Background: Trigeminal neuralgia (TN) is the most common cause of neuropathic facial pain. Atypical TN are usually refractory to conventional medical treatments and the standard microvascular decompression surgeries that lead to marked negative impact on the patient's quality of life. Objective: The aim of this study is to examine the efficacy and safety of radiofrequency (RF) ablation in cases with atypical TN that did not respond to standard medical treatments. Methods: Our study included 19 consecutive patients with refractory atypical TN for more than 6 months. Neurological examination and MRI brain did not reveal any significant correlated signs. RF thermocoagulation was performed under fluoroscopy guidance. Collected data included preoperative conditions, pre-and post-procedure visual analog scale (VAS) score, and complications. Patients were followed up for a period of 1-year duration to evaluate the long-term efficiency of the procedure. Results: A total of 19 patients were recruited into the study (56.32 ± 13.48 years, 21% males, 79% females). Females outnumbered males (15 female patients, 79%) versus (4 male patients, 21%). There was more than 50% improvement in VAS score (16 patients, 79% versus 3 patients, 21%) (p < 0.05). Age was the only statistically significant factor were more elderly patients showed better improvement regarding VAS score (p < 0.05). Conclusions: Radiofrequency thermocoagulation is an effective and relatively safe procedure for alleviating atypical facial pain.

Background: Failed back surgery syndrome (FBSS) is a common problem affecting 20-40% of cases undergoing spine surgeries. Spinal cord stimulation (SCS) has been shown to be an efficient and relatively safe treatment in managing many intractable chronic pain syndromes.Objectives: This study compares the efficacy and safety of MR-compatible sensor driven-position adaptive SCS and conventional SCS in treating FBSS. Methods: This is a retrospective case series of 120 consecutive FBSS patients who underwent SCS between February 2011 and March 2018. Pain levels, analgesic/opioid use, and sleep problems were assessed before and 3 months after the procedure in patients who received either conventional SCS (group 1; n = 62) or sensor-driven position adaptive SCS (group 2; n = 34). The degree of patient satisfaction, the change in the activities of daily living (ADLs) together with the rate of complications were compared in both treatment groups. Results: The two treatment groups were homogenous at baseline. Patients in both groups improved significantly regarding pain, opioid consumption, sleep, and ADLs. The magnitude of improvement was statistically higher in group 2. An absolute reduction of 6 points on the VAS in patients who received position adaptive SCS vs a 3.3 point reduction in conventional SCS cases (p < 0.0001). Half of the patients in group 2 (n = 17) showed excellent satisfaction after the procedure versus 14.5% of cases in group 1 (n = 9). Conclusion: SCS is an efficient and reliable treatment in FBSS. MR-compatible sensor driven-position adaptive SCS can be a more effective treatment in this patient group.

Background: Back pain is a frequent complaint among the individuals in the society. It significantly affects the daily activities and the social and psychological life aspects leading to an economic health burden. Epiduroscopy is a relatively new minimally invasive technique that is used as a diagnostic and therapeutic tool in cases of chronic back pain. Aim of the study: To evaluate the extent of long-term benefit of epiduroscopy in patients with refractory chronic back pain with/without radiculopathy. Materials and methods: Retrospective data of 148 patients with failed back surgery syndrome (FBSS) and/or symptomatic lumbosacral disc prolapse who underwent epiduroscopy were collected. A 50% reduction in the visual analog scale (VAS) score was set as the primary outcome. Pre-and post-procedure analgesic use, quality of sleep, and changes in the activities of daily livings (ADLs) after 1-year follow-up were reviewed. Incidence and types of complications were recorded. Results: The mean age of the studied sample was 56.6 years with a higher percentage of females (61.5%). Patients having radicular pain represented 45.1%. Disc prolapse was prevalent (61.5%) compared to patients with FBSS (38.5%). A reduction of 50% or more in VAS score was reached in 52.7% (p < 0.01). This reduction was more evident in younger patients (p = 0.004). There was an improvement in ADLs (p < 0.01), quality of sleep (p < 0.05), and analgesic intake (p < 0.05). Conclusion: Epiduroscopy is a relatively recent, safe, and minimally invasive tool that showed effectiveness in the difficult to treat patients with back pain with/without radiculopathy especially in FBSS.