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1.
Neuromodulation ; 25(1): 35-52, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35041587

RESUMEN

INTRODUCTION: The International Neuromodulation Society convened a multispecialty group of physicians based on expertise with international representation to establish evidence-based guidance on the use of neurostimulation in the cervical region to improve outcomes. This Neurostimulation Appropriateness Consensus Committee (NACC) project intends to provide evidence-based guidance for an often-overlooked area of neurostimulation practice. MATERIALS AND METHODS: Authors were chosen based upon their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when NACC last published guidelines) to the present. Identified studies were graded using the US Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS: The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS: The NACC recommends best practices regarding the use of cervical neuromodulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be utilized as a guide to assist decision making when clinically appropriate.


Asunto(s)
Terapia por Estimulación Eléctrica , Consenso , Humanos
2.
Pain Med ; 23(7): 1283-1298, 2022 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34718773

RESUMEN

OBJECTIVE: To conduct a comprehensive search for evidence with regard to whether central sensitization after an injury can act as a persistent autonomous pain generator after the inducing injury has healed. METHODS: We searched Medline on PubMed and the Cochrane Library, screening 3,572 abstracts, from which 937 full-text articles were obtained, with 186 of these discarded as irrelevant to the question being posed. The remaining 751 articles were studied for evidence. RESULTS: Fourteen publications were judged to provide weak evidence for the hypothesis of central sensitization as a persisting autonomous pain generator, but none addressed the question directly. No strong evidence for the affirmative answer was found. Sixty-one publications were judged to provide weak evidence for a negative answer, and ten were judged to provide strong evidence. Unexpectedly, serious weaknesses were discovered in the literature underpinning the validity of the clinical diagnosis of central sensitization in humans: 1) inappropriate extrapolation, in many publications, of laboratory animal data to humans; 2) failure to demonstrate the absence of peripheral pain generators that might be perpetuating central sensitization; and 3) many factors now shown to confound what is being measured by quantitative sensory testing, conditioned pain modulation, and the Central Sensitization Inventory. CONCLUSIONS: We found no evidence proving that central sensitization can persist as an autonomous pain generator after the initiating injury has healed. Our review has also shown that the evidential basis for the diagnosis of central sensitization in individual patients is seriously in question.


Asunto(s)
Sensibilización del Sistema Nervioso Central , Dolor , Humanos , Trastornos Somatomorfos
3.
J Clin Neurosci ; 90: 32-35, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34275570

RESUMEN

We describe a simple technique of securing surgically implanted leads for spinal cord (SCS), dorsal root ganglion (DRG) and occipital nerve stimulation (ONS), for both primary surgical implantation and correcting lead migration. This technique could also be adapted for securing percutaneously implanted leads. Thirty-nine patients underwent neurosurgical implantation of SCS, DRG, and ONS devices utilizing titanium mini-plates to obtain secure anchorage of leads to adjacent laminae close to their exit point from the epidural space, thereby minimizing the risk of further lead migration or electrode displacement. There were no cases of primary or recurrent lead migration in any patient undergoing lead placement using mini-plate anchorage. The technique appears to offer a reliable means of preventing post-operative lead migration in a variety of spinal and extra-cranial neuromodulation implants.


Asunto(s)
Electrodos Implantados/efectos adversos , Migración de Cuerpo Extraño/prevención & control , Procedimientos Neuroquirúrgicos/métodos , Estimulación de la Médula Espinal/métodos , Humanos , Masculino , Persona de Mediana Edad , Estimulación de la Médula Espinal/instrumentación
5.
7.
J Clin Neurosci ; 19(9): 1255-60, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22727749

RESUMEN

We have previously shown that the clinical utility of transcranial Doppler (TCD) ultrasound monitoring for vasospasm in patients with aneurysmal subarachnoid haemorrhage, as performed by untrained operators in a busy neurosurgical unit, is questionable, despite the recommendations for its use in the literature. We determined if formal training improved the utility of TCD. Twelve untrained operators and one trained operator performed a total of 206 TCD examinations. There was poor agreement of results between trained and untrained operators. For the left middle cerebral artery (MCA), right MCA, left anterior cerebral artery (ACA) and right ACA, the blood flow velocities (BFV) recorded by the trained operator were greater than those recorded by the untrained operators by a mean (95% confidence interval) of 27.7 (25.0-30.4), 24.3 (21.4-27.1), 28.2 (25.6-30.9) and 28.1 (24.9-31.1) cm/s, respectively (p<0.001 for all vessels). Greater sensitivity was observed in TCD measurements from the trained operator (100%) compared to untrained operators (40%). To improve the utility of TCD, operators should be provided with training or a professional sonographer employed.


