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Article: Impact of the COVID-19 Pandemic on Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain in a Medicare Population.

Manchikanti, Laxmaiah / Kaye, Alan D / Latchaw, Richard E / Sanapati, Mahendra R / Pampati, Vidyasagar / Gharibo, Christopher G / Albers, Sheri L / Hirsch, Joshua A

Pain and therapy

2023 Volume 12, Issue 2, Page(s) 505–527

Abstract: Introduction: The COVID-19 pandemic resulted in major disruptions in all aspects of human life including a decline of medical services utilized during 2020. An analysis of the impact of COVID-19 pandemic showed an 18.7% reduction in utilization patterns ...

Abstract	Introduction: The COVID-19 pandemic resulted in major disruptions in all aspects of human life including a decline of medical services utilized during 2020. An analysis of the impact of COVID-19 pandemic showed an 18.7% reduction in utilization patterns of interventional techniques in managing chronic pain in the Medicare population from 2019 to 2020. However, specific changes in utilization patterns of facet joint interventions have not been studied. Thus, we sought to assess the utilization patterns including an update of facet joint interventions from 2018 to 2020, with analysis of the impact of COVID-19 pandemic in managing chronic spinal pain utilizing facet joint interventions in the fee-for-service Medicare population of the United States. Methods: The present investigation was designed to assess utilization patterns and variables of facet joint interventions, in managing chronic spinal pain from 2010 to 2020 in the fee-for-service (FFS) Medicare population in the United States (US), and how the COVID-19 pandemic impacted these utilization patterns. Data for the analysis were obtained from the master database from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2020. Results: Results of this analysis showed significant impact of COVID-19 with overall decrease of 18.5% of all facet joint interventions per 100,000 Medicare population compared to 20.2 and 20.5% decrease for lumbar and cervical facet joint injections, 15 and 13.1% decrease per 100,000 Medicare population of lumbosacral and cervicothoracic facet joint neurolysis procedures. The results are significant in that comparative analysis from 2000 to 2010 and 2010 to 2019 showing an annual increase of 14.4 vs. 2.2%, illustrating a decelerating pattern. There were also significant growth patterns noted with decreases in facet joint injections and nerve blocks compared to facet joint neurolytic procedures. Conclusions: This analysis shows a significant effect of COVID-19 producing an overall decrease in utilization of facet joint interventions relative to pre-COVID data. Further, the analysis demonstrates continued deceleration of utilization patterns of facet joint interventions compared to the periods of 2000-2010 and 2010-2019.
Language	English
Publishing date	2023-02-01
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2701614-6
ISSN	2193-651X ; 2193-8237
ISSN (online)	2193-651X
ISSN	2193-8237
DOI	10.1007/s40122-023-00476-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Comparative Systematic Review and Meta-Analysis of Cochrane Review of Epidural Injections for Lumbar Radiculopathy or Sciatica.

Manchikanti, Laxmaiah / Knezevic, Emilija / Latchaw, Richard E / Knezevic, Nebojsa Nick / Abdi, Salahadin / Sanapati, Mahendra R / Staats, Peter S / Gharibo, Christopher G / Simopoulos, Thomas T / Shah, Shalini / Abd-Elsayed, Alaa / Navani, Annu / Kaye, Alan D / Albers, Sheri L / Hirsch, Joshua A

Pain physician

2022 Volume 25, Issue 7, Page(s) E889–E916

Abstract: Background: Epidural injections are among the most commonly performed procedures for managing low back and lower extremity pain. Pinto et al and Chou et al previously performed systematic reviews and meta-analyses, which, along with a recent update from ...

