Cryoneurolysis versus radiofrequency ablation outcome on pain experience in chronic low back pain (COPE): a single-blinded randomised controlled trial.

OBJECTIVE: A comparison of cryoneurolysis or radio frequency (RF) with placebo in patients with facetogenic chronic low back pain (LBP) for patient global impression of change (PGIC), pain intensity, function and quality of life, with 1-year follow-up. DESIGN: Single-centre, single-blinded placebo-controlled randomised controlled trial. SETTING: Single-centre study. PARTICIPANTS: Inclusion from March 2020 to September 2022: consenting adults over 18 years of age, LBP>3 months, average Numeric Rating Scale LBP≥4 average last 14 days and a positive response to a diagnostic medial branch block (>50% pain reduction after 60 min). INTERVENTIONS: 120 patients were block randomised 1:1:1 to cryoneurolysis, RF or placebo of the medial branch nerves. Physical therapy was added after 4 weeks for all groups. MAIN OUTCOME MEASURES: Primary outcome was PGIC 4 weeks after the intervention. Secondary outcomes included pain intensity (Numeric Rating Scale, NRS), quality of life (Short Form 36, EQ-5D-5L), disability (Oswestry Disability Index), depression (Major Depression Inventory) and catastrophising (Pain Catastrophising Scale). Outcomes were measured at 4 weeks, 3, 6 and 12 months. RESULTS: There was no statistically significant difference in PGIC at 4 weeks between cryoneurolysis and placebo (risk ratio (RR) 2; 95% CI 0.75 to 5.33, p=0.17) and RF and placebo (RR 1.6; 95% CI 0.57 to 4.49, p=0.37), except PGIC for cryoneurolysis at 6-month follow-up (RR 5.1; 95% CI 1.20 to 22.03, p=0.03). No statistically significant differences were found in secondary follow-up endpoints. CONCLUSIONS: Denervation of the medial branch nerve by either cryoneurolysis or RF compared with placebo did not demonstrate significant improvement in PGIC, pain intensity, function and quality of life in patients with facetogenic chronic LBP at short-term or long-term follow-up. TRIAL REGISTRATION NUMBER: NCT04786145.

Intraoperative neuromonitoring during intradural spinal neurosurgery.

Intraoperative neuromonitoring (IONM) allows for a perioperative evaluation of the functional integrity of the spinal cord and nerve roots during intradural neurosurgery. This review examines established techniques as somatosensory evoked potentials and motor evoked potentials, as well as electromyography which all provide real-time feedback for the surgical team. IONM represents a valuable tool which can identify emerging neurological complications, and thus can be utilised to reduce the incidence of postoperative neurological deficits by timely interventions.

Outcome and negative events in thoracic disc herniation surgery: a Danish registry study.

BACKGROUND: Thoracic disc herniation (TDH) is a surgically demanding entity. Various surgical approaches have been developed and advanced in an attempt to achieve sufficient outcomes and reduce consecutive complication rates. Still, controversy exists regarding selecting the best surgical approach. This retrospective study aims to support decision-making regarding surgical approach. METHODS: We performed a retrospective analysis of 71 patients who underwent thoracic discectomy at Aarhus University Hospital, Denmark, between 1996 and 2015. Patients were divided into two groups depending on whether a lateral approach or a posterior approach was used. Data on demographics, symptomatology, peri- and post-operative events, length of hospitalization and discharge disposition were assembled from medical records. RESULTS: Lateral and posterior approach had an approximately equal peri-operative event rate (39% versus 36%), whereas the lateral approach was associated with a higher post-operative event rate in-hospital and post-discharge than the posterior approach (50% versus 18%; 45% versus 40%). The overall probability of improvement in clinical outcome regardless approach at follow-up was 77% in the short-term and 80% in the long-term. Odds of clinical improvement at any time point was 29% higher with the lateral approach than with the posterior approach (OR = 1.29, 95% CI: 0.52-3.21, p = .76). Adjusting for time, the odds of clinical improvement at short-term follow-up was twice as high for the lateral than for the posterior approach (OR = 2.16, 95% CI: 0.16-30.11); however, the trend seems to fade away over time (OR = 1.10, 95% CI: 0.07-17.55). CONCLUSIONS: The probability of improving after TDH surgery is good. However, a clear conclusion regarding the best surgical approach cannot be established; thus, surgeons should consider pros and cons of each approach when allocating a patient to surgery.

Fewer complications with bolt-connected than tunneled external ventricular drainage.

BACKGROUND: Ventriculostomy/external ventricular drain (EVD) is a common neurosurgical procedure. Various techniques are used to fixate the drain and the objective of this study was, in a retrospective setting, to compare the incidence of complications when using bolt-connected EVD (BC-EVD) versus tunneled EVD (T-EVD). METHODS: All patients subjected to an EVD performed through a new burr hole from 2009 through 2010 at two Depts. of Neurosurgery in Denmark (Odense and Aarhus) were retrospectively identified. Patient files were evaluated for EVD fixation technique (tunneled or bolt-connected EVD) and complications including unintended removal, catheter obstruction, infection, CSF leakage, and mechanical problems. RESULTS: A total of 271 patients with 272 separate EVDs met the inclusion criteria. There was a statistically higher rate of complications leading to reinsertion in the tunneled EVD group (40 %), compared to the bolt-connected EVD group (6.5 %). There was no significant difference in infection rates. CONCLUSIONS: Tunneled EVD has a relatively high frequency of complications leading to reinsertion. The use of Bolt-connected EVD technique can lower this frequency significantly. The number needed to treat is three for preventing a complication requiring reinsertion. Infection rates are low for both types of ventriculostomies. Accordingly, we recommend use of Bolt-connected EVDs in neurosurgical practice.