System Delay and Mortality among Patients with STEMI Treated with Primary Percutaneous Coronary Intervention

BACKGROUND Chronic refractory low back and lower extremity pain is frustrating to treat Percutaneous adhesiolysis and spinal endoscopy are techniques which can treat chronic refractory low back and lower extremity painPercutaneous adhesiolysis is performed by placing the catheter into the tissue plane at the ventrolateral aspect of the foramen so that medications can be injected Adhesiolysis is used both for pain caused by scarring which is not resistant to catheter placement and other sources of pain, including inflammation in the absence of scarringMechanical lysis of scars with a catheter may or may not be necessary for percutaneous adhesiolysis to be effective Spinal endoscopy allows direct visualization of the epidural space and has the possibility to use laser energy to treat pathology STUDY DESIGN A systematic review of the effectiveness of percutaneous adhesiolysis and spinal endoscopic adhesiolysis to treat chronic refractory low back and lower extremity pain OBJECTIVE To evaluate and update the effectiveness of percutaneous adhesiolysis and spinal endoscopic adhesiolysis to treat chronic refractory low back and lower extremity pain METHODS The available literature on percutaneous adhesiolysis and spinal endoscopic adhesiolysis in treating persistent low back and leg pain was reviewed The quality of each article used in this analysis was assessed The level of evidence was classified on a 5-point scale from strong, based upon multiple randomized controlled trials to weak, based upon consensus, as developed by the US Preventive Services Task Force (USPSTF) and modified by ASIPP Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2015, and manual searches of the bibliographies of known primary and review articles OUTCOME MEASURES Pain relief of at least 50% and functional improvement of at least 40% were the primary outcome measures Short-term efficacy was defined as improvement of 6 months or less; whereas, long-term efficacy was defined more than 6 months RESULTS For this systematic review, 45 studies were identified Of these, for percutaneous adhesiolysis there were 7 randomized controlled trials and 3 observational studies which met the inclusion criteria For spinal endoscopy, there was one randomized controlled trial and 3 observational studies Based upon 7 randomized controlled trials showing efficacy, with no negative trials, there is Level I or strong evidence of the efficacy of percutaneous adhesiolysis in the treatment of chronic refractory low back and lower extremity pain Based upon one high-quality randomized controlled trial, there is Level II to III evidence supporting the use of spinal endoscopy in treating chronic refractory low back and lower extremity pain CONCLUSION The evidence is Level I or strong that percutaneous adhesiolysis is efficacious in the treatment of chronic refractory low back and lower extremity pain Percutaneous adhesiolysis may be considered as a first-line treatment for chronic refractory low back and lower extremity pain The evidence is Level II to III that spinal endoscopy is effective in the treatment of chronic refractory low back and lower extremity pain KEY WORDS Spinal pain, chronic low back pain, post lumbar surgery syndrome, epidural scarring, adhesiolysis, endoscopy, radicular pain

Percutaneous and Endoscopic Adhesiolysis in Managing Low Back and Lower Extremity Pain: A Systematic Review and Meta-analysis.

Lumbar spine surgery for spinal stenosis is a frequently performed procedure and was the fastest growing type of surgery in the US from 1980 to 2000. With increasing surgical invasiveness, postoperative complications also tend to be higher. Cross-sectional imaging techniques (CT and MRI) are more sensitive than radiographs and play an increasingly important role in evaluation of patients with lumbar spine surgery. Their use in patients with metallic implants is somewhat limited by artefacts, which can obscure pathology and decrease accuracy and reader confidence. Metal artefact reduction techniques have been developed, which can significantly improve image quality and enable early detection of postoperative complications. Complications can occur throughout postoperative course. Early complications include hardware displacement, incidental durotomy, postoperative collections—most commonly seroma, and less likely haematoma and/or infection. Incidental durotomy with CSF leak causing intracranial hypotension has characteristic MR brain findings and diagnosis of occult leak sites have been improved with use of dynamic CT myelography. Haematomas, even when compressing the thecal sac, are usually asymptomatic. Early infection, with nonspecific MR findings, can be diagnosed accurately using dual radiotracer studies. Delayed complications include loosening, hardware failure, symptomatic new or recurrent disc herniation, peri-/epidural fibrosis, arachnoiditis, and radiculitis. • CT and MRI play an increasingly important role in evaluation of patients with lumbar spine surgery
 • Complications can occur throughout the postoperative course and early detection is critical
 • Artefact reduction techniques can improve image quality for early and improved detection of complications

/pdf/imaging-of-lumbar-spinal-surgery-complications-5b3sfu2fen.pdf

Imaging of lumbar spinal surgery complications

Robotic and Navigated Pedicle Screws are Safer and More Accurate than Fluoroscopic Freehand Screws: A Systematic Review and Meta-Analysis.

A Rare Complication of Spine Surgery: Guillain-Barré Syndrome.

https://www.neuroimaging.theclinics.com/article/S1052-5149(14)00003-3/pdf

Postoperative Spine Complications

Overall improvement in the interpretation of images obtained in the emergency department and involvement in decision making will reinforce the participation of radiology in the local stroke team and will increase the added value of radiology to stroke care.

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2015151965

Recent Endovascular Trials: Implications for Radiology Departments, Radiology Residency, and Neuroradiology Fellowship Training at Comprehensive Stroke Centers

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Postoperative Spine Complications

Recent Endovascular Trials: Implications for Radiology Departments, Radiology Residency, and Neuroradiology Fellowship Training at Comprehensive Stroke Centers