Cancer Treatment Today » Orthopedics

MRI for low back pain

M Levin, MD — Sun, 20 Jan 2013 19:22:19 +0000

Low back pain (LBP) is one of the most common reason for physician visits in the United States. Under the pressuer to “do something”, MRI is often quickly performed. Unfortunately, several randomized clinical trials have shown that among patients without clinical signs and symptoms indicating serious underlying conditions, early MRI imaging before a trial of conservative therapy, does not improve overall outcomes. It must be remembered that the as many as 70% of acute LBP patients, especially younger patients without signs of serious illness, have nothing more than-spinal muscle strain or sprain. On the other hand, where there are signs, such as sacroiliac joint pain, MRI is the method of choice with sensitivity of 25–85% and specificity of 90–100% . Other signs pointing to radiation if pain, neurological symptoms or a space occupying lesion, such as tumor or abscess, also argue for prompt imaging.

In 1994,Agency for Health Care Policy and Research (AHCPR) published a set of guidelines to assist physicians in the management of LBP less than 3 months in duration.This guidelien was subsequently revised. The European Commission, Research Directorate-General, Department of Policy, Coordination, and Strategy and the American College of Physicians and the American Pain Society published guidelines as well. All of them emphasize the importance of a focused history and thorough physical examination before any imaging is ordered. In addition, all agree that for patients with acute LBP and without any risk factor for serious spine abnormalities, MRI imaging within the initial 4–8 weeks should not be performed. After this period, with conservative management tried and ineffective, imaging is appropriate.

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Radiofrequency coagulation for osteoblastic osteoma

M Levin, MD — Thu, 20 Sep 2012 14:44:19 +0000

Osteoid osteoma is a benign osteoblastic (bone producing) tumor. The literature suggests that its natural history is a history of resolving pain and healing of the lesions, but the course can be variable. The course of this disease is unpredictable and protracted, with intervals of resolution of pain that sometimes last 6-15 years. Initial treatment of osteoid osteoma remains nonoperative, with medications such as aspirin on other non-steroidal pain and inflammation relievers.

Percutaneous radiofrequency coagulation or ablation of the nidus the osteoma is performed by using an electrode placed in the lesion, coupled with a radiofrequency generator that produces local tissue destruction by converting radiofrequency into heat. Complete or nearly complete relief of pain often occurs within 3 days. Patients are sent home on same day of surgery, and they have no limitations in weight bearing, though aggressive athletics are restricted for 2-3 months. Patients may then return to normal activities immediately or within 24-48 hours after surgery. For this reason, it is currently the favored procedure for osteoblastic osteoma. It works fast; Pain resolves quickly, and limping resolves within 24 hours. Furthermore, this procedure requires only a small osseous access to allow insertion of the electrode; therefore, no substantial structural weakening of the bone occurs. Primary cure rates are 83-94%. Cure with a second ablation procedure is approximately 100% and recurrence is very rare.

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Hyperbaric oxygen for osteonecrosis of the jaw

M Levin, MD — Thu, 20 Sep 2012 14:40:04 +0000

Osteonecrosis, death of bone tissues, is a well known complication that can occur in different bones. Osteonecrosis of the jaw is a known complication on of several medical interventions, such as radiation and biphosphonates. It had been initially described with the biphosphonate Fosomax but began to be seen more frequently with the intravenous biphosphonates, such as Zometa. Conservative treatment is successful in approximately 50% of patients and consists of local rinses, antibiotics, and cessation of biphosphonates. Unfortunately some patients evidence progressive necrosis despite therapy and almost a half fail to completely heal. For this reason there is a great deal of interest in hyperbaric oxygen, as a therapy that has shown effectiveness front nonhealing wounds of various types as well as for osteonecrosis caused by radiation. Unfortunately, for osteonecrosis after biphosphonate use, the supporting evidence remains case reports and case series A 2006 American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws failed to recommend this therapy because of the lack of evidence.

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