Pragmatic approach to neuraxial anesthesia in obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system

2020 ◽  
pp. rapm-2020-101792
Author(s):  
Elisa Walsh ◽  
Yi Zhang ◽  
Hannah Madden ◽  
James Lehrich ◽  
Lisa Leffert
Keyword(s):  
Spinal Cord ◽  
Cesarean Delivery ◽  
Vertebral Column ◽  
Retrospective Studies ◽  
Case Series ◽  
Neuraxial Anesthesia ◽  
Neuromuscular System ◽  
Patient Harm ◽  
Mechanical Interference ◽  
Obstetrical Patient

Neuraxial anesthesia provides optimal labor analgesia and cesarean delivery anesthesia. Obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system present unique challenges to the anesthesiologist. Potential concerns include mechanical interference, patient injury and the need for imaging. Unfortunately, the existing literature regarding neuraxial anesthesia in these patients is largely limited to case series and rare retrospective studies. The lack of practice guidance may lead to unwarranted fear of patient harm and subsequent avoidance of neuraxial anesthesia for cesarean delivery or neuraxial analgesia for labor, with additional risks of exposure to general anesthesia. In this narrative review, we use available evidence to recommend a framework when considering neuraxial anesthesia for an obstetrical patient with neuraxial pathology.

Neurological Recovery in Traumatic Spinal Cord Injury Patient with Delayed Surgical Intervention

2018 ◽  
Vol 1 (2) ◽  
pp. 34
Author(s):  
Mochamad Targib Alatas
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Intervention ◽  
Case Series ◽  
Spinal Cord Injury Patient ◽  
Traumatic Spinal Cord Injury ◽  
Best Interest ◽  
Score Improvement ◽  
Cord Injury ◽  
Injury Patient

Early surgical treatment for traumatic spinal cord injury (SCI) patients has been proven to yield better improvement on neurological state, and widely practiced among surgeons in this field. However, it is not always affordable in every clinical setting. It is undeniable that surgery for chronic SCI has more challenges as the malunion of vertebral bones might have initiated, thus requires more complex operating techniques. In this case series, we report 7 patients with traumatic SCI whose surgical intervention is delayed due to several reasons. Initial motoric scores vary from 0 to 3, all have their interval periods supervised between outpatient clinic visits. On follow up they demonstrate significant neurological development defined by at least 2 grades motoric score improvement. Physical rehabilitation also began before surgery was conducted. These results should encourage surgeons to keep striving for the patient’s best interest, even when the injury has taken place weeks or even months before surgery is feasible because clinical improvement for these patients is not impossible. 

Anatomy and pathophysiology of spinal cord injury associated with neuraxial anesthesia

2017 ◽  
Vol 0 (4.83) ◽  
pp. 61-77
Author(s):  
O.A. Loskutov ◽  
A.M. Strokan ◽  
O.M. Mykhalchenko ◽  
V.V. Martsyniv
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuraxial Anesthesia ◽  
Cord Injury

Vertebral fractures and luxations in dogs and cats part 2: treatment and surgery options

2021 ◽  
Vol 26 (3) ◽  
pp. 15-19
Author(s):  
Ivona Orgonikova ◽  
Josep Brocal ◽  
Giunio Bruto Cherubini ◽  
Viktor Palus
Keyword(s):  
Spinal Cord ◽  
Vertebral Fractures ◽  
Vertebral Column ◽  
Compartment Model ◽  
Spinal Instability ◽  
Decompression Surgery ◽  
Implant Loosening ◽  
Bone Fragment ◽  
Three Compartment Model ◽  
Disc Extrusion

Assessing the presence of vertebral column instability is essential in animals with vertebral fractures or luxations. Spinal instability is most commonly assessed using a three-compartment model and unstable vertebral fractures and luxations require surgical stabilisation. In cases of compression of the spinal cord (by haematoma, traumatic intervertebral disc extrusion or bone fragment), decompression surgery is necessary. Prompt surgery prevents additional spinal cord damage, but the overall condition of the patient, including any concurrent injuries, needs to be continually kept in mind. The vertebral column can be stabilised using multiple techniques, such as screws, pins, polymethylmetacrylate and plating techniques, as well as external stabilisation and spinal stapling. Complications of spinal surgeries include haemorrhage, infection, neurological deterioration, particularly in cases of spinal stabilisations, implant loosening and failure.

scholarly journals Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110040
Author(s):  
Kuen Su Lee ◽  
Yoo Kyung Jang ◽  
Gene Hyun Park ◽  
In Jae Jun ◽  
Jae Chul Koh
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Therapeutic Potential ◽  
Case Series ◽  
Limb Amputation ◽  
Intractable Pain ◽  
Limb Pain ◽  
Cord Injury ◽  
Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

Myelopathy Due to CAR-T Related Neurotoxicity Treated with Siltuximab

2021 ◽  
pp. 10.1212/CPJ.0000000000001078
Author(s):  
Yasmin Aghajan ◽  
Alison Yu ◽  
Caron A. Jacobson ◽  
Austin I. Kim ◽  
Leslie Kean ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cell Therapy ◽  
Chimeric Antigen Receptor ◽  
Hematologic Malignancy ◽  
Case Series ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Car T ◽  
Large Case Series ◽  
Large Case

Chimeric antigen receptor T (CART) cell therapy is highly effective for relapsed/refractory hematologic malignancy [1,2]; however, cytokine release syndrome (CRS) and neurotoxicity are observed in up to 77% of patients [3]. In large case series, the most common presentations of neurotoxicity were encephalopathy (57%), headache (42%), tremor (38%) and aphasia (35%). CART mediated spinal cord toxicity is not well characterized. Structural neurologic damage (stroke and intracranial hemorrhage) was only observed in 1-2% and seizures were seen in 1%-8% of cases [3, 4]. Neuroimaging findings in patients with neurotoxicity are rare and not specific.

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