scholarly journals Spinal cord stimulator failure: Migration of a thoracic epidural paddle to the cervical spine

2019 ◽  
Vol 10 ◽  
pp. 118 ◽  
Author(s):  
Sarah S. Travers ◽  
Thorkild V. Norregaard
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Case Description ◽  
Spinal Cord Stimulator ◽  
Thoracic Region ◽  
X Ray ◽  
Thoracic Epidural ◽  
Pain Syndromes ◽  
Hardware Complications

Background: Spinal cord stimulators successfully treat a number of pain syndromes but carry a risk of hardware complications. Here, we present a case of cranial migration of a thoracic epidural paddle to the cervical spine. Case Description: A 53-year-old male underwent uncomplicated spinal cord stimulator placement at the T10– T11 with initially favorable results. However, postoperatively, he complained of paresthesias in his arms. An X-ray demonstrated cranial migration of the thoracic epidural paddle to the cervical spine. The stimulator/new paddle was placed again at the T10–T11 level, but the leads were now secured to the caudal lamina utilizing a cranial plating system. The patient subsequently did well without further sequelae. Conclusions: A thoracic epidural paddle (T10–T11) migrated postoperatively into the cervical spine. It was subsequently removed and replaced into the thoracic region, but the leads were now secured in place with a novel caudal lamina/cranial plating system.

scholarly journals Clinical and surgical management of holocervical spinal cord ependymomas

2019 ◽  
Vol 10 ◽  
pp. 223
Author(s):  
Kevin Mckay ◽  
Mark Attiah ◽  
Tianyi Niu ◽  
Daniel Nagasawa ◽  
Kunal Patel ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Cervical Spine ◽  
Neck Pain ◽  
Case Description ◽  
Total Resection ◽  
Perioperative Morbidity ◽  
Sensory Deficits ◽  
The Central Nervous System

Background: Spinal ependymomas are rare tumors of the central nervous system, and those spanning the entire cervical spine are atypical. Here, we present two unusual cases of holocervical (C1-C7) spinal ependymomas. Case Description: Two patients, a 32-year-old female and a 24-year-old male presented with neck pain, motor, and sensory deficits. Sagittal MRI confirmed hypointense lesions on T1 and hyperintense regions on T2 spanning the entire cervical spine. These were accompanied by cystic cavities extending caudally into the thoracic spine and rostrally to the cervicomedullary junction. Both patients underwent gross total resection of these lesions and sustained excellent recoveries. Conclusion: Two holocervical cord intramedullary ependymomas were safely and effectively surgically resected without incurring significant perioperative morbidity.

Explantation of Percutaneous Spinal Cord Stimulator Devices: A Retrospective Descriptive Analysis of a Single-Center 15-Year Experience

Pain Medicine ◽  
2019 ◽  
Vol 20 (7) ◽  
pp. 1355-1361 ◽  
Author(s):  
Thomas Simopoulos ◽  
Moris Aner ◽  
Sanjiv Sharma ◽  
Priyanka Ghosh ◽  
Jatinder S Gill
Keyword(s):  
Spinal Cord ◽  
Descriptive Analysis ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Spinal Cord Stimulator ◽  
Academic Center ◽  
Hardware Complications ◽  
Failed Back Surgery ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Conditional

Abstract Objectives The aims of this study were to identify the reasons for explanation of spinal cord stimulator (SCS) devices and to further quantify the proportions and time lines of these causes of explantation in order to determine improvement opportunities for the development of best practices. Design Retrospective, single academic center. Materials and Methods Patients who were implanted with percutaneous SCS devices from 2002 to 2015 and with follow-up available until the end of September 2017 were included in this retrospective chart analysis. Results Of the 356 patients trialed, 252 underwent implantation of an SCS device with a permanent to trial ratio of 71%. Of the patients who had a permanent implant, 50% had failed back surgery syndrome, 25% had complex regional pain syndrome, and 25% had other diagnoses. At the end of the study period, the explantation rate was 30%. The causes for explantation included biological complications (26.6%), paresthesia limitations or side effects (26.6%), hardware complications (13.3%), ineffective pain control (28%), and no further need for stimulation therapy (5.3%). Conclusions Device removal is not uncommon, and opportunities to enhance the long-term success of SCS devices do exist. These include modification of trialing methods, achieving better paresthesia overlay, using magnetic resonance imaging (MRI) conditional equipment, development of robust technologies and hardware to reduce equipment malfunction, and improving efficacy with new innovative wave forms.