Abstract	Background: Epidural injections are among the most commonly performed procedures for managing low back and lower extremity pain. Pinto et al and Chou et al previously performed systematic reviews and meta-analyses, which, along with a recent update from Oliveira et al showing the lack of effectiveness of epidural steroid injections in managing lumbar disc herniation, spinal stenosis, and radiculopathy. In contrast to these papers, multiple other systematic reviews and meta-analyses have supported the effectiveness and use of epidural injections utilizing fluoroscopically guided techniques. A major flaw in the review can be related to attributing active-controlled trials to placebo-controlled trials. The assumption that local anesthetics do not provide sustained benefit, despite extensive evidence that local anesthetics provide long-term relief, similar to a combination of local anesthetic with steroids is flawed. Study design: The Cochrane Review of randomized controlled trials (RCTs) of epidural injections in managing chronic low back and lower extremity pain with sciatica or lumbar radiculopathy were reanalyzed using systematic methodology and meta-analysis. Objectives: To re-evaluate Cochrane data on RCTs of epidural injections in managing chronic low back and lower extremity pain with sciatica or lumbar radiculopathy utilizing qualitative and quantitative techniques with dual-arm and single-arm analysis. Methods: In this systematic review, we have used the same RCTs from the Cochrane Review of a minimum of 20% change in pain scale or significant pain relief of >= 50%. The outcome measures were pain relief and functional status improvement. Significant improvement was defined as 50% or greater pain relief and functional status improvement. Our review was performed utilizing the Cochrane Review methodologic quality assessment and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB). Evidence was summarized utilizing the principles of best evidence synthesis and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Clinical relevance of the pragmatic nature of each study was assessed. Results: In evaluating the RCTs in the Cochrane Review, 10 trials were performed with fluoroscopic guidance. Utilizing conventional dual-arm and single-arm meta-analysis, the evidence is vastly different from the interpretation of the data within the Cochrane Review. The overall combined evidence is Level I, or strong evidence, at one and 3 months, and Level II, or moderate evidence, at 6 and 12 months. Limitations: The limitation of this study is that only data contained in the Cochrane Review were analyzed. Conclusion: A comparative systematic review and meta-analysis of the Cochrane Review of randomized controlled trials (RCTs) of epidural injections in managing chronic low back and lower extremity pain with sciatica or lumbar radiculopathy yielded different results. This review, based on the evidence derived from placebo-controlled trials and active-controlled trials showed Level I, or strong evidence, at one and 3 months and Level II at 6 and 12 months. This review once again emphasizes the importance of the allocation of studies to placebo-control and active-control groups, utilizing standards of practice with inclusion of only the studies performed under fluoroscopic guidance.
MeSH term(s)	Humans ; Radiculopathy/drug therapy ; Anesthetics, Local/therapeutic use ; Sciatica/drug therapy ; Low Back Pain/drug therapy ; Injections, Epidural/methods ; Steroids
Chemical Substances	Anesthetics, Local ; Steroids
Language	English
Publishing date	2022-10-24
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2146393-1
ISSN	2150-1149 ; 1533-3159
ISSN (online)	2150-1149
ISSN	1533-3159
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Article: Guidelines for diagnostic neuroangiography: a model to emulate from a neuroradiologist's perspective.

Latchaw, R E

AJNR. American journal of neuroradiology

2000 Volume 21, Issue 1, Page(s) 44–45

MeSH term(s)	Angiography/standards ; Humans ; Neuroradiography/standards ; Practice Guidelines as Topic
Language	English
Publishing date	2000-01
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	603808-6
ISSN	1936-959X ; 0195-6108
ISSN (online)	1936-959X
ISSN	0195-6108
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Article: The roles of diffusion and perfusion MR imaging in acute stroke management.

Latchaw, R E

AJNR. American journal of neuroradiology

1999 Volume 20, Issue 6, Page(s) 957–959

MeSH term(s)	Acute Disease ; Cerebrovascular Circulation/physiology ; Cerebrovascular Disorders/diagnosis ; Cerebrovascular Disorders/physiopathology ; Cerebrovascular Disorders/therapy ; Diffusion ; Humans ; Magnetic Resonance Imaging/methods
Language	English
Publishing date	1999-06
Publishing country	United States
Document type	Comment ; Editorial ; Review
ZDB-ID	603808-6
ISSN	1936-959X ; 0195-6108
ISSN (online)	1936-959X
ISSN	0195-6108
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Article: Acutely ruptured intracranial aneurysm: should we treat with endovascular coils or with surgical clipping?