Asunto(s)
Competencia Clínica , Hemorragia Subaracnoidea/diagnóstico por imagen , Adulto , Anciano , Arteria Cerebral Anterior/diagnóstico por imagen , Velocidad del Flujo Sanguíneo , Interpretación Estadística de Datos , Educación Médica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/diagnóstico por imagen , Selección de Paciente , Valor Predictivo de las Pruebas , Ultrasonografía Doppler Transcraneal/métodos , Vasoespasmo Intracraneal/diagnóstico por imagen
8.
J Clin Neurosci ; 19(6): 792-4, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22459182

RESUMEN

Prophylactic anticoagulation therapy with agents such as dabigatran etexilate (as an alternative to warfarin) promises substantial benefits to both patients and monitoring physicians in the treatment of those at high risk of stroke from atrial fibrillation. Such treatment has, however, one potentially lethal consequence. There is, as yet, no easily administered rapid means of reversal in instances of acute surgical emergency. The problems that may then be encountered in neurosurgical practice are discussed.


Asunto(s)
Ética Médica , Accidente Cerebrovascular/prevención & control , Anciano , Antitrombinas/efectos adversos , Fibrilación Atrial/complicaciones , Bencimidazoles/efectos adversos , Dabigatrán , Humanos , Masculino , Piridinas/efectos adversos , Accidente Cerebrovascular/etiología
9.
J Clin Neurosci ; 19(7): 950-5, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22281386

RESUMEN

The effect of transcranial Doppler (TCD) ultrasound monitoring of vasospasm on patient management following aneurysmal subarachnoid haemorrhage (aSAH) remains unclear. We reviewed our departmental use of TCD by retrospectively analysing 152 medical records. Results of investigations and management changes, including frequency of neurological monitoring and changes in triple H therapy, were examined. TCD monitoring occurred in 87 patients (57%) by untrained neurosurgical registrars. There was high variability in the number of operators for each patient (over 50% of patients had more than two different operators), insonation protocol and monitoring duration (at least 50% of patients were monitored for fewer than seven days). TCD results influenced management in only 18 (12%) patients, while clinical deterioration or improvement dictated more than 80% of changes in triple H therapy and neurological monitoring. Prospective validation in similar neurosurgical settings is needed to justify continued usage of TCD monitoring. Formal training for operators and a standard monitoring protocol should also be considered to increase TCD utility. Prospective evaluation of TCD at our centre has recently been completed.


Asunto(s)
Monitoreo Fisiológico/métodos , Hemorragia Subaracnoidea/diagnóstico por imagen , Ultrasonografía Doppler Transcraneal/métodos , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Hemorragia Subaracnoidea/cirugía , Tomografía Computarizada por Rayos X , Procedimientos Quirúrgicos Vasculares/métodos
10.
J Clin Neurosci ; 18(8): 1023-7, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21612929

RESUMEN

Decompressive craniectomy is considered a life-saving procedure for malignant middle cerebral artery territory infarction in selected patients. However, the procedure is associated with a significant risk of morbidity and mortality, and there is no universal agreement as to how this operation should be combined with optimal medical management. In this review we consider the goals of this procedure and the technical aspects which may be employed to optimise results.


Asunto(s)
Craniectomía Descompresiva/métodos , Infarto de la Arteria Cerebral Media/cirugía , Infarto Encefálico/etiología , Infarto Encefálico/cirugía , Craniectomía Descompresiva/instrumentación , Humanos , Infarto de la Arteria Cerebral Media/complicaciones , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Cráneo/diagnóstico por imagen , Cráneo/cirugía , Colgajos Quirúrgicos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
11.
J Clin Neurosci ; 18(8): 1018-22, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21592798

RESUMEN

Malignant middle cerebral artery (MCA) infarction (MMI) is associated with a mortality rate of 80%. Decompressive craniectomy is considered a life-saving procedure for patients with this devastating condition. Preclinical and clinical data suggest that this procedure should be undertaken as early as possible, prompting increasing demand for emergency surgery. This article reviews the pathophysiology of MMI, and the experimental and clinical evidence supporting this procedure. We consider some of the controversies surrounding patient selection for this procedure and discuss the role of intracranial pressure monitoring in MMI.


