By R. Arakos. Dordt College. 2017.

See Vascular Bone cysts buy 75mg sildenafil with visa, aneurysmal generic 50 mg sildenafil otc, far lateral herniation, malformations, spinal 310–311 143–144 therapy, 311 future developments in, 147 B Bone scanning, 42 herniated nucleus Balloon kyphoplasty, 334–348 Bones of spine, 1–11, 2–7, 3t pulposus, classic, biomechanical investigations, Botulinum toxins, 50–51 139–142, 140–141 346 Bupivicaine, use as anesthetic instrument entry point, 144 patient selection, 335, agent, 31, 32 intradiscal steroid 335–336 injection, 144 results, 345–346 C local anesthetic injection, technique, 336–345, 337–344 Calcified disc herniation, 355 144 vertebral body deformity in, intradiscal oxygen-ozone patient positioning, 144 334–335 treatment, results with, patient selection, 139–144 Battery failure, as implanted 355 postoperative care, 147 drug delivery Cancer, screening for, 44 probe placement for complication, 288 Cancer-related pain, implanted aspiration, 144–145 Betamethasone sodium drug delivery systems, procedural steps, 144–145, phosphate, 284–285 146 betamethasone acetate Capsaicin, mechanism of reherniation, at level of and, for spine injection, action, 50 previous surgery, 30–31 Carbamazepine 142–143 Bicarbonate, as anesthetic, for depression, 34 technique, 144–145 258 mechanism of action, 49 Index 361 Cardiac conduction prophylactic use of, 329 Corticosteroids, 30–31. See also abnormalities, patients technique, 329–331, under drug name with, 48 330–331 COX enzymes. See Cytochrome C-arm fluoroscopic imaging Tisseel fibrin sealant, 328 c oxidase enzymes equipment, mobile, 29 Monro-Kellie rule, 322 Cryoprecipitate Catheter tip obstruction, as pathophysiology, 322–324 blood-banked, 328–329 implanted drug delivery spontaneous intracranial drawback of using, 328 complication, 288 hypotension, 322–323 CT. See Computed tomography Caudal epidural steroid Cervical arteries, spine, 17 Curvature of spine. See Scoliosis injection, 157–160, Cervical discography, 112–116, Cytochrome c oxidase 158–159 114–116 enzymes, nonsteroidal initial description of, 149 Cervical epidural steroid block of, 48 Cavernous angioma, 304 injection, 160 therapy, 304 Cervical epidurography, 197 D Cavernous malformations, 304 Cervical epidurolysis, 197 Delivery systems for drugs, therapy, 304 Cervical spine, angiography, 22 implanted, 273–291 Cefazolin, as antibiotic, 32, 258 Cervical veins, spine, 26 cancer-related pain, Celestone Soluspan, 30–31 Childbirth, spontaneous outcomes in, 284–285 Celiac plexus blockade, 45, 219, intracranial hypotension clinic, 274–276, 276 223–226 from, 322–323 complications of, 286–290 indications, 223 Ciprofloxacin, as antibiotic, 32, device-related technique, 223–226, 224–225 258 complications, 287–289 Cement, selection, preparation, Circulatory disorders, infusate-related in percutaneous thermography, 42–43 complications, 289–290 vertebroplasty, 253–256, Clonazepam, mechanism of surgical complications, 254–255 action, 49 286–287 Central nerve blocks, Coaxial needle systems, for constant flow rate pump, 274 diagnostic, 45–46 biopsy, 74 implantation, 281–282 Centrifugal microcirculation, Cobb’s syndrome, 306 constant flow rate pump, spine, 20 Codeine, for analgesia, 33 281–282 Centripetal microcirculation, Cold application, 51 programmable pump, 282 spine, 20–22 Compression fractures, pump preparation, 281 Centripetal system vertebral, balloon intraspinal opioids, microcirculation, spine, kyphoplasty for pain exclusion, inclusion 20–22 relief, 334 criteria, 278 Cerebrospinal fluid Compression