Usman Latif

Purpose: To evaluate real-world safety and efficacy of a minimally invasive lateral interspinous fixation/fusion device for the treatment of lumbar spinal stenosis. Methods: 105 patients (mean age 70.6 ± 10 years) from ten private pain/spine care centers were entered into the registry for treatment with the device. Analysis was conducted on up to 63 with diagnostic and surgical data, 41 with baseline characteristics, 41 with patient satisfaction data, and 20– 23 with change-based clinical outcome data meeting completeness thresholds. Outcome measures included Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) back and leg pain, and Zurich Claudication Questionnaire (ZCQ) physical function (PF), symptom severity (SS), and satisfaction scores at 6 weeks, 3, 6, 12, and 24 months. A linear mixed effects model was used to evaluate cohort changes from baseline (α=0.05). Results: Most patients had baseline opioid usage (60%), previous injections (77%), moderate to severe stenosis (83%), and markers of segmental instability including fluid in the facet joints and/or spondylolisthesis (73%). Mean blood loss was 9.3 ± 4.7 mL. All outcome measures saw mean improvements at each follow-up, with significant improvement observed as early as 6 weeks for ODI (− 20%, p< 0.05), VAS-back (− 48%, p< 0.001), VAS-leg (− 35%, p< 0.05) and ZCQ-SS (− 26%, p< 0.001). Positive trends continued through 12 months, after which the high loss to follow-up limited interpretation. Patient satisfaction was favorable (80– 100% satisfied at all time points; 91% weighted overall subdomain satisfaction). No complications, adverse events, device failures or migrations, or related follow-on procedures within available early follow-up were reported. Conclusion: Patients commercially treated with a lateral interspinous fixation/fusion device had a high prevalence of prior injections, baseline opioid use, and indicators of segmental instability prior to treatment. Longitudinal analyses were limited by the small sample size but suggest favorable short-term patient-reported outcome trends, with no early adverse safety findings identified.

Background: Spinal cord stimulation (SCS) is an established therapy for chronic pain of the trunk and limbs. Conventional open‐loop systems are sometimes limited by habituation, positional variability, and inconsistent neural recruitment. Closed‐loop SCS is an approach that uses evoked compound action potentials (ECAPs) to adjust stimulation in real time to maintain consistent therapeutic effects. A systematic review is indicated to bring clarity to the efficacy and safety of these systems. Objective: To evaluate the efficacy of closed‐loop SCS for chronic back and leg pain in persistent spinal pain syndromes. Methods: A comprehensive search of MEDLINE, Embase, Scopus, ScienceDirect, Cochrane Library, Google Scholar, and clinicaltrials.gov was conducted through April 2025. Eligible studies included Randomized Controlled Trials (RCT), prospective or retrospective cohort studies, and real‐world observational studies evaluating closed‐loop SCS in adults with lumbar radiculopathy, chronic back and leg pain, or persistent spinal pain syndromes. Outcomes included pain intensity, percentage of pain relief, disability, health‐related quality of life, mood, sleep, and opioid use. Risk of bias was assessed using the Review Manager (Revman) tool within the Cochrane Collaboration resources. Results: Four eligible studies met inclusion criteria for chronic back and leg pain, with responder rates (≥ 50% pain reduction) ranging from 68% to 92% and high‐responder rates (≥ 80% pain reduction) from 50% to 60% across follow‐up periods up to 36 months. Significant improvements were observed in disability (ODI), sleep quality (PSQI), mood (POMS), and quality of life (EQ‐5D‐5L). The EVOKE RCT trial demonstrated closed‐loop SCS superiority over open‐loop stimulation in both pain reduction and functional outcomes. Opioid use decreased substantially, with up to 83% of patients reducing or discontinuing opioids at 24 months. Reported adverse events were consistent with those seen in conventional SCS, and no unexpected safety concerns were identified. Conclusion: Growing evidence suggests closed‐loop SCS provides predictive and durable pain relief with concurrent functional improvements in chronic back and leg pain, with additional benefits in opioid reduction for persistent spinal pain syndromes. Trial Registration: PROSPERO registration number: CRD42024580458

