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2020 ◽  
Vol 5 (Special) ◽  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Case Reports ◽  
Tethered Cord ◽  
Similar Efficacy ◽  
Tethered Cord Syndrome ◽  
Intractable Pain ◽  
History Of ◽  
Myelomeningocele Repair

Background: Neuromodulation techniques are an important part of the chronic refractory neuropathic pain treatment. Their effectiveness is insufficiently documented in patients with tethered cord syndrome. Case Description: We present the case of a 32-year-old woman with a history of myelomeningocele repair, followed by a detethering surgery complicated with cerebral fluid leakage. Her intractable pain in her left leg and low back was successfully treated with spinal cord stimulation. Pain intensity decreased from 8/10 to 1-2/10 on her visual analogue scale without regular analgesic intake and her quality of life improved significantly. Conclusions: A review of the literature documents only three case reports of similar efficacy of spinal cord stimulation in the treatment of pain in adult patients with tethered cord syndrome.

scholarly journals Spinal Cord Stimulation inpatient with Tethered Cord syndrome: A Case Report

2020 ◽  
Vol 5 (8) ◽  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Case Reports ◽  
Tethered Cord ◽  
Similar Efficacy ◽  
Tethered Cord Syndrome ◽  
Intractable Pain ◽  
History Of ◽  
Myelomeningocele Repair

Background: Neuromodulation techniques are an important part of the chronic refractory neuropathic pain treatment. Their effectiveness is insufficiently documented in patients with tethered cord syndrome. Case Description: We present the case of a 32-year-old woman with a history of myelomeningocele repair, followed by a detethering surgery complicated with cerebral fluid leakage. Her intractable pain in her left leg and low back was successfully treated with spinal cord stimulation. Pain intensity decreased from 8/10 to 1-2/10 on her visual analogue scale without regular analgesic intake and her quality of life improved significantly. Conclusions: A review of the literature documents only three case reports of similar efficacy of spinal cord stimulation in the treatment of pain in adult patients with tethered cord syndrome.

scholarly journals Is Impedance a Parameter to be Taken into Account in Spinal Cord Stimulation?

2007 ◽  
Vol 4;10 (7;4) ◽  
pp. 533-540
Author(s):  
David Abejon
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Energy Requirement ◽  
Age Groups ◽  
Primary Objective ◽  
Intractable Pain ◽  
Perception Threshold ◽  
Implanted Electrodes ◽  
Significant Difference

Background: Over the last few decades, spinal cord stimulation (SCS) has become one of the main treatments in the therapeutic arsenal available to pain treatment units. New stimulation systems have been developed and the indications of neurostimulation have been expanded. The premises for a successful technique remain the same; good patient selection, good surgical technique, and good management of electrical parameters when programming. Design: An observational report. Objectives: The primary objective of the study was to determine the relationship between changes in impedance (R) and energy requirement (E) elicited by changes in patients posture. The postures analyzed were supine (S), sitting (SI), standing (ST), and walking (W). As a second objective, the difference produced in the energy requirement when changing posture was analyzed. Methods: A study was carried out in 70 patients with chronic intractable pain implanted with a neurostimulation system between January 2000 and March 2006. We define the perception threshold (Tp); the discomfort threshold (Td); and the therapeutic threshold (Tt). The amplitude of perception was measured in mA. With the resulting data, the therapeutic range (TR) was determined. After performing all measurements with the patient in the ST position, the neurostimulation system was shut off and the patient maintained in the other position for 5 minutes before performing the measurements. The variables R and E were compared by age groups, sex, implant duration, and the time since implant placement. Patients were divided into groups according to whether the location of the implanted electrodes was cervical or thoracic. The full analysis by age, sex, and implant duration was performed in the cervical and thoracic implant groups. Results: No correlation was found between impedance and posture. When the results for R and E were analyzed by sex and age, no statistical differences were found in any of the values in any position. The analysis of time since implant greater than or less than 6 months did not find differences in the energy requirement, although there was a significant difference in the impedance value when patients were in the S position. No significant differences were observed in the analysis by age groups. Key words: Impedance, posture change, spinal cord stimulation

scholarly journals Spinal cord stimulation for recurrent tethered cord syndrome in a pediatric patient: case report

2016 ◽  
Vol 18 (1) ◽  
pp. 105-110 ◽  
Author(s):  
Rachana Tyagi ◽  
Carolyn Kloepping ◽  
Shruti Shah
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Treatment Options ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Dorsal Spinal Cord ◽  
Increased Risk ◽  
Permanent Implant ◽  
Dorsal Spinal ◽  
Initial Results

