Intraosseous Basivertebral Nerve Ablation: 5-Year Outcomes from Three Long-Term Follow-up Studies

Determine the relative effectiveness and safety profiles of percutaneous and minimally invasive interventions for chronic low back pain. A systematic search was performed for randomized controlled trials published in the past 20 years reporting on radiofrequency ablation of the basivertebral, disk annulus and facet nerve structures, steroid injection of the disk, facet joint, and medial branch, biological therapies, and multifidus muscle stimulation. Outcomes evaluated included Visual Analog Scale (VAS) pain scores, Oswestry Disability Index (ODI) scores, quality of life (SF-36 and EQ-5D) scores, and serious adverse event (SAE) rates. Basivertebral nerve (BVN) ablation was chosen as the subject of comparison to all other therapies using a random-effects meta-analysis. Twenty-seven studies were included. BVN ablation was found to provide statistically significant improvements in VAS and ODI scores for 6-, 12- and 24-month follow-up ( P ≤0.05). Biological therapy and multifidus muscle stimulation were the only 2 treatments with both VAS and ODI outcomes not significantly different from BVN ablation at 6-, 12-, and 24-month follow-up. All outcomes found to be statistically significant represented inferior results to those of BVN ablation. Insufficient data precluded meaningful comparisons of SF-36 and EQ-5D scores. The SAE rates for all therapies and all reported time points were not significantly different from BVN ablation except for biological therapy and multifidus muscle stimulation at the 6-month follow-up. BVN ablation, biological therapy, and multifidus stimulation all provide significant, durable improvements in both pain and disability compared with other interventions, which provided only short-term pain relief. Studies on BVN ablation reported no SAEs, a significantly better result than for studies of biological therapy and multifidus stimulation.

Although previous work has examined clinical outcomes in combat-deployed veterans, questions remain regarding how symptoms evolve or resolve following mild blast traumatic brain injury (TBI) treated in theater and their association with long-term outcomes. To characterize 5-year outcome in patients with nonmedically evacuated blast concussion compared with combat-deployed controls and understand what clinical measures collected acutely in theater are associated with 5-year outcome. A prospective, longitudinal cohort study including 45 service members with mild blast TBI within 7 days of injury (mean 4 days) and 45 combat deployed nonconcussed controls was carried out. Enrollment occurred in Afghanistan at the point of injury with evaluation of 5-year outcome in the United States. The enrollment occurred from March to September 2012 with 5-year follow up completed from April 2017 to May 2018. Data analysis was completed from June to July 2018. Concussive blast TBI. All patients were treated in theater, and none required medical evacuation. Clinical measures collected in theater included measures for concussion symptoms, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, balance performance, combat exposure intensity, cognitive performance, and demographics. Five-year outcome evaluation included measures for global disability, neurobehavioral impairment, PTSD symptoms, depression symptoms, and 10 domains of cognitive function. Forward selection multivariate regression was used to determine predictors of 5-year outcome for global disability, neurobehavior impairment, PTSD, and cognitive function. Nonmedically evacuated patients with concussive blast injury (n = 45; 44 men, mean [SD] age, 31 [5] years) fared poorly at 5-year follow-up compared with combat-deployed controls (n = 45; 35 men; mean [SD] age, 34 [7] years) on global disability, neurobehavioral impairment, and psychiatric symptoms, whereas cognitive changes were unremarkable. Acute predictors of 5-year outcome consistently identified TBI diagnosis with contribution from acute concussion and mental health symptoms and select measures of cognitive performance depending on the model for 5-year global disability (area under the curve following bootstrap validation [AUCBV] = 0.79), neurobehavioral impairment (correlation following bootstrap validation [RBV] = 0.60), PTSD severity (RBV = 0.36), or cognitive performance (RBV = 0.34). Service members with concussive blast injuries fared poorly at 5-year outcome. The results support a more focused acute screening of mental health following TBI diagnosis as strong indicators of poor long-term outcome. This extends prior work examining outcome in patients with concussive blast injury to the larger nonmedically evacuated population.