Purpose of Review Chronic pelvic pain (CPP), affecting approximately 26% of women globally, is a multifactorial condition with causes including, but not limited to, gynecologic disorders, musculoskeletal disorders, and neuropathic disorders including pudendal neuralgia. A comprehensive evaluation and a multimodal treatment strategy - encompassing medical, minimally invasive non surgical, and surgical therapies - are essential for effective management. This narrative review explores current minimally invasive interventional management options for pudendal neuralgia causing CPP. Recent Findings Pudendal nerve blocks demonstrated pain relief, but the duration of relief varied. Pulsed radiofrequency ablation revealed longer-lasting pain relief compared to pudendal nerve blocks, with several clinical trials and case reports supporting its efficacy. Additionally, neuromodulation techniques, including neuraxial and peripheral nerve neuromodulation, showed promising results in alleviating pain for patients who did not respond to conservative measures. Summary While studies describe interventional therapy for pudendal neuralgia, there is a dearth of randomized controlled trials, which limits the ability to generalize treatment options for pudendial neuralgia. Despite this, current data suggest the possible benefit of interventional management of for pudendal neuralgia.

Objective: As therapeutic options are rapidly expanding to treat pain of discogenic and vertebrogenic origin, it is important for the clinician to have an evidence-based understanding of the latest information regarding the normal and pathological anatomy of the intervertebral disc as well as imaging characteristics and treatment strategies. The American Society of Pain and Neuroscience (ASPN) commissioned the DISC project to inform and update the interventional spine community about anterior column pain syndromes. Methods: Using established literature review methods a clinical oversight group was convened to create an outline covering topics that will be key to meeting the objectives delineated by the ASPN scientific and guidelines leadership. This oversight group, using the created outline, selected key opinion leaders and experts to assemble the latest information on anterior column and intervertebral disc anatomy and treatment to serve as a living document that can be continuously updated to drive best practices and innovation. Results: A review of normal and pathological anatomy, a comprehensive understanding of biophysics applied to the anterior spinal column, and understanding of the current state of practice with regard to imaging, diagnostic classification systems and treatment.

Peripheral nerve stimulation (PNS) has evolved substantially over recent decades in terms of hardware and evidence supporting efficacy. Treatment targets continue to expand and address both pain and functional applications. The American Society of Pain and Neuroscience (ASPN) seeks to substantially update and expand upon a review of the evidence supporting PNS as well as provide guidelines for clinical practice. A diverse multidisciplinary panel of experts was selected to provide opinions and guidance based on evidence-graded assessment and clinical knowledge. This document aims to serve as a resource for clinicians and payors in the interest of expanding awareness of the breadth of research in the field of PNS and expanding access to therapy.

