BACKGROUND: \"Spinal ganglioneuroma\" is a rare entity of neuroblastic tumors, frequent among children, that has been sparsely reported in articles involving both the pediatric and adult populations. These tumors mostly arise from the sympathetic ganglia located in the paravertebral region, near the intervertebral foramina of the spine. This makes their extension into the spinal canal possible but quite rare, in a dumbbell fashion, producing radicular or medullary symptoms. We provide an extensive review of the pediatric cases found in the literature; while reporting a challenging case we have recently got to treat at the CHRU de Brabois in Nancy, France.
METHODS: We searched PubMed\'s database for articles and abstracts related to \"spinal ganglioneuromas,\" from inception until June 1, 2024. We combined every case among patients under 18 years of age and divided them between the different spinal areas. We excluded those that originated from outside of the spine. We particularly focused our attention on the thoraco-lumbar region, which involved our case report, since the surgical management is completely different from other regions of the spine.
RESULTS: As per June 1, 2024, 21 patients aged between 3 and 17 years were identified with \"spinal ganglioneuromas,\" with a predominance of females (81%). The thoracic region of the spine seems to be the area of predilection for these tumors (42.85%), although some have been found in the cervical (9.5%), cervico-thoracic (4.76%), thoraco-lumbar (19.04%), lumbar (19.04%), and sacral (4.76%) regions.
CONCLUSIONS: Our specific case included long-date abdominal pain and recent progressive paraparesis as the main symptoms, with radiological manifestations of renal atrophy and hydronephrosis, due to the compression and complete displacement of the kidney, as well as scoliosis. To our knowledge, this combination of symptoms has never been seen with spinal ganglioneuromas before in the pediatric population, given the gigantic size of the tumor, and its significant extension to both the spinal canal and the retroperitoneal space, which is quite uncommon.
CONCLUSIONS: Spinal ganglioneuromas are very rare, benign lesions, that should be included in the differential diagnosis of dumbbell tumors that can cause in the pediatric population, alongside neurological symptoms in the limbs and back pain, thoracic, abdominal, and even urinary symptoms.

OBJECTIVE: Globally medical management of labour and birth has significantly increased, with epidurals attributed to the cascade of interventions.
BACKGROUND: There are few randomised control trials that evaluate the effectiveness of antenatal education programs. A previous trial at two Australian hospitals found an antenatal program of integrative complementary therapies significantly reduced rates of interventions for low-risk primiparous women.
OBJECTIVE: To reduce rates of intervention in labour and birth, with a primary outcome of decreased epidural use during labour.
METHODS: Low to moderate risk primiparous women were randomised at 24-36 weeks\' gestation to the intervention group and standard care, or standard care alone. Clinical and psychological measures were analysed by intention-to-treat. Trial registration ACTRN12618001353280 FINDINGS: In total, 178 women participated (n = 88 intervention, n = 90 Standard care), demographic characteristics were similar between groups, almost half (49 %) reported a pre-existing medical condition, and wellbeing scores fell within the average range. Epidural use was lower in the intervention group (47.7% vs 56.7 %) with higher rates of vaginal birth (52.3% vs 42.2 %), however, no statistical differences for birth outcomes were found between groups. Attitude to childbirth scores were statistically higher for women who attended the intervention (59.1 vs 54.3 p00.001).
CONCLUSIONS: Higher psychometric scores demonstrated women in the intervention group felt an increased sense of coping and control. Antenatal education that includes complementary therapies can reduce fear and improve attitudes about childbirth.
CONCLUSIONS: Replicating study protocols enabled the generalisability of findings to a more diverse group of women, and data will contribute to a larger meta-analysis design to detect smaller treatment effects for operative birth.

