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Drinovac Vlah V, Bach-Rojecky L. Mirror-Image Pain Update: Complex Interactions Between Central and Peripheral Mechanisms. Mol Neurobiol 2024:10.1007/s12035-024-04102-x. [PMID: 38602655 DOI: 10.1007/s12035-024-04102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/06/2024] [Indexed: 04/12/2024]
Abstract
The appearance of contralateral effects after unilateral injury has been shown in various experimental pain models, as well as in clinics. They consist of a diversity of phenomena in contralateral peripheral nerves, sensory ganglia, or spinal cord: from structural changes and altered gene or protein expression to functional consequences such as the development of mirror-image pain (MP). Although MP is a well-documented phenomenon, the exact molecular mechanism underlying the induction and maintenance of mirror-like spread of pain is still an unresolved challenge. MP has generally been explained by central sensitization mechanisms leading to facilitation of pain impulse transfer through neural connections between the two sides of the central nervous system. On the contrary, the peripheral nervous system (PNS) was usually regarded unlikely to evoke such a symmetrical phenomenon. However, recent findings provided evidence that events in the PNS could play a significant role in MP induction. This manuscript provides an updated and comprehensive synthesis of the MP phenomenon and summarizes the available data on the mechanisms. A more detailed focus is placed on reported evidence for peripheral mechanisms behind the MP phenomenon, which were not reviewed up to now.
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Affiliation(s)
- Višnja Drinovac Vlah
- Department of Pharmacology, University of Zagreb Faculty of Pharmacy and Biochemistry, Domagojeva 2, 10000, Zagreb, Croatia
| | - Lidija Bach-Rojecky
- Department of Pharmacology, University of Zagreb Faculty of Pharmacy and Biochemistry, Domagojeva 2, 10000, Zagreb, Croatia.
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2
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Nguyen JP, Gaillard H, Suarez A, Terzidis-Mallat É, Constant-David D, Van Langhenhove A, Evin A, Malineau C, Tan SVO, Mhalla A, Lefaucheur JP, Nizard J. Bicentre, randomized, parallel-arm, sham-controlled trial of transcranial direct-current stimulation (tDCS) in the treatment of palliative care patients with refractory cancer pain. BMC Palliat Care 2023; 22:15. [PMID: 36849977 PMCID: PMC9972710 DOI: 10.1186/s12904-023-01129-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Pain is a common symptom in palliative care cancer patients and is often insufficiently relieved. In recent years, transcranial direct-current stimulation (tDCS) of the motor cortex has been shown to be effective to treat chronic pain, essentially neuropathic pain. We propose to test the efficacy of tDCS in patients experiencing cancer pain in the palliative care setting. METHOD/DESIGN This article describes the protocol of a bicentre, randomized, parallel-arm, sham-controlled clinical trial evaluating tDCS in the treatment of palliative care patients with refractory cancer pain. Seventy patients between the ages of 18 and 80 years experiencing refractory pain with a pain score of 4/10 on a numerical rating scale (NRS) ranging from 0 to 10 will be enrolled in this trial. The main exclusion criteria are patients unable to fill in the various rating scales and life expectancy less than 3 weeks. Treatment consists of 5 consecutive tDCS sessions targeting the motor cortex (one daily session for 5 days) on the contralateral side to the pain. After randomization (1:1 ratio), 35 patients will receive active stimulation and 35 patients will receive sham stimulation. The primary endpoint is the NRS score and the primary objective is a significant improvement of this score between the baseline score recorded between D-3 and D-1 and the score recorded 4 days after stopping treatment (D8). The secondary objectives are to evaluate whether this improvement is maintained 16 days after stopping treatment (D21) and whether the following scores are improved on D14 and D21: Brief Pain Inventory, Edmonton Symptom Assessment System, Hospital Anxiety and Depression scale, State-Trait Anxiety Inventory and Medication Quantification Scale. DISCUSSION Positive results of this trial would indicate that tDCS can improve pain and quality of life of cancer patients in the palliative care setting. Reduction of analgesic consumption and improvement of activities of daily living should allow many patients to return home with a decreased workload for caregivers.
