DOCSLIB.ORG

Abstracts of the 2018 AANS/CNS Joint Section on Disorders of the Spine

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Abstracts of the 2018 AANS/CNS Joint Section on Disorders of the Spine Abstracts of the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves Annual Meeting Orlando, Florida • March 14–17, 2018 (DOI: 10.3171/2018.3.FOC-ASPNabstracts) in the tetraplegic SCI population1. We investigate the combined J.A.N.E. Award Presentation effects of two neuromodulation strategies: transcutaneous electri- cal stimulation (TES) and buspirone pharmacological modulation, 100 Lateral Lumbar Interbody Fusion in the Elderly: A 10 for promoting upper limb motor recovery in chronic cervical SCI Year Experience tetraplegic subjects. Methods: A double-blind study protocol was used to deter- Nitin Agarwal MD; Andrew M Faramand MD; Nima Alan mine the effects of cervical electrical stimulation alone or in com- MD; Zachary J. Tempel MD; D. Kojo Hamilton MD; David O. bination with the monoaminergic agonist buspirone on upper limb Okonkwo MD, PhD; Adam S. Kanter MD motor function in subjects with chronic motor complete (ASIA B) cervical injury (n=6). Voluntary upper limb function was Introduction: Elderly patients, often presenting with multiple evaluated through measures of controlled hand contraction, hand- medical comorbidities, are touted to be at an increased risk of post- grip force production, dexterity measures, and validated clinical operative complications. As such, we describe our perioperative assessment batteries. Subjects underwent pre-intervention assess- outcomes in this cohort of patients over the age of 70 following ment followed by three treatment phases with TES and buspirone standalone LLIF. or placebo. A delayed post-treatment testing period was used to Methods: A retrospective query of a prospectively maintained assess for durable improvement in function. database was performed for patients over the age of 70 who under- Results: All subjects demonstrated improvement in hand went standalone LLIF. The preoperative and postoperative values strength and upper extremity functional metrics. Mean hand for the Oswetry Disability Index (ODI) were analyzed to compare strength increased greater than 300% after transcutaneous elec- outcomes after intervention. Femoral neck t-scores of the study trical stimulation plus buspirone. A corresponding improvement cohort were acquired from the bone density scans and correlated was observed in upper extremity functional metrics. Functional with the incidence of graft subsidence. Statistical analysis using improvements generally persisted after the study interventions t-test was performed with IBM SPSS Statistics (IBM, Armonk, NY). were discontinued. Results: Among the study cohort of 54 patients, the median Conclusion: We demonstrate that, with these novel inter- age at the time of surgery was 74 years (range, 70-87 years). ventions, the cervical spinal circuitry can be neuromodulated to Seventeen patients had at least 3 medical comorbidities at surgery. improve volitional control of hand function in tetraplegic subjects. Twenty-two patients underwent a one level, and 32 patients had The potential impact of these findings on individuals with upper 2 or more level fusions. The median length of hospital stay was limb paralysis could be dramatic functionally, psychologically, 2 days (range, 1-4 days). No statistically significant relationship and economically. was observed between the length of hospital stay and age at the time of surgery. There was one intraoperative death secondary to cardiac arrest, with a mortality rate of 1.9%. One patient developed Mayfield Clinical Science Award Presentation a transient femoral nerve injury. Five patients with radiographic graft subsidence subsequently required posterior instrumenta- 102 Crossing the Cervicothoracic Junction in Posterior tion. A lower femoral neck t-score < -1.0 correlated with a higher Cervical Decompression and Fusion: A Cohort Analysis chance of graft