Ogilvie's syndrome after paddle spinal cord stimulator implantation: An experience report.

Spinal cord stimulation (SCS) is an emerging technology to treat chronic pain from complex regional pain syndrome (CPRS) neuropathy and post-laminectomy syndrome. A rarely reported postoperative complication of SCS paddle implantation is abdominal pain that can result from thoracic radiculopathy. Ogilvie's syndrome (OS) is a disorder characterized by acute dilatation of the colon in the absence of an anatomic lesion that obstructs the flow of intestinal contents, which has seldom been observed after spine surgery. Here, we describe the case of a 70-year-old male who developed OS after SCS paddle implantation resulting in cecal perforation and multi-system organ failure with lethal outcome. We discuss the pathophysiology, present a method measuring the spinal canal to cord ratio (CCR) to prevent the risk of thoracic radiculopathy and OS after paddle SCS implantation, and propose suggestions for management and treatment of this condition.

Stellate Ganglion Block for Debilitating Photophobia Secondary to Trigeminal, Postherpetic Neuralgia.

OBJECTIVES: The primary objective of this case report was to demonstrate the therapeutic benefit of stellate ganglion block in trigeminal postherpetic neuralgia. METHODS: This was a case report on a single patient who presented with debilitating photophobia secondary to left-sided trigeminal postherpetic neuralgia. A left-sided stellate ganglion block was performed on the patient under fluoroscopic guidance. The primary endpoints were VAS pain scores and changes in functional capacity. RESULTS: The patient demonstrated significant reduction in her VAS pain score and improved functional capacity for approximately 6 months after the intervention. This case report provides evidence that sympathectomy via a stellate ganglion block can treat photophobia secondary to postherpetic neuralgia in the V1 distribution.

Concordant provocation as a prognostic indicator during interlaminar lumbosacral epidural steroid injections.

BACKGROUND: Interlaminar epidural steroid injection is a well-established intervention for the treatment of radicular pain. Pain is commonly reported during the injection into the epidural space; this provocation is typically either concordant or discordant with the patient's baseline pain. It is not well known how this provocation pain relates to treatment outcomes. OBJECTIVE: To determine the relationship between concordant versus discordant provocation during interlaminar epidural steroid injection and its effects on pain reduction at follow-up. STUDY DESIGN: Secondary analysis of a single center, prospective randomized double-blind study. METHODS: Interlaminar epidural steroid injections under fluoroscopic guidance were performed on 48 patients with radicular lumbosacral pain. After injection with 80 mg methylprednisolone and 2 mL of normal saline at a single level, patients were asked to report if pain was provoked, and whether the pain was concordant or discordant with their baseline pain. The primary outcome measure was self-rated percentage of pain reduction from baseline at 2-week follow-up. Secondary outcomes included improvement in activity level and decreased analgesic consumption. RESULTS: Provocation was observed in 37 out of 48 patients (77%). This was further classified as concordant (22/37, 60%) or discordant (15/37, 40%) pain. The concordant group achieved a significant decrease in self-reported pain as compared to the discordant group at 2-week follow-up (61%, t = 2.45, P < 0.01). There were also significantly more patients in the concordant group who reported 75% pain reduction as compared to the discordant group (X = 6.44, df(1), P < 0.05). There were no significant differences between concordant and discordant groups in regard to improvements in activity level (X = 2.56) and decreased analgesic use (X = 3.28). LIMITATIONS: The secondary analysis did not examine long-term outcomes. CONCLUSIONS: The concordant group demonstrated significantly higher pain reduction as compared to the discordant group. There were no significant differences between the 2 groups in terms of improved function or reduced analgesic requirements. Concordant provocation during interlaminar epidural injection may be a predictor of outcome.

The awake Glidescope intubation: an additional alternative to the difficult intubation.

BACKGROUND: The incidence of difficult intubations has consistently remained between 8 and 9%. We found a novel approach to the difficult intubation using a Glidescope in the awake spontaneously breathing patient. METHODS: In a difficult airway, the same approach for an awake fiberoptic intubation including excellent nerve blocks and sedation can be used with a Glidescope in the same fashion as a fiberoptic bronchoscope. RESULTS: The skill level for the awake Glidescope appears to be less, making it a useful tool for emergency room physicians and critical care physicians when used for awake intubation. It is particularly useful for the patient who fails the airway exam and also has macroglossia. CONCLUSION: This case report confirms that while not applicable to every patient, the awake Glidescope intubation does add to the previous existing armamentarium in this clinically challenging situation.

Orthogonal diffusion-weighted MRI measures distinguish region-specific degeneration in cerebellar ataxia subtypes.

The cerebellar peduncles are excellent candidates for composite indicators of regional degeneration in posterior fossa structures, as the peduncles show histopathological changes in degenerative ataxia. We postulate that magnetic resonance imaging will reveal evidence of disease specific peduncle degeneration through macrostructural (cross-sectional area) and microstructural (fractional anisotropy, mean diffusivity) measures. This study presents a "proof of principle" using orthogonal diffusion tensor imaging cross-sections of the cerebellar peduncles to distinguish categories of cerebellar disease.