Latchaw, R E

Radiology

1999 Volume 211, Issue 2, Page(s) 306–308

MeSH term(s)	Acute Disease ; Aneurysm, Ruptured/surgery ; Clinical Trials as Topic ; Endoscopy ; Humans ; Intracranial Aneurysm/surgery ; Vascular Surgical Procedures/instrumentation
Language	English
Publishing date	1999-05
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	80324-8
ISSN	1527-1315 ; 0033-8419
ISSN (online)	1527-1315
ISSN	0033-8419
DOI	10.1148/radiology.211.2.r99ma33306
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Article: No drug is benign.

Latchaw, R E

AJNR. American journal of neuroradiology

1998 Volume 19, Issue 8, Page(s) 1386–1387

MeSH term(s)	Animals ; Brain/drug effects ; Contrast Media/adverse effects ; Gadolinium DTPA/adverse effects ; Humans ; Infusions, Intravenous ; Injections, Intraventricular ; Magnetic Resonance Imaging
Chemical Substances	Contrast Media ; gadodiamide (84F6U3J2R6) ; Gadolinium DTPA (K2I13DR72L)
Language	English
Publishing date	1998-09
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	603808-6
ISSN	1936-959X ; 0195-6108
ISSN (online)	1936-959X
ISSN	0195-6108
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Article: The role of CT angiography in the long-term management of cerebrovascular dissection.

Latchaw, R E

AJNR. American journal of neuroradiology

1998 Volume 19, Issue 5, Page(s) 992–993

MeSH term(s)	Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/therapy ; Cerebral Angiography ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/therapy ; Time Factors ; Tomography, X-Ray Computed
Language	English
Publishing date	1998-05
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	603808-6
ISSN	1936-959X ; 0195-6108
ISSN (online)	1936-959X
ISSN	0195-6108
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Article: The American Society of Neuroradiology. Neuroradiology research: the opportunities and the challenges.

Latchaw, R E

Radiology

1998 Volume 209, Issue 1, Page(s) 3–7

Abstract: The next decade will witness an explosion of research and development in the neurosciences. The imaging of physiologic and functional processes--the frontier today--will become the norm. There are huge populations of patients with neurodegenerative and ... ...

Abstract	The next decade will witness an explosion of research and development in the neurosciences. The imaging of physiologic and functional processes--the frontier today--will become the norm. There are huge populations of patients with neurodegenerative and cerebrovascular diseases that require nonanatomic diagnostic evaluation. Radiologists must cease being just readers of morphologic images. They must broaden their scope and their areas of expertise. Imaging-guided therapy of all forms will alter the types of interventions we perform on patients. These new techniques will increase the efficacy of neuro-interventions while decreasing their morbidity and mortality. Resources, both human and financial, will be conserved. Radiologists can participate in this wonderful future if they broaden their training. Information management and the use of imaging for procedural guidance are the bases of our profession, but we are weak in the clinical applications of the technology. We must realize that our clinical colleagues are poised to assume the leadership in imaging research and development and in its performance. The challenge to the leaders of radiology is quite apparent: the recognition of the need to train for the future with the most open of minds and the least rigidity. This requires that we all understand the depth of the merger between the imaging and the clinical sciences that is occurring and that will increase substantially in the future. We must be the leaders in such a merger; otherwise, we will not be participants.
MeSH term(s)	Humans ; Neuroradiography/instrumentation ; Neuroradiography/methods ; Neuroradiography/trends ; Research/trends ; Societies, Medical ; United States
Language	English
Publishing date	1998-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	80324-8
ISSN	1527-1315 ; 0033-8419
ISSN (online)	1527-1315
ISSN	0033-8419
DOI	10.1148/radiology.209.1.9769802
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Article: Preoperative intracranial meningioma embolization: technical considerations affecting the risk-to-benefit ratio.

