Combined Paresthesia and Subperception Spinal Cord Stimulator Therapy for Management of Persistent Pain After Spinal Fusion Surgery for Congenital Scoliosis

2021 ◽  
pp. 33-36
Author(s):  
James C. Burns
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Back Pain ◽  
Case Report ◽  
Spinal Fusion ◽  
Congenital Scoliosis ◽  
Low Back ◽  
Spinal Cord Stimulator ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

Background: A significant number of patients who undergo spinal fusion surgery are managed in chronic pain clinics for low back pain or what is commonly described as failed back surgery syndrome (FBSS). There are a multitude of reasons for chronic long standing back pain after surgery, and the etiology is often multifactorial involving both preoperative and postoperative risk factors. In patients with scoliosis, it has been shown that fusion with Harrington rods extending into the lumbar region is associated with increases in postoperative back pain, especially with fusions to the L4-L5 region. Spinal cord stimulation (SCS) is a recognized treatment for this condition after repeat surgery or when conservative treatments have failed. Case Report: This case report describes the use of SCS with combination therapy in the management of severe low back pain after thoracolumbar fusion with Harrington rods in a patient with congenital scoliosis. After a failed trial of conservative medical management, a spinal cord stimulator capable of delivering combination traditional paresthesia with subperception and burst stimulation was placed. Regarding the choice of SCS therapy, there is a vast array of choices including traditional paresthesia, paresthesia-free, subperception, microburst, or combination treatment. The latter is capable of delivering multiple therapies over time designed to provide more thorough and longer-lasting relief. Conclusion: Simultaneous traditional paresthesia and subperception waveform therapy might offer superior pain relief in comparison to therapies utilizing a sing=le waveform. Further studies are needed to evaluate the use of combination over traditional SCS therapy for the treatment of axial back pain secondary to FBSS. Key words: Chronic pain, combination therapy, congenital scoliosis, neuromodulation, spinal cord stimulator, spinal fusion

Lead extrusion ten months after spinal cord stimulator implantation: a case report

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
David Reehl ◽  
Thomas Cheriyan ◽  
Owais Qureshi ◽  
Zhuo Sun ◽  
Paramvir Singh ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Rare Complication ◽  
Failed Back Surgery Syndrome ◽  
Low Back ◽  
Spinal Cord Stimulator ◽  
Failed Back Surgery ◽  
Back Surgery

AbstractObjectivesThe purpose of this case report is to describe an occurrence of a rare complication of lead extrusion, which was observed 10 months after spinal cord stimulator (SCS) implantation.MethodsA patient with low back pain and failed back surgery syndrome underwent implantation of a SCS without complications. Ten months after implantation, one SCS lead extruded from her lower back leading to surgical removal of the leads.ResultsAfter identifying the complication of a SCS lead extruding from the patient’s back, a surgical revision was performed to remove the SCS leads but retain the implantable pulse generator (IPG) in the gluteal region. During the surgery, it was noted that the anchors were in the appropriate position, sutured and fibrosed to a deep fascial layer. There were no complications from the surgical revision and no infectious process was observed.ConclusionsWe report the occurrence and management of a rare complication of SCS lead extrusion after SCS implantation for failed back surgery syndrome. After recognition, removal of the leads with retention of the IPG was able to effectively resolve the complication. The revising procedure was well tolerated but resulted in the recurrence of the patient’s previous low back pain. We believe that knowledge of this case and its management will aid future physicians in the recognition and management of this rare complication of SCS implantation. Furthermore, as there is a paucity of literature discussing the management of lead extrusion after SCS implantation, we hope that this case report will spur additional research on the management of this complication.

scholarly journals The psychometric properties of the Roland Morris disability questionnaire for patients with chronic mechanical low back pain

2007 ◽  
Vol 63 (2) ◽  
Author(s):  
H. Buchanan
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Psychometric Properties ◽  
Functional Status ◽  
Spinal Fusion ◽  
Internal Consistency ◽  
Low Back ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Disability Questionnaire

