Interventional non-operative management of low back and neck pain

Abstract

Background Chronic neck and back pain are among the most commonly encountered health problems in neurosurgical practice. Many cases fail prolonged pharmacological and physical therapy and are not proper candidates for surgical interventions, or had refused proposed surgical treatment. Objective To provide an informative critical summary of the literature about the topic of interventional management of axial neck and low back pain and highlighting the new trends and pieces of evidence. Methods The English literature published over the last two decades was reviewed by the author for recent and relevant data about the principles of interventional management of chronic neck and low back pain. A PubMed search was performed through phrase searching and combined searching using Boolean operators. The articles thought to be most relevant to the study aim and the neurosurgeons’ practice were extracted. Results Neck and low back pain continue to be among the most common musculoskeletal health problems and the most common cause of disability worldwide. A detailed understanding of relevant spine anatomy is crucial for interventionists who should deal with the concept of “functional spine unit” with multiple potential pain generators. Chronic spinal pain is best managed through a dedicated multidisciplinary team in well-equipped healthcare facilities. An algorithmic approach for the diagnosis and management of spinal pain is the mainstay of providing the best patient care and should be based on the commonality and treatability of pain generators, values of patients and available resources. Conclusion Management of chronic neck and back pain can represent a clinical dilemma due to the multiplicity of pain generators that may coexist in the same individual resulting in a complex type and pattern of pain. Approach to these patients requires contributions from the members of a multidisciplinary team, implementing a standardized approach in a well-equipped healthcare facility.

Nucleic acid-based therapeutics for the treatment of central nervous system disorders

“…CNS targeting by both ASOs and siRNAs can be achieved via direct brain delivery through IT (intrathecal) injection ( Goto et al, 2023 ). IT administration involves injecting the drug into the CFS within the spine and can be performed in a variety of ways, including intralaminar injection, transforaminal injection, or using a subcutaneously implanted catheter for repeat injections ( Figure 3 ) ( Lee et al, 2022 ; Alkosha, 2023 ). IT injection is the indicated route of administration for 16 oligonucleotide therapeutics that are under development as of 2022 ( Goto et al, 2023 ) ( Table 2 ).…”