1/76. Efficacy of spinal cord stimulation for neuropathic pain following idiopathic acute transverse myelitis: a case report.spinal cord stimulation (SCS) involves the electrical stimulation of dorsal structures within the spinal cord, and is the most widespread application of neurostimulation for the relief of chronic pain. Idiopathic acute transverse myelitis (IATM) is an acute monophasic lesion of the spinal cord that presents with symptoms associated with loss of cord function. The incidence of chronic pain secondary to this condition is unknown, but is considered rare. We report the efficacy of SCS for relief of severe neuropathic pain in both lower limbs secondary to IATM, which had failed to respond to conventional pain therapies.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/76. Histological findings after long-term infusion of intrathecal ketamine for chronic pain: a case report.ketamine, a selective, noncompetitive N-methyl-D-aspartate (NMDA)-receptor antagonist, is able to alter pain perception at the spinal level. Little clinical data exist on the intrathecal and epidural use of ketamine in chronic pain. Histopathologic findings after intrathecal injection of ketamine with and without preservatives are rarely reported. This outcome was evaluated in a 72-year-old woman with abdominal pain due to cancer who was treated with the intrathecal application of bupivacaine, clonidine, and morphine. We reached satisfactory pain relief with the addition of ketamine to the mixture for 7 days. On postmortem, focal lymphocytic vasculitis close to the catheter injection site was found. This finding has not been described previously after long-term application of ketamine intrathecally. The intrathecal infusion of ketamine with preservative, or the mixture of ketamine, clonidine, morphine, and bupivacaine resulted in isolated lymphocytic vasculitis of the spinal cord and leptomeninges without any clinical signs of neurological deficit.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
3/76. Ventral transdural herniation of the thoracic spinal cord: surgical treatment in four cases and review of literature.BACKGROUND: A specific cause of progressive brown-sequard syndrome has been identified: a ventral herniation of the thoracic spinal cord through the dural sleeve on one side. METHOD: Four female patients who were affected by a progressive Brown Sequard syndrome related to a transdural spinal cord herniation have been investigated and were submitted to surgery and postoperative evaluation. FINDINGS: The MRI scan showed atrophy and forward displacement of the spinal cord on one side and adhesion of the spinal cord to the dura mater. CT myelography demonstrated the disappearance of the premedullar rim at the level of the herniation and the shadow of the extradural herniation. Surgical treatment consisted in the excision of the arachnoid cyst when there was one, section of the dentate ligament, release of the adhesions, detachment of the spinal cord from the hernial orifice, and lastly suture of the dural tear or placement by a patch. Follow-up examination showed motor improvement with persistent sensory deficit in two cases and stabilisation in two cases. INTERPRETATION: The cause of the dural tear, either traumatic or congenital could not be confirmed in the four cases. Symptoms probably occur when herniation fills the orifice and strangulation happens which explains the late appearance and progressive evolution of this myelopathy. Mobilisation of the herniated spinal cord back into the intradural space can be achieved by surgery and may stop the evolution of the symptoms and signs.- - - - - - - - - - ranking = 1.6666666666667keywords = spinal (Clic here for more details about this article) |
4/76. Spinothalamic fibres, pain conduction and cordotomy.Description of four cases of cordotomy for intractable pain in which autopsy could be performed. In two of the cases the lesion had been placed (unintentionally) in the posterior quadrant of the spinal cord with good results as to the abolishing of pain. It is concluded that the conduction of pain and temperature stimuli is not restricted to the anterolateral part of the spinal cord but that this conduction may also take place along fibres in the posterolateral quadrant. A further conclusion is that the results of cordotomy are related to the number of cut fibres.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
5/76. Irreversible spinal cord injury as a complication of subarachnoid ethanol neurolysis.ARTICLE ABSTRACT: Subarachnoid neurolysis using ethanol to destroy selectively the posterior roots of the spinal cord is a method for providing pain relief in patients with advanced cancer. Weakness of the extremities is a complication of the procedure that has been attributed to spread of the neurolytic agent to the anterior roots. The authors provide evidence of spinal cord injury as a cause of lower extremity weakness in a patient after subarachnoid ethanol neurolysis.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