Latchaw, R E

AJNR. American journal of neuroradiology

1993 Volume 14, Issue 3, Page(s) 583–586

MeSH term(s)	Blood Loss, Surgical/prevention & control ; Embolization, Therapeutic/adverse effects ; Embolization, Therapeutic/methods ; Humans ; Magnetic Resonance Imaging ; Meningeal Neoplasms/blood supply ; Meningeal Neoplasms/diagnosis ; Meningeal Neoplasms/surgery ; Meningioma/blood supply ; Meningioma/diagnosis ; Meningioma/surgery ; Preoperative Care ; Risk Factors ; Tomography, X-Ray Computed
Language	English
Publishing date	1993-05
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	603808-6
ISSN	1936-959X ; 0195-6108
ISSN (online)	1936-959X
ISSN	0195-6108
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Article: The use of nonionic contrast agents in neuroangiography. A review of the literature and recommendations for clinical use.

Latchaw, R E

Investigative radiology

1993 Volume 28 Suppl 5, Page(s) S55–9; discussion S60–1

Abstract: Rationale and objectives: Several large studies have demonstrated the improved safety record of nonionic versus ionic contrast agents for intravenous administration. However, nonionic agents are much more expensive than ionic agents. The author ... ...

Abstract	Rationale and objectives: Several large studies have demonstrated the improved safety record of nonionic versus ionic contrast agents for intravenous administration. However, nonionic agents are much more expensive than ionic agents. The author addresses whether, given this large cost differential, nonionic contrast agents should always be used in neuroangiography (cerebral and spinal cord angiography and intravascular neurointerventional procedures). The answer could come from a closer examination of the effects of contrast agents on the brain. Methods: There have been a number of animal experiments and clinical trials performed using a variety of available intravascular contrast agents. In an attempt to arrive at some reasonable conclusions regarding the use of contrast agents today, the author reviews several of these studies. In the human studies, three areas were analyzed: 1) cerebral angiography, 2) spinal cord angiography, and 3) intravascular neurointervention. The author explains why demonstrating the effect of a contrast agent on the brain or spinal cord in the clinical setting is more difficult than studying the effect of this agent on the liver, heart, or kidney. For example, obtaining objective measurements of altered cerebral physiology following intravascular injection of a contrast agent may itself alter the physiology. In lieu of objective measurements, investigators must rely on apparent changes in behavior, mentation, or the production of a focal neurologic deficit. However, it is extremely difficult, if not impossible, to separate the effect of the contrast agent from the effects of the arteriographic procedure, or from the disease process being evaluated. Results: The neuronal environment is protected by the blood-brain barrier. A number of animal experiments have demonstrated that nonionic agents produce breakage of the blood-brain barrier less frequently than do ionic agents. In these studies, nonionic agents also produced fewer neurologic effects than did ionic agents. The human studies showed no statistically significant differences in neurologic effects when ionic and nonionic agents were compared. Cerebral: minor changes in heart rate were more common with ionic than with nonionic agents; there were no significant electroencephalogram changes in any of the patients studied. Spinal cord: the effects of intravascular injections of contrast material into the spinal cord of experimental animals have been rarely evaluated; direct comparisons of contrast agents in human spinal cord angiography have not been performed. Neurointervention: there have been no comparative studies of different contrast agents used during intravascular neurointerventional procedures in humans. Conclusions: Extensive animal data demonstrate that nonionic contrast agents are safer than ionic for cerebral angiography. Animals in the cited studies show less blood-brain barrier disruption, fewer direct neuronal effects, and fewer neurobehavioral deficits. However, the overwhelming conclusion from the human studies is that, while there is evidence in the experimental animal that nonionic agents produce fewer neurologic effects than do ionic agents, no study to date has been able to translate these findings into an apparent clinical difference in humans, mainly because it's so difficult to detect and measure neurologic changes in human trials. In addition, differences in neurologic effects between contrast agents used in human studies may be relatively small. Thus, one must make an educated guess as to the appropriate use of contrast agents in the context of their apparent clinical safety and cost-benefit ratio.
MeSH term(s)	Angiography ; Animals ; Blood-Brain Barrier/drug effects ; Cardiovascular System/drug effects ; Cerebral Angiography ; Contrast Media/adverse effects ; Humans ; Radiography, Interventional ; Spinal Cord/blood supply
Chemical Substances	Contrast Media
Language	English
Publishing date	1993-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80345-5
ISSN	1536-0210 ; 0020-9996
ISSN (online)	1536-0210
ISSN	0020-9996
DOI	10.1097/00004424-199311001-00017
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