Evidence map›Paper›PMID 30590777›Full record

ArticlePain medicine (Malden, Mass.)2019

Unilateral Epidural Targeting of Resiniferatoxin Induces Bilateral Neurolysis of Spinal Nociceptive Afferents.

Mark D Unger, Josef Pleticha, Joanne Steinauer, Rahul Kanwar, Felix Diehn, Katherine T LaVallee, Michaela S Banck, Bryan Jones, Tony L Yaksh, Timothy P Maus and 1 more

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Article in Pain medicine (Malden, Mass.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
0.7field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 10 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 1 country.

Mark D UngerDepartment of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Josef PletichaDepartment of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Joanne SteinauerDepartment of Anesthesiology, University of California, San Diego, California, USA.
Rahul KanwarDepartment of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Felix DiehnDepartment of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Katherine T LaValleeDepartment of Comparative Medicine, Mayo Clinic, Comparative Medicine, Rochester, Minnesota, USA.
Michaela S BanckDepartment of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Bryan JonesSorrento Therapeutics, Sorrento Pharmaceuticals, San Diego, California, USA.
Tony L YakshDepartment of Anesthesiology, University of California, San Diego, California, USA.
Timothy P MausDepartment of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Andreas S BeutlerDepartment of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Mayo Clinic · USUniversity of California, San Diego · USDuke University · USSorrento Therapeutics (United States) · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThis study modeled image-guided epidural drug delivery to test whether intraprocedural distribution of pre-injected contrast reliably predicts the neuroanatomical reach of resiniferatoxin-mediated nociceptive neurolysis.

methodsSwine (N = 12) received unilateral L4-S2 computed tomography fluoroscopy injections by a blinded neuroradiologist; 0.25 mL of contrast was pre-injected to confirm dorsal periganglionic targeting, followed by a 0.5-mL injection of 5 µg of resiniferatoxin/Tween80 or vehicle control. Epidural contrast distribution was graded according to maximum medial excursion. Spinal cord substance P immunostaining quantified the magnitude and anatomical range of resiniferatoxin activity.

resultsPeriganglionic injection was well tolerated by all animals without development of neurological deficits or other complications. Swine were a suitable model of human clinical spinal intervention. The transforaminal approach was used at all L4 and 50% of L5 segments; the remaining segments were approached by the interlaminar route. All injections were successful with unilateral contrast distribution for all resiniferatoxin injections (N = 28). Immunohistochemistry showed bilateral ablation of substance P+ fibers entering the spinal cord of all resiniferatoxin-treated segments. The intensity of substance P immunostaining in treated segments fell below the lower 99% confidence interval of controls, defining the knockout phenotype. Substance P knockout occurred over a narrow range and was uncorrelated to the anatomical distribution of pre-injected contrast.

conclusionsPeriganglionic resiniferatoxin/Tween80 induced bilateral ablation of spinal cord substance P despite exclusively unilateral targeting. These data suggest that the location of pre-injected contrast is an imperfect surrogate for the neuroanatomical range of drugs delivered to the dorsal epidural compartment that may fail to predict contralateral drug effects.

Indexed as

AnimalsDiterpenesFemaleFluoroscopyInjections, EpiduralNerve BlockNeurotoxinsSpinal Nerve RootsSwineTherapy, Computer-AssistedDiterpenesNeurotoxinsresiniferatoxinComputed Tomography FluoroscopyEpidural ContrastLarge Animal ModelNociceptive NeurolysisPeriganglionicResiniferatoxin

Identifiers

PMID30590777
OpenAlexW2906682595

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.