Purpose: Functional status measures are currently not widelyused in South Africa to facilitate clinical decision-making or document treatment outcomes for patients with low back pain (LBP). This study investigated the internal consistency and clinical utility of a back-specific functional status measure, the Roland Morris Disability Questionnaire (RMDQ), and determined its ability to confirm the need for spinal fusion surgery. Method: Aretrospective, descriptive design was used with 42 patients with chronic mechanical low back pain who consulted a private Orthopaedic surgeon in Cape Town over a one year  period. All patients completed the RMDQ prior to their consultation. On completion of the medical examination, a rating for surgery was determined for each patient. The completed questionnaires were analysed using Statistical Package for the Social Sciences (SPSS). Results: The mean RMDQ score was 8.6 (N=42; median=9.0; range=2-21). Cronbach’s alpha showed a high internal consistency between items (.92). A categorical principal component analysis (CATPCA) identified two distinct dimensions in the RMDQ. Item reduction improved the internal consistency and thus the construct validity of the RMDQ. There was a low correlation between the surgeon’s rating for surgery and RMDQ scores (r=.40; P<.01). Conclusion: The RMDQ shows some good psychometric properties but some adjustments could improve it. The RMDQ cannot be used to predict the need for spinal fusion surgery.

scholarly journals Significant cephalad lead migration with use of externally powered spinal cord stimulator

2018 ◽  
pp. bcr-2018-225813
Author(s):  
Sameer Jain ◽  
Michael A Fishman ◽  
Chengyuan Wu
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Back Pain ◽  
Pulse Generator ◽  
Chronic Back Pain ◽  
Low Back ◽  
Spinal Cord Stimulator ◽  
Technological Advances ◽  
Internal Pulse Generator ◽  
Neurosurgical Intervention

Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neuromodulation devices. Externally powered neuromodulation devices, that do not require an internal pulse generator (IPG) implantation, have recently been approved for treatment of chronic pain and the data on potential pitfalls and unforeseen complications with these devices is minimal. Here, we report a case of a 60-year-old woman with chronic back pain who underwent the implantation of one of such devices and developed complication that required neurosurgical intervention. The epidural stimulator leads in the patient migrated cranially to the T2 level that required extensive neurosurgical exploration. We believe this is the first reported case of such significant cranial epidural lead migration with the use of neurostimulation devices and demands more research into the safety of externally powered neurostimulation devices.

Efficacy of Transverse Tripolar Spinal Cord Stimulator for the Relief of Chronic Low Back Pain from Failed Back Surgery

2008 ◽  
Vol 3;11 (5;3) ◽  
pp. 333-338
Author(s):  
Asokumar Buvanendran
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Pain Relief ◽  
Failed Back Surgery Syndrome ◽  
Low Back ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Stimulation Of

Background: Failed back surgery syndrome is a common clinical entity for which spinal cord stimulation has been found to be an effective mode of analgesia, but with variable success rates. Objective: To determine if focal stimulation of the dorsal columns with a transverse tripolar lead might achieve deeper penetration of the electrical stimulus into the spinal cord and therefore provide greater analgesia to the back. Design: Case report. Methods: We describe a 42-year-old female with failed back surgery syndrome that had greater back pain than leg pain. The tripolar lead configuration was achieved by placing percutaneously an octapolar lead in the spinal midline followed by 2 adjacent quadripolar leads, advanced to the T7-T10 vertebral bodies. Results: Tripolar stimulation pattern resulted in more than 70% pain relief in this patient during the screening trial, while stimulation of one or 2 electrodes only provided 20% pain relief. After implantation of a permanent tripolar electrode system with a single rechargeable battery, the pain relief was maintained for one year. Conclusion: This is case report describing a case of a patient with chronic low back pain with a diagnosis of failed back surgery syndrome in which transverse tripolar stimulation using an octapolar and 2 quadripolar leads appeared to be beneficial. The transverse tripolar system consists of a central cathode surrounded by anodes, using 3 leads. This arrangement may contribute to maximum dorsal column stimulation with minimal dorsal root stimulation and provide analgesia to the lower back. Key words: Epidural, low back pain, spinal cord stimulation, failed back surgery syndrome, tripolar stimulation

scholarly journals Effect of the duration of chronic low back pain on pain sensitivity of patients undergoing lumbar fusion surgery

