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Background: The Sacroiliac Joint (SIJ) accounts for 10-27% of lower back pain. Radiofrequency neurotomy (RFN) is commonly utilized for refractory pain. Outcomes are variable and may be related to patient selection and procedural technique differences. Objective: To assess the effectiveness and outcome success predictors of SIJ RFN at three months. Design/Methods: Data of patients undergoing SIJ RFN were extracted from the electronic medical record of one physiatrist's interventional pain practice between 2016 and 2021. The extracted data included the following outcome variables: ≥2 decrease in Numerical Rating Scale (NRS) [minimal clinically important difference MCID-2], ≥50% NRS reduction, and ≥17 points decrease in the Pain Disability and Quality of Life Questionnaire - Spine (PDQQ-S) [MCID]. Predictor variables included block type [>79% LBB/LBB, >79% IA/LBB, 50-79% LBB/LBB, 50-79% IA/LBB, >79% LBB, and 50-79% LBB] and cannula type/configuration [16 g/longitudinal, Trident bipolar/perpendicular, and 18 g quadripolar/perpendicular]. Data analysis included descriptive statistics and logistic regression with an odds ratio (OR). Covariates included in the logistic regression models were age, gender, and laterality (right, left, and bilateral). Results: Of the 128 patients analyzed for this study (20.8% males; 60.4 ± 14.4 years of age), 66.9% achieved MCID-2 in NRS, 53.9% experienced ≥50% NRS reduction, and 50% experienced ≥17 points decrease in PDQQ-S. Achieving MCID-2 in NRS for the 18 g quadripolar/perpendicular technique was approximately four times higher than the odds for 16 g/longitudinal technique (OR = 3.91; 95% CI = 1.34-11.43; p = 0.013). Block type was not significantly associated with any outcome variable after adjusting for cannula type and other covariates (p > 0.05). Younger age was significantly associated with achieving MCID-2 in NRS, ≥50% NRS reduction, and ≥17 points decrease in PDQQ (p = 0.034, 0.020, and 0.002, respectively). Conclusion: SIJ RFN effectively reduces pain and improves function in most patients at three months. Quadripolar/perpendicular technique and younger age predict SIJ RFN treatment success, whereas block type does not.
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Objective: The Pain Disability Quality-Of-Life Questionnaire-Spine (PDQQ-S) is a validated six question patient reported outcome measure designed for usage in minimally invasive spine intervention. The purpose of this study was to determine the Minimal Clinically Important Difference (MCID) for the PDQQ-S. Design: Retrospective single arm cohort study involving 411 patients who had undergone lumbar facet and/or sacroiliac joint RFN and had completed pre-and 3-month post RFN PDQQ-S. Methods: The MCID using both distribution and anchor-based ("Rebook RFN"; "Analgesic Requirements") methods were calculated. Results: The distribution-based approach (using standard error of measurement) estimated the MCID to be -17.3 [PDQQ-S baseline mean (SD): 46.9 (7.9)]. This is supported by the anchor based approach, which calculated the MCID to be: -21.5 for rebook RFN; -11.3, -17.2 and -30.5 for mildly, moderately and dramatically decreased NSAID use respectively; and -11.7, -16.9 and -31.7 for mildly, moderately and dramatically decreased opioid use respectively. A moderate reduction in medication use was deemed to be clinically relevant. Conclusion: The MCID value for the PDQQ-S is a score reduction of 17.
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The Numerical Rating Scale Version of the Pain Disability Quality-Of-Life Questionnaire-Spine (NRS PDQQ-S) is a six question compensate patient reported outcome measure designed for use in the field of minimally invasive interventional spine care. Although acceptable reliability, validity and responsiveness have been confirmed for the Visual Analog Scale version of the PDQQ-S in patients undergoing lumbosacral spine corticosteroid injections and radiofrequency neurotomy, the Numerical Rating Scale version has undergone limited psychometric assessment. The purposes of this study were to define the validity and responsiveness of the NRS PDQQ-S, and to do so in a cohort undergoing an emerging type of spine intervention (platelet rich plasma [PRP] injection). Prospectively gathered pre-and 6months post lumbosacral spine PRP injection(s) NRS PDQQ-S and Oswestry Disability Index (ODI) data were analyzed on 75 patients. NRS PDQQ-S construct validity was evaluated by calculating the correlation with the ODI. Internal responsiveness was estimated for both PDQQ-S and ODI by calculating the effect size (Cohen's d). External responsiveness was estimated by calculating the correlation between the change scores of the NRS PDQQ-S and ODI. Strong statistically significant correlations were documented between the PDQQ-S and ODI questionnaires at pre-PRP injection (r â= â0.67; p<.0001) and 6 months post-PRP injection (r â= â0.82; p<.0001) supporting construct validity. Internal responsiveness was confirmed by large and comparable effect sizes for both the NRS PDQQ-S [1.1 (CI 0.8-1.4)] (1.1) and ODI [0.9 (CI 0.7-1.2)]. External responsiveness was confirmed by the strong correlation between the change scores of the NRS PDQQ-S and ODI [r â= â0.73 (p<.0001)]. This study supports the premise that the NRS PDQQ-S is a valid and responsive instrument that can be used to assess patients with low back pain who are treated with PRP injections.
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ABSTRACT: Hemorrhagic stroke is a catastrophic cause of both long-term morbidity and mortality. Many risk factors for development of these strokes are in fact preventable or modifiable in nature. This case report outlines an incident involving a previously healthy 24-year-old man with no apparent risk factors apart from consumption of preworkout supplementation who developed a hemorrhagic stroke. The supplements that this particular patient was consuming included various potential causative agents-with the most significant being Dendrobium extract, which contains compound B-phenylethylamine, a precursor in the amphetamine formation pathway. This case study highlights the potential correlation between the consumption of preworkout supplementation and occurrence of hemorrhagic stroke, as well as the implications of understanding potential effects of the constituent ingredients in commercially available preworkout supplements.