Hormonal Therapy and Radiation Therapy in Prostate Cancer: 5-Year Outcomes From a Trial Evaluating Combined Androgen Blockade With 5-Alpha Reductase Inhibitors as an Alternative to Gonadotropin Releasing Hormone Agonists

ID# 1902588 Intraosseous Basivertebral Nerve Ablation: 5-Year Outcomes from Three Long-Term Follow-Up Studies

BackgroundChronic low back pain (cLBP) represents a significant burden to global health, with a prevalence projected to reach 843 million individuals by 2050. Vertebrogenic cLBP, a distinct phenotype, is mediated by nociception transmitted through the basivertebral nerve. Advances in basic and translational science have established clinical imaging biomarkers of vertebrogenic cLBP, such Type 1 and 2 Modic changes, to more reliably identify this condition. Additionally, medical technology advances have provided the ability to selectively disrupt pain signaling from painful vertebral endplates by interosseous basivertebral nerve ablation (BVNA). The objective of this review is to highlight appropriate patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of BVNA in the treatment of vertebrogenic cLBP.MethodsPubMed, EMBASE, and Google Scholar databases were queried for articles published before September 2024. Two authors reviewed references for eligibility, extracted data, and appraised the quality of evidence.ResultsPatient selection criteria include the presence of Type 1 or Type 2 Modic changes on MRI in the context of clinical suspicion of anterior element spinal pain based on clinical evaluation. BVNA was found to result in clinically significant and sustained pain relief and functional improvements in individuals with vertebrogenic cLBP. Randomized controlled trials and systematic reviews demonstrate long-term efficacy, with clinically meaningful benefits sustained up to 5 years postprocedure. Healthcare utilization analyses indicate that BVNA significantly reduces low back pain-related healthcare utilization, opioid use, and surgical intervention rates. Economic analysis indicates that BVNA is cost-effective when compared to conventional management of vertebrogenic cLBP.ConclusionsIn appropriately selected patients, the overall body of evidence demonstrates that BVNA is an effective and durable treatment for vertebrogenic cLBP.

Long-term Therapy With Adefovir Dipivoxil for HBeAg-Negative Chronic Hepatitis B for up to 5 Years

Long-Term Real-World Follow-up Study of Luspatercept for Lower-Risk Myelodysplastic Neoplasms

There is a need for models that predict accurately the course of mental disorders. Eating-disordered female inpatients were assessed longitudinally at the beginning of treatment (t1), at the end of treatment (t2), at 2 or 3-year follow-up (t3), and at 6-year follow-up (t4). The sample consisted of 196 women with bulimia nervosa (BN) purging type, 103 women with anorexia nervosa (AN), and 68 women with binge eating disorder (BED; N=367). Confirmatory factor analysis and path analysis were used to predict the women's status at 6-year follow-up. The results for BN and BED show that the specific eating disorder pathology was influenced mainly by specific eating disorder pathology at earlier time points and not by non-eating-specific (general) psychopathology. Similarly, general psychopathology was influenced mainly by general psychopathology at earlier time points. For AN patients, both categories of psychopathology (eating specific and general) were relevant for the 6-year outcome. The potential impact of 14 factors on the level of pathology was estimated (a) at baseline (at the beginning of treatment), (b) during the course of illness (baseline controlled), and (c) on the 6-year outcome of eating disorders (baseline and course controlled). Although there were many correlations between potential factors and baseline pathology, there was only a limited number of significant correlations with the 6-year outcome. This effect was mediated largely by the level of general psychopathology. The models for outcome prediction based on structural equation modeling techniques were very similar for BN and BED. For both BN and BED, there were almost entirely separate predictions for the specific eating disorder on the one hand and non-eating-related (general) psychopathology on the other hand. This was true to a lesser degree for AN. The use of refined path analytic methods in follow-up studies on larger general populations will be helpful to increase our understanding of the course of illness of psychiatric disorders.

PurposeWe sought to evaluate the long-term outcomes for patients with exudative age-related macular degeneration (AMD) undergoing vitrectomy for breakthrough vitreous hemorrhage and to investigate possible prognostic factors.MethodsConsecutive patients treated at two high-volume referral-based tertiary hospitals between July 2006 and December 2019 were retrospectively reviewed. Surgery was performed using the standard three-port vitrectomy. The primary outcome was the change in best-corrected visual acuity (BCVA) over long-term follow-up, while secondary outcomes included the assessment of possible prognostic factors.ResultsAmong 50 eyes from 50 patients included in this study, 23 (46%) were diagnosed with polypoidal choroidal vasculopathy (PCV) and 27 (54%) were diagnosed with neovascular AMD. Preoperative vision at the time of vitreous hemorrhage onset was 20 / 3,027 (logarithm of the minimum angle of resolution [logMAR], 2.18 ± 0.34). At 12 months after surgery, the mean BCVA improved to 20 / 873 (logMAR, 1.64 ± 0.76; p < 0.001). At 24 months, the BCVA was 20 / 853 (logMAR, 1.63 ± 0.75; p < 0.001). Univariate analysis revealed that older age (odds ratio [OR], 0.879; p = 0.007] and the presence of submacular hemorrhage (OR, 0.081; p = 0.022) were factors associated with a poor 2-year visual outcome. Multivariable regression showed that older age (OR, 0.876; p = 0.026) and neovascular AMD (as compared with PCV) (OR, 0.137; p = 0.014) were significant negative factors influencing the 2-year visual outcome. The mean injection interval prior to vitrectomy was 4.53 months, which extended to 27.64 months after vitrectomy (p = 0.028).ConclusionsYounger age, the absence of submacular hemorrhage, and PCV type were associated with a favorable 2-year visual outcome after vitrectomy for vitreous hemorrhage in patients with exudative AMD. Overall, vitrectomy resulted in improved visual acuity and patients showed a decreased need for anti-vascular endothelial growth factor therapy thereafter.

