Interventional spinal procedures in the presence of a Chiari malformation: a potential contraindication.

Although Chiari malformations are much more prevalent than once believed, no study has described treatment with an interventional spinal procedure. The purpose of this report was to discuss the clinical course of a patient who was diagnosed with a Chiari malformation and treated with three cervical epidural injections. In 2012, a 50-yr-old woman presented to a neurology clinic with chronic suboccipital headaches, diplopia, and increasing numbness/tingling in her upper extremities. Magnetic resonance imaging confirmed a type I Chiari malformation and a cervical syrinx. The patient was treated with three cervical epidural injections, after which her symptoms exacerbated. Consequently, a posterior fossa suboccipital craniectomy with C1 laminectomy and excision of extradural and intradural adhesions was performed. After surgical intervention, notable neurologic improvements were observed. Given the marked worsening of symptoms, the present report suggests that interventional spinal procedures may be a contraindication in the presence of a Chiari malformation with a syrinx.

Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty.

Recently, investigators began using radiofrequency to manage knee osteoarthritis pain in patients at high risk who cannot undergo surgical intervention. To our knowledge, no study has investigated the use of radiofrequency ablation of the genicular nerves to alleviate chronic knee pain after total knee replacement. A single case is presented here in which genicular nerve ablation successfully improved pain and restored function. We believe that these preliminary results could be used in the development of future prospective cohort studies and randomized controlled trials that focus on the use of radiofrequency ablation to treat persistent knee pain after total knee replacement.