Adrian Kastler

Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients’ quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

To evaluate the efficacy of a simplified CT-guided greater occipital nerve (GON) infiltration approach in the management of occipital neuralgia (ON). Local IRB approval was obtained and written informed consent was waived. Thirty three patients suffering from severe refractory ON who underwent a total of 37 CT-guided GON infiltrations were included between 2012 and 2014. GON infiltration was performed at the first bend of the GON, between the inferior obliqus capitis and semispinalis capitis muscles with local anaesthetics and cortivazol. Pain was evaluated via VAS scores. Clinical success was defined by pain relief greater than or equal to 50 % lasting for at least 3 months. The pre-procedure mean pain score was 8/10. Patients suffered from left GON neuralgia in 13 cases, right GON neuralgia in 16 cases and bilateral GON neuralgia in 4 cases. The clinical success rate was 86 %. In case of clinical success, the mean pain relief duration following the procedure was 9.16 months. Simplified CT-guided infiltration appears to be effective in managing refractory ON. With this technique, infiltration of the GON appears to be faster, technically easier and, therefore, safer compared with other previously described techniques. • Occipital neuralgia is a very painful and debilitating condition • GON infiltrations have been successful in the treatment of occipital neuralgia • This simplified technique presents a high efficacy rate with long-lasting pain relief • This infiltration technique does not require contrast media injection for pre-planning • GON infiltration at the first bend appears easier and safer

The sphenopalatine ganglion (SPN) has been proven to be involved in various types of facial pain syndromes. Management of these cranio-facial pain syndromes can be challenging, and existing specific treatments are sometimes inefficient and may fail. The purpose of this study is to describe and evaluate alcohol SPN in the management of cranio-facial pain. Forty-two patients suffering from refractory facial pain who underwent 58 consecutive SPN were included in this study between 2000 and 2013. Patients were divided into three groups: group “cluster headache” (CH), group “persistent idiopathic facial pain” (PFIP), and group “Other”. Pain was assessed using Visual Analogue Scale scores (measured immediately before and after procedure and at regular intervals following the procedure). Alcohol SPN was considered to be effective when pain relief was equal to or greater than 50 % and lasting for at least 1 month. All procedures were realized ambulatory under CT guidance and consisted of an injection of 1 ml of absolute alcohol. Overall efficacy rate of alcohol SPN was 67.2 %, with mean pain relief duration of 10.3 months. Procedure was graded either not painful or tolerable by patients in 64.2 %. Analysis showed a higher efficacy rate in the groups CH (76.5 %) and PFIP (85.7 %) compared to the group Other (40 %). No difference was found between groups regarding the recurrence rate. Alcohol SPN under CT guidance appears as a safe and effective treatment of refractory facial pain, especially in cases of cluster headache and persistent idiopathic facial pain.

To assess the feasibility and efficacy of microwave ablation (MWA) of painful refractory bone and soft tissue tumors performed under local anesthesia. A retrospective study between 2011 and 2013. A single center, Academic Interventional Pain Management Unit. Fifteen patients with 25 refractory painful bone (N = 19) or soft tissue (N = 6) tumors treated with MWA were consecutively included. Local Institutional Review Board approval was obtained, and written informed consent was waived. Lesions included spinal (N = 3), sacral (N = 4), and extraspinal (N = 18) locations. Pain was measured on a visual analog scale (VAS) from 0 to 10 before and immediately after procedure, at 1 week, and on a monthly basis following procedure. MWA procedures were always performed under computed tomography guidance and local anesthesia along with nitrous oxide inhalation. Mean ablation time was 4.09 minutes (range 1-11) with an average of 4.2 cycles with a mean ablation power of 60 W. Preprocedure mean VAS score was 7.2 ± 0.97 (range 6-9). Follow-up postprocedure VAS scores were as follows: day 0: 1.64 ± 1.86, day 7: 1.82 ± 1.79, month 1: 2.05 ± 2.03 (14/15 patients), month 3: 2.13 ± 1.81, month 6: 2.36 ± 2.17; and were statistically significant (P < 0.001). Mean pain relief was 5.5 months. MWA is feasible, safe, and effective in the management of painful refractory bone and soft tissue tumors. It may therefore be considered as a potential alternative to existing percutaneous ablation techniques in the management of bone and soft tissue tumors.

