scholarly journals Comparative Study Regarding Efficacy of Radiofrequency Rhizotomy and the Microvascular Decompression in the Treatment of Trigeminal Neuralgia

2019 ◽  
Vol 23 (3) ◽  
pp. 193-198
Author(s):  
ABDUL MAJID ◽  
MUHAMMAD FAROOQ ◽  
MUHAMMAD SHAKIR ◽  
ZUBAIR MUSTAFA KHAN ◽  
SAJID IQBAL
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Controlled Trial ◽  
Neurovascular Compression ◽  
Chi Square ◽  
Significant Pain ◽  
Group I ◽  
Mild Improvement ◽  
Group Ii

Objective: Trigeminal neuralgia is the lancinating electric shock like pain because of neurovascular compression in trigeminal nerve distribution. We compared the efficacy of radiofrequency rhizotomy with microvascular decompression in terms of complete pain relief.Material and Methods: The randomized controlled trial study was conducted in the neurosurgery department, LGH Lahore for a period of one year June 2017 to June 2018. A total of 110 patients were included and distributed into two groups, i.e. group-I who underwent radiofrequency rhizotomy (RFR) and group-II who underwent microvascular decompression (MVD). Follow-up of all the patients was assured up to six months. All the data were analyzed using S.P.S.S Ver. 23.0.Results: There were 38 (34.6%) male and 72(65.4%) female. Mean age was 51.25 ± 8.80 years. At the end of six months, in Group-I (RFR), Nineteen (34.5%) patients were completely pain free, 25 (45.5%) patients had significant pain relief, 7 (12.7%) had mild improvement in the pain and 4 (7.3%) patients had no improvement in the pain. In group-II (MVD), 30 (54.5%) patients were completely pain free, 14 (25.5%) had significant pain relief, 9 (16.4%) had mild improvement and 2 (3.6%) had no improvement in their pain (Chi-square = 6.49, p = 0.090).Conclusion: Microvascular decompression had better results than a radiofrequency rhizotomy in patients presenting with trigeminal neuralgia regarding excellent pain relief and fewer complications.

scholarly journals Comparative Effectiveness of a One-Year Follow-Up of Thoracic Medial Branch Blocks in Management of Chronic Thoracic Pain: A Randomized, Double-Blind Active Controlled Trial

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 535-548
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Local Anesthetic ◽  
Facet Joint ◽  
Controlled Trial ◽  
The United States ◽  
Medial Branch ◽  
Thoracic Pain ◽  
Significant Pain ◽  
Group I ◽  
Group Ii

Background: Thoracic facet joints have been implicated as the source of chronic pain in the mid back or upper back in 34% to 42% of patients when the modified criteria of the International Association for the Study of Pain (IASP) is utilized. Various therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include intraarticular injections, medial branch blocks, and radiofrequency neurotomy of thoracic medial branch nerves. Study Design: A randomized, double-blind, active controlled trial. Setting: A private practice, interventional pain management setting, and a specialty referral center setting in the United States. Objective: To determine the clinical effectiveness of therapeutic local anesthetic medial branch blocks with or without steroid in managing chronic function-limiting mid back or upper back pain of facet joint origin. Methods: The study was performed in an interventional pain management private practice, a tertiary referral center, in the United States. A total of 100 participants were included, with 50 participants in each of the local anesthetic and steroid groups. All of the participants met the diagnostic criteria of thoracic facet joint pain by means of comparative, controlled diagnostic blocks and the inclusion criteria. Group I participants received thoracic medial branch blocks with bupivacaine, whereas Group II participants received thoracic medial branch blocks with bupivacaine and non-particulate betamethasone. Outcomes Assessment: Outcomes measures included numeric rating scores (NRS), Oswestry Disability Index (ODI), opioid intake, and return to work status at baseline, 3 months, 6 months, and 12 months. Significant pain relief was defined as ≥ 50% pain relief and/or a positive change in ODI scores. Results: In Group I and Group II 90% of participants showed significant pain relief and functional improvement at 12 months. The majority of the participants experienced significant pain relief of 47.2 ± 10.1 weeks in Group I and 46.3 ± 8.4 weeks in Group II, requiring approximately 3.5 treatments per year with an average relief of 15.8 ± 10.5 in Group I and 13.6 ± 3.6 weeks in Group II per episode of treatment. Limitations: Study limitations include the lack of a placebo group. Conclusions: Therapeutic thoracic medial branch blocks, with or without steroid, may provide a management option for chronic function-limiting mid back or upper back pain of facet joint origin. Clinical Trial: NCT00355706 Key words: Chronic spinal pain, thoracic pain, thoracic facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeutic thoracic medial branch blocks.

Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression

2002 ◽  
Vol 96 (3) ◽  
pp. 527-531 ◽  
Author(s):  
Elizabeth C. Tyler-Kabara ◽  
Amin B. Kassam ◽  
Michael H. Horowitz ◽  
Louise Urgo ◽  
Constantinos Hadjipanayis ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Content Type ◽  
Significant Pain ◽  
Fine Print

Object. Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution. Methods. The results of 2675 MVDs in 2264 patients were reviewed using information obtained from the department database. The authors examined immediate postoperative relief in 2003 patients with typical and 672 with atypical TN, and long-term follow-up results in patients for whom more than 5 years of follow-up data were available (969 with typical and 219 with atypical TN). Outcomes were divided into three categories: excellent, pain relief without medication; good, mild or intermittent pain controlled with low-dose medication; and poor, no or poor pain relief with large amounts of medication. The results for typical and atypical TN were compared and patient history and pain characteristics were evaluated for possible predictive factors. Conclusions. In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.

scholarly journals Fluoroscopic Epidural Injections in Cervical Spinal Stenosis: Preliminary Results of a Randomized, Double-Blind, Active Control Trial

2012 ◽  
Vol 1;15 (1;1) ◽  
pp. E59-E70
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Spinal Stenosis ◽  
Local Anesthetic ◽  
Chronic Neck Pain ◽  
Double Blind ◽  
Epidural Injections ◽  
Significant Pain ◽  
Group I ◽  
Cervical Spinal Stenosis ◽  
Group Ii

Background: Cervical spinal stenosis is a common disease that results in considerable morbidity and disability. There are multiple modalities of treatments, including surgical interventions and multiple interventional techniques including epidural injections. The literature on the effectiveness of cervical epidural steroids is sporadic. Emerging evidence for cervical interlaminar epidurals for various conditions in the cervical spine is positive; however, the effect of fluoroscopic epidural injections in cervical spinal stenosis has not been studied. Study Design: A randomized, double-blind, active control trial. Setting: A private interventional pain management practice, a specialty referral center in the United States. Objectives: To evaluate the effectiveness of cervical interlaminar epidural injections with local anesthetic with or without steroids in the management of chronic neck pain with upper extremity pain in patients with cervical central spinal stenosis. Methods: Patients with cervical central spinal stenosis were randomly assigned to one of 2 groups: injection of local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Sixty patients were included in this analysis. Randomization was performed by computer-generated random allocation sequence by simple randomization. Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake with assessment at 3, 6, and 12 months post-treatment. Significant pain relief or functional status was defined as a 50% or more reduction of NRS or NDI scores. Results: Significant pain relief was seen in 73% in Group I and 70% in Group II, in Group II showing both significant pain relief and functional status improvements. Group I’s average relief per procedures was 11.3 ± 5.8 weeks; for Group II it was 8.6 ± 3.6 weeks, whereas after initial 2 procedures, average relief was 13.7 ± 8.7 weeks in Group I, and 13.6 ± 4.7 weeks in Group II. In the successful group, the average total relief in a one-year period was 42.2 ± 14.7 weeks in Group I and 34.3 ± 13.4 weeks in Group II, with 76% in Group I and 77% in Group II. Limitations: Study limitations include the lack of a placebo group and that this is a preliminary report of only 60 patients, 30 in each group. Conclusion: Patients who have chronic function-limiting pain that is secondary to cervical central stenosis might receive relief with cervical interlaminar epidurals of local anesthetic, whether with or without steroids. Key words: Chronic neck pain, cervical disc herniation, cervical stenosis, cervical central stenosis, cervical epidural injections, epidural steroids, local anesthetics

scholarly journals The Durability of Pain Relief Following Endoscope-Assisted Microvascular Decompression for Trigeminal Neuralgia

