scholarly journals Preoperative Surveillance Thoracic MRI for Thoracic Dorsal Column Stimulation: Case Series

2019 ◽  
pp. 1-7
Author(s):  
Alexios Carayannopoulos
Keyword(s):  
Pulse Generator ◽  
Case Series ◽  
Dorsal Column ◽  
Control Group ◽  
Imaging Studies ◽  
Thoracic Imaging ◽  
Thoracic Epidural ◽  
Surveillance Imaging ◽  
Consensus Statements ◽  
Dorsal Column Stimulation

Background: To date, there have been no guidelines, studies, or consensus statements regarding the use of advanced imaging studies as a preoperative screening tool prior to patients undergoing spinal cord stimulation (SCS). Objectives: The purpose of this case series is to highlight the importance of obtaining thoracic imaging studies as part of a thorough initial clinical assessment prior to percutaneously or surgically placing an SCS electrode. Methods: We undertook a 3-year retrospective review of patients undergoing evaluation for SCS therapy in an academic interventional pain management and neurosurgery practice. Patients with chronic neuropathic pain underwent a trial with percutaneous dorsal column stimulation, and if response to the trial was > 50% reduction in pain and improvement in function, the patient was implanted using either a percutaneous approach or placement of a paddle electrode with an internal pulse generator (IPG). All patients had advanced thoracic imaging performed (magnetic resonance imaging [MRI] if possible, or computed tomography [CT] if contraindicated) prior to percutaneous trial or paddle electrode implantation. Results: In 3 years, 88 patients underwent a trial of SCS, of which 75 patients (85%) were referred for implantation of a permanent percutaneous or paddle stimulator with IPG. Two patients (1.2%) treated by trial and implant were found to have a thoracic lesion on surveillance imaging, which contraindicated SCS implantation. One patient had thoracic imaging prior to undergoing the trial and one patient had thoracic surveillance imaging after the trial, but before surgical paddle placement. Limitations: The retrospective nature and lack of a control group in this case series are limitations of this study. Conclusion: This case series outlines the importance of considering advanced thoracic imaging studies for screening/surveillance purposes prior to SCS therapy. Placement of SCS electrodes in the thoracic epidural space without prior understanding of spinal anatomy potentially puts patients at unnecessary risk. In the cases presented, had patients undergone SCS trial and subsequent implant without screening imaging, thoracic lesions would have been missed, increasing the likelihood of diagnostic and therapeutic complications. Our incidental findings of lesions on MRI prior to SCS trial or implant support the use of a screening protocol for other centers providing thoracic SCS therapies. Key words: Thoracic, dorsal column stimulation, chronic pain, surveillance MRI, patient selection

scholarly journals Considerations for the Use of Dorsal Column Stimulation for Lumbosacral Radiation Neuritis of the Nerve Root in the Spine Tumor Patient (A Case Series)

2017 ◽  
pp. 195-204
Author(s):  
Amitabh Gulati
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Dorsal Column ◽  
Spine Tumor ◽  
Tumor Patient ◽  
Post Procedure ◽  
Radiation Induced ◽  
Mri Conditional ◽  
Dorsal Column Stimulation

Background: Radiation therapy (RT) has become a mainstay in the treatment of various malignancies. Unfortunately, a potential side effect of this modality is radiation-induced neuritis. The time-course is varied and the emergence of pain syndromes can be delayed by several years after the completion of treatment. Risk factors include the total radiation dose, fractionation schedule, and radiation field size. Spinal cord stimulation (SCS) may have an important role in attenuating the symptoms of radiation-induced neuritis. Objectives: We aim to characterize a case series of oncologic patients who underwent SCS to treat iatrogenic radiation neuritis of the lumbosacral nerve roots. Study Design: This is a retrospective review of 4 cases of patients who were eligible for either intrathecal drug delivery or SCS (magnetic resonance imaging [MRI] conditional devices for spine surveillance), of which each patient elected to have a SCS trial and possible permanent implantation. Setting: The data were collected at a major cancer center in the US. Methods: In this case series, we present 4 patients with radiation-induced neuropathy. For each patient, we describe the use of SCS, which uses electric impulse generation, in an effort to treat the patient’s symptoms. To assess for efficacy, we compare pre- and post-procedure numerical rating scale (NRS) pain scores and post-procedure pain medication requirements. Results: Each patient had marked improvement in their pain (> 50%) during the trial lead placement and proceeded to the permanent implant. In subsequent months and years, the patients decreased their opioid utilization and reported an improvement in their overall pain. Limitations: This case series is a small sample size of heterogeneous malignancies with radiation treatment to the spine. Conclusions: Radiation-induced neuritis remains a severe and limiting outcome that some patients must live with after RT. Survivors of malignancy have often found this pathology to severely impact their quality of life, and it is difficult to treat. We have described the utilization of spinal cord neuromodulation as an effective treatment modality in the spine tumor patient population. Further research is needed to maximize the benefit and ensure appropriate case selection in the future. Key words: Radiation neuritis, radiation neuropathy, oncologic lumbar radiculopathy, spinal cord stimulation, neuromodulation, dorsal column stimulation, spinal tumor pain, MRI conditional spinal cord stimulation

