When the disease is in its chronic form -as it usually happens after spine surgery or following the acute and subacute phase of radiculitis from disc herniation that had been undertreated with conservative therapy- neuroplasty (adhesiolysis) with Racz catheter is indicated.
The American Society of Interventional Pain Physicians (ASIPP) published evidence-based guidelines for invasive techniques in the management of chronic spinal pain.
According to these guidelines, there is strong evidence indicating the efficacy of neuroplasty with corticosteroids in the short and long-term control of pain in refractory radiculopathy and neuropathic spinal pain.
In a phase 2 study, Rehwald et al (2003) evaluated the safety and efficacy of rituximab in patients with relapsed LPHD or other CD20(+) subtypes of Hodgkin disease (HD). Eligibility criteria required expression of the CD20 antigen on more than 30 % of malignant cells. A total of 14 patients were treated with 4 weekly intravenous infusions of rituximab (375 mg/m2). All patients had at least 1 prior chemotherapy (median, 2). The median time from first diagnosis was 9 years. Adverse events, such as rhinitis, fever, chills, and nausea, were usually transient and of mild to moderate grade, allowing outpatient treatment in most cases. All patients completed treatment and were eligible for a response. The overall response in 14 assessable patients was 86 %, with 8 complete remissions and 4 partial remissions, and 2 patients with progressive disease. At a median follow-up of 12 months, 9 of 12 responders were in remission. The median duration of response has not been reached yet (20+ months). The authors concluded that rituximab is both safe and effective in a subgroup of CD20(+) patients with HD.
The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.