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Alexandra D Baker ◽  
Melvin Field
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Microvascular Decompression ◽  
Retrospective Chart Review ◽  
Postoperative Recurrence ◽  
Pain Scale ◽  
Neurovascular Compression ◽  
Recurrence Rates

Abstract INTRODUCTION Trigeminal neuralgia (TGN) is a facial pain disorder that is paroxysmal, stabbing, and produces a shooting pain that affects the face due to the compression of the trigeminal nerve. Literature has suggested that the use of an endoscope for microvascular decompression (eMVD), as opposed to a microscope alone, is more likely to identify the source of neurovascular compression and ensure that the nerve is adequately decompressed. However, the recurrence of TGN pain continues to be an issue for patients. This project will assess the long-term success of eMVD using the reduction in Barrow Pain Scale score and recurrence rate at 1 yr. METHODS This retrospective chart review aims at exploring the efficacy of eMVD for TGN by studying rates of recurrence in a cohort of 300 patients and comparing them to the literature using descriptive statistics. This is the largest study to date evaluating postoperative recurrence for eMVD for TGN. RESULTS In this cohort, on average, patients reduced their pain scale by 2.99 units on the Barrow Pain Scale. Additionally, 95.5% of patients experienced an immediate pain relief after eMVD surgery, while only 4.3% had no improvement in TGN pain after the procedure. In this eMVD patient cohort, 22% of patients had partial recurrence of TGN pain. CONCLUSION The endoscope seems to provide long-term success for eliminating TGN pain and is at least as successful as traditional MVD. Over 95% of patients with follow-up data experienced an immediate pain relief, indicating that the efficacy of this procedure is excellent. Recurrence rates of TGN pain seem to be comparable to the existing literature on traditional MVD approaches. This cohort had a partial recurrence rate of 22%, while previous MVD studies have shown significant recurrence rates between 3% and 32%. This indicates that significant recurrence rates of TGN need to be further investigated.

scholarly journals Effectiveness of Thoracic Medial Branch Blocks in Managing Chronic Pain: A Preliminary Report of a Randomized, Double-Blind Controlled Trial; Clinical Trial NCT00355706

2008 ◽  
Vol 4;11 (8;4) ◽  
pp. 491-504
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Local Anesthetic ◽  
Facet Joint ◽  
Controlled Trial ◽  
Functional Improvement ◽  
Medial Branch ◽  
Thoracic Pain ◽  
Double Blind ◽  
Significant Pain ◽  
Group I

Background: Thoracic facet joints have been implicated as the source of chronic pain in the mid back or upper back in 34% to 48% of the patients. Various therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include intraarticular injections, medial branch blocks, and radiofrequency neurotomy of thoracic facet joint nerves. Objective: To determine the clinical effectiveness of therapeutic local anesthetic medial branch blocks with or without steroid in managing chronic function-limiting mid back or upper back pain of facet joint origin. Design: A randomized, double-blind, controlled trial. Setting: An interventional pain management private practice, a tertiary referral center, in the United States. Methods: A total of 48 patients were included, with 24 patients in each of the local anesthetic and steroid groups. All of the patients met the diagnostic criteria of thoracic facet joint pain by means of comparative, controlled diagnostic blocks and the inclusion criteria. Group I patients received thoracic medial branch blocks with bupivacaine, whereas Group II patients received thoracic medial branch blocks with bupivacaine and non-particulate betamethasone. Outcome Measures: Numeric pain scores (NRS), Oswestry Disability Index (ODI), opioid intake, and return to work status. All outcomes were assessed at baseline, 3 months, 6 months, and 12 months. Significant pain relief was defined as > 50% pain relief. Significant functional improvement was defined as 40% reduction of ODI. Results: In Group I, 79% of patients showed significant pain relief and functional improvement at 3 months, 6 months, and 12 months, a significant change from baseline. In Group II, 83%, 81%, and 79% of patients showed significant pain relief and functional improvement at 3 months, 6 months, and 12 months, a significant change from baseline. The majority of the patients experienced significant pain relief of 46 to 50 weeks, requiring approximately 3 to 4 treatments with an average relief of 16 weeks per episode of treatment. Conclusion: The majority of the patients in both groups experienced significant pain relief and improvement in functional status. Therapeutic thoracic medial branch blocks, with or without steroid, may provide a management option for chronic function-limiting mid back or upper back pain of facet joint origin. Key words: Chronic spinal pain, thoracic pain, thoracic facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeutic thoracic medial branch blocks

