Comparison of post-operative pain scores and opioid use between kyphoplasty and radiofrequency ablation (RFA) systems combined with cement augmentation.

OBJECTIVE: This retrospective chart review study aims to compare demographic information, post-operative pain scores, and opioid use following treatment with kyphoplasty alone, OsteoCool™ (Medtronic) system, and SpineSTAR ® (Merit Medicine). MATERIALS AND METHODS: Following institutional review board approval, retrospective chart review of 64 patients was examined between January 2011 and December 2017. Inclusion criteria for this study comprised patients greater than 18 years old having metastatic vertebral compression fracture involving the thoracolumbar spine. Exclusion criteria consisted of non-pathologic osteoporotic compression fractures, metastasis in cervical spine, or previous radiofrequency ablation (RFA) treatment. Age at intervention, gender, previous treatment, and nursing recorded VAS score from 0 to 10, with zero representing no pain and 10 representing worst pain were compared. Pain scores documented immediately pre- and post-operatively, as well as 7-14 days post-operatively were targeted for analysis. Post-procedure opioid intake during the first month following surgery was also assessed. RESULTS: A total of 63 patients were included in this retrospective analysis. The demographic characteristics between the treatment arms were similar. Difference of square means analysis showed no statistical difference in pain scores at each time interval between the two RFA systems, or was there a statistical difference in pain scores when each RFA system was compared independently to kyphoplasty alone. Chi-squared analysis showed no statistical difference in opioid use between the treatment arms 1 month post-operatively. DISCUSSION: To our knowledge, this is the first study that evaluates post-operative pain scores between the two novel RFA systems and kyphoplasty alone. Each system results in improved pain scores post-operatively; however, no additional benefit was seen from the addition of RFA.

Pain Medicine Fellowship Video Interviews: A COVID-19 Trend or Here to Stay?

BACKGROUND: The COVID-19 pandemic ushered in a shift to a video format for pain medicine fellowship interviews for the 2021-2022 academic year, which represented a major change in the fellowship interview paradigm. OBJECTIVES: Our aim was to assess the experience of a video-only format in place of in-person interviews for Pain Medicine fellowship program directors and applicants after the 2020 fellowship interview season to determine the feasibility for continuation beyond COVID-19 travel restrictions. STUDY DESIGN: Survey via Qualtrics. SETTING: Academic pain medicine programs. METHODS: A consortium of program directors converged to discuss methods for determining the effectiveness and future direction of the video format for pain medicine fellowship interviews. Two surveys were formulated, one targeting pain medicine fellowship program directors and the other for candidates interviewing for the year 2021-2022. RESULTS: For applicants, 55 out of 170 responded for a response rate of 32.3%, and for program directors, 38 out of 95 responded for a response rate of 40%. Of the applicants, 45.7% stated that they would prefer video interviews, whereas 27.3% of program directors preferred video interviews. Savings of time and money were the most common reason for preferring video interviews. LIMITATIONS: The number of pain fellowship applicants invited was limited to those who interviewed at a subset of pain fellowships, which may not have been representative of all pain fellow applicants. CONCLUSIONS: The video format for pain medicine fellowship interviews was viewed positively by both candidates and program directors. We suspect that the video format alone or as a part of a hybrid model will become a routine method for the interview process in the future, given its time and cost benefits.