scholarly journals Caesarean section in a primigravida with spina bifida occulta and a spinal cord stimulator: Preconception counselling, antenatal care and anesthetic considerations

2018 ◽  
Vol 35 (2) ◽  
pp. 192
Author(s):  
HadijatO Raji ◽  
ZakariA Suleiman ◽  
ZainabA Abdulkadir ◽  
Aminudeen Abdulrahman
Keyword(s):  
Spinal Cord ◽  
Caesarean Section ◽  
Spina Bifida ◽  
Antenatal Care ◽  
Spina Bifida Occulta ◽  
Spinal Cord Stimulator ◽  
Anesthetic Considerations ◽  
Preconception Counselling

scholarly journals History of the current understanding and management of tethered spinal cord

2016 ◽  
Vol 25 (1) ◽  
pp. 78-87 ◽  
Author(s):  
Sam Safavi-Abbasi ◽  
Timothy B. Mapstone ◽  
Jacob B. Archer ◽  
Christopher Wilson ◽  
Nicholas Theodore ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spina Bifida ◽  
20Th Century ◽  
Surgical Management ◽  
Spinal Dysraphism ◽  
Current Understanding ◽  
Spina Bifida Occulta ◽  
Tethered Spinal Cord ◽  
Modern Management ◽  
Modern Imaging

An understanding of the underlying pathophysiology of tethered cord syndrome (TCS) and modern management strategies have only developed within the past few decades. Current understanding of this entity first began with the understanding and management of spina bifida; this later led to the gradual recognition of spina bifida occulta and the symptoms associated with tethering of the filum terminale. In the 17th century, Dutch anatomists provided the first descriptions and initiated surgical management efforts for spina bifida. In the 19th century, the term “spina bifida occulta” was coined and various presentations of spinal dysraphism were appreciated. The association of urinary, cutaneous, and skeletal abnormalities with spinal dysraphism was recognized in the 20th century. Early in the 20th century, some physicians began to suspect that traction on the conus medullaris caused myelodysplasia-related symptoms and that prophylactic surgical management could prevent the occurrence of clinical manifestations. It was not, however, until later in the 20th century that the term “tethered spinal cord” and the modern management of TCS were introduced. This gradual advancement in understanding at a time before the development of modern imaging modalities illustrates how, over the centuries, anatomists, pathologists, neurologists, and surgeons used clinical examination, a high level of suspicion, and interest in the subtle and overt clinical appearances of spinal dysraphism and TCS to advance understanding of pathophysiology, clinical appearance, and treatment of this entity. With the availability of modern imaging, spinal dysraphism can now be diagnosed and treated as early as the intrauterine stage.

scholarly journals Anesthetic Considerations and Perioperative Management of Spinal Cord Stimulators: Literature Review and Initial Recommendations

2017 ◽  
Vol 4 (20;4) ◽  
pp. 319-329 ◽  
Author(s):  
Michael E. Harned
Keyword(s):  
Spinal Cord ◽  
Perioperative Management ◽  
Care Team ◽  
Cochrane Library ◽  
Anesthesia Care ◽  
Spinal Cord Stimulator ◽  
Cardiac Devices ◽  
Anesthetic Considerations ◽  
Monopolar Electrocautery ◽  
Full Body

Background: Patients with implanted spinal cord stimulators (SCS) present to the anesthesia care team for management at many different points along the care continuum. Currently, the literature is sparse on the perioperative management. What is available is confusing; monopolar electrocautery is contraindicated but often used, full body magnetic resonance imaging (MRI) is safe with particular systems but with other manufactures only head and specific extremities exams are safe. Moreover, there are anesthetizing locations outside of the operating room where implanted SCS can interact with surrounding medical equipment and pose significant risk to patient and device. Objectives: The objective of this review is to present relevant known literature about the safe management of SCS in the perioperative period and to begin to develop recommendations. Study Design: A review of current literature and each manufacturers’ labeling was performed to assess risk of interference and patient harm between SCS and technology used in and around typical anesthetizing locations. Methods: A systematic search of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A computerized search was conducted for English articles in print up to April 2016 via PubMed www.ncbi.nlm.nih.gov/pubmed; EMBASE www.embase. com; and Cochrane Library www.thecochranelibrary.com. Search terms included “spinal cord stimulator AND MRI,” “spinal cord stimulator AND ECG,” “spinal cord stimulator AND implanted cardiac device,” “spinal cord stimulator AND electrocautery,” and “spinal cord stimulator AND obstetrics.” In addition, a search of Google and Google Scholar was performed. Websites of SCS manufactures were reviewed. Results: Generalized recommendations include turning the amplitude of the SCS to the lowest possible setting and turning off prior to any procedure. Monopolar electrocautery is contraindicated but is still often utilized; placing grounding pads as far away from the device can reduce the risk to device and patient. Bipolar cautery is favored. Implanted cardiac devices can interfere with SCS, but risks can be minimized. Neuraxial anesthesia can be attempted in a patient with implanted SCS, provided the device is not in the expected path. MRI labeling differences present the biggest difference among SCS manufactures. Medtronic’s SureScan SCS, Boston Scientific’s Precision system, St. Jude’s Proclaim, and Stimwave’s Freedome SCS are full body MRI compatible under specific conditions, while other manufacturers have labeling that restricts exams of the trunk and certain extremities. Limitations: This review was intended to be a comprehensive, cumulative review of recommendations for perioperative SCS management; however, the limitations of a review of this nature is the complete reliance on previously published research and the availability of these studies using the methods outlined. Conclusions: SCS is being used earlier in the treatment algorithm for patients with chronic pain. The anesthesia care team needs working knowledge of where the device resides in the neuraxial space and what risks different medical technologies pose to the patient and device. This understanding will lead to appropriate perioperative management which can reduce risk and improve patient outcomes. Key words: Spinal cord stimulation, perioperative management, MRI, anesthetic considerations, CT scan, interventional pain management