neuropathy, from non-cancer-related pain, hypoglycemia, 326 thyroid disorders, outcomes in, 285–286 Cerebrospinal fluid screening for, 44 outcomes, 284–286 hypovolemia, 322–334 Computed tomographic pain types, characteristics of, diagnosis, 322–324 fluoroscopy, in biopsy, 73 277 epidural blood patch, multidirectional fluoroscope, patient selection, 276–280, 324–328 73 277t, 278t, 279t alternative treatments, 325 Computed tomography, 42 programmable pump, contraindications, 325 Constant flow rate pump, for 274–275 prophylactic use of, 326 drug delivery, 274, screening techniques, steroids, 326 281–282 280–281 technique, 326–328 Contrast agents, 34–35 percutaneous technique, fibrin glue patch, 328–331 iodinated, 34 280 blood-banked nonionic, 34 surgical technique, 280–281 cryoprecipitate, 328–329 allergic reaction to, 34 surgical implantation cryoprecipitate, drawback Controlled-release morphine, technique, 282–284 of using, 328 for analgesia, 33 Synchromed implanted drug FDA-approved fibrin Conus medullaris delivery programmer, sealants, 328 arteriovenous 276, 284 fever with, 329 malformation, 299–304, World Health Organization Hemaseel fibrin sealant, 328 300–303 analgesic ladder, 279 362 Index Demerol, for analgesia, 33 multiple, 354 technical considerations, 95 Depo-Medrol. See intervertebral, 8–11, 9–11, thoracic, 108–112, 109–112 Methylprednisolone 123 Dolophine, for analgesia, 33 acetate spinal pain and, 123 Dorsal-longitudinal arteries, Depression lumbar, annular lesions of, spine, 16 evaluation of, 46 107 Dural arteriovenous as exacerbating component material, 173 malformation, 292–296, of pain, 47 narrowing of space, 41 293t, 295–297 Diabetes, screening for, 44 Disc material, pathological therapy, 296 Diagnostic procedures, 37–52 filling defect produced Dysesthetic pain, 33–34 biological aspects of pain, 40 by, 173 Dysproteinemia, screening for, diagnostic nerve blocks, 44–46 Disc space, narrowing of, in 44 central nerve blocks, 45–46 radiograph, 41 peripheral nerve blocks, 45 Discectomy, lumbar, E electrodiagnostics, 43–44 automated Electrical stimulation, for electromyography, 43 percutaneous, for muscle spasm, 51 nerve conduction studies, herniated disc, 137–148 Electrodiagnostics, 43–44 44 aspiration of disc, 145 electromyography, 43 history taking, 40 discitis, suspected, 144 nerve conduction studies, 44 imaging studies, 41–43 far lateral herniation, Electromyography, 43 bone scanning, 42 143–144 EMG. See Electromyography computed tomography future developments in, 147 Endovascular therapy, spine, scanning, 42 herniated nucleus pulposus, 292–321 magnetic resonance classic, 139–142, 140–141 aneurysmal bone cysts, imaging, 42 instrument entry point, 144 310–311 myelography, 42 intradiscal steroid injection, therapy, 311 radiographs, conventional, 144 arteriovenous fistulas, 41 local anesthetic injection, 144 malformations, thermography, 42–43 patient positioning, 144 classification scheme for, ultrasound, 42 patient selection, 139–144 292–293 laboratory tests, 44 postoperative care, 147 conus medullaris screening, 44 probe placement for arteriovenous physical examination, 41 aspiration, 144–145 malformation, 299–304, psychological evaluation, procedural steps, 144–145, 300–303 46–47 146 dural arteriovenous anxiety, 46 reherniation, at level of malformation, 292–296, depression, 46 previous surgery, 293t, 295–297 treatment targets, 38 142–143 therapy, 296 Dihydrocodeine, for analgesia, technique, 144–145 epidural arteriovenous 33 Discitis, 144 fistulas, 292 Dilaudid, for analgesia, 33 suspected, 144 therapy, 292 Disc. See