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Curtis W Slipman

Publications and source records attributed to Curtis W Slipman.

At least 19 recordsLinked to original sources
PubMed2006

Sacral stress fractures.

Sacral stress fractures are a relatively common occurrence and can be a debilitating source of low back pain. They generally occur in two distinctly different patient populations, and are of two different etiologies. Sacral insufficiency-type fractures are seen in elderly osteoporotic persons, and fatigue fractures are seen young active individuals. Although the clinical presentation of these fractures is similar, medical rehabilitation and interventional spine management strategies differ according to etiology. Although conservative management strategies have resulted in good outcomes, other treatment options have recently developed. This article provides an overview of the clinical presentation, pathology, and treatment options for sacral stress fractures and discusses some of the recent literature surrounding this interesting topic.

Algorithms↗
PubMed2006

Side effects and complications after percutaneous disc decompression using coblation technology.

OBJECTIVE: To report the short-term side effects and complications after percutaneous disc decompression utilizing coblation technology. DESIGN: Following institutional review board approval, consecutive patients who were to undergo percutaneous disc decompression using coblation technology (nucleoplasty) were prospectively enrolled. Patients were questioned preoperatively, postoperatively, and 24 hrs, 72 hrs, 1 wk, and 2 wks postprocedure by an independent reviewer regarding 17 possible symptom complications, which included bowel or bladder symptoms, muscle spasm, new pain, numbness/tingling or weakness, fevers/chills, rash/pruritus, headaches, nausea/vomiting, bleeding, and needle insertion site soreness. Statistical analysis was performed using Wilcoxon's signed-rank test. RESULTS: A total of 53 patients enrolled, of whom four patients dropped out. Two patients had increased symptoms and opted for surgery. Two patients could not be contacted. The most common side effects at 24 hrs postprocedure was soreness at the needle insertion site (76%), new numbness and tingling (26%), increased intensity of preprocedure back pain (15%), and new areas of back pain (15%). At 2 wks, no patient had soreness at the needle insertion site or new areas of back pain; however, new numbness and tingling was present in 15% of patients. Two patients (4%) had increased intensity of preprocedure back pain. There were statistically significant reductions in visual analog scale score for back pain and leg pain (P < 0.05). CONCLUSIONS: Based on this preliminary data, nucleoplasty seems to be associated with short-term increased pain at the needle insertion site and increased preprocedure back pain and tingling numbness but without other side effects.

Adolescent↗
PubMed2005

Complications and side effects of cervical and lumbosacral selective nerve root injections.

OBJECTIVE: To determine the incidence of complications and side effects of cervical and lumbosacral selective nerve root injections (SNRIs). DESIGN: Prospective, nonrandomized controlled trial of consecutive patients with independent interviews for immediate, 1-week, and 3-month follow-ups. SETTING: Tertiary, academic spine center. PARTICIPANTS: Of 160 patients eligible for SNRI, 151 underwent 306 SNRIs (study group). Sixty patients who had not undergone any intervention served as the control group. INTERVENTIONS: Diagnostic and therapeutic fluoroscopically guided cervical and lumbosacral SNRIs. Lidocaine (Xylocaine) was used in the diagnostic injections and a mixture of lidocaine and betamethasone was used in the therapeutic injections. MAIN OUTCOME MEASURES: Complications and side effects experienced during the procedure were recorded by the interventionalist. Side effects and complications experienced immediately, 1 week, and 3 months after injection were determined through independent interviews using a questionnaire format. The control group was independently interviewed using the same questionnaire. RESULTS: There were no major complications, such as death, paralysis, spinal nerve injury, infection, or allergic reaction, during the study. Ninety-one percent of subjects had no side effects during the procedure. A positive response on interview was reported by 39.4% of the study subjects immediately after the procedure. Lumbosacral SNRI side effects were as follows: increased pain at the injection site (17.1%); increased radicular pain (8.8%); lightheadedness (6.5%); increased spine pain (5.1%); nausea (3.7%); nonspecific headache (1.4%); and vomiting (0.5%). Immediate side effects from cervical SNRI were as follows: increased pain at injection site (22.7%); increased radicular pain (18.2%); lightheadedness (13.6%); increased spine pain (9.1%); nonspecific headache (4.5%); and nausea (3.4%). At the 1-week interview, comparison of the study and control groups showed statistical significance for the following: pain at injection site, cervical ( P =.001) and lumbar ( P =.005); nonspecific headache, cervical ( P =.019); and nonspinal headache, cervical ( P =.002). At 3 months, 2 subjects complained of increased neck pain and 1 reported heartburn and fluid retention. Two lumbar SNRI subjects were lost to follow-up. CONCLUSIONS: There were no major complications with cervical and lumbosacral SNRIs, although various minor side effects occurred.