Pain medicine ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 8-15
Author(s):  
Mei-ping Qian ◽  
Mei-rong Dong ◽  
Fang Kang ◽  
Juan Li
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Hospital Stay ◽  
Chronic Low Back Pain ◽  
Pain Sensitivity ◽  
Lumbar Fusion ◽  
Low Back ◽  
Fusion Surgery ◽  
Lumbar Fusion Surgery

Background: chronic low back pain is a serious social problem. In recent years, patients who choose lumbar fusion surgery due to chronic low back pain has been increasing. Pre-existing chronic pain has been associated with severe postoperative pain. In this study, we have sought to prospectively analyze the association between the duration of chronic low back pain and pain sensitivity after lumbar fusion surgery. Methods: 400 patients who underwent lumbar fusion surgery were divided into three groups based on the duration of chronic pain. During the first postoperative day, the maximum pain scores of each patient day and night, the pain scores at the day of discharge, the consumption of postoperative analgesics and the length of hospital stay were recorded. Results: of 400 patients recruited, 369 patients completed the experiment. There was no significant difference in gender, age, height, weight, pre-operative pain at rest, and operation time in the three groups. During the day, the pain sensitivity of the three groups were 1.71 ± 0.66, 2.40 ± 0.74, 2.90 ± 0.80. During the night, the pain sensitivity of the three groups were 3.45 ± 0.81, 4.31 ± 1.06, 4.86 ± 1.05. At the day of discharge, the pain sensitivity of three groups were 1.26 ± 0.46, 1.47 ± 0.58, 1.96 ± 0.64. There were significant differences in pain sensitivity among the three groups during the day and night on the first postoperative day and at the day of discharge (p < 0.05). The length of hospital stay (7.31 ± 1.36 days, 8.82 ± 1.48 days, 9.60 ± 1.61 days) and analgesic consumption (25.04 ± 36.56 mg, 33.52 ± 24.04 mg, 45.15 ± 24.89 mg, morphine equivalent) were also significant differences (p < 0.05). Conclusion: we found the duration of chronic low back pain before lumbar fusion surgery affects patient’ postoperative pain sensitivity, consumption of analgesic drugs and hospital stay. The longer the preoperative chronic pain lasts, the higher the postoperative VAS score is, the more analgesic drugs were consumed, and the longer hospital stay is.

Hybrid imaging (SPECT/computed tomography) with three-dimensional reconstruction: a new diagnostic tool for the study of low back pain after spinal fusion surgery

2015 ◽  
Vol 15 (2) ◽  
pp. 377-378 ◽  
Author(s):  
Estefania López Rodriguez ◽  
Rosario Garcia Jimenez ◽  
Marta Sanchez Aguilar ◽  
Julio Valencia Anguita ◽  
Javier Luis Simon
Keyword(s):  
Computed Tomography ◽  
Low Back Pain ◽  
Back Pain ◽  
Diagnostic Tool ◽  
Hybrid Imaging ◽  
Three Dimensional ◽  
Low Back ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Dimensional Reconstruction

A Minimally Invasive Cage for Spinal Fusion Surgery Utilizing Superelastic Hinges

2012 ◽  
Author(s):  
Walter Anderson ◽  
Cory Chapman ◽  
Zohreh Karbaschi ◽  
Mohammad Elahinia
Keyword(s):  
Minimally Invasive ◽  
Spinal Fusion ◽  
Test System ◽  
Low Back ◽  
Fusion Surgery ◽  
Safety And Efficacy ◽  
Annulus Fibrosis ◽  
Spinal Fusion Surgery ◽  
Lower Back ◽  
Spinal Disc