under specific disc Discogenic pain extradural arteriovenous aspiration of, 145 intradiscal electrothermal malformation, 298–299 calcified therapy, 61 therapy, 299 herniation, 355 thermal energy for, 61 intradural arteriovenous intradiscal oxygen-ozone Discography, 54–56, 94–120 fistula, 296–298, 297 treatment, results with, cervical, 112–116, 114–116 therapy, 298 355 lumbar, 96–107, 99–105, 107t intramedullary arteriovenous herniated lumbar disc annular lesions, malformation, 299 automated percutaneous classification of, 107 metastatic lesions affecting lumbar discectomy, lumbar fusion, 107–108 spine, 311 137–148 postdiscography care, neoplastic vascular lesions, calcified, 355 116–117 spinal cord, 304 lumbar, intradiscal result reporting, 117 cavernous malformations, oxygen-ozone in sedation, 95–96 304 treatment, 349–358 spinal deformity, 107–108 hemangioblastomas, 304 Index 363 Spetzler classification of pathoanatomy, 149–151 patient positioning, 178 spinal vascular lesions, technique, 151–164 patient preparation, 177–178 292–293 thoracic, 160 radiation safety, 178 spinal angiography, transforaminal, 155–157, recent developments in, technique, 311–319, 156–157 197–199, 197–200 312–315, 316–318 Epidurography, 171–202 thoracic, 197 spinal vascular cervical, 197 Epinephrine, in anesthetic, malformations, 292–304 complications of, 183–187 258–259 systemic syndromes with subarachnoid injection, 187 Erythrocyte sedimentation rate, spinal vascular subdural injection, 187 in screening for malformations, 306 vascular runoff, 183–187, autoimmune Cobb’s syndrome, 306 184–186 dysfunction, 44 Klippel-Trenaunay, 306 contraindications to, 174–175 Evaluation of patient. See Osler-Weber-Rendu indications for, 174–175 Patient evaluation Syndrome, 306 informed consent, 177 Evoked pain, 277 Parkes-Weber syndromes, laboratory work, 177 306 monitoring of patient, F vertebral hemangiomas, 177–178 Facet abnormalities, in 306–310 normal, 179–183, 180–183 radiograph, 41 type A, 307–308, 308–309 pathological filling defects, Facet arthropathy, on type B, 309–310 structural abnormalities extension, facet type C, 310 producing, 173 rhizolysis for pain, 51 Epidural arteriovenous fistulas, patient preparation, 177–178 Facet blockade, 56–58. See also 292–302 positioning of patient, 178 Facet injections therapy, 292 radiation safety, 178 Facet injections, 203–218 Epidural blood patch, 324–328 recent developments in, anatomy, 203–205, 204–205 cerebrospinal fluid 197–199, 197–200 facet joint block technique, hypovolemia, 324–328 thoracic, 197 208–213, 210–213 alternative treatments, Epidurolysis, 171–202 medial branch block 325 cervical, 197 technique, 213–216, contraindications, 325 contraindications to, 174–175 214–216 prophylactic use of, 326 indications for, 174–175 postoperative care, 216–217 steroids, 326 informed consent issues, 177 spinal pain, 205–216, 206–207 technique, 326–328 injections, 191–197 Facet joint syndrome, 45 sumatriptan, 326 contrast injection, 191–194, Facet rhizolysis for pain on Epidural fibrosis 192–193 extension, 51 pathological changes with, hyaluronidase injection, 195 Failed spinal fusions, in 197 hypertonic saline infusion, radiograph, 41 pathological filling defect 196–197 Fibrin glue patch produced by, 173 injection epidurolysis, cerebrospinal fluid spinal endoscopy, 197 local anesthetic injection, hypovolemia, 328–331 Epidural scarring, pathological 195 blood-banked filling defect produced local anesthetic injection, cryoprecipitate, 328–329 by, 173 195–196, 196 cryoprecipitate, drawback Epidural steroid injection, 60, steroid