subsidence (p=0.006). The mean ODI 1 year post- operatively of 31.1 was significantly (p = 0.003) less than the mean Kevin T. Huang, MD; Maya Harary, BA; Muhammad M Abd- preoperative ODI of 46.2. El-Barr, MD, PhD; Yi Lu, MD, PhD; Michael W. Groff, MD, Conclusion: Standalone LLIF can be safely and effectively FACS; John H. Chi, MD, MPH performed in the elderly population. Despite an association with increased comorbidities, age alone should not be a deterrent when Introduction: Multilevel decompression and fusion is a well- considering an LLIF procedure in the elderly population. known procedure for spine surgeons. Current convention notes that the cervicothoracic junction (CTJ) has inherent instability and that surgeons should avoid ending constructs there. However, Mayfield Basic Science Award Presentation there exists little data to guide this practice.1 Methods: We retrospectively reviewed a consecutive series 101 Engaging Cervical Spinal Cord Circuitry with of 130 adult patients who underwent multilevel posterior cervi- Non-invasive Transcutaneous Electrical Stimulation and a cal decompression and fusion at our institution. All patients had Serotonin Agonist to Re-enable Volitional Control of Hand surgery for degenerative cervical conditions and received a fusion Function in Tetraplegic Patients that either stopped at C7 or extended beyond the CTJ. Data was collected on demographic, baseline, and intraoperative variables Nicholas Au Yong, MD, PhD; Yevgeniy Freyvert, MD; Tianyi as well as any complications or subsequent needs for reoperation. Niu, MD; Erika Morikawa; Sharon Zudnowski; Melanie Sarino; Results: A total of 67 patients had a fusion ending at the CTJ Yury Gerasimenko; Reggie Edgerton, PhD; Daniel C. Lu, MD, PhD compared to 63 whose fusion crossed the CTJ. The groups were not significantly different in terms of age (p=0.4594), smoking Introduction: Spinal cord injury (SCI) affects significant status (p = 0.7753), American Society of Anesthesiologists score societal and personal impact which scales with ascending level (p=0.2856), or amount of available follow-up (p=0.1437). Patients of injury. Recovery of upper extremity function is the top priority whose fusion crossed the CTJ had more levels fused (mean: 5.8 ± A1 Neurosurg Focus Volume 44 • March 2018 Unauthenticated | Downloaded 10/01/21 05:50 PM UTC AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves: 2018 Meeting Abstracts 2.0 vs. 3.5 ± 0.8 levels, p<0.0001), longer surgical times (mean: Charles Kuntz IV Scholars 216.5 ± 82.6 vs. 148.5 ± 44.7 minutes, p<0.0001), and higher EBL (mean: 480 ± 775 vs. 115 ± 113 mL, p=0.0002). The groups did 104 Early Kyphoplasty is Associated with Reduced Risk not differ significantly in overall reoperation rate (10.4% vs. 9.5%, of Persistent Opioid Prescribing for Nearly 12,000 Privately- p=1.0000), but crossing the CTJ was associated with a higher rate Insured Patients with Osteoporotic Vertebral Fractures of wound dehiscence (7.9% vs. 0%, p=0.0246). Those patients with constructs ending at the CTJ had higher rates of adjacent seg- Jay Kiran Nathan, MD; Mitchell A Johnson, BS; Jennifer ment disease (4.5% vs. 0%, p=0.2449) and hardware complication Waljee, MD; Nicholas J. Szerlip, MD, FACS; Paul Park, MD; (4.5% vs. 1.6%, p=0.6198), but these differences were not statisti- Mark E. Oppenlander, MD cally significant. Conclusion: The relative merits of crossing the CTJ in pos- Introduction: Osteoporotic vertebral fracture is a painful con- terior cervical fusions are not a forgone conclusion. Deciding to dition typically requiring opioid analgesia. However, these particu- cross the CTJ may involve balancing increased surgical times larly frail patients face increased risks with even short-term opioid and wound complication rates on one hand with the possibility of use. There are mixed data on efficacy of kyphoplasty to reduce pain increased adjacent segment disease and hardware complications scores, and no large-scale data regarding opioid prescribing before on the