Asunto(s)
Craniectomía Descompresiva/métodos , Infarto de la Arteria Cerebral Media/cirugía , Factores de Edad , Dominancia Cerebral , Humanos , Infarto de la Arteria Cerebral Media/fisiopatología , Presión Intracraneal/fisiología , Monitoreo Intraoperatorio/métodos , Resultado del Tratamiento
14.
J Clin Neurosci ; 16(10): 1259-61, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19564116

RESUMEN

The past decade (1999-2009) has witnessed a dramatic increase in the use of electrical stimulation to treat chronic, intractable pain. The implantation of electrodes in close proximity to peripheral nerves, known as peripheral nerve stimulation, has been enthusiastically adopted by neurosurgeons and interventional pain specialists. The most common conditions treated with this technique are headache and complex regional pain syndromes. The potential application of peripheral neuromodulation to relatively common and frequently disabling conditions such as migraine and lower back pain represents an exciting phase in the evolution of contemporary pain surgery. We review the available evidence relating to the use of peripheral nerve stimulation for the treatment of medically refractory, chronic non-cancer pain in a variety of clinical situations, highlight the absence of randomised controlled studies, and emphasise the need for scientifically sound research in this field.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Manejo del Dolor , Nervios Periféricos/fisiología , Humanos
15.
J Clin Neurosci ; 15(11): 1216-21, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18829325

RESUMEN

Low back pain is a common condition. This is a retrospective study of new referrals to neurosurgical outpatients at the Western Hospital, Victoria, Australia. Two hundred and fifteen histories were systematically reviewed. Statistical analysis was performed using univariate and multivariate analyses. Patients who had tried physiotherapy, epidural injection or had no pre-outpatient imaging were more likely to get MRI (p<0.02). Patients with clinical features of neurogenic claudication (p<0.01) or with neurological signs (p=0.02) were more likely to proceed to surgery. CT scan demonstrated significant correlation to MRI for lumbar canal stenosis, disc disease or the absence of disease (p<0.01). Referral guidelines for general practitioners regarding back pain are proposed. Recommendations are also made to facilitate the selected use of CT scan and MRI.


Asunto(s)
Dolor de la Región Lumbar/cirugía , Procedimientos Neuroquirúrgicos/métodos , Pacientes Ambulatorios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Australia , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Estudios Retrospectivos , Tomógrafos Computarizados por Rayos X , Adulto Joven
16.
J Clin Neurosci ; 13(2): 272-5, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16503491

RESUMEN

The authors describe two patients presenting with a previous history of spinal trauma and a several-year history of sensory changes secondary to spinal cord compression. Both patients underwent laminectomy and spinal decompression operations. In both cases intradural bone causing neural compression was removed at operation. Potential mechanisms to explain intradural ossification and the relevant literature are reviewed.


Asunto(s)
Osificación Heterotópica/complicaciones , Compresión de la Médula Espinal/etiología , Adulto , Descompresión Quirúrgica , Duramadre/patología , Femenino , Humanos , Laminectomía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Debilidad Muscular/etiología , Examen Neurológico , Procedimientos Neuroquirúrgicos , Osificación Heterotópica/patología , Osificación Heterotópica/cirugía , Dolor/etiología , Parestesia/etiología , Compresión de la Médula Espinal/cirugía , Traumatismos Vertebrales/complicaciones
17.
J Neurosurg Spine ; 2(2): 116-22, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15739521

RESUMEN

OBJECT: The authors prospectively evaluated the clinical and radiological outcomes after anterior cervical discectomy and fusion (ACDF) involving placement of a Solis cage and local autograft in patients who presented with symptomatic cervical spondylosis. METHODS: Twenty-two consecutive patients underwent ACDF for radiculopathy (13 cases), myeloradiculopathy (eight cases), or myelopathy alone (one case) and were assessed at 3, 6, and 12 months. Plain cervical spine radiography demonstrated a significant change in both local (p < 0.05) and regional (p < 0.05) kyphotic angles as well as an increase in segmental height (p < 0.05). At 12 months, plain radiography demonstrated Grades I, II, and III new bone formation in two, three, and 17 patients, respectively. Clinical outcomes were assessed using a visual analog scale for both neck and arm pain and a modified Japanese Orthopaedic Association (JOA) scale for myelopathy. There was a significant improvement in both arm (p < 0.05) and neck pain (p < 0.05). At 12 months, 16 (84%) of 19 and 19 (86%) of 22 patients reported complete resolution of arm pain and neck pain, respectively. There was a significant improvement in JOA scores following surgery (p < 0.05). There were two complications in the series: one case of deep venous thrombosis and one case of postoperative arm pain that resolved after conservative treatment. There were no technical complications. CONCLUSIONS: Early experience with Solis cage-augmented ACDF indicates good clinical and radiological outcomes; additionally, there are the advantages of absent donor site morbidity and anterior plate system-related morbidity.