UNASSIGNED: To evaluate the effectiveness of cervical transforaminal epidural steroid injection (CTFESI) for the treatment of unilateral cervical radicular pain.
UNASSIGNED: Single-group prospective cohort study.
UNASSIGNED: Outcomes included ≥50% reductions in Numeric Rating Scale (NRS) for arm pain, ≥30% Neck Disability Index (NDI-5) improvement, health-related quality of life (EQ-5D), global improvement (PGIC), personal goal achievement (COMBI), Chronic Pain Sleep Index (CPSI), and healthcare utilization at one, three, six, and 12 months. Data analysis included descriptive statistics with the calculations of 95% confidence intervals (CIs), contingency table analysis, and multilevel logistic regression (LR) analysis, including a worst-case (WC) sensitivity analysis in which missing data were treated as treatment failure. Participants who were treated surgically were considered failures in the categorical analyses.
UNASSIGNED: 33 consecutively enrolled participants (63.6% females, 51.2 ± 12.2 years of age, BMI 28.3 ± 4.5 kg/m2) were analyzed. Success rates for ≥50% reduction in NRS for arm pain at one, three, six and 12 months were 57.6% (95% CI 40.8-72.8%), 71.9% (95% CI 54.6-84.4%), 64.5% (95% CI 46.9-78.9%), and 64.5% (95% CI 46.9-78.9%). Success rates for ≥30% improvement in NDI-5 were 60.6% (95% CI 43.7-75.3%), 68.8% (95% CI 51.4-82.0%), 61.3% (95% CI 43.8-76.3%), and 71.0% (95% CI 53.4-83.9%). In WC analysis, success rates for ≥50% arm NRS and NDI-5 were 0-4.3% lower between 1 and 12 months. PGIC scores were at least \"much improved\" or \"very much improved,\" in 48.4-65.6% of participants between 1 and 12 months. 6.1%, 6.1%, and 3.0% had one, two, or three repeat injections, respectively. 18.2% of participants underwent surgery by 12 months. Participants showed significant improvements in arm NRS and NDI-5 after treatment (p < 0.05), multilevel logistic regression models showed no significant decline in improvements across the follow-up time points (p > 0.05).
UNASSIGNED: Statistically significant and clinically meaningful improvements in pain and disability were observed after CTFESI for up to 12 months in individuals with unilateral cervical radicular pain.

UNASSIGNED: Several studies have compared outcomes from lumbar epidural steroid injections (ESIs) based upon technique (transforaminal (TF) vs interlaminar (IL) vs caudal). However, little on this topic has been reported in the cervical spine, and results have been conflicting.
UNASSIGNED: To compare success rates of fluoroscopically-guided cervical TFESIs vs ILESIs.
UNASSIGNED: Retrospective, observational, in vivo study of consecutive patients at outpatient Physical Medicine & Rehabilitation clinics at a single academic spine center.
UNASSIGNED: Consecutive patients who received a cervical TF or IL ESI between January 2010 and October 2018.
UNASSIGNED: NRS pain scores within 60 days of the ESI.
UNASSIGNED: Current procedural terminology (CPT) codes were used to search all consecutive patients at a single outpatient academic spine center who received a cervical TF or IL ESI between January 2010 October 2018. All patients with pre and post injection NRS pain scores within 60 days of the injection were included in the analysis.
UNASSIGNED: A total of 178 ​TF and 185 ILESIs were analyzed. Success was defined as ≥ 50% improvement in NRS pain score. 52% [95% CI: 47 - 57%] of all patients receiving a cervical ESI achieved a successful outcome. There was a strong trend towards better results in the ILESI group with 59% [95% CI: 52 - 66%] of patients achieving at least 50% pain relief compared to 46% [95% CI: 39 - 53%] in the TF group. A higher proportion of patients in the IL group obtained at least 80% pain relief (37% [95% CI: 30 - 44%]) compared to those in the TF group (17% [95% CI: 11 - 23%]). Post-procedure median NRS pain scores, and improvement in median NRS pain scores were better in the ILESI group compared to the TFESI group (p<0.001).
UNASSIGNED: This retrospective study demonstrated better results in the cervical ILESI group compared to the cervical TFESI group.

UNASSIGNED: Describe a catastrophic complication of cervical epidural injection (CEI) in a patient with prior anterior cervical discectomy with fusion (ACDF).
UNASSIGNED: Interlaminar CEI at C7-T1 was performed under minimal sedation.
UNASSIGNED: Right hemiparesis, diffuse dysesthesia, and tactile allodynia were immediately described after the procedure. 24 hours after CEI, an MRI showed an increased T2 signal and decreased T1 signal in the spinal cord extending from C3-T3. Postsurgical ACDF changes, cervicovertebral ligament anomalies, repetitive microtrauma from serial CEI\'s, and epidural space compromise may have complicated the loss of resistance technique and increased the risk for dural puncture and intrinsic cord injury.
UNASSIGNED: Knowledge of cervical spinal anatomy, biomechanical implications of ACDF, ligamentous inflammation, pre-operative image review, and perioperative patient feedback are valuable insights that may mitigate the risk of severe adverse events.