other. versus after the procedure, the focus of the present study. Methods: Using claims from a large private US insurer, we identified adults with osteoporotic vertebral fracture who Kline Peripheral Nerve Top Abstract Presentation underwent kyphoplasty from 2001 to 2014, had at least 1 year of continuous insurance enrollment around their index procedure, 103 Lipid-rich Vesicular Transport in Myelinating and were prescribed opioids during this time. Intensity of opioid Schwann Cells In-vitro prescribing was classified based on CDC guidelines and average daily oral morphine equivalents (OME), and duration of prescrip- Joey Kevin Grochmal, MD, PhD tions relative to fracture and intervention was calculated. Results: A total of 11,964 adults met inclusion criteria, 4418 Introduction: Peripheral nerve myelin synthesis requires a (36.9%) of whom were opioid naïve prior to fracture. Median large volume of hydrocarbon molecules to support the exponential age was 77, and 71.9% were female. 10,365 patients (86.6%) production of lipid bilayer inherent in its formation; this provision underwent only 1 kyphoplasty, which was single-level in 80.1% occurs through a process that is yet unclear. of cases. Intensity of daily OME prescribing before fracture Methods: Using spectral confocal microscopy, we studied remained the same or decreased for 55.9% of patients immediately exogenous BFP expressing Schwann cells as they progressively after the procedure. 28.9% of patients were not prescribed any myelinated in GFP-DRG explant co-cultures (Figure 1: In-vitro opioids beyond 30 days following kyphoplasty, while multivariate myelination by exogenous BFP and endogenous GFP expressing logistic
Load more

Recommended publications
  • Transforaminal Endoscopic Discectomy to Relieve Sciatica and Delay Fusion in a 31-Year-Old Man with Pars Defects and Low-Grade Spondylolisthesis
    NEUROSURGICAL FOCUS Neurosurg Focus 40 (2):E4, 2016 Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis Karthik Madhavan, MD,2 Lee Onn Chieng, BS,2 Christoph P. Hofstetter, MD, PhD,1 and Michael Y. Wang, MD2 1Department of Neurological Surgery, University of Washington, Seattle, Washington; and 2Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization. A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted.
    [Show full text]
  • Spinal Cord Stimulation in Failed Back Surgery Syndrome: Effects on Posture and Gait—A Preliminary 3D Biomechanical Study
    Hindawi Pain Research and Management Volume 2017, Article ID 3059891, 9 pages https://doi.org/10.1155/2017/3059891 Research Article Spinal Cord Stimulation in Failed Back Surgery Syndrome: Effects on Posture and Gait—A Preliminary 3D Biomechanical Study L. Brugliera,1 A. De Luca,2 S. Corna,1 M. Bertolotto,3 G. A. Checchia,4 M. Cioni,5 P. Capodaglio,1 and C. Lentino2,4 1 Istituto Auxologico Italiano, Unita` di Riabilitazione Osteoarticolare, Ospedale S Giuseppe, Strada Cadorna 90, Piancavallo, Italy 2Laboratorio Analisi del Movimento Ospedale Santa Corona di Pietra Ligure, Viale 25 Aprile 38, 17027 Pietra Ligure, Italy 3Centro Terapia del Dolore e Cure Palliative, Dipartimento di Riabilitazione, Ospedale Santa Corona di Pietra Ligure, Viale 25 Aprile 38, 17027 Pietra Ligure, Italy 4Struttura Complessa Recupero e Rieducazione Funzionale, Ospedale Santa Corona di Pietra Ligure, Viale 25 Aprile 38, 17027 Pietra Ligure, Italy 5Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Dipartimento di Scienze Biomediche e Biotecnologiche, Universita` degli Studi di Catania, Piazza Universita2,95131Catania,Italy` Correspondence should be addressed to P. Capodaglio; [email protected] Received 30 March 2017; Revised 21 June 2017; Accepted 1 August 2017; Published 25 September 2017 Academic Editor: Emily J. Bartley Copyright © 2017 L. Brugliera et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We studied 8 patients with spinal cord stimulation (SCS) devices which had been previously implanted to treat neuropathic chronic pain secondary to Failed Back Surgery Syndrome.