injection, 195–196, of using, 328 149–170 196 fever with, 329 caudal epidural, 157–160, laboratory work, 177 fibrin sealants, 328 158–159 mechanical, catheter prophylactic use of, 329 initial description of, 149 placement, 187–191, technique, 329–331, 330–331 cervical, 160 188–190 headache with, 329 complications of, 164–168, monitoring of patient, Fibrosis, epidural 165–166 177–178 pathological changes with, interlaminar lumbar epidural needle placement, 178–179 197 injection, 151–155, 152, pathological filling defects, pathological filling defect 154–155 structural abnormalities produced by, 173 midline, introduction of, 149 producing, 173 spinal endoscopy, 197 364 Index Fluoroscopic imaging equipment intradiscal steroid contraindications, 325 biplane, 28 injection, 144 prophylactic use of, 326 fixed, single-plane, 28 local anesthetic injection, steroids, 326 mobile C-arm, 29 144 technique, 326–328 Fluoroscopy, in biopsy, 73 patient positioning, 144 fibrin glue patch, 328–331 Follow up of patients, 52 patient selection, 139–144 blood-banked postoperative care, 147 cryoprecipitate, 328–329 G probe placement for cryoprecipitate, drawback Gabapentin aspiration, 144–145 of using, 328 for depression, 34 procedural steps, 144–145, FDA-approved fibrin mechanism of action, 49 146 sealants, 328 Gadolinium, as contrast agent, reherniation, at level of fever with, 329 34 previous surgery, Hemaseel fibrin sealant, Gait abnormalities, correction 142–143 328 of, 51 technique, 144–145 prophylactic use of, 329 Glaucoma, patients with, 48 calcified, 355 technique, 329–331, Glucosamine sulfate, lumbar, intradiscal oxygen- 330–331 therapeutic use of, 50 ozone treatment, Tisseel fibrin sealant, 328 349–358 spontaneous intracranial H action of, description, hypotension, 322–323 Heat application, 51 350–351 Hemangioblastomas, 304 calcified disc herniations, I therapy, 304, 305 results with, 355 Image-guided spine Hemangiomas, vertebral, clinical experience, interventions, 27–36, 306–310 351–353, 352–353 53–68 type A, 307–308, 308–309 complications, 357 analgesics, 32–33, 49–51 therapy, 307–308 degenerative disease adjuvant, 33–34 type B, 309–310 complicated by for dysesthetic pain, 33–34 therapy, 309–310 herniation, results with, anesthetic agents, 31–32 type C, 310 352, 356 antibiotics, 32 therapy, 310 multiple disc herniations, biplane fluoroscopic Hemaseel fibrin sealant, 328 results with, 354 equipment, 27–29 Hemorrhagic telangiectasia, oxygen-ozone mixture, 350 conventional surgical hereditary. See Osler- results, 353–356, 353–356 management, compared, Weber-Rendu Syndrome technical aspects, 351 53–68 Herbal remedies, therapeutic tissue structure alterations, corticosteroids, 30–31 use of, 50 357 cryoanalgesia, 35 Hereditary hemorrhagic multiple, 354 discography, 54–56 telangiectasia. See Osler- Hydrocodone, for analgesia, 33 epidural steroid injections, Weber-Rendu Syndrome Hydromorphone, for analgesia, 60, 149–170, 325 Herniated disc 33 facet blockade, 56–58, automated percutaneous Hypogastric plexus blockade, 203–218 lumbar discectomy, 219, 229–232 fixed, single-plane 137–148 indications, 229, 230 fluoroscopic equipment, aspiration of disc, 145 technique, 230, 231 28 discitis, suspected, 144 Hypoglycemia, cerebrospinal imaging equipment, 27–30, far lateral herniation, fluid, treatment of, 326 28–29 143–144 Hypotension, intracranial, biplane fluoroscopic future developments in, spontaneous, 322–323 equipment, 28 147 Hypovolemia, cerebrospinal fixed, single-plane herniated nucleus fluid, 322–334 fluoroscopic pulposus, classic, diagnosis, 