scholarly journals Cervical spinal canal body ratio in normal individuals and Stenosis with Cervical Myelopathy: A simple but novel study using a graph paper over a plain X-ray lateral view of the cervical spine

2020 ◽  
Vol 11 (4) ◽  
pp. 5388-5394
Author(s):  
Elangovan D ◽  
Prem Gowtham E ◽  
Kanchana B ◽  
Karthikeyan D ◽  
Mohan S
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Spinal Canal ◽  
Lateral View ◽  
Healthy Individuals ◽  
X Ray ◽  
Cervical Spinal Canal ◽  
Graph Paper ◽  
Minimal Trauma

Cervical spine spondylosis is so prevalent in almost all because it is a degenerative disease. Cervical spine spondylosis is a condition caused by the narrowing of the space required for the spinal cord and the nerve roots that pass through the spine to the rest of the body. Suspected cases or warranted cases are advised to avoid trauma or stress to prevent a dreadful complication that is myelopathy. This research is to study and assess the Cervical Spine Canal Body Ratio in healthy individuals and also in patients with myelopathy. The cervical spinal canal and body with disc space ratio are measured using lateral view plain X-ray of the cervical spine, placed over a graph paper. This test was done both in healthy individuals from the age group of twenty-five to thirty-five of female and male. Out of these, twelve patients were with cervical myelopathy. Cervical Spinal canal stenosis may be either congenital or acquired. The content of the canal that is the Spinal cord is more likely to get compromised when the canal is shallow even a minimal trauma or degenerative arthrosis can precipitate myelopathy. In healthy individuals it is unit and when <0.85 it indicates stenosis. This simple, less expensive study can be done even in a peripheral set up. The healthy Canal Body ratio is 0.97 to 1.02. In myelopathy it is about 0.8. Corresponding sagittal diameter is 18 to 21 mm in normal and 9 to 11 mm in cervical stenosis.

scholarly journals Cervical instability in a patient with rheumatoid arthritis

2021 ◽  
Author(s):  
Victoria Perovic-Kaczmarek ◽  
Julita Czech ◽  
Beata Tarnacka
Keyword(s):  
Rheumatoid Arthritis ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Cord Compression ◽  
Joint Involvement ◽  
Cervical Instability ◽  
X Ray ◽  
Cervical Spine Surgery ◽  
Neurological Improvement

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune connective tissue disease characterized by symmetrical arthritis associated with extra-articular changes. Although peripheral joint involvement is the dominant symptom of RA, many patients develop cervical spine involvement in the course of the disease, manifesting as cervical instability. Aim: The aim of this study is to describe a case of an RA patient with spinal myelopathy to increase awareness of this complication, hoping that its early diagnosis may prevent further serious consequences. Case study: A 63-year-old patient, who was diagnosed with RA 18 years ago, was admitted to the Rheumatology Clinic due to suspected exacerbation of rheumatic disease. Functional X-Ray and MRI was performed, which showed instability in the C3–C4 segment with spinal cord compression. Subsequently, the patient underwent cervical spine surgery. After the surgery and rehabilitation, the patient demonstrated neurological improvement. Results and discussion: Every patient diagnosed with RA should be educated about the possibility of a complication of cervical instability and be familiar with the neurological symptoms that may result from it. If cervical instability and subsequent cervical myelopathy are detected early, the symptoms may be reversible or significantly reduced by surgical spinal cord decompression and cervical stabilization. Conclusions: It is very important to perform a functional X-ray of the cervical spine to exclude instability, especially before rehabilitation treatment. Neck pain in patients diagnosed with RA may indicate cervical instability that requires more thorough neurological examination to exclude cervical myelopathy.