    [Show full text]
  • Failed Back Syndrome Daniel Aghion, MD, Pradeep Chopra, MD, Adetokunbo A
    Failed Back Syndrome Daniel Aghion, MD, Pradeep Chopra, MD, Adetokunbo A. Oyelese, MD, PhD APPROXIMATELY 250,000 SURGERIES with predominant complaints of back to significant nerve root injury (2-3%) for low back pain are performed annu- pain.3 This is because it is usually more because more retraction on the neural ally in the USA.1 Approximately 40% straightforward to identify the source of elements is necessary to gain access to of patients undergoing lumbar surgery pain or “pain generator” on an MRI in the the disc pathology. Conversely, excessive continue to report significant pain after case of a pinched nerve causing radicular bone removal as with a laminectomy, in surgery, and a significant portion of these symptoms than it is to identify the pain which a significant amount of facet joint will result in failed back syndrome (FBS). generator causing low back pain. Thus, removal is performed, may lead to spinal FBS is defined as persistent or recurrent many patients with asymptomatic but instability and pain. chronic pain after one or more surgical abnormal appearing degenerated discs FBS after a lumbar fusion can ensue procedures on the lumbosacral spine. The on MRI or with myofascial pain may be due to extensive instrumentation or fu- incidence of true FBS is as high as 15%. subjected to inappropriate lumbar surgery sion across multiple segments. This can Unfortunately, the diagnosis of FBS does with resulting poor outcomes. result in a ‘flat back syndrome’ or loss not point to the actual cause for treatment of normal lumbar lordosis leading to failure. Multiple factors can contribute to One of the most FBS.
    [Show full text]
  • Role of Litigation
    Spinal Cord (2000) 38, 63 ± 70 ã 2000 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/00 $15.00 www.nature.com/sc Scienti®c Review Aspects of the failed back syndrome: role of litigation JMS Pearce*,1 1Hull Royal In®rmary, 304 Beverly Road, Anlaby, East Yorks HU10 7BG Objective: A review that attempts to identify the mechanism and causation of persistent or recurring low back pain. Design: A personal assessment of clinical features with a selective review of the literature. Results: Thirty to forty per cent of our population aged 10 ± 65 years report that back trouble occurs on a monthly basis and in 1% to 8% this interferes with work. A de®nite patho-anatomical cause for the pain is demonstrable in only a minority. It can be deduced that psychosocial factors, including insurance bene®ts are of importance for this variation. Conclusions: Neither non-operative nor surgical procedures have a major impact on the capacity for work in this substantial minority of backache suerers. The main risk factors identi®ed are: Wrong diagnosis, repeated medical certi®cates for sickness bene®ts, failed surgery, symptoms incongruous with signs or imaging, multiple spinal procedures, poor social support and poor motivation, psychological illness, clinical depression before or after injury or operation. Pending compensation and delays in settlement are important additional features in claimants for compensation. For patients with unproven diagnostic labels such as `pain- behaviour', no evidence exists that any type of surgery is cost eective. Spinal Cord (2000) 38, 63 ± 70 Keywords: low back pain; backache; sciatica; lumbar disk; failed back; chronic pain syndrome Introduction Thirty to 40% of our population aged 10 ± 65 years patients who undergo major spinal surgery for other report that back trouble occurs on a monthly basis and reasons, eg for a tumour, start to walk within a week in 1% to 8% this interferes with work.