Despite the well documented importance and success of interventional pain procedures in the management of painful spine conditions, detractors have questioned their role as part of the care paradigm since their inception. One of the many unexpected consequences of the COVID-19 pandemic in the United States was the forced shut down of elective procedures in early 2020. This caused many patients suffering with pain, who had already been deemed appropriate for an interventional procedure to have to wait an extended period of time. This unprecedented period in modern healthcare provided the opportunity for a long term examination of how this cohort of patients suffering with pain faired while being forced to wait for pain relieving intervention, and to demonstrate the vital importance of these procedures for not only pain relief but for improvement in quality of life. This study will show that an overwhelming number of patients reported that their pain had not improved spontaneously over time, and were anxious to proceed with intervention once given the opportunity.

UNASSIGNED: The first aim of this study was to investigate the analgesic efficacy of US-guided caudal epidural pulsed radiofrequency (PRF) stimulation in patients with failed back surgery syndrome (FBSS); the second was to evaluate the effects on opioid use, disability, quality of life and patient satisfaction.
UNASSIGNED: Thirty patients with > 6-month history of chronic leg pain of >4 on a numerical rating scale (NRS) due to FBSS were included. These patients had unsatisfactory responses to conventional treatments and at least two epidural steroid injections. PRF stimulation with ultrasound guidance was administered to the caudal epidural space. NRS was evaluated before treatment, at 2, 4, and 8 weeks after intervention. Short Form-36 (SF-36) for health-related quality of life, Oswestry Disability Index (ODI), changes in opioid use and patient satisfaction were evaluated at baseline and 8 weeks after treatment.
UNASSIGNED: Mean NRS scores were significantly lower at weeks 2, 4 and 8 compared to baseline (P ​< ​0.001). There were significant improvements in SF-36 and ODI scores compared with pretreatment (P ​< ​0.05). It was found that 31% and 13% of opioid users, respectively, discontinued and tapered off their opioid medication. 40% of patients were overall satisfied with the treatment.
UNASSIGNED: In a cohort of patients with FBSS, caudal epidural PRF stimulation provided pain relief in 36% of treated subjects. Patients also experienced significant improvement in functionality, quality of life and opioid use. This technique can be considered as an alternative before considering neuromodulation, opiate therapy, or reoperation in patients with FBSS.

UNASSIGNED: The goal of this study is to assess the clinical effectiveness and prognostic potential of simultaneous bilateral lumbar transforaminal epidural steroid injections (TFESIs) in patients with bilateral radicular back pain with previous history of lumbar laminectomy and/or fusion surgery.
UNASSIGNED: Retrospective case series.
UNASSIGNED: Single physiatrist in an academic setting.
UNASSIGNED: 23 patients with previous lumbar surgery who received bilateral TFESIs.
UNASSIGNED: Cumulative bilateral radicular back pain was assessed with a pain numerical rating scale (NRS, 0-10) prior to receiving bilateral TFESI and at minimum 2 weeks follow-up. Responders included patients who experienced any NRS pain reduction post-procedure and non-responders were patients who reported no change in pain. A minimal clinically important difference (MCID) was defined as NRS change ≥2.0 to identify the proportion of responders who experienced a clinically significant reduction in pain. Other outcome measures included subsequent repeat bilateral TFESI, operations at the level of injections, and operative outcomes of these patients.
UNASSIGNED: There was a statistically significant (P ​< ​0.0001) reduction of 2.2 in mean NRS at average 3.7 weeks follow-up. With the MCID defined as NRS pain reduction ≥2, 13 of 16 responders (56%; CI 36.8-74.4%) achieved a clinically significant reduction in pain. Nine patients (39.1%) went on to receive repeat bilateral TFESIs and 9 patients (39.1%) underwent surgical interventions involving the same spinal level as the injections. Eight of the 9 patients who underwent repeat bilateral TFESIs met follow-up criteria and each responded to repeat injections with an average NRS pain reduction of 2.2. Of the 9 surgical patients, 5 responded to the previous injections and each reported improvements in pain and function after their operations (PPV ​= ​100%). Of the 4 surgical patients who were non-responders to the injections, 2 reported improvements in pain and function post-operatively and the remaining 2 reported no change or worsening outcomes (NPV ​= ​50%).
UNASSIGNED: This study suggests bilateral TFESIs are clinically effective in short-term management of bilateral radicular back pain in patients with previous lumbar surgery, and they reveal potential prognostic information for subsequent surgical intervention.