6/76. Punctate midline myelotomy for the relief of visceral cancer pain.OBJECT: This study offers clinical support for the concept that neurosurgical interruption of a midline posterior column pathway by performing a punctate midline myelotomy (PMM) provides significant pain relief without causing adverse neurological sequelae in cancer patients with visceral pain refractory to other therapies. methods: A PMM of the posterior columns was performed in six cancer patients in whom visceral pain had been refractory to other therapies. The cause of the visceral pain was related to residual, progressive, or recurrent local cancer or postirradiation effects. Clinical efficacy of the procedure was examined by comparing patient pain ratings and narcotic usage pre- and post-PMM. Follow-up periods ranged from 3 to 31 months. Examination of the results indicates a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed. One spinal cord has been recovered for postmortem examination. CONCLUSIONS: These findings provide corroborating clinical evidence for the existence of a newly recognized midline posterior column pathway that mediates the perception of visceral pelvic and abdominal pain. Preliminary data indicate that significant pain relief can be obtained following PMM with minimal neurological morbidity and suggest that the procedure may provide an alternative treatment modality for cancer-related pain in patients in whom adequate pain control with narcotics cannot be achieved or narcotic side effects cannot be tolerated.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
7/76. Neuropathic pain syndrome as an occult manifestation of injury of the spinal cord after surgical repair of aortic coarctation.Injury to the spinal cord injury with paraplegia, is a rare complication of surgical repair of aortic coarctation recognized immediately post-operatively. We present the case of a 41-year-old male undergoing surgery for restenosis at the site of a repair. Intra-operatively, he suffered inadvertent injury to an intercostal arterial branch during isolation of the aorta below the graft. Over the following months, he developed unusual symptoms involving the legs and genitourinary tract which, only after extensive investigations, were attributed to ischemic damage to the spinal cord related to the surgery. We suspect that similar syndromes reflecting injury to the spinal cord injury may be unrecognized following surgical repair of coarctation.- - - - - - - - - - ranking = 1.1666666666667keywords = spinal (Clic here for more details about this article) |
8/76. midazolam for the treatment of phantom limb pain exacerbation: preliminary reports.Phantom pain is one of the most difficult intractable pains to manage. The pain may result from the imbalance of self-sustaining neural activity that exceeds the inhibitory control. The management of acute severe exacerbation of phantom pain is extremely difficult. midazolam acts by potentiation of gamma aminobutyric acid (GABA) and enhance the inhibitory action of glycine receptor at spinal neurons. We describe two preliminary reports of complete pain relief of severe phantom pain exacerbation by intravenous midazolam 3-5 mg.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
9/76. Atlanto-axial subluxation syndrome and management of intractable headache, neck pain and shoulder pain with auricular stimulation: a clinical case report.Atlanto-axial subluxation syndrome is a condition that is easily overlooked, misdiagnosed and mismanaged. anatomy, neurovascular involvement and description of clinical manifestations are reviewed. Bi-Digital O-Ring Test is employed to establish an accurate diagnosis and its value and accuracy described briefly. Bi-Digital O-Ring Test has been an important diagnosis confirmation method (reconfirmed by CT or MRI in over 95% of more than 850 clinical cases) in this author's practice of spinal disorder and intractable pain management. A newly described device, the KIM-STIM, offers auricular stimulation of multiple points, using electrical microcurrent. Each unit is individually custom-molded to the patient's ear, and fitted with multiple electrodes. It was found to be very effective in managing the majority of intractable pain, especially pain requiring multiple daily treatments in order for the patient to live and function normally. The KIM-STIM device allows the patient to self-manage the pain, by day or night, thus allowing for a reduction or elimination of medication intake and diminishing the necessity for frequent doctor visits.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
10/76. Management of progressive pain in a patient with intramedullary chordoma of the spine.OBJECTIVES: The case here presented adequately reflects the difficulties involved in the treatment of pain in patients where the neuropathic component of pain predominates, and shows the different therapeutic steps that may be taken-from surgery and radiotherapy, to the administration of different drugs via the spinal route, to, finally, the presently little-used option of a direct intraventricular access. CONCLUSIONS: Spinal tumors are infrequent, but pose great difficulties for the management and control of the pain they cause. The utility of the spinal route as an early approach for the provision of adequate analgesia seems clear. However, it also appears to lose efficacy with time, and dose incrementing and/or the addition of drugs that enhance the analgesic action of morphine are not always effective. In such selected cases, the intraventricular route may constitute a useful alternative, allowing improved symptoms control with lower morphine doses, and the use of the system previously implanted for intrathecal spinal infusion.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
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