Quick Reference: Chapter 1: The Musculoskeletal System: The Hand and Upper Extremity

2000 ◽  
Vol 5 (5) ◽  
pp. 4-5
Keyword(s):  
Dorsal Column ◽  
Persistent Pain ◽  
Illness Behavior ◽  
Abnormal Illness Behavior ◽  
Organ Systems ◽  
Spinal Cord Dorsal ◽  
Objective Basis ◽  
Dorsal Column Stimulation ◽  
Underlying Pathology

Abstract Spinal cord (dorsal column) stimulation (SCS) and intraspinal opioids (ISO) are treatments for patients in whom abnormal illness behavior is absent but who have an objective basis for severe, persistent pain that has not been adequately relieved by other interventions. Usually, physicians prescribe these treatments in cancer pain or noncancer-related neuropathic pain settings. A survey of academic centers showed that 87% of responding centers use SCS and 84% use ISO. These treatments are performed frequently in nonacademic settings, so evaluators likely will encounter patients who were treated with SCS and ISO. Does SCS or ISO change the impairment associated with the underlying conditions for which these treatments are performed? Although the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not specifically address this question, the answer follows directly from the principles on which the AMA Guides impairment rating methodology is based. Specifically, “the impairment percents shown in the chapters that consider the various organ systems make allowance for the pain that may accompany the impairing condition.” Thus, impairment is neither increased due to persistent pain nor is it decreased in the absence of pain. In summary, in the absence of complications, the evaluator should rate the underlying pathology or injury without making an adjustment in the impairment for SCS or ISO.

scholarly journals Evaluation of Dry Eye after Implantable Collamer Lens Surgery

2020 ◽  
Author(s):  
Haiting Chen ◽  
Xueyan Feng ◽  
Guangzeng Niu ◽  
Yuxiang Fan
Keyword(s):  
Dry Eye ◽  
Ocular Surface ◽  
Case Series ◽  
Meibomian Gland ◽  
Quality Score ◽  
Control Group ◽  
Ocular Surface Disease Index ◽  
Implantable Collamer Lens ◽  
Lens Surgery ◽  
Breakup Time

<b><i>Objectives:</i></b> To evaluate dry eye (DE) and associated meibomian gland dysfunction parameters after Implantable Collamer Lens (ICL) surgery. <b><i>Methods:</i></b> This is a prospective observational case series. Patients who underwent ICL implantation without previous ocular diseases or ophthalmic treatments were enrolled. Their Ocular Surface Disease Index (OSDI), noninvasive breakup time (NIBUT), meibography, slit-lamp examination of the lid margin, corneal fluorescein staining (CFS), and Schirmer test I were examined preoperatively and at 1 and 3 months postoperatively. <b><i>Results:</i></b> A total of 117 eyes of 60 patients were enrolled, and 107 eyes completed 3-month follow-up period. OSDI, lid marginal abnormality, and meibomian gland (MG) secretion, and meibum quality score were significantly higher at 1 month postoperatively and recovered partially at 3 months after surgeries, while NIBUT was significantly decreased all the time. Patients with previous DE symptoms (OSDI score ≥12) showed not only lower Schirmer and TBUT values but also higher CFS, lid margin score, MG loss, MG secretion, and meibum quality scores compared with those in the control group after operations. Low Schirmer, NIBUT values, and high meibum quality score were determined as risk factors for DE symptoms after ICL surgery. <b><i>Conclusions:</i></b> ICL implantation has a bad influence on the ocular surface and MG functions. The influence may be more obvious in patients with existing DE.

scholarly journals Autologous Platelet-Rich Fibrin (PRF) as an Adjunct in the Management of Osteoradionecrosis and Medication-Related Osteonecrosis of Jaws. Case Series in A Single Centre

2021 ◽  
Vol 11 (8) ◽  
pp. 3365
Author(s):  
Benjie Law ◽  
Hui Yuh Soh ◽  
Syed Nabil ◽  
Rama Krsna Rajandram ◽  
Abd Jabar Nazimi ◽  
...  
Keyword(s):  
Case Series ◽  
Cost Effective ◽  
Control Group ◽  
Platelet Rich Fibrin ◽  
Tissue Healing ◽  
Number Of Patients ◽  
Short Period ◽  
Oral And Maxillofacial Region ◽  
Surgical Adjunct ◽  
Autologous Platelet

