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Origins of RSD
Published in Hooshang Hooshmand, Chronic Pain, 2018
Nathan’s WDR phenomenon refers to the WDR being at axial as well as vertical levels of substantia gelatinosa. The vertical level extends as far as three adjacent nerve roots in each direction in caudal and cephalad levels. This explains why rhizotomy is useless surgical treatment on a long–term basis.
The Clinical Management of Spasticity and Contractures in Cerebral Palsy
Published in Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway, Neurological Rehabilitation, 2018
Dr Warwick Peacock in South Africa used Fasano’s technique to manage patients with spastic cerebral palsy diplegia. After moving to the West Coast of America, Peacock’s technique spread widely among North American neurosurgeons. The selection criteria employed by Dr Peacock required high levels of spasticity; a diagnosis of spastic diplegia and adequate muscle strength. An emphasis was placed on the careful selection of patients. As with any technique, a wave of enthusiasm was followed by a period of retrenchment, with many North American clinicians associated with the management of cerebral palsy regarding the technique as unhelpful. A wave of enthusiasm for selective dorsal rhizotomy in Scandinavia has been documented by the CPUP National Surveillance Program, with an interesting decline in the number of patients operated on in recent years. Dr Peacock’s technique consisted of an extensive laminectomy from L1 down to L5, enabling visualisation of the whole of the cauda equine [45] (Figure 4.4).
The Gallbladder (GB)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Intercostal nerves four through six course along the lateral pectoralis fascia and then branch into the breast parenchyma. Sensory branches separate from the intercostal nerves in the mid-axillary line,4 which makes GB 22 and GB 23 relevant in this regard. Surgery, irradiation, or other procedures near the breast and GB 22 or GB 23 may damage local nerves and their supporting structures. This has the potential to induce chronic breast pain and neuroma formation.5 Intercostal neuromas following breast surgery may affect one or more intercostal nerves along the lateral chest wall. Intercostal neuralgia produces pain of a burning, electrical, or stabbing type.6 Causes include breast surgery, pregnancy, and herpes zoster infection. Intercostal neuralgia is frequently refractory to pharmaceutical and surgical interventions. While thoracic dorsal rhizotomy at multiple levels has been reported as successful, neuroablative procedures should be reserved for those cases where less invasive approaches have failed. Myofascial sources of chest wall pain have likely escaped notice by conventional practitioners who omit palpation and a search for trigger points from their patient examination.
Ethical questions arising from Otfrid Foerster’s use of the Sherrington method to map human dermatomes
Published in Journal of the History of the Neurosciences, 2022
Brian Freeman, John Carmody, Damian Grace
Other issues arise from the absence of medical histories of the patients; for example, it is not revealed that some patients underwent prior anterolateral cordotomy to reduce pain before undergoing dorsal rhizotomy.17The female patients of Figures 51 and 52 in the 1933 paper were described previously by Foerster and Gagel (1932) as Case 1 (Abb. 13) and Case 17 (Abb. 55), respectively. And it is only when one reads Foerster’s subsequent paper summarizing his life’s work in the treatment of pain (Foerster 1935) that one realizes that many of the patients depicted in the 1933 paper may have undergone both dorsal and ventral rhizotomies. This is significant because the impression given in the Schorstein lecture is that only dorsal roots had been sectioned.
Use of lasers in minimally invasive spine surgery
Published in Expert Review of Medical Devices, 2018
Facet syndrome or facet joint arthritis is one of the major etiologies of low back pain for which surgical intervention might be applied [55,56]. Lumbar facets or zygapophyseal joints are synovial arthroses richly innervated with nerve endings from the medial branch of the posterior primary ramus [57]. Current treatment options include facet joint block or medial branch block for short-term pain relief and facet joint denervation for long-term pain relief by radiofrequency or cryotherapy. The results of facet joint denervation or rhizotomy have been variable, with many patients requiring repeated procedures or experiencing inadequate pain relief. Some authors have reported laser facet denervation techniques [56,58,59]. The patient is placed prone on the radiolucent table. Under fluoroscopic guidance or endoscopic visualization, the Ho:YAG straight-firing laser probe is directed at the medial branch or the dorsal ramus, the nerve that gives rise to the articular branches at each level. Each facet joint is innervated from above and below the segments. The laser probe can be also directed to the facet joint itself. The target points are the lower, middle, and upper portions of the facet joint. The total irradiation energy at one facet is about 500–600 J. Laser has the advantage of coagulating a relatively larger area in the vicinity of the probe tip compared with a radiofrequency probe. Laser facet denervation can be applicable and efficient for patients who failed to be relieved by block or radiofrequency facet rhizotomy.
Management of veins during microvascular decompression for idiopathic trigeminal neuralgia
Published in British Journal of Neurosurgery, 2018
Xu Zhao, Shuai Hao, Minqing Wang, Chao Han, Deguang Xing, Chengwei Wang
Significant pain recurrence occurred in 7 patients by the end of follow-up. Of the patients with recurring pain, one patient exhibited pain recurrence three days after the initial operation and immediately underwent a repeated MVD. During the second operation, the omitted offending vessel was confirmed, and the patient thereafter obtained complete pain relief. The other recurrences (6 cases) occurred between 4 months and 30 months after the initial operation. Three patients were managed by a partial sensory rhizotomy and obtained complete pain relief. Two patients received gamma-knife treatment and obtained complete pain relief. The remaining patient was managed with traditional Chinese medicine alone and obtained partial pain relief.