transforaminal epidural injection with one of two corticosteroid preparations. SETTING: This study was undertaken in a private practice setting. PATIENTS: Those with single-level, unilateral radicular pain with advanced imaging demonstrating single-level neural compression. INTERVENTIONS: Patients received a single cervical transforaminal epidural injection with either dexamethasone or triamcinolone. OUTCOME MEASURES: Ratings were obtained by an independent unbiased assessor at 4 weeks via a telephone interview. A visual analog pain scale was used preprocedurally and a verbal integer scale was used at 4 weeks to assess the severity of the patient's radicular pain. As a secondary outcome measure, a patient-specified functional outcome measure was obtained. RESULTS: Both groups exhibited statistically and clinically significant improvements in pain at 4 weeks. Although the triamcinolone group exhibited a somewhat greater improvement, the difference between groups was not significantly different. CONCLUSION: The study found that the effectiveness of dexamethasone was slightly less than that of triamcinolone, but the difference was neither statistically nor clinically significant. A theoretically safer nonparticulant agent appears to be a valid alternative to particulate agents that have been used to date, and which have been associated with hazard.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Sacroiliac joint pain.

The sacroiliac joint is a source of pain in the lower back and buttocks in approximately 15% of the population. Diagnosing sacroiliac joint-mediated pain is difficult because the presenting complaints are similar to those of other causes of back pain. Patients with sacroiliac joint-mediated pain rarely report pain above L5; most localize their pain to the area around the posterior superior iliac spine. Radiographic and laboratory tests primarily help exclude other sources of low back pain. Magnetic resonance imaging, computed tomography, and bone scans of the sacroiliac joint cannot reliably determine whether the joint is the source of the pain. Controlled analgesic injections of the sacroiliac joint are the most important tool in the diagnosis. Treatment modalities include medications, physical therapy, bracing, manual therapy, injections, radiofrequency denervation, and arthrodesis; however, no published prospective data compare the efficacy of these modalities.

Arthralgia↗