Adult↗
PubMed2005

Incidence of vocal cord dysfunction after fluoroscopically guided steroid injections in the axial skeleton.

OBJECTIVE: To report on the incidence of dysphonia and/or associated throat symptoms after steroid injections in the axial skeleton. DESIGN: A prospective cohort study. SETTING: Academic spine center. PARTICIPANTS: Patients (N = 100) undergoing a diagnostic injection followed by a therapeutic injection in the axial skeleton. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Presence or absence of dysphonia and/or associated throat symptoms, as determined by completion of a predetermined 10-item questionnaire. This questionnaire was administered before participation in the study and at specific intervals after a diagnostic injection and, again, after a therapeutic spinal injection. RESULTS: There was a 12% incidence of transient dysphonia and/or associated throat symptoms in this study population after a therapeutic injection. CONCLUSIONS: Throat symptoms are a potential, albeit transient side effect, after an epidural space corticosteroid injection. The mechanism through which dysphonia or other throat symptoms develop is unknown but appears to be mediated by a systemic steroid effect.

Adult↗
PubMed2005

A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy.

OBJECTIVE: To critically review the best available trials of the utility of transforaminal epidural steroid injections (TFESIs) or selective nerve root blocks (SNRBs) to treat lumbosacral radiculopathy. DATA SOURCES: MEDLINE (PubMed, Ovid, MDConsult), EMBASE, and the Cochrane database. Databases were searched from inception through 2003. STUDY SELECTION: A database search was conducted by using the following key words: prospective , transforaminal and foraminal epidural steroid injections , selective nerve root block and injection , and periradicular and nerve root injection . We included English-language, prospective, randomized studies of patients with lower-limb radicular symptoms treated with fluoroscopically guided nerve root or transforaminal epidural injections. DATA EXTRACTION: Data were compiled for each of the following categories: inclusion criteria, randomization protocol, total number of subjects enrolled initially and at final analysis, statistical analysis utilized, documentation of technique, outcome measures, follow-up intervals and results (positive or negative), and reported complications. These data were abstracted by 1 reviewer and reviewed by a second. Study quality was assessed with the system developed by the Agency for Health Care and Policy Research. DATA SYNTHESIS: We selected 6 articles for review. Our analysis identified a single article as the highest quality study addressing the appropriate use of TFESIs or therapeutic SNRBs. Coupled with the evidence provided by 4 other articles (1 article was excluded because its patients were not truly randomized), our review of the evidence for TFESIs found level III (moderate) evidence in support of these minimally invasive and safe procedures in treating painful radicular symptoms. However, conclusive evidence (level I) is lacking. CONCLUSIONS: The evidence for TFESIs reveals level III (moderate) evidence in support of these minimally invasive and safe procedures in treating painful lumbar radicular symptoms. Current studies support use of TFESIs as a safe and minimally invasive adjunct treatment for lumbar radicular symptoms. However, more prospective, randomized, placebo-controlled studies using sham procedures are needed to provide conclusive evidence for the efficacy of TFESIs in treating lumbar radicular symptoms.

Clinical Trials as Topic↗
PubMed2005

Transforaminal cervical blood patch for the treatment of post-dural puncture headache.

A 40-yr-old woman received a series of three interlaminar epidural steroid injections for the treatment of axial neck pain secondary to degenerative disc disease. Immediately after her third injection, she experienced symptoms of a dural puncture-induced headache. This headache persisted on a daily basis for 3 mos, despite two epidural blood patches using an interlaminar approach, which was finally completely abated with a transforaminal blood patch. The headache was immediately relieved and remained alleviated through the follow-up interval of 1 yr. In this patient, a fluoroscopically guided transforaminal epidural blood patch proved to be more effective than the classic blind interlaminar approach in the treatment of post-dural puncture headache.

Adult↗
PubMed2005

Dysphonia associated with shoulder steroid injection.

Glucocorticosteroid injections into the shoulder are commonly used in the treatment of rotator cuff tendinitis. These injections rarely result in any serious complications and are generally considered a safe therapeutic intervention. Despite the extensive application of this treatment, there have been no reports of dysphonia occurring after corticosteroid injection into the subacromial space. We report the case of a 66-yr-old man with dysphonia after undergoing subacromial glucocorticosteroid injection for treatment of rotator cuff tendinitis.

Aged↗
PubMed2005

Intradiscal electrothermal annuloplasty.