    [Show full text]
  • 1 Brain and Spine Center South Florida CURRICULUM VITAE
    Brain and Spine Center South Florida SPECIALIZING IN SURGERY OF THE BRAIN AND SPINE 4675 Linton Boulevard, Suite 102 Delray Beach, FL 33445 CURRICULUM VITAE LLOYD ZUCKER, M.D., FAANS AREAS OF SPECIAL INTEREST: Neurosurgery of the Brain and Spine Complex Spinal Surgery and Instrumentation Minimally Invasive Brain & Spinal Surgery Stereotactic Navigation /Spine & Brain Brain Tumor Surgery/Radiosurgery/Laser Interstitial Thermal Therapy Deep Brain Stimulation/for Movement Disorders Focused Ultrasound for Movement Disorders Clinical Trial Participation & Development PRIVATE PRACTICE: 09/1994 – present Delray Medical Center 5352 Linton Boulevard Delray Beach, Florida 33445 Boca Raton Region Hospital Marcus Neuroscience Institute 800 Meadows Road Boca Raton, Florida 33486 09/2020 – present Good Samaritan Medical Center 1309 N Flagler Drive West Palm Beach, Florida 33401 01/2000 - present Neurosurgical Consultants of South Florida d/b/a Brain and Spine Center South Florida 4675 Linton Boulevard, Suite 102 Delray Beach, FL 33445 01/1994 - present Florida Neuroscience Institute- President 17950 Monte Vista Drive Boca Raton, FL 33496 07/1993 – 07/1994 Muhlenberg Regional Medical Center Plainfield, New Jersey Attending Staff, Neurosurgery JFK Medical Center Edison, New Jersey Attending Staff, Neurosurgery 07/1991 – 07/1992 New Britain General Hospital New Britain, Connecticut Bristol Hospital Bristol, Connecticut 1 Bradley Memorial Hospital Southington, Connecticut Attending Staff, Neurosurgery 08/1988 – 07/1991 UMDNJ/Robert Wood Johnson University
    [Show full text]
  • Spondylolisthesis.Pdf
    Y Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis | NASS Clinical Guidelines 1 G Evidence-Based Clinical Guidelines for Multidisciplinary ETHODOLO Spine Care M NE I DEL I U /G ON Diagnosis and Treatment of I NTRODUCT Degenerative Lumbar I Spondylolisthesis 2nd Edition NASS Evidence-Based Clinical Guidelines Committee Paul Matz, MD R.J. Meagher, MD Tim Lamer, MD William Tontz Jr, MD Committee Co-Chair Diagnosis/Imaging Medical/Interventional Surgical Treatment and and Surgical Treatment Section Chair Section Chair Value Section Chair Section Chair Thiru M. Annaswamy, MD John E. Easa, MD Terrence D. Julien, MD Jonathan N. Sembrano, MD R. Carter Cassidy, MD Dennis E. Enix, DC, MBA Matthew B. Maserati, MD Alan T. Villavicencio, MD Charles H. Cho, MD, MBA Bryan A. Gunnoe, MD Robert C. Nucci, MD Jens-Peter Witt, MD Paul Dougherty, DC Jack Jallo, MD, PhD, FACS John E. O’Toole, MD, MS North American Spine Society Clinical Guidelines for Multidisciplinary Spine Care Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis Copyright © 2014 North American Spine Society 7075 Veterans Boulevard Burr Ridge, IL 60527 USA 630.230.3600 www.spine.org ISBNThis clinical 1-929988-36-2 guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason- ably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physi- cian and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution. I NTRODUCT 2 Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis | NASS Clinical Guidelines Financial Statement This clinical guideline was developed and funded in its entirety by the North American Spine Society (NASS).
    [Show full text]
  • PATHOLOGY of FAILED BACK SURGERY SYNDROME L Background and Diagnostic Alternatives
    lAMES ZUCHERMAN, MD JEROME SCHOFFERMAN, MD PATHOLOGY OF FAILED BACK SURGERY SYNDROME L Background and Diagnostic Alternatives From TheSpine Center, St. Mary's More than 200,000 patients undergo Hospital and Medical Center, San lumbarspine surgery each year.'^The patient Francisco, California and surgeon expect a successful outcome, defined as elimination or significant reduc tion of pain and disability, and markedly Reprint requests to Dr. Schoffer- man. The Spine Center, St. Mary's improved function. It is hoped that the pa Hospital and Medical Center, 2235 tients will return to work, discontinue medi Hayes St., San Francisco, CA cations and resume a normal place in family 94117. and society. Unfortunately, 20-40% of pa tients will fail to gain the desired outcome. In fact, 1-10%ofpatients will be worse after ini tial surgery. *2 The physician who must treat the patient who has the failed back surgery syndrome (FBSS) faces an even more for midable taskthan the initial physician. He or she must consider the many possible causes for FBSS, which include structural and me chanical problems with the spine itself, re lated or unrelated to the initial surgery, poor body mechanics and deconditioning, alter native diagnoses which were the actual cause of the initial back pain or a contributing cause which arose after the surgery, psy chological variables, and medication pro blems. An overview ofeach ofthese areas is essential to help the physician plan diagnos tic evaluation and short- and long-term therapy. ALTERNATIVE DIAGNOSIS Only a small number of patients who fail to benefit from lumbar spine surgery will be found to have disorders unrelated to the initial indication for surgery.