EFFECT OF MICROVASCULAR DECOMPRESSION IN TRIGEMINAL NEURALGIA PATIENTS WITH OR WITHOUT CONSTANT PAIN

Neurosurgery ◽  
2008 ◽  
Vol 63 (1) ◽  
pp. 93-100 ◽  
Author(s):  
Tiril Sandell ◽  
Per Kristian Eide
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Senior Author ◽  
Total Study Population ◽  
Significant Pain ◽  
Constant Pain ◽  
Study Population ◽  
First Time

ABSTRACT OBJECTIVE To study the effect of microvascular decompression (MVD) in trigeminal neuralgia (TN) patients with or without constant pain. METHODS The study includes all first-time MVDs for facial pain performed by the senior author (PKE) during the 6-year period from 1999 to 2005 in the Department of Neurosurgery at the National Hospital. At the time of follow-up, pain relief was assessed using a standard mail questionnaire; those patients still having residual pain were further examined in the outpatient clinic or interviewed by phone. RESULTS The total study population includes 135 patients who underwent initial MVDs (67% of MVDs for TN without constant pain and 33% of MVDs for TN with constant pain). At the time of follow-up, the response rate was 95%, which provided us with 128 patients. The median observation period was 38 months (range, 12–87 mo). For episodic pain, MVD caused complete (i.e., 100%) pain relief in 78% of TN patients without constant pain and in 77% of TN patients with constant pain before MVD, and a significant pain relief (i.e., worst pain marked as 0–3 cm on a 10-cm visual analog scale) in 85 and 81%, respectively. For constant pain, MVD caused complete pain relief in 70% of the TN patients with constant pain before MVD, and significant pain relief in 77%. CONCLUSION In TN patients with constant pain before MVD, significant relief of episodic and constant pain was observed in 81 and 77%, respectively. Hence, the presence of constant pain should not prevent TN patients from being offered MVD.

scholarly journals TREATMENT OF ACUTE LUMBAGO

2008 ◽  
Vol 15 (04) ◽  
pp. 440-444
Author(s):  
TAHIR AHMAD KHAN ◽  
ASHER AHMAD ◽  
IRFAN ZAFAR HAIDER
Keyword(s):  
Pain Relief ◽  
Statistical Significance ◽  
Diclofenac Sodium ◽  
Vitamin B ◽  
Duration Of Treatment ◽  
Chi Square ◽  
Group I ◽  
Group Ii ◽  
Pain At Rest ◽  
Acute Lumbago

Objective: To determine whether concomitant use of vitamins B1, B6, B12 along with low dose of diclofenac sodium causesquicker pain relief in patients of acute lumbago compared with diclofenac sodium alone. Design: A randomized clinical trial. Setting: SurgicalDepartment of C M H Attock. Period: From September 2004 to August 2005 Patients & Methods: A total of 50 patients were selected forthe study. The patients complaints were of acute lumbago of less than 3 days duration with severe impairments of movements. The age groupof patients was between 20 and 65 years. The patients were randomly assigned into two groups. Group I was prescribed tablet diclofenacsodium 25mg along with vitamin B-complex containing combination of 100mg thiamine nitrate (B1), 100mg pyridoxine hydrochloride (B6), and200mcg cyanocobalmine (B12) three times a day. Group II patients were prescribed 25mg of tablet diclofenac sodium alone. Improvement inthe intensity of pain at rest and during movements (as assessed by the patients) was noted in accordance to visual analogue scale 1 to 10.The effectiveness of diclofenac sodium in combination with vitamin-B complex with diclofenac sodium alone was judged on the basis of extentof pain relief after 7 days of treatment. Results: A total of 25 patients were treated with combination of diclofenac sodium & vitamin-B complex(Group I) and 25 were treated with diclofenac sodium alone (Group II). As far as the extent of pain relief in first 7 days is considered, 22 patients(88%) belonging to group I and 10 patients (12%) belonging to group II had an excellent pain relief and were able to carry on with their normalroutine activities. Remaining 3 patients in group I were completely relieved of pain in next 3 days while 15 patients in group II had to completeanother 10 days for complete cure. To test the statistical significance of the result chi-square test was applied and the result showed thatpatients of Group I responded significantly well to the treatment as compared to those in Group II. Conclusion: Using the parameters of painrelief and movements of vertebral column, the combination of diclofenac sodium & vitamin-B complex was found to be more effective modeof treatment as the duration of treatment and the dosage of diclofenac sodium was less and also relief of pain was more rapid.