Low back pain is a common problem, and although the majority of cases of low back pain resolve, a subset of patients will continue to have intractable pain despite appropriate conservative treatments. Intradiscal electrothermal annuloplasty is a minimally invasive spinal procedure that has been proposed to treat provocation discography-proven internal disk disruption syndrome. The early uncontrolled and nonrandomized intradiscal electrothermal annuloplasty literature suggests it may provide some relief in a small proportion of strictly defined patients; however, more recent randomized, placebo-controlled trials have not substantiated these initial findings. This article will review the published literature, indications, contraindications, safety, and efficacy of the intradiscal electrothermal annuloplasty procedure for the treatment of chronic, intractable, axial back pain.

Contraindications↗
PubMed2004

Therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain.

OBJECTIVE: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic selective nerve root block in the nonsurgical treatment of traumatically induced cervical spondylotic radicular pain. DESIGN: Retrospective study with independent clinical review. A total of 15 patients who met specific physical examination or electrodiagnostic criteria and failed to improve clinically after at least 4 wks of physical therapy were included. Each patient demonstrated a positive response to a fluoroscopically guided cervical selective nerve root block. Therapeutic selective nerve root blocks were administered in conjunction with physical therapy. Outcome measures included visual analog scale pain scores, employment status, medication usage, and patient satisfaction. RESULTS: Patients' symptom duration before diagnostic injection averaged 13.0 mos. An average of 3.7 therapeutic injections were administered. Follow-up data collection transpired at an average of 20.7 mos after discharge from treatment. An overall good or excellent outcome was observed in three patients (20.0%). Among those treated without surgery, a significant reduction (P = 0.0313) in pain score was observed at the time of follow-up. Six patients (40.0%) proceeded to surgery. CONCLUSIONS: These initial and preliminary findings do not support the use of therapeutic selective nerve root block in the treatment of this challenging patient population with traumatically induced spondylotic radicular pain.

Adult↗
PubMed2004

Inciting events initiating injection-proven sacroiliac joint syndrome.

OBJECTIVE: To determine the inciting events leading to the development of sacroiliac joint syndrome (SIJS). METHODS: This was a retrospective descriptive cohort series from an academic interdisciplinary spine center. Consecutive patients presenting with low back or buttock pain with or without leg symptoms who met specific inclusion and exclusion criteria for the diagnosis of SIJS were included in the study. Inciting events leading to the development of SIJS in these patients were categorized into traumatic, cumulative, and idiopathic events. RESULTS: Of 194 patients who were included in the study, 54 patients had symptom resolution with one or more therapeutic intraarticular sacroiliac joint injections, following a positive diagnostic injection. Those patients were given the diagnosis of SIJS. Of these, 24 (44%) had had a traumatic event (13 motor vehicle accidents, six falls onto the buttock, three immediately postpartum, one severe football tackle, and one pelvis fracture). Eleven (21%) patients were considered to have a cumulative injury (four lifting, two running, three altered gait due to lower extremity disorder, one crew training injury, and one forceful hip extension injury). Nineteen (35%) patients had spontaneous or idiopathic onset of sacroiliac joint pain. CONCLUSION: SIJS can occur following a traumatic event or cumulative shear events, or can occur spontaneously.

Adult↗
PubMed2003

Epidemiology of spine tumors presenting to musculoskeletal physiatrists.

OBJECTIVE: To report the incidence and epidemiologic formation of previously undetected primary and secondary spine tumors presenting as spinal and/or extremity pain to a physiatrist practicing in an academic or private practice multidisciplinary spine center. DESIGN: Multicenter retrospective chart review. SETTING: Three multidisciplinary spine settings (1 academic, 2 private). PARTICIPANTS: Charts of patients from 33 academic and 18 private practice settings. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Epidemiologic data collected included incidence, age, gender, race, and duration of symptoms before initial presentation. Symptom presentation data collected included intensity of pain when supine, sitting, standing, or walking; character of the pain; pain intensity as measured on the visual analog scale (VAS); spontaneous versus traumatic etiology; unexplained weight loss; presence of night pain; and fever. In addition, the results of radiographic studies including plain films, imaging, bone scan, and magnetic resonance imaging were recorded. The type of neoplastic disease was also assessed, primary versus metastatic, as well as the metastatic source. RESULTS: The incidence of spine tumors was.69% in academic multidisciplinary spine centers and.12% in private practice multidisciplinary spine centers. Patients with spinal pain because of neoplastic disease who presented to musculoskeletal physiatrists were an average age of 65.3 years and reported a relatively high likelihood of night pain, aching character of symptom manifestation, spontaneous onset of symptoms, history of cancer, standing and walking provoking symptoms, and unexplained weight loss. In addition, the pain intensity level ranged widely, with an average VAS score of 6.8. CONCLUSIONS: There are many similarities and differences in the clinical presentation of patients with spinal pain from spine tumors who present to musculoskeletal physiatrists practicing in multidisciplinary spine centers when compared with those presenting to a primary care setting.

Adult↗
PubMed2003

Sacral stress fracture in a female field hockey player.