    [Show full text]
  • Syndrome, Failed Back
    WA Coding Rules are a requirement of the Clinical Coding Policy MP0056/17 Western Australian Coding Rule 0318/12 Failed back syndrome ACCD Coding Rule Failed back syndrome (Ref No: Q3106) was retired on 30 June 2017. ICD- 10-AM/ACHI/ACS Tenth Edition (effective 1 July 2017) provides guidelines for procedural complications in ACS 1904 Procedural complications. Page 1 of 3 © Department of Health WA 2018 WA Coding Rules are a requirement of the Clinical Coding Policy MP0056/17 Western Australian Coding Rule 0916/14 Failed back syndrome WA Coding Rule 0716/04 Failed back syndrome is superseded by ACCD Coding Rule Failed back syndrome (Ref No: Q3106) effective 1 Oct 2016; (log in to view on the ACCD CLIP portal). DECISION WA Coding Rule 0716/04 Failed back syndrome is retired. [Effective 1 Oct 2016, ICD-10-AM/ACHI/ACS 9th Ed.] Page 2 of 3 © Department of Health WA 2018 WA Coding Rules are a requirement of the Clinical Coding Policy MP0056/17 Western Australian Coding Rule 0716/04 Failed back syndrome Q. How should failed back syndrome be coded? A. Failed back syndrome is a synonym for postlaminectomy syndrome. ACS 1344 Postlaminectomy syndrome instructs coders that postlaminectomy syndrome (M96.1 Postlaminectomy syndrome, not elsewhere classfied) is a term used to describe pain which persists in spite of back surgery attempted to relieve it and that it should only be coded when ‘postlaminectomy syndrome’ is documented. We believe this instruction is intended to prevent coders from assigning M96.1 for back pain following surgery. It does not preclude the assignment of this code for synonyms of postlaminectomy syndrome.
    [Show full text]
  • Outline of Neurosurgery 1
    Flotte – Outline of Neurosurgery 1 OOuuttlliinnee ooff NNeeuurroossuurrggeerryy E.R. Flotte 2004 Flotte – Outline of Neurosurgery 2 Tumors.................................................................................................................................................3 Astrocytomas ...................................................................................................................................................... 5 Epilepsy .............................................................................................................................................29 Infectious...........................................................................................................................................31 Peripheral Nerve ...............................................................................................................................33 Functional..........................................................................................................................................37 Pain ....................................................................................................................................................39 Spine ..................................................................................................................................................42 Vascular.............................................................................................................................................51 Pediatric.............................................................................................................................................59
    [Show full text]
  • The Effects of Massage After Failed Lumbar Disc Surgery
    The effects of massage after failed lumbar disc surgery Ken Abrahamson- Student [email protected] CNS Center for Neurosomatic Studies 13825 Icot Blvd, Suite 604 Clearwater, FL 33760 Randall Clark- President and Case Report Supervisor [email protected] Abstract Background: 31 year old woman presents low back pain with radicular pain into hips bilaterally, the right knee behind the patella and pain and some numbness into right ankle. The low back pain has been ongoing for a number of years and since 2000 had progressively worsened leading to excision surgery of extruded nucleus pulposus at L4-5 vertebra in June 2011. Client reported that for about three months post-surgery, low back pain diminished. Since then low back pain has progressively increased and daily living has been difficult. The client has been given the option by her medical doctor of lower lumbar spinal fusion. Purpose: The objective in this case report is to describe the effects therapeutic massage has on the client’s symptoms and impairments of low back pain after failed disc excision surgery. Research Design: The research design was a case report at a private school- The Center for Neurosomatic Studies. The application of assessment and treatment designed over a 6 week period of 5 sessions of 1 hour per treatment session. Common Swedish type massage and myofascial techniques were applied. Assessment and therapeutic massage was based on neuromuscular therapy. Massage and myofascial release techniques were applied to the back, pelvic region, thigh and lower leg. Client homework was also given to include exercise in activating supporting musculature and educating the client about condition management.
