Spinal cord stimulation (SCS) of the dorsal columns Clinical outcomes between kyphoplasty and vertebroplasty are similar, however kyphoplasty increases vertebral body height and reduces cement leakage while vertebroplasty is a quicker procedure and more cost efficient.Mechanism of action is a combination of thermal necrosis and chemotoxicity of the intraosseous pain receptors.Kyphoplasty inflates a balloon within the vertebral body prior to the application of PMMA. Vertebroplasty consists of injecting a polymethyl methacrylate (PMMA) cement into the vertebral body.Literature has presented successful outcomes for these procedures with limited adverse events, but overall efficacy remains controversial.PDD techniques include percutaneous laser disc decompression (PLDD), coblation nucleoplasty, and automated lumbar discectomy (APLD).Addresses radicular pain secondary to intervertebral disc herniation.Aims to remove a portion of the disc nucleus material in order to reduce intradiscal pressure, limit release of inflammatory mediators and decompress the spinal cord and/or nerve root.Has received noncoverage status from the Center for Medicare and Medicaid Services because of the lack of supporting evidence.Involves placement of an electrode or catheter into the disc annulus to apply electrothermal energy which denervates the annulus.Coblation nucleoplasty involves the use of a bipolar radiofrequency current to decrease the volume of the disc tissue leading to decompression.Biacuplasty involves the utilization of bipolar and monopolar RFA electrodes to create lesions in the posterior and posterolateral annulus which coagulates nociceptors.Heat-based procedures include the following:.Effectiveness of these interventions based on recent randomized controlled trials (RCT) is controversial.Application of heat along the annulus to denervate it and/or reconfigure the collagen structure of the disc to stabilize annular tears and relieve pain.Infrequently utilized in contemporary practice, however, is useful for research purposes.There is concern that discography may cause accelerated disc degeneration and herniation.Validity of discography remains controversial.Performed to identify the disc as the source of a patient’s axial pain.Placement of contrast dye within the intervertebral disc nucleus pulposus under fluoroscopy followed by computed tomography (CT) imaging of the spine.RFA is an effective treatment for low back pain, especially when prior diagnostic blocks have resulted in a high level of pain relief.Nerve regeneration is expected to occur over 9 to 12 months.Performed to provide pain relief by denervation of facet or sacroiliac joints for an extended period of time.In general, greater improvement of pain following MBBs correlates with better outcomes after RFA. The decision to perform an RFA follows a successful diagnostic MBB.RFA/TRN uses the application of radiofrequency current to create heat to lesion the afferent nerve supply of the facet and sacroiliac joints.Radiofrequency Ablation (RFA) / Thermal Radiofrequency Neurotomy (TRN) Most studies have shown at least moderate efficacy when used either therapeutically or diagnostically prior to RFA.Sacroiliac joint injections involve intra-articular placement of corticosteroid and an anesthetic into the joint for diagnostic or therapeutic value.
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