scholarly journals Dietary therapy to promote neuroprotection in chronic spinal cord injury

2012 ◽  
Vol 17 (2) ◽  
pp. 134-140 ◽  
Author(s):  
Langston T. Holly ◽  
Donald Blaskiewicz ◽  
Aiguo Wu ◽  
Cameron Feng ◽  
Zhe Ying ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Dietary Therapy ◽  
Cellular Injury ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Thoracic Region ◽  
Thoracic Epidural ◽  
Biochemical Effects ◽  
Cord Injury ◽  
Syntaxin 3

Object The pathogenesis of cervical spondylotic myelopathy (CSM) is related to both primary mechanical and secondary biological injury. The authors of this study explored a novel, noninvasive method of promoting neuroprotection in myelopathy by using curcumin to minimize oxidative cellular injury and the capacity of omega-3 fatty acids to support membrane structure and improve neurotransmission. Methods An animal model of CSM was created using a nonresorbable expandable polymer placed in the thoracic epidural space, which induced delayed myelopathy. Animals that underwent placement of the expandable polymer were exposed to either a diet rich in docosahexaenoic acid and curcumin (DHA-Cur) or a standard Western diet (WD). Twenty-seven animals underwent serial gait testing, and spinal cord molecular assessments were performed after the 6-week study period. Results At the conclusion of the study period, gait analysis revealed significantly worse function in the WD group than in the DHA-Cur group. Levels of brain-derived neurotrophic factor (BDNF), syntaxin-3, and 4-hydroxynonenal (4-HNE) were measured in the thoracic region affected by compression and lumbar enlargement. Results showed that BDNF levels in the DHA-Cur group were not significantly different from those in the intact animals but were significantly greater than in the WD group. Significantly higher lumbar enlargement syntaxin-3 in the DHA-Cur animals combined with a reduction in lipid peroxidation (4-HNE) indicated a possible healing effect on the plasma membrane. Conclusions Data in this study demonstrated that DHA-Cur can promote spinal cord neuroprotection and neutralize the clinical and biochemical effects of myelopathy.

Localization of cervical and cervicomedullary stimulation leads for pain treatment using median nerve somatosensory evoked potential collision testing

2011 ◽  
Vol 114 (1) ◽  
pp. 200-205 ◽  
Author(s):  
Jeffrey R. Balzer ◽  
Nestor D. Tomycz ◽  
Donald J. Crammond ◽  
Miguel Habeych ◽  
Parthasarathy D. Thirumala ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Cervical Spinal Cord ◽  
Pain Syndrome ◽  
Somatosensory Evoked Potential ◽  
Spinal Cord Stimulator ◽  
Epidural Stimulation ◽  
Pain Syndromes ◽  
Lead Placement ◽  
Patient Reported

