Search

The evidence-based practice guidelines for the management of chronic spinal pain with interventional techniques were developed to provide recommendations to clinicians in the United States.To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain, utilizing all types of evidence and to apply an evidence-based approach, with broad representation by specialists from academic and clinical practices.Study design consisted of formulation of essentials of guidelines and a series of potential evidence linkages representing conclusions and statements about relationships between clinical interventions and outcomes.The elements of the guideline preparation process included literature searches, literature synthesis, systematic review, consensus evaluation, open forum presentation, and blinded peer review. Methodologic quality evaluation criteria utilized included the Agency for Healthcare Research and Quality (AHRQ) criteria, Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria, and Cochrane review criteria. The designation of levels of evidence was from Level I (conclusive), Level II (strong), Level III (moderate), Level IV (limited), to Level V (indeterminate).Among the diagnostic interventions, the accuracy of facet joint nerve blocks is strong in the diagnosis of lumbar and cervical facet joint pain, whereas, it is moderate in the diagnosis of thoracic facet joint pain. The evidence is strong for lumbar discography, whereas, the evidence is limited for cervical and thoracic discography. The evidence for transforaminal epidural injections or selective nerve root blocks in the preoperative evaluation of patients with negative or inconclusive imaging studies is moderate. The evidence for diagnostic sacroiliac joint injections is moderate. The evidence for therapeutic lumbar intraarticular facet injections is moderate for short-term and long-term improvement, whereas, it is limited for cervical facet joint injections. The evidence for lumbar and cervical medial branch blocks is moderate. The evidence for medial branch neurotomy is moderate. The evidence for caudal epidural steroid injections is strong for short-term relief and moderate for long-term relief in managing chronic low back and radicular pain, and limited in managing pain of postlumbar laminectomy syndrome. The evidence for interlaminar epidural steroid injections is strong for short-term relief and limited for long-term relief in managing lumbar radiculopathy, whereas, for cervical radiculopathy the evidence is moderate. The evidence for transforaminal epidural steroid injections is strong for short-term and moderate for long-term improvement in managing lumbar nerve root pain, whereas, it is moderate for cervical nerve root pain and limited in managing pain secondary to lumbar post laminectomy syndrome and spinal stenosis. The evidence for percutaneous epidural adhesiolysis is strong. For spinal endoscopic adhesiolysis, the evidence is strong for short-term relief and moderate for long-term relief. For sacroiliac intraarticular injections, the evidence is moderate for short-term relief and limited for long-term relief. The evidence for radiofrequency neurotomy for sacroiliac joint pain is limited. The evidence for intradiscal electrothermal therapy is moderate in managing chronic discogenic low back pain, whereas for annuloplasty the evidence is limited. Among the various techniques utilized for percutaneous disc decompression, the evidence is moderate for short-term and limited for long-term relief for automated percutaneous lumbar discectomy, and percutaneous laser discectomy, whereas it is limited for nucleoplasty and for DeKompressor technology. For vertebral augmentation procedures, the evidence is moderate for both vertebroplasty and kyphoplasty. The evidence for spinal cord stimulation in failed back surgery syndrome and complex regional pain syndrome is strong for short-term relief and moderate for long-term relief. The evidence for implantable intrathecal infusion systems is strong for short-term relief and moderate for long-term relief.These guidelines include the evaluation of evidence for diagnostic and therapeutic procedures in managing chronic spinal pain and recommendations for managing spinal pain. However, these guidelines do not constitute inflexible treatment recommendations. These guidelines also do not represent a "standard of care."

24 páginas, 16 figuras, 5 tablas.-- et al., This paper provides an overview of the Low Frequency Instrument (LFI) programme within the ESA Planck mission. The LFI instrument has been developed to produce high precision maps of the microwave sky at frequencies in the range 27–77 GHz, below the peak of the cosmic microwave background (CMB) radiation spectrum. The scientific goals are described, ranging from fundamental cosmology to Galactic and extragalactic astrophysics. The instrument design and development are outlined, together with the model philosophy and testing strategy. The instrument is presented in the context of the Planck mission. The LFI approach to ground and inflight calibration is described. We also describe the LFI ground segment. We present the results of a number of tests demonstrating the capability of the LFI data processing centre (DPC) to properly reduce and analyse LFI flight data, from telemetry information to calibrated and cleaned time ordered data, sky maps at each frequency (in temperature and polarization), component emission maps (CMB and diffuse foregrounds), catalogs for various classes of sources (the Early Release Compact Source Catalogue and the Final Compact Source Catalogue). The organization of the LFI consortium is briefly presented as well as the role of the core team in data analysis and scientific exploitation. All tests carried out on the LFI flight model demonstrate the excellent performance of the instrument and its various subunits. The data analysis pipeline has been tested and its main steps verified. In the first three months after launch, the commissioning, calibration, performance, and verification phases will be completed, after which Planck will begin its operational life, in which LFI will have an integral part., The Planck-LFI project is developed by an International Consortium led by Italy and involving Canada, Finland, Germany, Norway, Spain, Switzerland, UK and USA. The Italian contribution to Planck is supported by the Agenzia Spaziale Italiana (ASI) and INAF. We also wish to thank the many people of the Herschel/Planck Project and RSSD of ESA, ASI, THALES Alenia Space Industries and the LFI Consortium that have contributed to the realization of LFI. We are grateful to our HFI colleagues for such a fruitful collaboration during so many years of common work. The German participation at the Max-Planck-Institut für Astrophysik is funded by the Bundesministerium für Wirtschaft und Technologie through the Raumfahrt- Agentur of the Deutsches Zentrum für Luft- und Raumfahrt (DLR) [FKZ: 50 OP 0901] and by the Max-Planck-Gesellschaft (MPG). The Finnish contribution is supported by the Finnish Funding Agency for Technology and Innovation (Tekes) and the Academy of Finland. The Spanish participation is funded by Ministerio de Ciencia e Innovacion through the project ESP2004-07067-C03 and AYA2007-68058-C03. The UK contribution is supported by the Science and Technology Facilities Council (STFC). C. Baccigalupi and F. Perrotta acknowledge partial support of the NASA LTSA Grant NNG04CG90G.