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Aims: The aim of this observational study is to describe the use of epiduroscopy to decrease the enlargement of the ligamentum flavum (LF) in patients with spinal stenosis, as well as the selection of the appropriate patient and the safety measures that enhance procedural success.
Materials & Methods: We introduce the patient selection protocol, define the appropriate indication and the safety measures to use the epiduroscopy as a tool to decrease the size of the LF and increase space, reducing possible complications.
Results: Among patients included in the study, there were no cases of access difficulty or coccydynia, and one case of urinary incontinence occurred in a patient with Schizas grade D (very severe) stenosis. In patients with grade C or lower stenosis, we have not found any case of sphincter incontinence.In four patients, we found paresthesias and in one patient a transient increase in pain. Dural puncture was performed in three patients, none developed headache.
Conclusions: Exclusion of patients with very severe canal stenosis according to magnetic resonance imaging (MRI) criteria, the use of sacral hiatus measurements and the neurophysiological monitoring helps diminish the occurrence of neurological complications of epiduroscopy in patients with spinal stenosis.
Clinical Trial Registration: https://www.clinicaltrials.gov identifier is NCT03863067.
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http://dx.doi.org/10.1080/17581869.2025.2552636 | DOI Listing |
JAMA Netw Open
September 2025
Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Lübeck, Lübeck, Germany.
Importance: Patients with inflammatory rheumatic diseases (IRDs) frequently experience psychological distress; however, access to psychological support remains limited.
Objective: To investigate the effectiveness of a digital psychological intervention for individuals with IRDs.
Design, Setting, And Participants: Participants aged 18 years or older were recruited across Germany between February 22 and June 4, 2024, if they had been diagnosed with rheumatoid arthritis, psoriatic arthritis, or systemic lupus erythematosus and reported psychological distress and reduced quality of life.
JAMA Netw Open
September 2025
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock.
Importance: Patients with kidney failure (KF) receiving long-term dialysis have increased incidence of atrial fibrillation (AF). Patients with KF and AF have increased risk of stroke, death, and bleeding compared with age-matched cohorts. In KF, the use of oral anticoagulants (OACs) increases hemorrhage risk, offsetting potential benefits and making left atrial appendage occlusion (LAAO) a potentially promising solution for risk reduction in AF.
View Article and Find Full Text PDFEur J Trauma Emerg Surg
September 2025
Emergency Medical Services of Karlovy Vary Region, Zavodni 390/98C, Karlovy Vary, 36006, Czech Republic.
Background And Importance: In the Czech Republic, paramedics are required to consult a physician before administering intravenous opioids, which may delay effective prehospital pain management. As paramedic competencies expand in Europe, it is important to evaluate the safety and efficacy of independent opioid administration in prehospital emergency care settings.
Objectives: To assess the safety and effectiveness of intravenous sufentanil administered independently by trained paramedics compared to administration following remote physician consultation in adult trauma patients.
Pediatr Ann
September 2025
Department of Pediatrics, George Washington University, Washington, DC and.
Routine growth monitoring includes plotting children on World Health Organization or Centers for Disease Control and Prevention charts that have primarily been developed on typical, healthy populations. However, it is advisable to plot children with known genetic conditions on specialized growth curves (SGCs) when they are available. In this review, we highlight the most common genetic conditions for which SGCs are available, clinical reasons to use SGCs based on specific rare diseases, and how these SGCs can be found.
View Article and Find Full Text PDFJ Manipulative Physiol Ther
September 2025
Clinical & Health Services Research, Southern California University of Health Sciences, Whittier, California.
Objective: The purpose of this study was to evaluate the risk of selected adverse outcomes for older adults with a new episode of neck pain (NP) receiving chiropractic care compared to those receiving primary medical care with Prescription Drug Therapy (PDT) or primary care without medication.
Methods: Through analysis of Medicare claims data, we designed a retrospective cohort study including 291 604 patients with a new office visit for NP in 2019. We developed 3 mutually exclusive exposure groups: the Chiropractic Manipulative Therapy (CMT) group received spinal manipulative therapy from a chiropractor with no primary care visits; the PDT group visited primary care and filled an analgesic prescription within 7 days without chiropractic care, and the Primary Care Only (PCO) group visited primary care without chiropractic care or analgesic prescriptions.