Background: Peripheral nerve stimulation (PNS) has been employed as a therapeutic modality for managing chronic pain across diverse etiologies and neural targets. Nevertheless, its application in treating chronic axial neck pain remains markedly underexplored. Accordingly, this study aimed to both review the existing literature and present a retrospective single-center case series of patients who underwent temporary PNS targeting the cervical medial branch nerves (CMBNs) for chronic axial neck pain. Methods: This investigation comprises a narrative literature review alongside a single-center, retrospective case series evaluating percutaneous, temporary PNS for the management of cervical spondylosis facet arthropathy in the absence of myelopathy or radiculopathy. The primary outcomes were pain reduction, as measured by the numeric rating scale, and improvements in functional disability, with assessments conducted at baseline and at 60 days post-intervention. Results: PNS represents a neuromodulatory, nondestructive intervention that targets the CMBN to alleviate chronic axial neck pain, in contrast to the destructive mechanisms inherent in cervical radiofrequency ablation (CRFA). Although PNS has been applied to other neural targets, its use in the cervical region is sparsely documented, with limited case studies available. Notably, this case series is the first to report pain and disability outcomes specifically associated with CMBN PNS. At the 60-day follow-up, 66% of subjects achieved the minimal clinically important difference (MCID) for pain reduction, while 77% met the MCID for disability reduction. Moreover, our analysis uniquely examined the impact of previous CRFA and a history of cervical spine surgery on treatment outcomes, revealing that patients with such interventions experienced more modest improvements compared to their surgery- and CRFA-naive counterparts. Conclusions: The current literature reveals a significant gap regarding the use of CMBN PNS, underscoring an unmet need in the treatment algorithm for chronic axial neck pain beyond conservative modalities. Our findings suggest that CMBN PNS may offer a promising adjunctive therapy for carefully selected patients with refractory chronic axial neck pain who have not improved after medications, physical therapy, or injections. Additionally, the comparative analysis of outcomes in patients with a history of CRFA or cervical surgery underscores potential advantages of PNS prior to destructive therapies. Future research, ideally in the form of prospective studies with larger cohorts and extended follow-up durations, is warranted to further evaluate long-term outcomes and refine the place of PNS in the treatment algorithm.

Introduction: Artificial intelligence (AI) is rapidly evolving and becoming more ubiquitous. Significant advancements have been made in the last few years, driving rapidly increasing adoption. The scale of publications on AI makes it difficult to keep abreast of relevant findings. Objective: The ASPN Artificial Intelligence Guidelines are designed to help clinicians understand AI and implement it into their practice. This Neuron Project is designed to evolve with the changing landscape of AI. Methods: An expert panel was chosen to discuss and write the best practice guidelines on AI. The primary authors conducted a literature search on PubMed, cross-referencing key terms in pain management and AI. After a thorough review of the current literature, the information collected was divided into broad categories of potential benefits, potential harms, and ways to ensure the benefits outweigh the potential harms of AI. These guidelines include only the most essential aspects of AI that clinicians need to know and understand before implementing AI into their practice. Results: Over 12,000 articles were found using the above search results. Many articles were reviews and clinical guidelines. The framework created from these guidelines allowed authors to fill in knowledge gaps and discuss the most critical elements pain clinicians should comprehend about AI. Conclusion: All authors achieved consensus on guidelines for implementing and using AI in pain management following a process of critical review and edits by the entire group of authors. All authors approved final guidelines. Discussion: The field of artificial intelligence is rapidly growing. As it expands into healthcare, it is necessary to prevent breaches of sensitive data and potential harm to patients. Guidelines that constantly evolve and grow with expanding indications for AI are essential to maximize benefit and prevent harm. This paper is part of ASPN’s Neuron Project and is designed to update continuously as this field evolves.

Peripheral nerve stimulation (PNS) has evolved with various applications and durations of therapy. In recent years, extensive data has been developed on a 60-day treatment using a novel approach. Confusion exists on the use of a trial therapy, a permanent implant, and a 60-day duration treatment. The American Society of Pain and Neuroscience (ASPN) seeks to clarify the literature associated with this neuromodulation approach. A diverse group of experts was nominated to provide opinions and guidance based on evidence-graded assessment and clinical knowledge. This guidance is the first to specifically assess the clinical use of 60-day PNS and best medical practice.

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Conventionally, peripheral nerve stimulation (PNS) for treatment of chronic pain has involved a two-stage process: a short-term (e.g., 7 days) trial and, if significant pain relief is achieved, a permanent PNS system is implanted. A percutaneous PNS treatment is now available where a coiled lead may be implanted for up to 60 days with the goal of producing sustained relief. In the present review, published prospective trials using percutaneous PNS treatment were identified and synthesized. The collected evidence indicates that percutaneous PNS treatment for up to 60 days provides durable clinically significant improvements in pain and pain interference. Similar efficacy across diverse targets and etiologies supports the broad applicability for use within the chronic pain population using this nonopioid technology.