scholarly journals Preliminary Results of a Randomized, Equivalence Trial of Fluoroscopic Caudal Epidural Injections in Managing Chronic Low Back Pain: Part 2 — Disc Herniation and Radiculitis

2008 ◽  
Vol 6;11 (12;6) ◽  
pp. 801-815 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Lower Extremity ◽  
Disc Herniation ◽  
Local Anesthetic ◽  
Low Back ◽  
Epidural Injections ◽  
Significant Pain ◽  
Group I ◽  
Group Ii ◽  
Caudal Epidural

Background: The pathophysiology of lumbar radicular pain is a subject of ongoing research. The prevalence of sciatica or radiculitis ranges from 1.2% to 43%. Epidural injections are one of the most commonly performed interventions in the United States in managing chronic low back and lower extremity pain secondary to disc herniation and radiculitis. There is a paucity of evidence with contemporary methodology used in performing epidural injections under fluoroscopy and based on pain relief and functional status improvement. Study Design: A randomized, double-blind, equivalence trial. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objective: To evaluate the effectiveness of caudal epidural injections with or without steroids in managing chronic low back and lower extremity pain secondary to disc herniation or radiculitis in providing effective and long-lasting pain relief and evaluate the differences between local anesthetic with or without steroids. Methods: Patients were assigned to one of 2 groups; Group I patients received caudal epidural injections with an injection of local anesthetic (lidocaine 0.5%), whereas, Group II patients received caudal epidural injections with 0.5% lidocaine 9 mL mixed with 1 mL of steroid. Randomization was performed by computer-generated random allocations sequence by simple randomization. Outcomes Assessment: Multiple outcome measures were utilized which included the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3 months, 6 months, and 12 months post-treatment. Significant pain relief was defined as 50% or more, whereas significant improvement in disability score was defined as a reduction of 40% or more. Results: The percentage of patients with significant pain relief of 50% or greater at 12 months was 79% in Group I and 81% in Group II. Reduction of Oswestry scores of at least 40% was seen in 83% of the patients in Group I and 91% in Group II. The overall average procedures per year were 3.9 ± 1.26 in Group I and 3.6 ± 1.08 in Group II with an average total relief per year of 35.2 ± 17.18 weeks in Group I and 35.9 ± 15.34 weeks in Group II over a period of 52 weeks. Limitations: The results of this study are limited by lack of a placebo group and a preliminary report of 42 patients in each group. Conclusion: Caudal epidural injections with or without steroids may be effective in patients with disc herniation or radiculitis with between 79% to 91% of patients showing significant pain relief and improvement in functional status. Key words: Chronic low back pain, disc herniation, radiculitis, lower extremity pain, caudal epidural injections, epidural steroids, local anesthetic

scholarly journals A Preliminary Report of a Randomized DoubleBlind, Active Controlled Trial of Fluoroscopic Thoracic Interlaminar Epidural Injections in Managing Chronic Thoracic Pain

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. E357-E369 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Disc Herniation ◽  
Local Anesthetic ◽  
Preliminary Report ◽  
Controlled Trial ◽  
Thoracic Pain ◽  
Discogenic Pain ◽  
Epidural Injections ◽  
Group I ◽  
Group Ii

