Outpatient surgery can be a safe and effective route for many orthopedic procedures
During the COVID-19 pandemic, I've consulted many times with patients and referring physicians about postponing "non-essential" surgeries. While safety considerations continue to be top of mind for all of us, delaying important procedures can leave patients stranded with pain and mobility issues that will impact them now and for the rest of their lives.
As an orthopedic surgeon who spends most of my waking hours replacing joints and relieving patients' pain, when I hear the words "non-essential," I always think, "non-essential" to whom? Non-essential isn't "non-essential" when postponing a recommended surgery or procedure that negatively affects a patient's daily life.
In COVID-19, many people have become fearful of the potential risks of undertaking medical procedures for conditions they don't perceive as life-threatening. Plus, depending on location and the strain on hospitals and staff, it can be challenging to schedule "non-essential" surgery in a hospital. But when a delay can have a critical impact on a patient's long-term well-being, we physicians need to be proactive in finding alternatives.
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Call for Abstracts & Poster Presentations |
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The deadline has been extended to MARCH 18
Take advantage of this opportunity and submit your proposal today!
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Proposals accepted through
March 18th
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A $50 submission fee is required upon completion of the form. |
Questions can be directed to
Savannah Gold
at 270.554.9412 ext 4219 or
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- Top 3 will present during the general session on the final day.
- Top 10 will present during the abstract breakout session.
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Rapid review and publication in the Pain Physician journal will be extended to the Top 10 authors accepted for meeting presentations.
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Tropical disease hit middle America and could pop up again, agency scientists say
While the lavender-scented spritz from Walmart might have seemed the furthest thing from exotic, the Burkholderia pseudomallei bacteria inside sparked a deadly melioidosis outbreak that CDC scientists highlighted as a reason to watch for unexpected infections.
"Health care providers should consider melioidosis in patients with a compatible illness, even if they do not have a history of travel to melioidosis-endemic areas," Jay E. Gee, PhD, of the CDC's Bacterial Special Pathogens Branch in Atlanta, and colleagues reported in a brief report in the New England Journal of Medicine (NEJM).
The bacterium, typically associated with travel to tropical and subtropical areas like Thailand and Malaysia, where it's endemic in soil and water, was a mystery when it showed up in four patients in Georgia, Kansas, Minnesota, and Texas in 2021.
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Interactive timeline shows COVID's meteoric rise from nowhere to top of the mortality list
Month over month, heart disease and cancer have been the leading causes of death in the U.S. for years, but the pandemic introduced a major disruption to this trend.
After the first U.S. deaths were reported in early 2020, COVID quickly climbed to become the third leading cause of death, before surpassing cancer to take the second spot in early spring. Toward the end of 2020, COVID-19 briefly replaced heart disease as the leading cause of death. For the year overall, COVID-19 was the third-leading cause of death.
In 2021, COVID-19 twice held stints as the leading cause of death, early in the year during the winter peak, and during the height of the Delta wave. For all of 2021, deaths attributed to the virus again landed in the third spot.
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NEXT EXAM DATE:
Saturday, April 2, 10am CST
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Small-fiber neuropathy may stem from defective immune response to SARS-CoV-2
Prolonged, often disabling, small-fiber neuropathy in long COVID may be caused by a defective immune response, a small longitudinal study suggested.
Peripheral neuropathy was identified in 59% of 17 people with long COVID (16 of whom had mild cases of SARS-CoV-2 infection), reported Anne Louise Oaklander, MD, PhD, of Massachusetts General Hospital in Boston, and co-authors in Neurology: Neuroimmunology & Neuroinflammation.
This is one of the early papers looking into causes of long COVID, Oaklander noted. "Our findings suggest that some long-COVID patients had damage to their peripheral nerve fibers, and that damage to the small-fiber type of nerve cell may be prominent," she said in a statement.
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AMA worries PCPs will be bypassed; community pharmacists feel left out
With one sentence tucked into the March 1 State of the Union address, President Biden kicked off a new effort to combat COVID-19: "We are launching the 'Test to Treat' initiative so people can get tested at a pharmacy and, if they prove positive [for SARS-CoV-2], receive the antiviral pills on the spot at no cost," he stated.
But the idea that pharmacy-based testing sites could independently provide antivirals, such as Pfizer's nirmatrelvir-ritonavir (Paxlovid) and Merck's molnupiravir was met with concerns from both the American Medical Association (AMA) and pharmacy groups.
HHS confirmed in an FAQ that the program would be limited to the "nation's largest pharmacy chains" with onsite clinics, such as CVS MinuteClinics, along with long-term care centers, community health centers, and veterans' health centers.
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- ASIPP Members Only Site Information - |
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To log in for the first time you will need to click “forgot password” at the bottom of the login window.
- Check your email and then log in as directed.
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If you have problems logging into your account, click here.
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Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.
Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.
Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to sgold@asipp.org for consideration.
For more information or to submit your articles, click here.
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| CASE REPORT |
Roger Liu, DO, Marya Ghazzi, BS, Tomasz Chec, MD, Derek Ju, MD, Jeffrey Gehret, DO, Kristin Gustafson, DO, and Jeremy I. Simon, MD
Abstract
BACKGROUND: Minimally invasive lumbar decompression (MILD) is an interventional procedure for the treatment of patients with symptomatic lumbar spinal stenosis. Spinal cord injury after MILD has not yet been reported in literature.