We report a collegiate field hockey player who sustained a sacral fatigue-type stress fracture that manifested as persistent low back and leg pain. The diagnosis of sacral stress fracture was suggested by history and physical examination and confirmed by magnetic resonance imaging. Our patient experienced complete resolution of symptoms after a 3-mo interval of activity restriction. This article describes the first reported case of a sacral stress fracture in a field hockey player.

Adult↗
PubMed2003

A historical review and current perspective on the intervertebral disc prosthesis.

Spinal fusion for degenerative disc disease has been associated with a variety of side effects, including increased morbidity, infection, failed back syndrome, pseudoarthrosis, and acceleration of degenerative changes in adjacent intervertebral discs and facet joints. Based on the experience of arthroplasty of hip and other joints, there has been an escalating in research emphasizing the design and development of an artificial disc prosthesis. However, these artificial discs have not been very successful when compared with hip or knee replacements. Based on clinical and anatomical data, multiple authors have postulated that the degenerative process of intervertebral disc evolves through three stages; dysfunction, instability and stabilization, with relatively distinct clinical and radiological findings. Even though magnetic resonance imaging is considered as the primary diagnostic tool for degenerative disease, it is unable to reliably ascertain which disc level is responsible for generating axial pain symptoms. Consequently, discography is the most precise test to localize the level of pathology. Multiple design criteria have been proposed for an ideal intervertebral prosthesis which included endurance, materials behavior, geometry, kinematics, dynamics, motion constraints, fixation to bones and safety. The development of artificial disc technology has culminated into two types of disc replacements, namely total disc replacement and a nucleus pulposus replacement. In addition, four prosthetic models have been proposed which include hydraulic, elastic, composite, and mechanical. Clinical outcomes of total disc replacement and nucleus replacement have been variable. This review describes natural history of disc disease and the diagnostic process, anatomical and biomechanical considerations, design criteria for an ideal intervertebral prosthesis, evolution of artificial disc prosthesis, clinical outcomes of the total disc and nucleus replacement, and prospects and meridians for future research.

Journal Article↗
PubMed2002

Therapeutic spinal corticosteroid injections for the management of radiculopathies.

Current literature and a recent meta-analysis suggest a favorable role for corticosteroid injections in the nonoperative treatment of radiculopathy [70]. The superior results reported in recent literature may be attributable to precise fluoroscopically guided transforaminal placement of injectate close to the disc-nerve root interface and near the dorsal root ganglia, maximizing the therapeutic effect. The favorable results of corticosteroid injections in the treatment of radiculopathy caused by a focal disc herniation are consistent with the biochemical construct of radicular pain. The preliminary unfavorable results of therapeutic SNRB for radicular pain caused by epidural or intraneural fibrosis or occurring after trauma may relate to a biomechanical rather than a biochemical etiology. Outcomes for acquired cervical or lumbar spinal stenosis are intermediate compared with those observed for herniated discs and scarring or trauma. Such results may stem from the multifactorial origin of stenosis symptoms; they may develop from impaired venous flow, restricted neural glide, inflammation, or structural root injury. Better-designed studies that use strict inclusion criteria that stratify patients into categories according to the mechanism of injury (atraumatic versus traumatic), the presence or absence of neurologic deficits or imaging abnormalities, and prior treatment will provide the basis for evidence-based treatment decisions. Such an emphasis is just beginning and inevitably will occur. Until then, decisions have to be predicated on the limited and flawed work conducted to date [71]. Nevertheless, the information gleaned from these published reports provides valuable insight not available just a decade ago.

Animals↗
PubMed2002

Diagnostic selective nerve root blocks: indications and usefulness.

Diagnostic SNRIs are a useful tool in the diagnosis of radicular pain in atypical presentations. Diagnostic SNRI is indicated in the following circumstances: (1) for atypical extremity pain; (2) when imaging studies and clinical presentation do not correlate; (3) when electromyography and MRI are not corroborative or are equivocal; (4) for anomalous innervations, such [figure: see text] as conjoint nerve roots or furcal nerves [71]; (5) for failed back surgery syndrome with atypical extremity pain; and (6) for transitional vertebrae. Patients should have demonstrated a failure to improve with less invasive treatment. In these patients, a diagnostic SNRI may localize the pain to a specific spinal nerve. It must be emphasized that the diagnostic SNRI only determines if pain is emanating from a specific nerve root or spinal nerve. A diagnostic SNRI does not determine what has caused the nerve root or spinal nerve pain, nor does it provide prognostic information. The etiology of the nerve root pain, mechanism of injury, underlying anatomy, duration of symptoms, comorbidities, patient desire, physician skill, and a host of other factors determine the appropriate treatment and prognosis.

Aged↗