Background: The proportion of patients suffering from thoracic pain secondary to thoracic disorders is relatively small compared to low back and neck pain. Furthermore, thoracic interventions are not performed as often as in cervical and lumbar regions. In addition, there is a paucity of literature regarding thoracic intervertebral discs and thoracic disc herniation as causative structures of thoracic pain. Study Design: A randomized, double-blind, active controlled trial. Setting: A private practice, interventional pain management and specialty referral center in the United States. Objectives: To evaluate the effectiveness of thoracic interlaminar epidural injections in providing effective pain relief in managing chronic mid and upper back pain secondary to disc herniation or radiculitis and discogenic pain with local anesthetic alone or with steroids. Methods: Inclusion criteria consisted of patients who either had disc herniation or radiculitis, or patients with discogenic pain proven by controlled comparative local anesthetic blocks not to be caused by facet joint pain. Patients were assigned to one of 2 groups. One group received injections containing local anesthetic only; the other group, local anesthetic mixed with nonparticulate betamethasone. Randomization was performed by computer-generated random allocations sequence by simple randomization. Outcomes Assessment: Participant outcomes were measured at baseline, 3, 6, and 12 months post-treatment with the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake. Decrease of ≥ 50% of NRS scores and Oswestry scores were considered significant. Results: A total of 40 participants are included in this preliminary report with 20 participants in each group. Significant pain relief (≥ 50%) and reduction (by at least 50%) in ODI from baseline was seen at 12 months in 80% of patients in Group I and 85% in Group II. Limitations: This is a preliminary report and there was no placebo group. Conclusion: Overall, 80% of participants in Group I (who received injections without steroids) and 85% in Group II (who received injections with steroids) with thoracic pain secondary to disc herniation or radiculitis and discogenic pain might benefit from thoracic interlaminar epidural injections. Key words: Chronic thoracic pain, chest wall pain, disc herniation, discogenic pain, radiculitis, thoracic interlaminar epidural injections, epidural steroids, local anesthetic

scholarly journals Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology

2009 ◽  
Vol 27 (5) ◽  
pp. E10 ◽  
Author(s):  
Raymond F. Sekula ◽  
Andrew M. Frederickson ◽  
Peter J. Jannetta ◽  
Sanjay Bhatia ◽  
Matthew R. Quigley ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Statistical Significance ◽  
Clinical Impression ◽  
Chi Square ◽  
Venous Compression ◽  
Complete Pain Relief ◽  
Pain Status ◽  
Chi Square Test

Object The authors have the clinical impression that patients with isolated V2, or maxillary division, trigeminal neuralgia (TN) are most often women of a younger age with atypical pain features and a predominance of venous compression as the pathology. The aim of this study was to evaluate a specific subgroup of patients with V2 TN. Methods Among 120 patients who underwent microvascular decompression (MVD) for TN in 2007, data were available for 114; 6 patients were lost to follow-up. Patients were stratified according to typical (Burchiel Type 1), mixed (Burchiel Type 2a), or atypical (Burchiel Type 2b) TN. A pain-free status without medication was used to determine the efficacy of MVD. All patients were contacted in June 2008 and again in January 2009 at 12–24 months after surgery (median 18.4 months) and asked to rate their response to MVD as excellent (complete pain relief without medication), fair (complete pain relief with medication or some relief with or without medication), or poor (continued pain despite medication; that is, no change from their preoperative baseline pain status. Results Of 114 patients, 14 (12%) had isolated V2 TN. Among these 14 were 2 typical (14%), 1 mixed (7%), and 11 atypical cases (79%) of TN. Among the remaining 100 cases were 37 typical (37%), 14 mixed (14%), and 49 atypical cases (49%) of TN. In the isolated V2 TN group, all patients were women as compared with 72% of women in the larger group of 100 patients (p = 0.05, chi-square test). The average age in the isolated V2 TN group was 51.2 years (median 48.1 years) versus 54.2 years (median 54.0 years) in the remainder of the group (p = NS, unpaired Student t-test). In the isolated V2 TN group, there was a predominance of atypical pain cases (79%) versus 49% in the remainder of the group, and this finding trended toward statistical significance (p = 0.07, chi-square test). Venous contact or compression (partly or wholly) was noted in 93% of the patients with isolated V2 versus 69% of the remainder of the group (p = 0.13, chi-square test). The likelihood of excellent outcomes in the patients with V2 TN (71%) was compared with that in typical pain cases (79%) among patients in the rest of the group (that is, the bestoutcome group), and no difference was found between the 2 groups (p = 0.8, chi-square test). Conclusions The authors confirmed that patients with isolated V2 TN were more likely to be female, tended toward an atypical pain classification with venous pathology at surgery, and fared just as well as those presenting with typical pain.

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