    [Show full text]
  • Asj.2017.11.4.642Asian Spine J 2017;11(4):642-652
    Asian Spine Journal 642 Jae HwanReview Cho et Article al. Asian Spine J 2017;11(4):642-652 • https://doi.org/10.4184/asj.2017.11.4.642Asian Spine J 2017;11(4):642-652 Neuropathic Pain after Spinal Surgery Jae Hwan Cho1, Jae Hyup Lee2, Kwang-Sup Song3, Jae-Young Hong4 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 2Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea 3Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea 4Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea Neuropathic pain after spinal surgery, the so-called failed back surgery syndrome (FBSS), is a frequently observed troublesome disease entity. Although medications may be effective to some degree, many patients continue experiencing intolerable pain and functional disability. Only gabapentin has been proven effective in patients with FBSS. No relevant studies regarding manipulation or physiotherapy for FBSS have been published. Spinal cord stimulation (SCS) has been widely investigated as a treatment option for chronic neuropathic pain, including FBSS. SCS was generally accepted to improve chronic back and leg pain, physical function, and sleep quality. Although the cost effectiveness of SCS has been proved in many studies, its routine application is limited considering that it is invasive and is associated with safety issues. Percutaneous epidural adhesiolysis has also shown good clinical outcomes; however, its effects persisted for only a short period. Because none of the current methods provide absolute superiority in terms of clinical outcomes, a multidisciplinary approach is required to manage this complex disease.
    [Show full text]
  • Post-Laminectomy Syndrome
    International Journal of ISSN 2692-5877 Clinical Studies & Medical Case Reports DOI: 10.46998/IJCMCR.2021.11.000266 Research Article Failed Back Surgery Syndrome (Post-Laminectomy Syndrome): The Preva- lence, Accompanying Signs, Possible Causes, Management and Outcomes; One-Year Trial at the Teaching Hospitals in Sana’a City, Yemen Majed Ali Amer Ali1, Monya Abdullah Yahya El-Zine2, Hassan Abdulwahab Al-Shamahy3 1Department of Neurosurgery, Faculty of Medicine and Health Sciences, Sana’a University, Republic of Yemen 2Departement of Histopathology, Faculty of Medicine and Health Sciences, Sana’a University, Republic of Yemen 3Department of Basic Sciences, Faculty of Dentistry, Sana’a University, Republic of Yemen *Corresponding author: Hassan A Al-Shamahy, Faculty of Dentistry, Sana’a University. P.O. Box 775 Sana’a, Ye- men. Tel: +967-1-239551, Mobile: +967-770299847, E-mail: [email protected], https://orcid.org/0000-0001- 6958-7012 Received: July 02, 2021 Published: July 26, 2021 Abstract Background: FBSS is a term that groups the conditions with recurring low back pain after spine surgery with or without a radicular component. Aims: The study aimed to investigate the prevalence of FBSS and describe the age, gender, accompanying signs, possible causes of FBSS, methods of diagnosis, management, and outcomes after treatment for patients admitted to Al-Kuwait Univer- sity Hospital, Sana’a. Yemen for spine surgery. Materials and methods: A one-year follow-up study was conducted on patients after spine surgery at Kuwait University Hos- pital - Sana’a, for one year from October 1, 2018 until October 31, 2019. The variables of the study were qualitative (gender, signs, symptoms, type managements, the outcome) and quantitative (age).
    [Show full text]