322–324 arrangement, 28 139–142, 140–141 epidural blood patch, mobile C-arm fluoroscopic instrument entry point, 324–328 arrangement, 29 144 alternative treatments, 325 kyphoplasty, 61–63, 334–348 Index 365 minimally invasive programmable pump, 282 calcified disc herniations, intradiscal therapy, pump preparation, 281 results with, 355 60–61 intraspinal opioids, clinical experience, 351–353, mobile C-arm fluoroscopic exclusion, inclusion 352–353 equipment, 29 criteria, 278 complications, 357 nerve root blockade, 58–60, non-cancer-related pain, degenerative disease 161–168, 232–233 outcomes in, 285–286 complicated by nonionic contrast agents, outcomes, 284–286 herniation, results with, allergic reaction to, 34 pain types, characteristics of, 352, 356 pharmacological agents, 277 multiple disc herniations, 30–35, 50, 273–291 patient selection, 276–280, results with, 354 analgesics, 32–33, 49 277t, 278t, 279t oxygen-ozone mixture, 350 anesthetics, 31–32 programmable pump, results, 353–356, 353–356 antibiotics, 32 274–275 risks of, 357 corticosteroids, 30–31 screening techniques, technical aspects, 351 radiographic contrast agents, 280–281 tissue structure alterations, 34–35 percutaneous technique, 357 sacroiliac joint injections, 58, 280 Intradiscal steroid injection, 144 234–244 surgical technique, 280–281 Intradural arteriovenous tricyclic antidepressants, for surgical implantation fistula, 296–298, 297 postherpetic neuralgia, technique, 282–284 therapy, 298 phantom limb pain, 34 Synchromed implanted drug Intradural arteriovenous vertebroplasty, 61–63, delivery programmer, malformation, 298–299 245–272 276, 284 Intramedullary arteriovenous Imaging studies, 41–43 World Health Organization malformation, 299 bone scanning, 42 analgesic ladder, 279 Intraspinal opioids, exclusion, computed tomography Informed consent issues inclusion criteria, 278 scanning, 42 in epidurography, 177 Intrathecal infusion techniques, magnetic resonance imaging, in epidurolysis, 177 52 42 in percutaneous Iodinated contrast agents, 34 myelography, 42 vertebroplasty, 256 Isovue, as contrast agent, 34 radiographs, conventional, Interlaminar lumbar epidural 41 steroid injection, K thermography, 42–43 151–155, 152, 154–155 Kava, in treatment of anxiety, ultrasound, 42 Intervertebral discs, 8–11, 9–11 50 Impar ganglion blockade, 219, spinal pain and, 123 Ketoralac, for analgesia, 22 232–233 Intervertebral joints, 8–11, 9–11 Klippel-Trenaunay syndrome, indications, 232, 232 Intracranial hypotension, 306 technique, 233 spontaneous, 322–323 Kyphoplasty, 61–63, 334–348 Implanted drug delivery Intradiscal electrothermal biomechanical investigations, systems, 273–291 annuloplasty, 121–136 346 cancer-related pain, anatomy, 121–123, 122 patient selection, 335, outcomes in, 284–285 development of, 123 335–336 clinic, 274–276, 276 history of, 123–133, 124 results, 345–346 complications of, 286–290 indications for, 124–133, technique, 336–345, 337–344 device-related 126–132 vertebral body deformity in, complications, 287–289 intervertebral discs, spinal 334–335 infusate-related pain and, 123 complications, 289–290 postoperative care, 133–134 L surgical complications, technique, 124–133, 126–132 Laboratory tests, in diagnosis, 286–287 Intradiscal oxygen-ozone, for 44 constant flow rate pump, 274 herniated lumbar disc, Lactated Ringer solution, as implantation, 281–282 349–358 anesthetic, 259 constant flow rate pump, action of, description, Lamotrigine, mechanism of 281–282 350–351 action, 49 366 Index Levofloxacin, as antibiotic, 32 Lumbar discography, 96–107, Midline