The authors present a patient with a lipomyelomeningocele and worsening back pain due to recurrent tethered cord syndrome. Because of the increased risk and unlikely improvement in symptoms with repeated surgical untethering, she was offered an alternative treatment with a trial of dorsal spinal cord stimulation. She had an excellent response to the percutaneous trial, and a permanent implant was placed, with good initial results. The authors review her case as well as the treatment options, indications, and outcomes for recurrent tethered cord syndrome.

scholarly journals Spinal cord untethering after fetal myelomeningocele repair

2021 ◽  
Vol 3 (3(September-December)) ◽  
pp. e862021
Author(s):  
Leopoldo Mandic Furtado ◽  
José Aloysio Da Costa Val Vilho ◽  
José Antônio Lima Vieira ◽  
Aieska Kellen Dantas dos Santos
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
In Utero ◽  
Technical Note ◽  
Tethered Cord Syndrome ◽  
Neurophysiological Monitoring ◽  
Fetal Life ◽  
Myelomeningocele Repair

The incidence of tethered cord syndrome after myelomenigocele (MMC) repair is higher in patients undergoing in utero than postnatally. However, a paucity of studies have described the details of untethering in children which MMC was corrected during fetal life. In this technical note, we describe the  spinal cord untethering of a girl after MMC in utero repair, highlighting the main steps regarding the anatomic recognition as well as neurophysiological monitoring finding role.

scholarly journals Tethered Cord Syndrome Secondary to the Unusual Constellation of a Split Cord Malformation, Lumbar Myelomeningocele, and Coexisting Neurenteric Cyst

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Humphrey Okechi ◽  
A. Leland Albright ◽  
Ancent Nzioka
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Prophylactic Surgery ◽  
Split Cord Malformation ◽  
Pathological Examination ◽  
Neurenteric Cyst ◽  
History Of ◽  
Spinal Mri ◽  
Large Bone

We describe a seminal case report of a child with a tethered cord syndrome secondary to the unusual constellation of a split cord malformation, lumbar myelomeningocele, and coexisting neurenteric cyst. A 17-year-old adolescent girl with a several-month history of myelopathy and urinary incontinence was examined whose spinal MRI scan demonstrated a type II split cord malformation with a large bone spur and an intradural neurenteric cyst in addition to lumbar myelomeningocele. Untethering of the spinal cord was achieved via a lumbar laminectomy. Pathological examination confirmed the intradural cyst to be a neurenteric cyst. Postoperatively there was stabilization of the neurological symptoms. Prophylactic surgery with total resection of the neurenteric cyst when feasible and spinal cord un-tethering appears to be associated with excellent outcomes.

Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain

2015 ◽  
Vol 123 (4) ◽  
pp. 851-860 ◽  
Author(s):  
Leonardo Kapural ◽  
Cong Yu ◽  
Matthew W. Doust ◽  
Bradford E. Gliner ◽  
Ricardo Vallejo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Low Frequency ◽  
Leg Pain ◽  
Intractable Pain ◽  
Limited Effectiveness ◽  
Provide Pain Relief

Abstract Background: Current treatments for chronic pain have limited effectiveness and commonly known side effects. Given the prevalence and burden of intractable pain, additional therapeutic approaches are desired. Spinal cord stimulation (SCS) delivered at 10 kHz (as in HF10 therapy) may provide pain relief without the paresthesias typical of traditional low-frequency SCS. The objective of this randomized, parallel-arm, noninferiority study was to compare long-term safety and efficacy of SCS therapies in patients with back and leg pain. Methods: A total of 198 subjects with both back and leg pain were randomized in a 1:1 ratio to a treatment group across 10 comprehensive pain treatment centers. Of these, 171 passed a temporary trial and were implanted with an SCS system. Responders (the primary outcome) were defined as having 50% or greater back pain reduction with no stimulation-related neurological deficit. Results: At 3 months, 84.5% of implanted HF10 therapy subjects were responders for back pain and 83.1% for leg pain, and 43.8% of traditional SCS subjects were responders for back pain and 55.5% for leg pain (P < 0.001 for both back and leg pain comparisons). The relative ratio for responders was 1.9 (95% CI, 1.4 to 2.5) for back pain and 1.5 (95% CI, 1.2 to 1.9) for leg pain. The superiority of HF10 therapy over traditional SCS for leg and back pain was sustained through 12 months (P < 0.001). HF10 therapy subjects did not experience paresthesias. Conclusion: HF10 therapy promises to substantially impact the management of back and leg pain with broad applicability to patients, physicians, and payers.

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