CASE REPORT: We describe a case of a 95-year-old woman who underwent the MILD procedure at the L1-L2 level for symptomatic lumbar spinal stenosis. Following the procedure, the patient noticed lower extremity weakness and numbness, suprapubic numbness, groin pain, and urinary retention. Emergent magnetic resonance imaging of the lumbar spine exhibited new cord signal change at T12-L1. She subsequently underwent emergent L1-S1 decompression with gradual improvement of symptoms.
CONCLUSIONS: Direct trauma to the cord or increased pressure in a severely stenotic canal from injectate volume may have contributed to this patient’s injury. Consideration of the severity and location of stenosis is critical as these results may pose additional risk factors for injury with the MILD procedure.
KEY WORDS: MILD, spinal stenosis, spinal cord injury, interventional procedure
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| RETROSPECTIVE REVIEW |
Omar S. Akbik, MD, Salah G. Aoun, MD, Owoicho Adogwa, MD, Carlos A. Bagley, MD, and Mazin Al Tamimi, MD
Abstract
Background: Spinal cord stimulation (SCS) is an accepted treatment for certain chronic pain syndromes. It is imperative that patients undergo a stimulation screening trial. For trial stimulation, typically patients undergo a percutaneous lead placement. Due to technical considerations, there exists a subset of patients who are not candidates for a percutaneous trial.
Objective: We present our experience with open paddle trial for spinal cord stimulation and review the characteristics of this patient population as well as the technique and efficacy of an open paddle lead trial for spinal cord stimulation.
Study design: Retrospective review.
Setting: University of Texas Southwestern Medical Center, Department of Neurosurgery.
Methods: We retrospectively identified 25 patients undergoing a paddle lead trial for spinal cord stimulation from September 2014 to September 2019.
Results: Twenty-five patients underwent a paddle lead trial for spinal cord stimulation. The average age was 61 with a range of 40 to 82 years; 19 were women and 6 were men. Twenty-two patients (88%) had failed back surgery syndrome (FBSS). Nine patients had attempted percutaneous trials that were unsuccessful, and 14 patients had extensive hardware and/or scar tissue, necessitating an open paddle trial. Twenty-three (92%) patients had a positive trial and went on to permanent implantation.
Limitations: The retrospective nature is a major limitation as well as loss to follow-up on several patients.
Conclusion: Patients, who have either failed or are deemed suboptimal for percutaneous trialing for spinal cord stimulation, should be considered for open paddle lead trialing. A multidisciplinary approach improves communication and helps to identify that subset of patients who otherwise may be left to pursue conservative measures only.
Keywords: failed back surgery syndrome; spinal cord stimulator; Paddle lead trial.
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| NONRANDOMIZED CLINICAL TRIAL |
Jian-Xiong An, MD, PhD, Guo-Ping Wu, MD, Kun Niu, MD, You-Ping Wei, MD, Hui Liu, MD, Xin-You Gao, MD, Jian-Ping Wu, MD, Yong Wang, MD, Harald Renz, MD, and John P. Williams, MD
Abstract
Background: Osteonecrosis of the femoral head (ONFH) is a progressive and painful disorder due to impaired blood supply to the femoral head, yet little is known about the effect of ozone therapy in femoral head necrosis.
Objectives: We aimed to evaluate the clinical and radiographic outcomes of ozone therapy in the treatment of ONFH.
Study design: Nonrandomized clinical trial.
Settings: The study was conducted in a single-center, academic institution.
Methods: A total of 71 patients (107 hip joints) with Association Research Circulation Osseous (ARCO) stage-I, II, III, and IV ONFH were included and assigned to undergo either intraarticular O2-O3 mixture hip injections with ozonated autohemotherapy (ozone therapy group, n = 39, 58 hip joints) or protected weight bearing (control group, n = 32, 49 hip joints). The primary outcomes included the Visual Analog Scale (VAS) for pain intensity and Harris Hip Score (HHS) for hip function. The secondary outcomes included bone marrow edema examination, and conversion to total hip arthroplasty (THA).
Results: Ozone therapy effectively improves VAS for pain intensity and HHS during the follow-up period compared to the control group. Ozone therapy showed a significant resolution of bone marrow edema of the femoral head compared to the control group (P < 0.001). Thirteen of the 49 hips (26.53%) in the control group underwent THA, whereas only 6 hips (10.34%) in the ozone therapy group required THA during a 30-month follow-up (P = 0.041). The cumulative analysis revealed a low rate of conversion to THA in the ozone therapy group (logrank test; P = 0.022).
Limitations: The study is limited by a single treatment protocol in addition to the lack of a randomized design.
Conclusions: Ozone therapy was associated with significant pain relief, improvement in hip function, and bone marrow edema resolution that may delay the need for THA in patients affected by ONFH.Institutional Review Board (IRB) approval number: HK2018-10-28.Clinical trials registration number: ChiCTR1900023449.
Keywords: differential expressed genes; gene ontology; hip function; hip injection; ozone therapy; pain intensity; transcriptomics; Osteonecrosis of the femoral head.
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Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
Norcal Mutual is A-Rated by AM best and is licensed in all 50 states. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary award-winning risk management CME activities, click here.
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ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value-added services for independent physicians. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.
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ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service.
We have received a tremendous amount of interest in the ASIPP® billing and coding program.
Click here to learn more about the negotiated rate for practices and more!
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up-to-date news related to you, your practice, and your patients!
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