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Affiliation(s)
- Jean-Paul Nguyen
- Unité de Stimulation Transcrânienne, Clinique Bretéché, Groupe Elsan, Nantes, 44000 France ,grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Hélène Gaillard
- grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Alcira Suarez
- Unité de Stimulation Transcrânienne, Clinique Bretéché, Groupe Elsan, Nantes, 44000 France
| | | | - Diane Constant-David
- grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Aurélien Van Langhenhove
- grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Adrien Evin
- grid.277151.70000 0004 0472 0371UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930 France
| | - Catherine Malineau
- Unité de Stimulation Transcrânienne, Clinique Bretéché, Groupe Elsan, Nantes, 44000 France
| | - Son V. O. Tan
- Service de Neurochirurgie, University Hospital, Ho Chi Minh ville, Vietnam
| | - Alaa Mhalla
- grid.410511.00000 0001 2149 7878EA43910, Faculté de Médecine, Université Paris-Est, Créteil, 94000 France ,grid.50550.350000 0001 2175 4109Unité Douleur et Soins Palliatifs intégrés, DMU Cancer et spécialités, CHU Henri Mondor-Albert Chenevrier, APHP, Créteil, 94000 France
| | - Jean-Pascal Lefaucheur
- grid.410511.00000 0001 2149 7878EA43910, Faculté de Médecine, Université Paris-Est, Créteil, 94000 France ,grid.412116.10000 0004 1799 3934Unité de Neurophysiologie clinique, Hôpital Henri Mondor, APHP, Créteil, 94000 France
| | - Julien Nizard
- UIC22 et Service Douleur Soins Palliatifs et Soins de Support, Centre Hospitalo-Universitaire (CHU), Nantes, 44930, France. .,EA43910, Faculté de Médecine, Université Paris-Est, Créteil, 94000, France.
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Treister R, Honigman L, Berger A, Cohen B, Asaad I, Kuperman P, Tellem R, Hochberg U, Strauss I. Temporal Summation Predicts De Novo Contralateral Pain After Cordotomy in Patients With Refractory Cancer Pain. Neurosurgery 2022; 90:59-65. [PMID: 34982871 DOI: 10.1227/neu.0000000000001734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Percutaneous cervical cordotomy (PCC), which selectively interrupts ascending nociceptive pathways in the spinal cord, can mitigate severe refractory cancer pain. It has an impressive success rate, with most patients emerging pain-free. Aside from the usual complications of neurosurgical procedures, the risks of PCC include development of contralateral pain, which is less understood. OBJECTIVE To evaluate whether sensory and pain sensitivity, as measured by quantitative sensory testing (QST), are associated with PCC clinical outcomes. METHODS Fourteen palliative care cancer patients with severe chronic refractory pain limited mainly to one side of the body underwent comprehensive quantitative sensory testing assessment pre-PPC and post-PCC. They were also queried about maximal pain during the 24 h precordotomy (0-10 numerical pain scale). RESULTS All 14 patients reported reduced pain postcordotomy, with 7 reporting complete resolution. Four patients reported de novo contralateral pain. Reduced sensitivity in sensory and pain thresholds to heat and mechanical stimuli was recorded on the operated side (P = .028). Sensitivity to mechanical pressure increased on the unaffected side (P = .023), whereas other sensory thresholds were unchanged. The presurgical temporal summation values predicted postoperative contralateral pain (r = 0.582, P = .037). CONCLUSION The development of contralateral pain in patients postcordotomy for cancer pain might be due to central sensitization. Temporal summation could serve as a potential screening tool to identify those who are most likely at risk to develop contralateral pain. Analysis of PCC affords a unique opportunity to investigate how a specific lesion to the nociceptive system affects pain processes.