Targeted axillary sampling (TAS) is a new surgical concept for the assessment of axillary lymph node status in breast cancer that is hypothesized to be more effective at minimizing postoperative morbidities than axillary lymph node dissection (ALND), provided the metastatic axillary lymph node can be accurately detected without missing data; however, the oncologic outcomes over long-term follow-up have not been sufficiently investigated. This was a retrospective analysis to evaluate the 10-year oncologic outcomes in T1-3N1 breast cancer after TAS. Between 2008 and 2013, 230 female patients with cT1-3N1 breast cancer underwent breast and axillary surgery (ALND, n=171; TAS, n=59) at our institute. After TAS was applied, additional axillary radiotherapy was performed. Various postoperative complications, including postoperative seroma, lymphedema, and 10-year oncological outcomes, were evaluated and compared between the ALND and TAS groups. Although overall survival during the 10-year follow-up period was better in the TAS group, there was no statistically significant difference in oncologic outcomes, including locoregional recurrence, distant metastasis, and overall survival (p=0.395, 0.818, and 0.555, respectively). Furthermore, the incidence of lymphedema on the ipsilateral arm was significantly higher in the ALND group (p<0.001). The 10-year oncological outcomes of TAS were not inferior to those of conventional ALND in T1-3N1 breast cancers; however, the incidence of lymphedema was significantly higher in the ALND group.

A 12-week crossover study was carried out in 24 patients with chronic hypertension to compare the effect of clonidine given in a sustained-release form with that of a standard tablet. A long-term study (48 weeks) was performed immediately afterwards in the same patients to determine the effectiveness and acceptability of the sustained-release form in maintenance therapy. Using approximately the same dose of clonidine (300 or 450 micrograms/day for the standard tablet, 250 or 500 micrograms/day for the sustained-release form), no significant difference in hypotensive effect was found between the two forms of administration. The sustained-release form, however, was preferred by all patients because of lesser side-effects. During the long-term follow-up, the hypotensive effect was fully maintained in all patients. Side-effects which occasionally occurred at the start of the study, in particular dry mouth and a slight sensation of dizziness, subsided in the course of therapy. Laboratory investigations and clinical findings gave no indication of any chronic toxic changes.

Vertebrogenic pain due to degenerated or damaged vertebral endplates is a significant source of chronic low back pain.1 The pathogenesis of vertebrogenic pain is attributed to the presence of endplates nociceptors that transmit afferent signals to the basivertebral nerve (BVN), located posteriorly within the vertebral body.2,3 Chronic endplate inflammation triggers nociceptor proliferation, and associated chemical sensitization and mechanical stimulation leads to pain signals transmitted via the BVN and perceived as low back pain.1,2 Therefore, radiofrequency ablation of the BVN has emerged as a potential minimally-invasive technique for management of vertebrogenic low back pain.4,5 The thermal damage induced adjacent to the conducting region of the radiofrequency probe leads to interruption of pain transmission from vertebral endplates.5,6 This video article gives an overview of the indications, procedural considerations, technical approach of basivertebral nerve ablation (BVNA), as well as post-procedure care and patient outcomes with representative clinical images obtained from our experience.

Minimum 10-year clinical and functional outcomes after arthroscopic bony Bankart bridge for the treatment of bony Bankart lesions.

Comparison of Long-Term (4-Year) Outcomes of Patients With Unprotected Left Main Coronary Artery Narrowing Treated With Drug-Eluting Stents Versus Coronary-Artery Bypass Grafting

Randomized Comparison of Ridaforolimus-Eluting and Zotarolimus-Eluting Coronary Stents: 2-Year Clinical Outcomes From the BIONICS and NIREUS Trials