Evolve Restorative Center

Infections related to neuromodulation devices such as spinal cord stimulators (SCS) and intrathecal pumps (ITPs) present complex challenges due to potential complications such as localized infections, deep infections, sepsis, and neurological injury. Prompt diagnosis requires patients and providers to be educated on wound management and sepsis symptoms for immediate medical attention. Antibiotic therapy and duration vary based on infection severity, with deep infections often requiring device removal despite recent improvements in salvage rates with aggressive initial intervention. Deep infections necessitate timely diagnosis through imaging modalities such as magnetic resonance imaging (MRI) or computed tomography (CT), followed by device removal and culture-guided antibiotic therapy, often in collaboration with infectious disease specialists and spine surgeons. ITP infections pose similar challenges along with the risk of meningitis and may require careful management of medication withdrawal symptoms during emergent pump removal. Lab monitoring may aid treatment assessment, although negative cultures can occur due to post-antibiotic exposure. Postoperative recommendations stress standardized guidelines, patient education, and vigilant surveillance, with close follow-up crucial for early infection detection and intervention. Managing device-related infections demands a multi-specialty approach to minimize complications and optimize outcomes. This paper outlines best practices for diagnosing, managing, and treating neuromodulation device infections, focusing on guiding clinical decision-making from the onset of infection through treatment and potential reimplantation.

Little research has been conducted solely exploring gender diversity in people with intellectual disabilities. This review explores the literature, discusses the prevalence, and identifies clinical best practices for people at the intersection of gender diversity and intellectual disability. A scoping review was conducted utilising PRISMA methodology of the following databases: PubMed, CINAHL Complete (EBSCO), Cochrane Library (Wiley), Dissertations & Theses Global (ProQuest), PsycInfo (EBSCO), Scopus and Web of Science. Five hundred seventy five titles and abstracts were screened, 61 full-text articles were reviewed and 17 met inclusion criteria. Four major themes were identified: prevalence, trauma and co-occurring mental health disorders, barriers to care and best practices. This review highlights the lack of research and provides valuable insight into the experiences of people with gender diversity and intellectual disability. Further research is needed to understand the prevalence and explore the intersection and experience of gender-diverse people with intellectual disabilities.

ObjectiveThe aim of this study was to evaluate the efficacy and safety of a 60‐day peripheral nerve stimulation (PNS) treatment targeting the occipital nerves for reducing pain and improving function in individuals diagnosed with cervicogenic headache or occipital neuralgia.BackgroundHeadache conditions are prevalent and commonly disabling, and conventional therapeutic strategies are often insufficient. Development of a percutaneous 60‐day PNS treatment has created new opportunities to evaluate PNS of the occipital nerves.MethodsThis study was an institutional review board‐approved, multicenter, prospective, single‐arm study that enrolled participants from October 2022 to March 2024. Participants with cervicogenic headache or occipital neuralgia received a 60‐day PNS treatment targeting the occipital nerves. The primary endpoint was the proportion reporting clinically significant (≥30%) reductions in average pain and/or pain interference at end of treatment (EOT). Additional analysis included the proportion of participants with ≥50% reduction in average pain intensity and/or pain interference and additional outcomes including Patient Global Impression of Change, six‐item Headache Impact Test, and Neck Disability Index.ResultsAt EOT, 90% of participants (18/20) met the primary endpoint. Further, 85% (17/20) and 83% (15/18) reported ≥50% reductions in pain and/or pain interference at EOT and 3 months, respectively. Clinically meaningful improvements were observed in functional and headache‐related disability and quality‐of‐life measures. All study‐related adverse events were non‐serious.ConclusionMost participants reported significant reductions in pain and/or pain interference following 60‐day PNS targeting the occipital nerves. Outcomes through 3 months demonstrate how 60‐day PNS offers an effective approach for the treatment of headache.

IntroductionInterventional treatment options for the lumbar degenerative spine have undergone a significant amount of innovation over the last decade. As new technologies emerge, along with the surgical specialty expansion, there is no manuscript that utilizes a review of surgical treatments with evidence rankings from multiple specialties, namely, the interventional pain and spine communities. Through the Pacific Spine and Pain Society (PSPS), the purpose of this manuscript is to provide a balanced evidence review of available surgical treatments.MethodsThe PSPS Research Committee created a working group that performed a comprehensive literature search on available surgical technologies for the treatment of the degenerative spine, utilizing the ranking assessment based on USPSTF (United States Preventative Services Taskforce) and NASS (North American Spine Society) criteria.ResultsThe surgical treatments were separated based on disease process, including treatments for degenerative disc disease, spondylolisthesis, and spinal stenosis.ConclusionsThere is emerging and significant evidence to support multiple approaches to treat the symptomatic lumbar degenerative spine. As new technologies become available, training, education, credentialing, and peer review are essential for optimizing patient safety and successful outcomes.