Caesarean section in a parturient with a spinal cord stimulator

2010 ◽  
Vol 19 (1) ◽  
pp. 114-117 ◽  
Author(s):  
D. Sommerfield ◽  
P. Hu ◽  
D. O’Keeffe ◽  
K. McKeatinga
Keyword(s):  
Spinal Cord ◽  
Caesarean Section ◽  
Spinal Cord Stimulator

scholarly journals A Congenital Defect in the Spinal Cord of the Manx Cat

1971 ◽  
Vol 8 (3) ◽  
pp. 232-238 ◽  
Author(s):  
A. H. Martin
Keyword(s):  
Spinal Cord ◽  
Spina Bifida ◽  
Blood Vessels ◽  
Neural Tissue ◽  
Congenital Defect ◽  
Spina Bifida Occulta ◽  
Incomplete Fusion ◽  
Vascular Defect ◽  
Secondary Mechanism

The lumbar part of the spinal cords of two Manx kittens showed syringomyelia associated with spina bifida occulta. The syringomyelia may have been caused by a secondary mechanism, such as occlusion of blood vessels, that occurred after formation of the spinal cord. There was no apparent hyperplasia of neural tissue. Incomplete fusion of vertebral arches may also have been caused in part by such a vascular defect.

Tethering tracts in spina bifida occulta: revisiting an established nomenclature

2007 ◽  
Vol 7 (3) ◽  
pp. 315-322 ◽  
Author(s):  
Sharad Rajpal ◽  
M. Shahriar Salamat ◽  
R. Shane Tubbs ◽  
David R. Kelly ◽  
W. Jerry Oakes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spina Bifida ◽  
Dermoid Cyst ◽  
Epithelial Membrane Antigen ◽  
Sinus Tract ◽  
Spina Bifida Occulta ◽  
Dermal Sinus ◽  
Dermal Sinus Tract ◽  
Histological Confirmation ◽  
Sinus Opening

Object The goal of the present study goal was to systematically confirm the previously recognized nomenclature for tethering tracts that are part of the spectrum of occult spinal dysraphic lesions. Methods The tethering tract in 20 patients with spina bifida occulta underwent histological examination with H & E staining and epithelial membrane antigen (EMA) immunolabeling, and additional selected specimens were stained with Masson trichrome. Results All tethering tracts contained fibrous connective tissue. Four tracts were lined with epithelial cells and either originated within a dermoid cyst, terminated at a skin dimple/sinus opening, or had both of these characteristics. No tethering tracts exhibited EMA positivity or meningeal elements. Although all tethering tracts originated in juxtaposition to the spinal cord, their termination sites were variable. Conclusions Based on histological findings and presumed embryological origin, the authors broadly classified tethering tracts terminating within the dura mater, epidural space, or lamina as “short tethering tracts” (STTs). The STTs occurred mostly in conjunction with split cord malformations and had a purely fibrous composition. Tethering tracts terminating superficial to the overlying lamina were classified as “long tethering tracts” (LTTs), and the authors propose that these are embryologically distinct from STTs. The LTTs were of two varieties: epithelial and nonepithelial, the former being typically associated with a skin dimple or spinal cord (epi)dermoid cyst. In fact, analysis of the data suggested that not every tethering tract terminating in or on the skin should be classified as a dermal sinus tract without histological confirmation, and because no evidence of meningeal tissue–lined tracts was detected, the use of the term “meningocele manqué” may not be appropriate.

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