Lumbopelvic Medical Procedures Flashcards
What is the probability of continuing opioids for 1 year after 8 days of consuming?
13.5%
What is the probability of continuing opioids for 1 year if a second opioid is prescribed or a refill is received?
14%
What is the probability of continuing opioids for 1 year after 31 days?
30%
Which opioid has the highest probability of dependency?
Long-acting opioids (oxycontin, fentanyl)
Which opioid has the second highest probability of long-term use?
Tramadol
What percentage of patients remain taking opioids for more than 1 month?
64%
Define opioid tolerance.
Decreased drug effect over time
What are the complications associated with opioid tolerance?
Opioid-induced constipation and respiratory depression
Define opioid-induced hyperalgesia.
Paradoxical state of increased nociceptive sensitization
How does opioid-induced hyperalgesia manifest?
Diffuse pain less defined in quality, extending to other areas
What were the study’s findings on pain reduction in the ED with ibuprofen/acetaminophen vs opioid/acetaminophen combinations?
No significant or clinically important differences in pain reduction
What was the objective of the 12-month randomized trial comparing opioids to nonopioids?
To compare opioid vs nonopioid medications on pain-related function, pain intensity, and adverse effects
What were the conclusions regarding opioid therapy for chronic back pain or hip/knee osteoarthritis pain?
Opioid therapy was not superior to nonopioid medications for pain-related function improvement
What was the pain severity score in the opioid group?
4.0
What was the pain severity score in the non-opioid group?
3.5
Describe prolotherapy.
Repeated injections of irritant solutions to strengthen ligaments
What are the common solutions used in prolotherapy?
Dextrose, glycerine, and other osmotic shock agents
What is the conclusion regarding the efficacy of prolotherapy?
Conflicting evidence; effective when combined with other treatments
What are the effects of PRP injections for low back pain according to the meta-analysis?
Significantly reduced pain scores and improved patient satisfaction
What were the patient satisfaction results for PRP injections?
Relatively good patient satisfaction
Were there any increases in adverse events after PRP injection?
No increase in adverse events
What were the conclusions on stem cell injections for axial back pain?
Insufficient data to support efficacy and safety; need more RCTs
How many publications and patients were included in the systematic review of stem cell injections?
14 publications, 147 patients
What were the follow-up periods for the stem cell injection studies?
6 months to 6 years
What is PLIF in lumbar fusion?
Posterior lumbar interbody fusion
What is TLIF in lumbar fusion?
Transforaminal lumbar interbody fusion
What is MI-TLIF in lumbar fusion?
Minimally invasive transforaminal lumbar interbody fusion
What is OLIF/ATP in lumbar fusion?
Oblique lumbar interbody fusion/anterior to psoas
What is LLIF in lumbar fusion?
Lateral lumbar interbody fusion
What is ALIF in lumbar fusion?
Anterior lumbar interbody fusion
Is there definitive evidence for one lumbar fusion approach being superior?
No clear definitive evidence for one approach being superior
Which fusion method is preferred for discogenic LBP and lordosis restoration?
ALIF
Which fusion methods are reasonable for central canal stenosis or recurrent disc herniation?
PLIF and TLIF
Which approach is preferred for Isthmic spondylolisthesis?
PLIF
Is OLIF suitable for all cases?
No, LLIF is not suitable
Describe the SI joint fusion procedure.
Minimally invasive procedure, often secondary after failed L5-S1 fusion
What percentage of continued pain after failed L5-S1 fusion is from the SI joint?
29-40%
What is the effectiveness vs risk/complications of SI joint fusion?
Mixed evidence
What is opioid-induced constipation?
Complication of opioid tolerance
What is the more serious threat associated with opioid tolerance?
Respiratory depression
