OBJECTIVE: The purpose of this study was to evaluate the safety of oligodendrocyte progenitor cells (LCTOPC1) derived from human pluripotent stem cells administered between 7 and 14 days postinjury to patients with T3 to T11 neurologically complete spinal cord injury (SCI). The rationale for this first-in-human trial was based on evidence that administration of LCTOPC1 supports survival and potential repair of key cellular components and architecture at the SCI site. METHODS: This study was a multisite, open-label, single-arm interventional clinical trial. Participants (n = 5) received a single intraparenchymal injection of 2 × 10⁶ LCTOPC1 caudal to the epicenter of injury using a syringe positioning device. Immunosuppression with tacrolimus was administered for a total of 60 days. Participants were followed with annual in-person examinations and MRI for 5 years at the time of this report and will be followed with annual telephone questionnaires for 6 to 15 years postinjection. The primary endpoint was safety, as measured by the frequency and severity of adverse events related to the LCTOPC1 injection, the injection procedure, and/or the concomitant immunosuppression administered. The secondary endpoint was neurological function as measured by sensory scores and lower-extremity motor scores as measured by the International Standards for Neurological Classification of Spinal Cord Injury examinations. RESULTS: No unanticipated serious adverse events related to LCTOPC1 have been reported with 98% follow-up of participants (49 of 50 annual visits) through the first 10 years of the clinical trial. There was no evidence of neurological decline, enlarging masses, further spinal cord damage, or syrinx formation. MRI results during the long-term follow-up period in patients administered LCTOPC1 cells showed that 80% of patients demonstrated T2 signal changes consistent with the formation of a tissue matrix at the injury site. CONCLUSIONS: This study provides crucial first-in-human safety data supporting the pursuit of future human embryonic stem cell–derived therapies. While we cannot exclude the possibility of future adverse events, the experience in this trial provides evidence that this cell type can be well tolerated by patients, with an event-free period of up to 10 years. Based on the safety profile of LCTOPC1 obtained in this study, a cervical dose escalation trial was initiated (NCT02302157).

Physician burnout is recognized as reversible with the potential to negatively influence quality of care and patient outcomes. The study objective was to evaluate associations between patient satis... Lay abstract Physician burnout can have a negative impact on the quality of care provided to patients as well as medical outcomes of patients. The current study investigates if patient satisfaction...

Objective: To determine the prevalence of vitamin B1 (VitB1) deficiency in the stroke population admitted to acute inpatient rehabilitation. Design: Retrospective cohort study. Setting: Acute inpatient rehabilitation facility at an academic medical center. Participants: 119 consecutive stroke patients admitted to stroke service from 1 January 2018 to 31 December 2018. Interventions: Not applicable. Main Outcome Measures: Plasma VitB1 level. Results: There were 17 patients (14%; 95% CI 9–22%) with low VitB1 with a range of 2–3 nmol/L, an additional 58 (49%; CI 40–58%) patients had normal low VitB1 with a range of 4–9 nmol/L, twenty-five patients (21%; CI 15–29%) had normal high VitB1 with a range of 10–15 nmol/L, and nineteen patients (16%; CI 10–24%) had high VitB1 with a range of 16–43 nmol/L. Conclusions: In this cohort of patients admitted to the stroke service at an acute rehabilitation facility, there is evidence of thiamine deficiency. Moreover, the data suggest that there is inadequate acute intake of VitB1. Given the role of thiamine deficiency in neurologic function, further study of the role of thiamine optimization in the acute stroke rehabilitation population is warranted.