Object Spinal cord stimulation (SCS) is being currently used to treat medically refractory pain syndromes involving the face, trunk, and extremities. Unlike thoracic SCS surgery, during which patients can be awakened from conscious sedation to confirm good lead placement, safe placement of paddle leads in the cervical spine has required general anesthesia. Using intraoperative neurophysiological monitoring, which is routinely performed during these cases at the authors' institution, the authors developed an electrophysiological technique to intraoperatively lateralize lead placement in the cervical epidural space. Methods Data from 44 patients undergoing median and tibial nerve somatosensory evoked potential (SSEP) monitoring during cervical laminectomy or hemilaminectomy for placement or replacement of dorsal column stimulators were retrospectively reviewed. Paddle leads were positioned laterally or just off midline and parallel to the axis of the cervical spinal cord to effectively treat what was most commonly a predominant unilateral pain syndrome. During SSEP recording, the spinal cord stimulator was activated at 1.0 V and increased in increments of 1.0 V to a maximum of 6.0 V. A unilateral reduction or abolishment of SSEP amplitude was regarded as an indicator of lateralized placement of the stimulator. A bilateral diminutive effect on SSEPs was interpreted as a midline or near midline lead placement. Results Epidural stimulation abolished or significantly reduced SSEP amplitudes in all patients undergoing placement for a unilateral pain syndrome. In 15 patients, electrodes were repositioned intraoperatively to achieve the most robust SSEP amplitude reduction or abolishment using the lowest epidural stimulation intensity. In all cases in which a significant unilateral reduction in SSEP was observed, the patient reported postoperative sensory alterations in target locations predicted by intraoperative SSEP changes. Placement of cervical spinal cord stimulators for bilateral pain syndromes often resulted in bilateral but asymmetrical SSEP changes. In no cases were significant SSEP changes, other than those induced using the device to directly stimulate the dorsal surface of the spinal cord, observed. No case of new postoperative neurological deficit was observed. Conclusions Somatosensory evoked potentials can be used safely and successfully for predicting the lateralization of cervical spinal cord stimulator placement. Moreover, they can also intraoperatively alert the surgical team to inadvertent displacement of a lead during anchoring. Further studies are needed to determine whether apart from assisting with proper lateralization, SSEP collision testing may help to optimize electrode positioning and improve pain control outcomes.

Curable Paraplegia Due to Extradural Hematopoietic Tissue in Thalassemia

Neurosurgery ◽  
1982 ◽  
Vol 11 (6) ◽  
pp. 804-807 ◽  
Author(s):  
Kazem Abbassioun ◽  
Abbass Amir-Jamshidi
Keyword(s):  
Spinal Cord ◽  
Rare Complication ◽  
Extramedullary Hematopoiesis ◽  
Cord Compression ◽  
Hematopoietic Tissue ◽  
Thoracic Region ◽  
X Ray ◽  
Mesodermal Origin ◽  
Chest X Ray ◽  
Paravertebral Mass

Abstract Two patients with β-thalassemia and spinal cord compression due to extradural extramedullary hematopoietic tissue are presented and the related literature is reviewed. This rare complication, once diagnosed, may be treated readily with surgical decompression or radiation. The diagnosis is suggested by evidence of extramedullary hematopoiesis elsewhere and the presence of an extradural lesion, usually in the mid- and lower thoracic region, on myelography and, at times, a paravertebral mass on chest x-ray films. Our findings lend support to the hypothesis that such hematopoietic tissue in the spinal cord vicinity arises from embryonal rests in the extradural areolar tissue of mesodermal origin.

scholarly journals Acute Cervical Spine Injuries: Diagnosis and Management

2003 ◽  
Vol 42 (148) ◽  
Author(s):  
MR Sharma
Keyword(s):  
Public Health ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Cervical Spine Injuries ◽  
X Ray ◽  
Diagnosis And Management ◽  
Spine Stabilization ◽  
Public Resources ◽  
Spine Injuries

Acute cervical spine injuries (CSI) are devastating types of injuries occurring largely in the economicallyproductive population. CSI have been of major public health problems because of consumption of largeamount of both personal and public resources in addition to giving rise to long-term disability for thepatient. Over the years an effort has been made to develop ways to evaluate the cervical spine in the settingof trauma using reasonably fast and accurate methods. Similarly, refinement in the management of thesepatients has significantly improved the outcome. In this article an attempt has been made to review thepertinent literature and extract the information tailored to us regarding the diagnosis and management ofcervical spine injuries, which can be used effectively in areas where even only x-ray facility is available.Key Words: Trauma, spinal cord, cervical spine, stabilization.

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