epidural steroid Lidocaine, 31, 48, 258–259 99–105, 107t injection, introduction of mechanism of action, 50 Lumbar epidural injection, technique, 149 "no-sting" solution, 259 interlaminar, 151–155, Minimally invasive intradiscal Local anesthetics, 48–49, 49t 152, 154–155 therapy, 60–61 Lortab, for analgesia, 33 Lumbar fusion, discography, Mobile C-arm fluoroscopic Lumbar disc 107–108 imaging equipment, 29 annular lesions, classification Lumbar spine, angiography, 22 Monro-Kellie rule, in of, 107 Lumbar sympathetic blockade, cerebrospinal fluid herniated, intradiscal 219, 226–229 hypovolemia, 322 oxygen-ozone treatment, ganglion, 45 Morphine, controlled-release, 349–358 indications, 226 for analgesia, 33 action of, description, technique, 227–229, 227–229 MRI. See Magnetic resonance 350–351 Lumbar veins, spine, 26 imaging calcified disc herniations, Lumbosacral arteries, spine, 17 MS Contin, for analgesia, 33 results with, 355 Multiple disc herniations, clinical experience, M intradiscal oxygen-ozone 351–353, 352–353 Macrocirculation, spine, 15–20, treatment, results with, complications, 357 16–17, 18t, 19 354 degenerative disease cervical arteries, 17 Muscle spasm complicated by dorsal-longitudinal arteries, electrical stimulation for, 51 herniation, results with, 16 ultrasound, 51 352, 356 lumbosacral arteries, 17 Myelography, 42 multiple disc herniations, pretransverse arteries, 16 Myofascial syndromes, results with, 354 radicular arteries, 18 thermography, 42–43 oxygen-ozone mixture, 350 radiculomedullary arteries, results, 353–356, 353–356 18–19 N technical aspects, 351 radiculopial arteries, 18 Needle systems, for biopsy, 73 tissue structure alterations, spinal arteries, diameter, 18 coaxial, 74 357 thoracic arteries, 17 Neoplastic vascular lesions, Lumbar discectomy, automated ventrolateral arteries, 16 spinal cord, 304 percutaneous, for Magnetic resonance imaging, cavernous malformations, herniated disc, 137–148 42, 247–250 304 aspiration of disc, 145 in biopsy, 73 therapy, 304 discitis, suspected, 144 Malnutrition, screening for, 44 hemangioblastomas, 304 far lateral herniation, Medtronic Corporation, therapy, 304, 305 143–144 development of Nerve blocks, 51, 160–164, future developments in, 147 programmable pump, 161–164 herniated nucleus pulposus, 274–275 complications of, 164–168, classic, 139–142, 140–141 Membrane-stabilizing agents, 165–166 instrument entry point, 144 48 diagnostic, 44–46 intradiscal steroid injection, Meperidine, for analgesia, 33 central nerve blocks, 144 Metastatic lesions affecting 45–46 local anesthetic injection, 144 spine, 70–71, 311 peripheral nerve blocks, 45 patient positioning, 144 Methadone, for analgesia, 33 root of nerve, 58–60 patient selection, 139–144 N-methyl-D-aspartate, for pain, Nerve conduction studies, 44 postoperative care, 147 38 Nerves of spine, 11–14, 13 probe placement, for Methylprednisolone acetate, Neuralgia, postherpetic, aspiration, 144–145 30–31 tricyclic antidepressants procedural steps, 144–145, for spine injection, 30–31 for, 34. See also under 146 Mexiletine, 48 drug name reherniation, at level of Microcirculation, spine, 20–22, Neurodestructive techniques, previous surgery, 21 51 142–143 centrifugal system, 20 Neurontin, for depression, 34 technique, 144–145 centripetal system, 20–22 Neuropathic pain, 277 Index 367 Neuropathy balloon kyphoplasty, 334–348 oxygen-ozone, intradiscal, thermography for, 42 biplane fluoroscopic for herniated disc, from thyroid disorders, equipment, 28 349–358 screening for, 44 blood patches, epidural, for patient evaluation, 37–52 