![]() Exclusions were as follows: 18 procedures performed under moderate sedation, 11 C1-C2 facet injections, 10 unconventional or peripheral joint injections, and 15 inpatient or emergency room patients. Of these, 276 met inclusion criteria for this study (Table 1). The following procedures were included: outpatient interlaminar epidural steroid injection, selective nerve root block, transforaminal epidural steroid ResultsĪ total of 330 procedures were performed in the 1-year period. A search was performed for all fluoroscopically guided spine interventional pain injections performed by interventional neuroradiology in a 12-month period between 20. This retrospective quality study was approved by our institutional review board and approved by our Quality System and Health Care Improvement Assessment review. We hypothesized that a clinic-based procedure room (CBPR) would reduce turnover time and improve procedural efficiency without compromising patient safety. We sought to determine if there were differences in efficiency and safety between sites of spine procedures to improve our throughput but also provide consistent care to a larger number of patients. Because of the high volume of referrals, a second procedural room with a C-arm was opened in a clinic on our hospital campus to accommodate requests. In recent years, as our spine interventional practice has grown with a steadily increasing volume of procedural requests, we found increasing wait times for our patients adding to the overall system burden. Maximizing operating efficiency of interventional suites has implications not only for patient satisfaction but also for health system cost savings, with one study focused on decreasing operating room turnover time showing a potential of up to $1.02 million in savings and $1.8 million in additional generated income per year. Other studies have demonstrated that implementation of quality initiatives such as the Lean Six Sigma approach and usage of forms to document patient workflow progress can decrease procedure delays in musculoskeletal and other interventional procedures. Patient flow delay in interventional radiology is a known issue, with a prior study demonstrating significantly worse wait times for outpatient procedures compared with inpatient (81.4% compared with 45.0%), with room or physician unavailability accounting for nearly a third of delayed cases. Though each interventional practice varies, radiologists commonly perform these procedures in a hospital-based interventional fluoroscopic suite with a rotating plane. In general, these minimally invasive procedures are performed in the outpatient setting without sedation and with short recovery time. Multiple specialties perform image-guided injections including pain anesthesiologists, physiatrists, and radiologists. Usage of these spine procedures has increased dramatically in the last three decades, with both lumbar epidural steroid injections and facet injections increasing by 300% in the span of two decades. Both lumbar and cervical injections have been found to be cost-effective, showing greater clinical effectiveness than with conservative management alone. Image-guided injections for back pain, such as epidural steroid injections, nerve root blocks, facet injections, and sacroiliac joint injections, are minimally invasive and frequently used as a more conservative means of treatment before consideration of surgery. ![]() As a general guideline, the more severe slips (especially Grades III and above) are most likely to require surgical intervention.Back pain is one of the most common causes of US workforce disability and one of the costliest to manage. Most degenerative spondylolisthesis cases involve Grade I or Grade II. Lonner will consider the degree of slip, and such factors as intractable pain and neurological symptoms, when deciding on the most suitable treatment. If the body completely slips off the body below it is classified as a Grade V slip, known as spondyloptosis.ĭr. Grade III indicates a 50-74% slip and Grade IV indicates a 75%-99% slip. Thus a Grade I slip indicates that 1-24% of the vertebral body has slipped forward over the body below. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below. This is a relatively easy to understand system. ![]() In general, physicians use the Meyerding Grading System for classifying slips. We will discuss with you the extent of your spondylolisthesis. There are several methods used to "grade" the degree of slippage ranging from mild to most severe.
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