To describe and evaluate the feasibility and efficacy of CT-guided radiofrequency neurolysis (RFN) vs. local blockade of the stellate ganglion in the management of chronic refractory type I complex regional pain syndrome (CRPS) of the upper limb. Sixty-seven patients were included in this retrospective study between 2000 and 2011. All suffered from chronic upper limb type I CRPS refractory to conventional pain therapies. Thirty-three patients underwent stellate ganglion blockade and 34 benefited from radiofrequency neurolysis of the stellate ganglion. CT guidance was used in both groups. The procedure was considered effective when pain relief was ≥50 %, lasting for at least 2 years. Thirty-nine women (58.2 %) and 28 men (41.8 %) with a mean age of 49.5 years were included in the study. Univariate analysis performed on the blockade and RFN groups showed a significantly (P < 0.0001) higher success rate in the RFN group (67.6 %, 23/34) compared with the blockade group (21.2 %, 7/33) with an odds ratio of 7.76. CT-guided radiofrequency neurolysis of the stellate ganglion is a safe and successful treatment of chronic refractory type I CRPS of the upper limb. It appears to be more effective than stellate ganglion blockade. • Complex regional pain syndrome is painful, disabling and often refractory to treatment. • Sixty-seven percent of patients had lasting pain relief (2 years) after radiofrequency neurolysis. • Retrospective study showed a significantly higher success rate for radiofrequency neurolysis. • CT guidance is mandatory for a successful and safe procedure.

Chronic inguinal neuralgia involving ilioinguinal and iliohypogastric nerves is a frequent complication of surgical procedures involving a lower abdominal incision such as hernia repair, appendicitis surgery, or cesarean sections. Chronic inguinal neuralgia is a very painful condition and diagnosis can be challenging as it is an overlooked impairment. Existing specific treatments are inefficient and often fail. The purposes of this study are to describe, evaluate, and compare ilioinguinal and iliohypogastric radiofrequency neurolysis (RFN) and local injection. Retrospective comparison cohort study from 2005 to 2011. A single center, Academic Interventional Pain Management Unit Forty-two patients suffering from chronic inguinal pain refractory to specific medication were included. A total of 18 RFN procedures (14 patients) and 28 injections (28 patients) were performed. Pain was assessed in both groups using Visual Analog Scale (VAS) scores (0-10) measured immediately before and after the procedure and at one, 3, 6, 9, and 12 months after the procedure. Mean duration of pain prior to the procedure and mean duration of pain relief were noted. Moreover, mean maximum early pain relief was assessed. All procedures were ambulatory under computed tomography (CT) guidance. Injections contained 1.5 mL of cortivazol and 3 mL of lidocaine-ropivacaine (30%-70%). Radiofrequency neurolysis was performed using a Neurotherm RF Generator. In both cases, 22-gauge needles were used. After needle retrieval, control slices were taken and the patient was supervised for 30 minutes at the CT unit. The mean age in both groups was 48.7 years. Forty-two patients (97.6%) presented postsurgical inguinal pain, 62% of which occurred after hernia repair. All included patients had undergone previously unsuccessful pain therapies. Mean VAS scores were 7.72 in the RF group and 7.46 in the infiltration group. Maximum early pain relief did not statistically differ (77% in the RFN group and 81.5% in the injection group). Mean duration of pain relief was statistically significant (P = .005) in the RF group (12.5 months) compared to the infilitration group (1.6 months). Mean VAS scores during the year following the procedure were all significantly in favor of radiofrequency neurolysis management. Those inherent to small study samples and retrospective studies. Radiofrequency neurolysis appears to be significantly more effective than local nerve infiltrations. It is a safe and effective treatment for chronic inguinal pain. Local steroid injection along with local injection of anesthetics should be used as a confirmation of ilioinguinal neuropathy before performing radiofrequency neurolysis.

To evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency (RF) neurolysis (RFN) in the management of refractory inguinal neuralgia. Local institutional review board approval was obtained and written informed consent was waived. Twelve patients 26-75 years of age with chronic (>6 months) inguinal pain refractory to specific medication were included between 2005 and 2011. Data on patient demographics, clinical history, and pain management history were retrospectively assessed. Pain was measured on a visual analog scale (VAS) from 0 to 10 before and immediately after the procedure and at 1, 3, 6, 9 and 12 months. Diagnosis was always confirmed by a positive nerve block test result. Ambulatory CT-guided RF was the rule. Sixteen RFN procedures were performed. Pain was present for an average of 3.2 years (range: 2-8 years) prior to initial RFN. Mean VAS score before the procedure was 7.75 of 10. Immediate pain relief of 100% was achieved in all patients. Pain reduction at 1-, 3-, 6-, 9-, and 12-month follow-up was statistically significant. Important pain reduction (≥80%) was obtained in 75% of RFN procedures at 6-month follow-up and in 50% of cases at 12 months. The mean duration of pain relief was 11.8 months after RFN, with a maximum average pain reduction of 84.5%. No complications were noted during or after the procedure. RFN with CT guidance is an effective technique in the management of refractory inguinal pain with lasting satisfactory pain reduction; it may be considered as an alternative treatment to surgery. These results should be confirmed in a controlled trial with a larger series of patients.