Minimally Invasive Procedures for Central and Neuroforaminal Spinal Stenosis
Dr. Steve Aydin reflects on the evolution of minimally invasive treatments for lumbar spinal stenosis, questioning whether these procedures truly change patient outcomes or mainly improve symptoms. He compares options like MILD (percutaneous lumbar decompression) and interspinous devices (Vertiflex, Minuteman), noting that while imaging rarely shows significant post-procedure change, patients often experience relief. The talk highlights challenges in patient selection, balancing risks like facet pain after spacers, and the importance of individualized algorithms for central versus foraminal stenosis. Aiden emphasizes adaptability as techniques evolve, aiming for the least invasive intervention with meaningful symptom improvement over aggressive surgical alternatives.
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Intrathecal Neurolysis
This powerful presentation explores the role of intrathecal neurolysis in managing refractory cancer pain in palliative care. Highlighting that 30% of cancer patients do not respond to standard multimodal analgesia, Dr. Perez Moreno advocates for chemical neurolysis—primarily using alcohol or phenol—to achieve meaningful relief. Detailed comparisons between aqueous and glycerinated phenol and alcohol reveal their chemical behaviors, densities, and risk profiles. Through compelling clinical cases, including terminal patients requesting euthanasia due to unbearable pain, Dr. Perez Moreno demonstrates how carefully executed intrathecal neurolysis can offer dramatic pain relief, preserve dignity, and avoid motor complications, reinforcing its value as a compassionate, evidence-informed intervention.
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This presentation explores lumbar spinal stenosis and the evolution of minimally invasive treatments, focusing on fusion techniques for patients with instability. The speaker reviews the stages of spinal stenosis, common symptoms like neurogenic claudication, and current interventions including MILD, Vertiflex, and interspinous fixation devices. While mild and Vertiflex address decompression, they lack stability for advanced cases. The discussion emphasizes posterolateral minimally invasive fusion with devices such as Minuteman, which restore alignment, lift disc height, and achieve standalone fixation with reduced tissue damage and lower infection risk. Clinical cases and biomechanical data demonstrate improved fusion rates, pain reduction, and functional outcomes.
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Posterolateral Mis Fusion for Degenerative Instability
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Persistent Idiopathic Facial Pain
In this expert-level lecture, Dr. Day presents a thorough and practical overview of Persistent Idiopathic Facial Pain (PIFP)—a complex, underdiagnosed condition often mistaken for trigeminal neuralgia. He emphasizes the need for detailed history-taking, anatomical mastery, and targeted imaging protocols for accurate diagnosis. Dr. Day discusses treatment algorithms, including pulsed radiofrequency of the sphenopalatine ganglion, its anatomical approach, and procedural nuances to avoid complications. He stresses that PIFP is a diagnosis of exclusion, and procedural success hinges on precise anatomical targeting and clinical discernment, especially in cases where imaging fails to show clear pathology. The goal: safe, evidence-based, and effective relief.
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Update in Sphenopalatine Ganglion Block Target Headaches
The session reviews the sphenopalatine ganglion (SPG), its anatomy, functions, and role in pain syndromes like cluster headaches, trigeminal neuralgia, and migraines. Located in the pterygopalatine fossa, SPG integrates parasympathetic, sympathetic, and sensory fibers. Pathophysiology involves neurogenic inflammation triggering severe headache symptoms. Interventional options include SPG blocks (most evidence-based), radiofrequency ablation, and neuromodulation. Approaches range from topical intranasal methods (simple, low-risk but indirect) to transnasal, transoral, and image-guided techniques (more precise but riskier). Neuromodulation offers promising results but is device-dependent. Emphasis is on evidence-based indications, repetitive blocks before irreversible lesions, and careful patient selection—especially avoiding aggressive interventions in younger patients.