Osteoradionecrosis (ORN) of the jaws and medication-related osteonecrosis of the jaws (MRONJ) are uncommon but serious diseases affecting the oral and maxillofacial region with clinically similar appearance but distinct pathophysiology. Management of ORN and MRONJ is inherently challenging and the treatment outcomes are unpredictable. The use of autologous platelet concentrates (APCs) to promote hard and soft tissue healing is well described in the literature, and the efficacy of leucocyte and platelet-rich fibrin (L-PRF) has been well documented in a number of clinical studies. The aim of this study was to present our treatment strategy and the outcomes of incorporating L-PRF as a surgical adjunct in management of ORN and MRONJ in our centre. Methods: eight cases of ORN and MRONJ were treated with a combination of sequestrectomy and L-PRF as a surgical adjunct. Results: the overall success was 87.5%. Using L-PRF as an adjunct, we were able to predictably manage ORN and MRONJ without causing significant morbidity. Conclusion: our experience shows that L-PRF may be used as a valuable and cost-effective adjunct to surgical management of ORN and MRONJ. However, due to a limited number of patients, and a short period of review, the true effectiveness of the method is yet to be demonstrated in a longer follow-up study including a greater number of patients, besides the inclusion of a control group.

Safety of a Protective Funnel in Primary Breast Augmentation: A Retrospective Analysis of 380 Multicenter Cases in the United States

2021 ◽  
Author(s):  
Aldo Lombardo ◽  
Alfred R Antonetti ◽  
Joel Studin ◽  
Frank Stile ◽  
Dudley Giles ◽  
...  
Keyword(s):  
Breast Augmentation ◽  
Case Series ◽  
The United States ◽  
Future Research ◽  
Control Group ◽  
Superficial Infection ◽  
Class 1 ◽  
Median Volume ◽  
Implant Size ◽  
Potential Risk Factors

Abstract Background Protective funnels devices are commonly used to deliver implants in primary breast augmentation (BA) yet there is a paucity of evidence-based data describing their safety in the literature. Objectives The purpose of the study was to assess the safety of protective funnels in primary BA within the first 30-days postoperatively. Methods This multi-center, Level 3 study retrospectively reviewed the surgical records of 380 consecutive patients (760 breasts) who underwent primary BA by nine board-certified plastic surgeons using the iNPLANT Funnel (Proximate Concepts LLC, Allendale, NJ, USA) for implant delivery between November 2019 and December 2020. Data was collected pertaining to demographics, implant information, surgery details, and postoperative complications. Results The mean patient age was 33 years and 76% patients had a BMI &lt; 25. Of this cohort, 11.4% were smokers, 0.8% had diabetes, and 83% were ASA class 1. All patients received smooth implants with a median volume of 375cc. A total of 8 (2.1%) complications were reported including: 3 hematomas (0.79%), 1 seroma (0.26%) and 1 superficial infection (0.26%). No patient required explantation. We identified ASA class, BMI, surgery duration, and implant size as potential risk factors. Conclusions The data suggest that use of protective funnels, such as the iNPLANT Funnel, in primary BA are a safe option when used according to the manufacturer’s IFU. Its use led to a low infection rate (0.26%) and a complication rate (2.1%) consistent with the average reported in the literature (2%-2.5%). 1 Implications for clinical practice are encouraging and future research will include a prospective analysis with a larger case series and potentially a control group.

Changes in headache frequency in premenopausal obese women with migraine after bariatric surgery: A case series

Cephalalgia ◽  
2011 ◽  
Vol 31 (13) ◽  
pp. 1336-1342 ◽  
Author(s):  
V Novack ◽  
L Fuchs ◽  
L Lantsberg ◽  
S Kama ◽  
U Lahoud ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Reduction ◽  
Case Series ◽  
Control Group ◽  
Obese Women ◽  
Specific Effects ◽  
Migraine Frequency ◽  
Reduced Frequency ◽  
Causal Nature ◽  
Post Bariatric Surgery

Background: The association between migraine and obesity gives the clinician with an exciting possibility to alleviate migraine suffering through weight-reduction gastric-restrictive operations. We hypothesized that bariatric weight-reduction intervention (gastric banding) will be associated with reduction of migraine burden in this population. Methods: A total of 105 women between 18 and 50 years of age, admitted for bariatric surgery between April 2006 and February 2007, were screened for migraine. Twenty-nine with diagnosis of migraine were enrolled into the prospective phase. We followed the migraine pattern of these patients for 6 months post bariatric surgery. Results: Baseline median migraine frequency was six headache days a month. Post bariatric surgery, the migraine-suffering women reported of a lower frequency of migraine attacks ( p < 0.001), shorter duration of the attacks ( p = 0.02), lower medication use during the attack ( p = 0.005), less non-migraine pain (44.8 vs. 33%, p = 0.05), and post-bariatric surgery reduction in headache-related disability assessed by the MIDAS and HIT-6 scores. There was a reduction in migraine frequency among both episodic (from four to one episodes a month) and chronic (from 16.8 to 8.5 episodes per month) migraine patient cohorts separately and combined. Conclusions: Among migraine-suffering premenopausal obese women, we found a reduced frequency of migraine attacks and improvement of headache-related disability post bariatric surgery. Our findings should be interpreted cautiously. The absence of a control group and the non-blinded nature of our small study make it difficult to draw firm conclusions about the causal nature of the headache changes observed in this population. Further study is needed to evaluate the possible specific effects of surgical weight loss on migraine in obese women.