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Affiliation(s)
- Roi Treister
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Liat Honigman
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Assaf Berger
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Cohen
- Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Israa Asaad
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Pora Kuperman
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Rotem Tellem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Palliative Medicine Care Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Uri Hochberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Strauss
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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4
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Raslan AM, Ben-Haim S, Falowski SM, Machado AG, Miller J, Pilitsis JG, Rosenberg WS, Rosenow JM, Sweet J, Viswanathan A, Winfree CJ, Schwalb JM. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain. Neurosurgery 2021; 88:437-442. [PMID: 33355345 DOI: 10.1093/neuros/nyaa527] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Managing cancer pain once it is refractory to conventional treatment continues to challenge caregivers committed to serving those who are suffering from a malignancy. Although neuromodulation has a role in the treatment of cancer pain for some patients, these therapies may not be suitable for all patients. Therefore, neuroablative procedures, which were once a mainstay in treating intractable cancer pain, are again on the rise. This guideline serves as a systematic review of the literature of the outcomes following neuroablative procedures. OBJECTIVE To establish clinical practice guidelines for the use of neuroablative procedures to treat patients with cancer pain. METHODS A systematic review of neuroablative procedures used to treat patients with cancer pain from 1980 to April 2019 was performed using the United States National Library of Medicine PubMed database, EMBASE, and Cochrane CENTRAL. After inclusion criteria were established, full text articles that met the inclusion criteria were reviewed by 2 members of the task force and the quality of the evidence was graded. RESULTS In total, 14 646 relevant abstracts were identified by the literature search, from which 189 met initial screening criteria. After full text review, 58 of the 189 articles were included and subdivided into 4 different clinical scenarios. These include unilateral somatic nociceptive/neuropathic body cancer pain, craniofacial cancer pain, midline subdiaphragmatic visceral cancer pain, and disseminated cancer pain. Class II and III evidence was available for these 4 clinical scenarios. Level III recommendations were developed for the use of neuroablative procedures to treat patients with cancer pain. CONCLUSION Neuroablative procedures may be an option for treating patients with refractory cancer pain. Serious adverse events were reported in some studies, but were relatively uncommon. Improved imaging, refinements in technique and the availability of new lesioning modalities may minimize the risks of neuroablation even further.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-on-neuroablative-procedures-patients-wi.
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Affiliation(s)
- Ahmed M Raslan
- Department of Neurological Surgery, School of Medicine, Oregon Health & Science University Healthcare, Portland, Oregon
| | - Sharona Ben-Haim
- Department of Neurological Surgery, University of California San Diego, San Diego, California
| | | | - André G Machado
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jonathan Miller
- Department of Neurological Surgery, Case Western Reserve University, Cleveland, Ohio
| | - Julie G Pilitsis
- Department of Neurosurgery and Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, New York
| | | | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer Sweet
- Department of Stereotactic & Functional Neurosurgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Christopher J Winfree
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan
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5
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Farrell SM, Pereira EAC, Brown MRD, Green AL, Aziz TZ. Neuroablative surgical treatments for pain due to cancer. Neurochirurgie 2020; 67:176-188. [PMID: 33129802 DOI: 10.1016/j.neuchi.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 12/20/2022]
Abstract
Cancer pain is common and challenging to manage - it is estimated that approximately 30% of cancer patients have pain that is not adequately controlled by analgesia. This paper discusses safe and effective neuroablative treatment options for refractory cancer pain. Current management of cancer pain predominantly focuses on the use of medications, resulting in a relative loss of knowledge of these surgical techniques and the erosion of the skills required to perform them. Here, we review surgical methods of modulating various points of the neural axis with the aim to expand the knowledge base of those managing cancer pain. Integration of neuroablative approaches may lead to higher rates of pain relief, and the opportunity to dose reduce analgesic agents with potential deleterious side effects. With an ever-increasing population of cancer patients, it is essential that neurosurgeons maintain or train in these techniques in tandem with the oncological multi-disciplinary team.