Watch Now
Dr. Steve Aydin reflects on the evolution of minimally invasive treatments for lumbar spinal stenosis, questioning whether these procedures truly change patient outcomes or mainly improve symptoms. He compares options like MILD (percutaneous lumbar decompression) and interspinous devices (Vertiflex, Minuteman), noting that while imaging rarely shows significant post-procedure change, patients often experience relief. The talk highlights challenges in patient selection, balancing risks like facet pain after spacers, and the importance of individualized algorithms for central versus foraminal stenosis. Aiden emphasizes adaptability as techniques evolve, aiming for the least invasive intervention with meaningful symptom improvement over aggressive surgical alternatives.
Minimally Invasive Procedures for Central and Neuroforaminal Spinal Stenosis
Watch Now
This powerful presentation explores the role of intrathecal neurolysis in managing refractory cancer pain in palliative care. Highlighting that 30% of cancer patients do not respond to standard multimodal analgesia, Dr. Perez Moreno advocates for chemical neurolysis—primarily using alcohol or phenol—to achieve meaningful relief. Detailed comparisons between aqueous and glycerinated phenol and alcohol reveal their chemical behaviors, densities, and risk profiles. Through compelling clinical cases, including terminal patients requesting euthanasia due to unbearable pain, Dr. Perez Moreno demonstrates how carefully executed intrathecal neurolysis can offer dramatic pain relief, preserve dignity, and avoid motor complications, reinforcing its value as a compassionate, evidence-informed intervention.
Intrathecal Neurolysis
Watch Now
Posterolateral Mis Fusion for Degenerative Instability
This presentation explores lumbar spinal stenosis and the evolution of minimally invasive treatments, focusing on fusion techniques for patients with instability. Dr. Baher Yanni reviews the stages of spinal stenosis, common symptoms like neurogenic claudication, and current interventions including MILD, Vertiflex, and interspinous fixation devices. While mild and Vertiflex address decompression, they lack stability for advanced cases. The discussion emphasizes posterolateral minimally invasive fusion with devices such as Minuteman, which restore alignment, lift disc height, and achieve standalone fixation with reduced tissue damage and lower infection risk. Clinical cases and biomechanical data demonstrate improved fusion rates, pain reduction, and functional outcomes.
Watch Now
In this expert-level lecture, Dr. Day presents a thorough and practical overview of Persistent Idiopathic Facial Pain (PIFP)—a complex, underdiagnosed condition often mistaken for trigeminal neuralgia. He emphasizes the need for detailed history-taking, anatomical mastery, and targeted imaging protocols for accurate diagnosis. Dr. Day discusses treatment algorithms, including pulsed radiofrequency of the sphenopalatine ganglion, its anatomical approach, and procedural nuances to avoid complications. He stresses that PIFP is a diagnosis of exclusion, and procedural success hinges on precise anatomical targeting and clinical discernment, especially in cases where imaging fails to show clear pathology. The goal: safe, evidence-based, and effective relief.
Persistent Idiopathic Facial Pain
Watch Now
The session reviews the sphenopalatine ganglion (SPG), its anatomy, functions, and role in pain syndromes like cluster headaches, trigeminal neuralgia, and migraines. Located in the pterygopalatine fossa, SPG integrates parasympathetic, sympathetic, and sensory fibers. Pathophysiology involves neurogenic inflammation triggering severe headache symptoms. Interventional options include SPG blocks (most evidence-based), radiofrequency ablation, and neuromodulation. Approaches range from topical intranasal methods (simple, low-risk but indirect) to transnasal, transoral, and image-guided techniques (more precise but riskier). Neuromodulation offers promising results but is device-dependent. Emphasis is on evidence-based indications, repetitive blocks before irreversible lesions, and careful patient selection—especially avoiding aggressive interventions in younger patients. Update in Sphenopalatine Ganglion Block Target Headaches
Published on March 29, 2019
From Pain School International, Dr. Agnes Stogicza gives a presentation on the use of ultrasound to better identify structures related to the cervical spine. She shows how the scanning technique,...