Nonsteroidal anti- hypovolemia patient history, 40 inflammatory drugs, 48 syndromes, 322–334 phantom limb, 34 for analgesia, 33 botulinum toxins, 50–51 pharmacological agents, 30–35 block of cytochrome c characteristics of, 277 physical examination, 41 oxidase enzymes, effect corticosteroids, 30–31 physical medicine, 51 on pain, 48 cryoanalgesia, 35 procedure selection criteria, NSAIDs. See Nonsteroidal anti- depression with, 47 47–52 inflammatory drugs evaluation, 46 psychological evaluation, Nucleus pulposus, herniated, diagnostic procedures, 37–47 46–47 lumbar disc, automated discography, 94–120 rehabilitation, 51 percutaneous dysesthetic, 33–34 sacroiliac joint injection, discectomy, 139–142, electrodiagnostics, 43–44 234–244 140–141 endovascular therapy, screening for, 44 292–321 spinal cord stimulation, O epidurography, diagnostic, 51–52 Opioids, 33, 50 171–202 steroid injections, epidural, intraspinal, exclusion, epidurolysis, 171–202 149–170 inclusion criteria, 278 evoked, 277 of terminal disease, World Osler-Weber-Rendu Syndrome, facet joint injections, 203–218 Health Organization 306 facet rhizolysis for, 51 treatment ladder, 39 Osteoporosis, in radiograph, 41 fibrin patches, for thermography, 42–43 Overfilling of pump, as hypovolemia topical agents, 50 implanted drug delivery syndromes, 322–334 transcutaneous electrical complication, 288 image-guided interventions, nerve stimulation, 46 Oxycodone, for analgesia, 33 27–36, 53–68 treatment targets, 38 Oxycontin, for analgesia, 33 imaging equipment, 27–30, tricyclic antidepressants, 48 Oxygen-ozone, intradiscal, for 28–29 types of, characteristics of, herniated disc, 349–358 imaging studies, 41–43 277 implanted drug delivery vertebral compression P systems, 273–291 fracture, 334 PABA. See p-aminobenzoic acid intrathecal infusion vertebroplasty, Pain, spinal techniques, 52 percutaneous, 245–272 algorithm for, 39 laboratory tests, 44 visceral, 277 alternative medications, 50 local anesthetics, 48–49, 49t zygapophyseal joints as amplification of, with medical therapies, 47–51 source of, 56 prostaglandins, 48 membrane-stabilizing agents, Paraspinal biopsy approach, analgesics, 32–34. See also 48 bone, 75 under drug name nerve blocks, 44–46, Paraspinal oblique biopsy anatomy of spine and, 1–26 149–170 approach, disc, 75 anesthetic agents, 31–32 neural blockade, 51 Parkes-Weber syndrome, 306 annuloplasty, intradiscal, neurodestructive techniques, Pars interarticularis defects, in electrothermal, 121–136 51 radiograph, 41 antibiotics, 32 neuropathic, 277 Pathological filling defects, antiepileptic agents, 48 treatment algorithm, 39 structural abnormalities anxiety and, 46, 47 nonionic contrast agents, producing, 173 anxiolytic medications, 50 allergic reaction to, 34 Patient evaluation, 37–52 automated percutaneous nonsteroidal anti- biological aspects of pain, 40 lumbar discectomy, for inflammatory drugs, 48 diagnostic nerve blocks, herniated disc, 137–148 as cytochrome c oxidase 44–46 autonomic nerve blockade, enzyme block, 48 central nerve blocks, 45–46 219–244 opioids, 50 peripheral nerve blocks, 45 368 Index Patient evaluation (Continued) posterolateral electrical stimulation, for electrodiagnostics, 43–44 bone, 75 muscle spasm, 51 electromyography, 43 disc, 75 gait abnormalities, correction nerve conduction studies, 44 soft tissues, 75 of, 51 history taking, 40 postoperative care, 91–92 heat application, 51 imaging studies, 41–43 transcostovertebral, bone, 75 strengthening exercises, 51 bone scanning, 42 transpedicular, bone, 75 stretching exercises, 51 computed tomography