Background/Importance Ultrasound (US)-guided cervical selective nerve root injections (CSNRI) have been proposed as an alternative to fluoroscopic (FL) -guided injections. When choosing US guidance, the proceduralist should be aware of potential issues confirming vertebral level, be clear regarding terminology, and up to date regarding the advantages and disadvantages of US-guided CSNRI. Objective Review the accuracy and effectiveness of US guidance in avoiding vascular puncture (VP) and/or intravascular injection (IVI) during CSNRI. Evidence Review Queries included PubMed, CINAHL and Embase databases from 2005 to 2019. Three authors reviewed references for eligibility, abstracted data, and appraised quality. Findings The literature demonstrates distinct safety considerations and limited evidence of the effectiveness of US guidance in detecting VP and/or IVI. As vascular flow and desired injectate spread cannot be visualized with US, the use of real-time fluoroscopy, and if needed digitial subraction imaging, is indicated in cervical transforaminal epidural injections (CTFEIs). Given the risk of VP and/or IVI, the ability to perform and to retain FL images to document that the procedure was safely conducted is valuable in CTFEIs. Conclusion US guidance remains to be proven as a non-inferior alternative to FL guidance or other imaging modalities in the prevention of VP and/or IVI with CTFEIs or cervical selective nerve root blocks. There is a paucity of adequately powered clinical studies evaluating the accuracy and effectiveness of US guidance in avoiding VP and/or IVI. US-guided procedures to treat cervical radicular pain has limitations in visualization of anatomy, and currently with the evidence available is best used in a combined approach with FL guidance.

Chronic knee pain often results from degenerative conditions such as knee osteoarthritis (OA) and can worsen after surgical interventions like total knee arthroplasty (TKA). Knee OA affects approximately 86 million individuals globally, leading to decreased function, mobility limitations, and disability. While TKA is a common surgical treatment for refractory knee OA, though up to 20 % of patients experience chronic post-operative knee pain worse than their pre-operative pain. Genicular nerve radiofrequency ablation (GnRFA) has emerged as a promising intervention for knee OA pain unresponsive to conservative management and for chronic post-TKA pain. GnRFA is an evidence-based technique supported by multiple prospective cohort studies and randomized controlled trials (RCTs). However, practice patterns and GnRFA techniques vary, and no peer-reviewed publication has yet quantified these variations in real-world clinical practice. This study aims to understand the practice patterns of interventional pain physicians regarding patient selection, use of prognostic blocks, imaging, nerve targets, GnRFA types, and GnRFA techniques in treating knee pain secondary to OA or persistent post-TKA pain. An anonymous 29-question survey was distributed via electronic mail to members of the International Pain and Spine Intervention Society (IPSIS) from January 16, 2024, to February 29, 2024. The survey assessed practice patterns related to patient selection, prognostic block use, and GnRFA techniques. Data were collected and stored using REDCap software, with descriptive statistics calculated. A total of 150 completed surveys were analyzed, representing a completion rate of 2.0 % of surveys sent, 3.5 % of emails opened, and 56.8 % of those who clicked on the survey link. Respondents generally use common selection protocols regarding OA grade (Kelgren-Lawrence 3 and 4), duration of failed conservative care (3–6 months), a single anesthetic block paradigm, and use of fluoroscopic guidance for the GnRFA procedure. More variability was reported between respondents regarding the volume of anesthetic used during prognostic blocks, the threshold to consider a prognostic block “positive,” the technology used, and nerves targeted during the GnRFA procedure. The study provides valuable insights into the current practice patterns of GnRFA among interventional pain physicians. While there is consensus on some aspects of patient selection and procedural techniques, significant variability exists in prognostic block protocols and nerve targets for GnRFA. These findings highlight the need for further research to explore the long-term efficacy and safety of GnRFA and to standardize techniques and protocols across different practice settings, ultimately improving patient outcomes and quality of life. The low response rate may limit generalizability, and the survey did not include data on active tip sizes used for ablation or whether other procedures should be exhausted before resorting to GnRFA. Additionally, a survey to IPSIS membership only may not fully represent a diverse cohort of pain management specialists, potentially introducing sampling bias. Future studies should include members from a broader range of professional organizations to enhance representativeness.

Chronic 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. PubMed, 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. Patient 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. In appropriately selected patients, the overall body of evidence demonstrates that BVNA is an effective and durable treatment for vertebrogenic cLBP.