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Affiliation(s)
- S M Farrell
- Nuffield Department of Clinical Sciences, John-Radcliffe Hospital, OX3 9DU Oxford, United Kingdom; The Royal Free London NHS Foundation Trust, London, United Kingdom.
| | - E A C Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom.
| | - M R D Brown
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom.
| | - A L Green
- Nuffield Department of Clinical Sciences, John-Radcliffe Hospital, OX3 9DU Oxford, United Kingdom.
| | - T Z Aziz
- Nuffield Department of Clinical Sciences, John-Radcliffe Hospital, OX3 9DU Oxford, United Kingdom.
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Drinovac Vlah V, Bach-Rojecky L. What have we learned about antinociceptive effect of botulinum toxin type A from mirror-image pain models? Toxicon 2020; 185:164-173. [DOI: 10.1016/j.toxicon.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022]
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Hochberg U, Berger A, Atias M, Tellem R, Strauss I. Tailoring of neurosurgical ablative procedures in the management of refractory cancer pain. Reg Anesth Pain Med 2020; 45:696-701. [PMID: 32699105 DOI: 10.1136/rapm-2020-101566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Neurosurgical ablative procedures can offer immediate and effective pain relief for patients suffering from refractory cancer pain. However, choosing the appropriate procedure for each patient may not be straightforward and warrants an interdisciplinary approach. The purpose of the current study was to evaluate the outcome of patients with cancer who were carefully selected for neurosurgical intervention by a dedicated interdisciplinary team composed of a palliative physician and nurse practitioner, a pain specialist and a neurosurgeon. METHODS A retrospective review was carried out on all patients who underwent neurosurgical ablative procedures in our institute between March 2015 and September 2019. All patients had advanced metastatic cancer with unfavorable prognosis and suffered from intractable oncological pain. Each treatment plan was devised to address the patients' specific pain syndromes. RESULTS A total of 204 patients were examined by our service during the study period. Sixty-four patients with localized pain and nineteen patients with diffuse pain syndromes were selected for neurosurgical interventions, either targeted disconnection of the spinothalamic tract or stereotactic cingulotomy. Substantial pain relief was reported by both groups immediately (cordotomy: Numerical Rating Scale (NRS) 9 ≥1, p=0.001, cingulotomy: NRS 9 ≥2, p=0.001) and maintained along the next 3-month follow-up visits. CONCLUSIONS An interdisciplinary collaboration designated to provide neurosurgical ablative procedures among carefully selected patients could culminate in substantial relief of intractable cancer pain. TRIAL REGISTRATION NUMBER IR0354-17.
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Affiliation(s)
- Uri Hochberg
- Institute of Pain Medicine, Division of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel .,Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Asaf Berger
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.,Deparment of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miri Atias
- Deparment of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rotem Tellem
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.,The Palliative Care Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Strauss
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.,Department of Neurosurgery, Neuromodulation Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Berger A, Hochberg U, Zegerman A, Tellem R, Strauss I. Neurosurgical ablative procedures for intractable cancer pain. J Neurosurg 2020; 133:144-151. [PMID: 31075782 DOI: 10.3171/2019.2.jns183159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cancer patients suffering from severe refractory pain may benefit from targeted ablative neurosurgical procedures aimed to disconnect pain pathways in the spinal cord or the brain. These patients often present with a plethora of medical problems requiring careful consideration before surgical interventions. The authors present their experience at an interdisciplinary clinic aimed to facilitate appropriate patient selection for neurosurgical procedures, and the outcome of these interventions. METHODS This study was a retrospective review of all patients who underwent neurosurgical interventions for cancer pain in the authors' hospital between March 2015 and April 2018. All patients had advanced metastatic cancer with limited life expectancy and suffered from intractable oncological pain. RESULTS Sixty patients underwent surgery during the study period. Forty-three patients with localized pain underwent disconnection of the spinal pain pathways: 34 percutaneous-cervical and 5 open-thoracic cordotomies, 2 stereotactic mesencephalotomies, and 2 midline myelotomies. Thirty-nine of 42 patients (93%) who completed these procedures had excellent immediate postoperative pain relief. At 1 month the improvement was maintained in 30/36 patients (83%) available for follow-up. There was 1 case of hemiparesis.Twenty patients with diffuse pain underwent stereotactic cingulotomy. Nineteen of these patients reported substantial pain relief immediately after the operation. At 1 month good pain relief was maintained in 13/17 patients (76%) available for follow-up, and good pain relief was also found at 3 months in 7/11 patients (64%). There was no major morbidity or mortality. CONCLUSIONS With careful patient selection and tailoring of the appropriate procedure to the patient's pain syndrome, the authors' experience indicates that neurosurgical procedures are safe and effective in alleviating suffering in patients with intractable cancer pain.