Percutaneous vertebroplasty, ultrasound, with muscle scanning, 42 245–272 spasm, 51 magnetic resonance anesthesia, 258–259, 258t Pial arteriovenous fistula, imaging, 42 antibiotics, 258 296–298, 297 myelography, 42 cement injection, 262–264, Pocket, movement of pump in, radiographs, conventional, 263 as implanted drug 41 cement selection, delivery complication, thermography, 42–43 preparation, 254–255, 255 288–289 ultrasound, 42 complications of, 268–269 Posterolateral biopsy approach laboratory tests, 44 image guidance, 256–258, 257 bone, 75 screening, 44 biplane disc, 75 physical examination, 41 fluoroscopy/angiograph soft tissues, 75 psychological evaluation, y, 256–258 Postherpetic neuralgia, tricyclic 46–47 informed consent issues, 256 antidepressants for, 34.

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Physicians should maintain a high index of sus- specificity in detecting cases of depression purchase sildenafil 100 mg visa, more than picion for nutritional deficiencies in these patients order sildenafil 100mg, as well three-quarters of which had been undiscovered by the as in patients with low incomes, social isolation, multiple primary care physicians at least as long as the year before medication use, malabsorption syndromes, or chronic the clinical interview. Preventive Services Task Force recommends than one in five of those testing positive with the GDS 15 that all patients, regardless of age, be administered peri- in this study reached the diagnostic threshold for depres- odic height and weight measurements. Body mass index sion upon further testing by researchers blinded to GDS (BMI) is the recommended gauge, although obtaining score. Use of the single question: "Have you lost 10 gressive disease whose etiology is not yet known and for pounds over the last 6 months without trying to do so? Persons weighing less than 100 lb having mild cognitive impairment (but not meeting clin- (45. For the pur- physicians identify older persons at risk for malnourish- poses of the systematic review, criteria for mild cognitive ment. Bloom Mini-Mental Status Exam (MMSE), the Short Portable (HHIE-S) are both valid screening tools with similar Mental Status Questionnaire, and the Clock-Drawing specificities and likelihood ratios, but audioscope testing Test. A very simple three-item recall test has a sensitiv- is the more sensitive test in both older120–122 and ity of 90% for patients unable to remember all three younger123 adults and is considered to be the gold stan- items after 1 min. The majority of older adults receiving both these tive impairment is indicated by scores between 18 and 24 screening tests in one primary care setting preferred on the Mini-Mental Status Exam. The MMSE must be audioscope testing (60%) to the HHIE-S (13%) because adjusted for high education or intelligence levels. The they believed it to be more "reliable," an important con- Clock-Drawing Test, despite multiple scoring systems, has sideration as many older adults are reluctant to follow a mean sensitivity and specificity of 85% and a likelihood through on recommendations to get further testing and ratio greater than 10. Depending on whether a quadrant of the clock alone are almost diagnostic of cutoff score of 8 or 24 is used, the HHIE-S has a sensi- dementia. The audioscope, depending on reference note that depression, language differences, hearing standard used, has a sensitivity range of 64% to 96%, impairment, and aphasia can affect the accuracy of cog- specificity of 80% to 91%, and positive likelihood ratio nitive screening tests.