Preliminary percutaneous dorsal column stimulation prior to permanent implantation

1972 ◽  
Vol 37 (2) ◽  
pp. 242-245 ◽  
Author(s):  
Yoshio Hosobuchi ◽  
John E. Adams ◽  
Philip R. Weinstein
Keyword(s):  
Dorsal Column ◽  
Screening Procedure ◽  
Intractable Pain ◽  
Content Type ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ Percutaneous dorsal column stimulation was done as a screening procedure in 34 candidates before implantation of a permanent dorsal column stimulator for the treatment of intractable pain. This procedure was useful in forecasting the tolerance of the patient to the “vibratory sensation” produced by a dorsal column stimulator, and the efficacy of the device in relieving pain. Eight patients termed the “vibratory sensation” intolerable. Sixteen found it unpleasant but preferable to the pain, and two found it actually pleasant.

Chronic Dorsal Column Stimulation

Neurosurgery ◽  
1980 ◽  
Vol 6 (5) ◽  
pp. 564-566 ◽  
Author(s):  
Dennis M. Feeney ◽  
Gerald N. Gold
Keyword(s):  
Dorsal Column ◽  
Dorsal Column Stimulation

scholarly journals Indication of Electrical Deep Brain or Dorsal Column Stimulation and a New Scoring System for Prolonged Impaired Consciousness

1998 ◽  
Vol 7 (1) ◽  
pp. 14-23
Author(s):  
Toru Matsui ◽  
Satoru Fujiwara ◽  
Hiroshi Takahashi ◽  
Toshiyuki Shiogai ◽  
Morikazu Ueda ◽  
...  
Keyword(s):  
Scoring System ◽  
Dorsal Column ◽  
Impaired Consciousness ◽  
Dorsal Column Stimulation ◽  
New Scoring ◽  
Deep Brain

scholarly journals Neurotoxicity of subarachnoid Gd-based contrast agent accumulation: a potential complication of intraoperative MRI?

2021 ◽  
Vol 50 (1) ◽  
pp. E12
Author(s):  
Monika Lauer ◽  
Arne Lauer ◽  
Se-Jong You ◽  
Sara Kluge ◽  
Elke Hattingen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Contrast Agent ◽  
Malignant Glioma ◽  
Adjuvant Treatment ◽  
Subarachnoid Space ◽  
Case Series ◽  
Extent Of Resection ◽  
Intraoperative Mri ◽  
Control Group ◽  
Icu Stay

OBJECTIVEIntraoperative MRI with Gd-based contrast agent (GBCA) improves the extent of resection of contrast-enhancing brain tumors. Signal changes of CSF due to perioperative GBCA leakage in the subarachnoid space have been reported. However, although GBCA potentially exhibits neurotoxic effects, so far no associated complications have been described. In this case series, the authors report a single-center cohort of patients with subarachnoid GBCA extravasation after intraoperative MRI and discuss potential neurotoxic complications and potential ways of avoiding them.METHODSAll patients with CSF signal increase on unenhanced T1-weighted and FLAIR images on postoperative MRI, who had previously undergone tumor resection with use of intraoperative MRI, were retrospectively included and compared with a control cohort. The control group was matched in age, tumor characteristics, and extent of resection; comparisons were made regarding postoperative seizures and ICU stay. A subgroup with initially diagnosed malignant glioma was additionally analyzed for potential delay of initiation of adjuvant treatment and overall survival.RESULTSSeven patients with postoperative GBCA accumulation in the subarachnoid space were identified; 5 presented with focal seizures and altered mental status postoperatively. Poor patient condition led to extended ICU stay and prolonged delay of the initiation of adjuvant treatment in patients with newly diagnosed malignant glioma. Overall survival was reduced compared to the matched control group.CONCLUSIONSThe results suggest that there might be a risk of neurotoxic complications if GBCA that is intravenously applied during neurosurgery leaks into the subarachnoid space. Patients with highly vascularized tumors with intraoperative bleeding seem to be especially at risk for GBCA accumulation and neurotoxic complications. Therefore, awareness of the potential risk of complicating GBCA leakage is mandatory in the application of intraoperative GBCA.

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