An innovative shape memory alloy actuated cage has been developed for spinal fusion surgery. Spinal fusion surgery is performed on people suffering from low back pain. The viscoelastic spinal disc between the two vertebrae can degenerate in some fashion, such as herniation, and the space needs to be restored to relive the pressure on the nerves within the lower back. There are two main parts to a spinal disc, the annulus fibrosis and the nucleolus. The annulus fibrosis is a cartilaginous structure and is of interest to preserve. Therefore a minimally invasive cage utilizing superelastic elements has been developed. Furthermore, the cage safety and efficacy has been proven and will be presented here. Within this work, the efficacy and longevity of the cage will be presented. To this end, ASTM testing for spinal implants has been conducted on an electromechanical test system capable of inducing simultaneous axial and torsional forces.

scholarly journals Improvement of pulmonary dysfunction in patients with severe adult spinal deformity after corrective spinal fusion surgery

2018 ◽  
Vol 4 (2) ◽  
pp. 15
Author(s):  
Yuki Mihara ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Sho Kobayashi ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pulmonary Function ◽  
Cobb Angle ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Low Back ◽  
Pulmonary Dysfunction ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

In some cases of adolescent idiopathic scoliosis, corrective surgery can improve pulmonary function. However, the effectiveness of corrective surgery in improving pulmonary function in adult spinal deformity (ASD) has not been reported. Therefore, the purpose of our study was to investigate the recovery of pulmonary function after corrective fusion surgery in 4 patients with severe ASD and associated pulmonary dysfunction. The first patient was a 42-year-old woman with spondylo-epiphyseal dysplasia, whose main presenting complaint was dyspnea. As a result of her respiratory dysfunction, associated with her severe spinal deformity, she required Home Oxygen Therapy (HOT). Prior to surgery, her %vital capacity (VC) was 25%, with a kyphosis angle of 170°. The second patient was a 55-year-old woman with a history of acromegaly, who presented with low back pain. Prior to surgery, she had a %VC of 48% and a Cobb angle of 85°. The third patient was a 59-year-old woman with adolescent idiopathic scoliosis, which had been previously treated, and who was now experiencing increasing low back pain. Prior to surgery, she had a %VC of 58% and a Cobb angle of 87°. The fourth patient was a 60-year-old man, with a history of tuberculous spine, who presented with low back pain. Prior to surgery, his %VC of 75% and Cobb angle of 100°. Pulmonary function improved after corrective fusion surgery in all cases. Halo traction with respiratory rehabilitation should be recommended before corrective spinal fusion surgery for patients with severe ASD and pulmonary dysfunction.

scholarly journals Intranasal Premedication Combined with Erector Spinae Plane Block during Spinal Surgery for a Paediatric Patient: A Case Report

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Bao L ◽  
◽  
Qu M ◽  
Jing S ◽  
◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Spinal Surgery ◽  
Congenital Scoliosis ◽  
Posterior Spinal Fusion ◽  
Erector Spinae ◽  
Surgical Trauma ◽  
Fusion Surgery ◽  
Perioperative Analgesia ◽  
Spinal Fusion Surgery ◽  
Erector Spinae Plane Block

Posterior spinal fusion surgery for congenital scoliosis may cause substantial surgical trauma. Erector Spinae Plane Block (ESPB) can alleviate pain in adults who undergo spinal surgery; however, reports regarding its use in paediatric patients are limited. Here, we report the case of a 2-year-old girl who underwent posterior spinal fusion for congenital scoliosis. The patient initially experienced severe sadness upon separation from her parents; however, after performing various interactive activities, premedication using intranasal dexmedetomidine and midazolam was administered to sedate the patient. Ultrasound-guided bilateral ESPB was applied for perioperative analgesia. The anaesthesiologist identified mild-to-moderate pain during the first 6 days after surgery using the visual analogue scale for pain and Face, Legs, Activity, Cry, and Consolability scale. Therefore, ESPB may provide a satisfactory analgesic effect and help reduce postoperative opioid consumption in children who require spinal fusion surgery.

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