UNASSIGNED: Low back pain of disc origin is common yet challenging to treat. Intradiscal platelet rich plasma (PRP) has been advocated, but is associated with risk of discitis. Epidural PRP is less invasive and avoids this risk. Few studies exist evaluating effectiveness and safety of epidural PRP for discogenic low back pain without radiculopathy and the follow-up of the studies tends to be short.
UNASSIGNED: Prospectively evaluate for 12 months the effectiveness of PRP epidural injections for patients with low back pain without radiculopathy, suspected to be of disc origin.
UNASSIGNED: 11 consecutive patients with refractory low back pain suspected to be of disc origin (compatible clinical assessment; negative lumbosacral medial branch blocks (MBBs) and/or magnetic resonance imaging (MRI) with high intensity zone (HIZ), Modic 1 or 2 changes) participated. Each underwent one (n = 5) or two (n = 6) epidural injections (caudal or interlaminar). The PRP was leukocyte/red cell depleted with an average platelet concentration of ∼2X whole blood. Numerical rating scale (NRS), Pain Disability Quality-Of-Life Questionnaire (PDQQ) score, Oswestry Disability Index (ODI) score, effect on analgesic intake, treatment satisfaction and endorsement were recorded prior to and at 3, 6 and 12-months post-treatment.
UNASSIGNED: Significant improvements in pain and disability were documented post-treatment. Pre-, 3, 6, and 12-month post mean(sd) NRS scores were 7.8(1.8), 5.8(2.7), 5.1(2.5), 4.9(2.8) respectively (F = 7.2; p = 0.002). At 12 months post PRP epidural, the mean improvement in NRS was 36%, 36% had experienced ≥50% pain relief (95% confidence interval (CI): 2%, 70%), and 73% achieved minimal clinically important differences (MCID) (95% CI: 41%, 100%). Similar magnitude improvements in disability (PDQQ and ODI) were documented. At 1-year post, 50% of analgesic users had reduced intake, 91% were satisfied with the treatment and would recommend the procedure to family and friends. No complications were reported.
UNASSIGNED: This pilot project suggests that PRP epidural injections provide modest yet significant improvements in pain and disability that lasts at least 12 months in patients with low back pain suspected to be of disc origin. Additional research including larger sample size and robust study design is encouraged.

UNASSIGNED: Is there a statistically significant association between preoperative epidural steroid injections (ESI) and postoperative cervical and lumbar spinal surgery infections (SSI)?
UNASSIGNED: A systematic review and meta-analysis was completed of patients 18 years or older who underwent elective cervical or lumbar spinal surgery. Those who underwent surgery with preoperative ESI were compared to those without. We assessed for differences in postoperative SSI incidence. Electronic literature databases were searched through October 2022. Peer-reviewed publications that included raw data regarding epidural exposure and non-exposure were included. Case reports, case series, abstracts, editorials, or publications that did not include raw data were excluded. Odd\'s ratios (OR) were calculated from the raw data collected. Meta-analysis was done using RevMan v5 with a fixed effects model.
UNASSIGNED: We identified 16 articles for inclusion. When not controlling for the type of surgery and time from ESI to surgery, there was a statistically significant OR between preoperative ESI and postoperative SSI. The association persisted when the ESI was performed within 30 days or 31-90 days of the surgery. No association was discovered when evaluating only cervical spine surgeries. The evidence is assigned a \"moderate\" GRADE rating.
UNASSIGNED: Our analysis shows a small, time-dependent, statistically significant association between preoperative ESI and postoperative lumbar SSI may exist. However, the OR produced, while statistically significant, are close enough to 1.0 that clinically, the effect size is \"small.\" The number needed to treat for an ESI in the appropriate clinical setting is, at worst, 3. The number needed to harm, meaning the number of patients who undergo an ESI at any time before their spine surgery and then develop a SSI, is 111 patients. Ultimately, the surgical sparing potential from an ESI outweighs the SSI risk based on our findings.