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Perioperative Management of Spinal Cord Stimulators and Intrathecal Pain Pumps. J Am Acad Orthop Surg 2022; 30:e1095-e1105. [PMID: 35439220 DOI: 10.5435/jaaos-d-22-00053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/13/2022] [Indexed: 02/01/2023] Open
Abstract
Spinal cord stimulators (SCSs) and intrathecal pain pumps (IPPs) are implantable devices used in the management of chronic pain or spasticity. Complications, such as infection, lead migration/failure, cerebrospinal fluid leak, neurologic injury, and other medical complications, can occur after placement and may require surgical intervention. Orthopaedic surgeons may encounter patients with these devices and should have a basic understanding of their function. In addition, they should be aware that patients may have residual stenosis or deformity contributing to their symptoms; thus, spine surgery referral may be indicated. If a patient with a SCS or IPP is undergoing revision spinal surgery, a preoperative discussion regarding retention versus removal of the device is imperative because indications for device retention, revision, and removal are complex. This review summarizes potential complications and intraoperative considerations concerning the proper perioperative management of SCSs/IPPs and will provide evidence-based data regarding management strategies for these devices.
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Letaif OB, Tavares-Júnior MC, dos Santos GB, Ferreira RJ, Marcon RM, Cristante AF, de Barros-Filho TE. Standardization of an experimental model of intradural injection after spinal cord injury in rats. Clinics (Sao Paulo) 2021; 76:e2740. [PMID: 33787659 PMCID: PMC7978664 DOI: 10.6061/clinics/2021/e2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/11/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The intrathecal route has not yet been thoroughly standardized and evaluated in an experimental model of spinal cord injury (SCI) in Wistar rats. The objective of this study was to standardize and evaluate the effect of intradural injection in this animal model. METHOD The animals were divided into 6 groups: 1) laminectomy and intradural catheter; 2) laminectomy, intradural catheter and infusion; 3) only SCI; 4) SCI and intradural catheter; 5) SCI, intradural catheter and infusion; and 6) control (laminectomy only). Motor evaluations were performed using the Basso, Beattie and Bresnahan (BBB) scale and the horizontal ladder test; motor evoked potentials were measured for functional evaluation, and histological evaluation was performed as well. All experimental data underwent statistical analysis. RESULTS Regarding motor evoked potentials, the groups with experimental SCI had worse results than those without, but neither dural puncture nor the injection of intrathecal solution aggravated the effects of isolated SCI. Regarding histology, adverse tissue effects were observed in animals with SCI. On average, the BBB scores had the same statistical behaviour as the horizontal ladder results, and at every evaluated timepoint, the groups without SCI presented scored significantly better than those with SCI (p<0.05). The difference in performance on motor tests between rats with and without experimental SCI persisted from the first to the last test. CONCLUSIONS The present work standardizes the model of intradural injection in experimental SCI in rats. Intrathecal puncture and injection did not independently cause significant functional or histological changes.
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Affiliation(s)
- Olavo B. Letaif
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Mauro C.M. Tavares-Júnior
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Gustavo B. dos Santos
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ricardo J.R. Ferreira
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Raphael M. Marcon
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexandre F. Cristante
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tarcísio E.P. de Barros-Filho
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Bakare AA, Weyhenmeyer J, Lee A. Subarachnoid-to-Subarachnoid Shunt for Correction of Nonfunctioning Baclofen Pump in a Severe Case of Chronic Debilitating Post-Spinal Cord Injury Spasticity. World Neurosurg 2017; 110:26-29. [PMID: 29101071 DOI: 10.1016/j.wneu.2017.10.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Perhaps the most disabling condition seen in patients with spinal cord injury (SCI) is spasticity. Spasticity is characterized as hyperreflexia and hypertonicity as a result of damage to the supraspinal tracts in the aftermath of SCI. Intrathecal baclofen (ITB) is the mainstay therapy for spasticity unresponsive to oral baclofen. One of the problems associated with post-SCI spasticity unresponsive to ITB is the development of scar tissue that prevents the diffusion of baclofen in the desired spinal cord area. This case offers a unique strategy to deal with multilevel scar tissue. CLINICAL PRESENTATION This 46-year-old paraplegic male with a T8 SCI whose spasticity had been well managed with ITB therapy for many years recently suffered intractable spasticity necessitating multiple reoperations for a nonfunctioning ITB catheter secondary to extensive scar tissue and intrathecal adhesions. Placement of a subarachnoid-to-subarachnoid shunt eliminated the problem of extensive scar tissue preventing adequate baclofen therapy. CONCLUSIONS After undergoing multilevel thoracic and lumbar laminectomies with subarachnoid-to-subarachnoid spinal shunt, the patient's spasticity was finally brought under control with adequate daily baclofen infusion. This case demonstrates a creative way to address ITB catheter failure before considering other measures, such as neuroablative procedures (e.g., rhizotomy, myelotomy). This case reinforces the recommendation that ablative procedures, which have far greater complications, should be reserved for patients who have failed medical or other nonablative therapies.
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Affiliation(s)
- Adewale A Bakare
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan Weyhenmeyer
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Albert Lee
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA; Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Schreiber AL, Fried GW, Formal CS. Normalization of central cord syndrome spinal cord injury urodynamics after intrathecal baclofen therapy: a case report. Neuromodulation 2009; 12:310-4. [PMID: 22151422 DOI: 10.1111/j.1525-1403.2009.00227.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective. To report a case of improved urodynamics in a central cord syndrome spinal cord injury after intrathecal baclofen therapy. Methods. A 47-year-old man fell resulting in C4-C5 disc herniation with ventral spinal cord compression and cord edema. Results. He underwent an anterior cervical discectomy and fusion. Postoperatively, his examination revealed a C4 ASIA D injury in a central cord syndrome pattern. Cystometrogram (CMG) revealed a hyperactive detrusor with sphincter dyssynergia managed with intermittent self-catheterization. One and a half years later, he was impaired by severe lower limb spasticity, despite oral medications and botulinum toxin injections. After intrathecal pump therapy, CMG revealed relatively normal detrusor and minimal sphincter tone. He volitionally voids with urgency but improved continence, which was maintained in one-year follow-up. Conclusion. Although the main indication for intrathecal baclofen therapy is spasticity, improved urodynamics can be an additional benefit in central cord syndrome spinal cord injury.
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Affiliation(s)
- Adam L Schreiber
- Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA; and Magee Rehabilitation, Philadelphia, PA, USA
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A New Method for the Treatment of Chronic Fungal Meningitis: Continuous Infusion into the Cerebrospinal Fluid for Coccidioidal Meningitis. Am J Med Sci 2009; 338:79-82. [DOI: 10.1097/maj.0b013e3181a3dac8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sharp J, Keirstead HS. Therapeutic applications of oligodendrocyte precursors derived from human embryonic stem cells. Curr Opin Biotechnol 2008; 18:434-40. [PMID: 18023336 DOI: 10.1016/j.copbio.2007.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 10/09/2007] [Accepted: 10/09/2007] [Indexed: 12/21/2022]
Affiliation(s)
- Jason Sharp
- Reeve-Irvine Research Center, Department of Anatomy and Neurobiology, University of California at Irvine, 2111 Gillespie Neuroscience Research Facility, Irvine, CA 92697-4292, United States.
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