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Affiliation(s)
- Assaf Berger
- 1Department of Neurosurgery
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Hochberg
- 4Institute of Pain Medicine; and
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Zegerman
- 5Division of Anesthesiology, Tel Aviv Medical Center; and
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rotem Tellem
- 3The Palliative Care Service
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Strauss
- 1Department of Neurosurgery
- 2Neuromodulation Unit
- 6Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Clinical Study of Thirteen Patients with Spinal Cord Infarction. J Stroke Cerebrovasc Dis 2019; 28:104418. [PMID: 31585772 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/27/2019] [Accepted: 09/12/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A concept of sensory tracts in the spinal cord has been established in relation to a dorsolateral pathway which is located in the posterior part of the lateral column and conveys the deep sense. METHODS The clinical status at onset, neurological symptoms, and magnetic resonance imaging (MRI) findings in 13 patients of spinal cord infarction were studied. RESULTS The clinical status was acute in 11 patients and subacute in 2 patients. Palsy of the extremities was noted in 11 patients. Segmental sensory disturbance was shown in all patients. One patient showed disturbance of all senses and paraplegia, which indicated transverse myelopathy. In the other 12 patients, 11 patients showed impairment of pain sense although joint position sense was preserved, excluding 1 patient whose sensory disturbance showed dysesthesia alone. In these 11 patients, soft touch and vibration senses were impaired in 7 patients. Abnormality of spinal cord MRI was detected 7 patients. The lesions were located in the cervical cord in 3 patients, cervical to thoracic cord in 1 patient, and thoracic cord in 3 patients. CONCLUSIONS In the 11 patients in whom pain sense was impaired and joint position sense was preserved, involvement of the anterior spinal cord artery (ASCA) was the mainstay. Impairment of vibration sense was accompanied in 7 patients in patients of ASCA infarction. It was speculated that impairment of vibration sense can occur in patients with ASCA infarction whose ischemia spread to the dorsolateral pathway in the posterior part of the lateral column.
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Abandoned techniques in spine surgery. Neurocirugia (Astur) 2019; 31:37-41. [PMID: 30792110 DOI: 10.1016/j.neucir.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/05/2019] [Indexed: 11/20/2022]
Abstract
In spine surgery, certain surgical techniques and devices are currently in marked decline or have been completely abandoned. Although used in thousands of patients, such treatments failed to demonstrate durable and sound effectiveness, and sometimes associate inacceptable morbidity. Chemopapain injections, percutaneous discectomy, laser discectomy or antiadhesion gels are examples of abandoned therapies. Some other techniques are in frank decline like implantation of interspinous devices or lumbar disc prosthesis. In general, a technique is abandoned due to inefficacy, excessive associated morbidity, substituted by another more efficacious and less aggressive technique, end of commercialization, or usage prohibition. In the last decades, a great commercial pressure plus an increasing social demand have managed to convince many spine surgeons to indicate treatments not sufficiently supported by scientific evidence nor consolidated over time, many of which are eventually abandoned.
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Strauss I, Berger A, Arad M, Hochberg U, Tellem R. O-Arm-Guided Percutaneous Radiofrequency Cordotomy. Stereotact Funct Neurosurg 2018; 95:409-416. [DOI: 10.1159/000484614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/18/2017] [Indexed: 12/11/2022]
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12
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Recent Literature Feature Editor: Paul C. Rousseau. J Palliat Med 2016. [DOI: 10.1089/jpm.2015.0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Recent Literature Feature Editor: Paul C. Rousseau. J Palliat Med 2015. [DOI: 10.1089/jpm.2015.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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