Asunto(s)
Trasplante Óseo/instrumentación , Vértebras Cervicales/cirugía , Discectomía/instrumentación , Desplazamiento del Disco Intervertebral/cirugía , Prótesis e Implantes , Fusión Vertebral/instrumentación , Osteofitosis Vertebral/cirugía , Adulto , Anciano , Vértebras Cervicales/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Examen Neurológico , Estudios Prospectivos , Radiculopatía/diagnóstico por imagen , Radiculopatía/cirugía , Radiografía , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/cirugía , Osteofitosis Vertebral/diagnóstico por imagen , Resultado del Tratamiento
18.
AJNR Am J Neuroradiol ; 25(5): 854-8, 2004 May.
Artículo en Inglés | MEDLINE | ID: mdl-15140735

RESUMEN

Dural arteriovenous fistulas (DAVFs) in the craniocervical junction are rare but clinically important. DAVFs can be associated with subarachnoid hemorrhage (SAH), a feature distinguishing them from DAVFs in the thoracolumbar region. These lesions are often overlooked at cerebral angiography performed to assess SAH and account for a small proportion of angiographically negative SAHs. After managing two cases of cervical spinal DAVF manifesting as SAH, we analyzed all cases in the literature to identify features associated with bleeding at presentation.


Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Hemorragia Subaracnoidea/etiología , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad
19.
J Neurosurg ; 100(1 Suppl Spine): 13-9, 2004 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-14748568

RESUMEN

OBJECT: Cervical myelopathy may develop as a result of spinal cord compression with or without deformity. The effect of persistent kyphotic deformity on the ability of the cervical cord to recover following decompressive surgery is not known. METHODS: Between 1997 and 2000, a total of 28 patients with progressive myelopathy and kyphotic deformity underwent anterior decompression, deformity correction (0-4 degrees of lordosis), and fusion with anterior plating. Patients received clinical and radiological follow-up care, with independent analysis. Variables assessed included patient characteristics, severity of preoperative myelopathy, neck pain, and cervical sagittal alignment. Twenty-six patients (93%) underwent follow-up review for a minimum of 18 months. Two patients died: one died in the perioperative period and was excluded from further analysis, and in the other only 3 months of follow-up data could be obtained. Local deformity was corrected to neutral or lordosis in 24 cases (89%), and the overall cervical curve was corrected to neutral or lordosis in 20 cases (74%). There was a significant improvement in myelopathy scores in those patients in whom the target (0 to 4 degrees of lordosis) local angle was achieved (p = 0.04). There was a variable change in overall cervical sagittal alignment following local correction. Improvement in myelopathy was unrelated to patient age, previous surgery, or number of segments fused. Improvement in pain score was not related to correction of kyphotic angle. CONCLUSIONS: The correction of sagittal alignment may promote recovery in spinal cord function in patients with kyphotic deformity.


Asunto(s)
Cifosis/cirugía , Dolor de Cuello/cirugía , Complicaciones Posoperatorias/diagnóstico , Compresión de la Médula Espinal/cirugía , Fusión Vertebral , Osteofitosis Vertebral/cirugía , Actividades Cotidianas/clasificación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Cifosis/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dolor de Cuello/diagnóstico , Examen Neurológico , Compresión de la Médula Espinal/diagnóstico , Osteofitosis Vertebral/diagnóstico
20.
Arch Neurol ; 60(10): 1369-73, 2003 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-14568806

RESUMEN

OBJECTIVE: To assess the usefulness, compatibility, and long-term operability of a microelectrode array into the median nerve of the left arm of a healthy volunteer, including perception of feedback stimulation and operation of an instrumented prosthetic hand. SETTING: The study was carried out from March 14 through June 18, 2002, in England and the United States. RESULTS: The blindfolded subject received feedback information, obtained from force and slip sensors on the prosthetic hand, and subsequently used the implanted device to control the hand by applying an appropriate force to grip an unseen object. Operability was also demonstrated remotely via the Internet, with the subject in New York, NY, and the prosthetic hand in Reading, England. Finally, the subject was able to control an electric wheelchair, via decoded signals from the implant device, to select the direction of travel by opening and closing his hand. The implantation did not result in infection or any perceivable loss of hand sensation or motion control. The implant was finally extracted because of mechanical fatigue of the percutaneous connection. Further testing after extraction has not indicated any measurable long-term defects in the subject. CONCLUSIONS: This implant may allow recipients to have abilities they would otherwise not possess. The response to stimulation improved considerably during the trial, suggesting that the subject learned to process the incoming information more effectively.


Asunto(s)
Miembros Artificiales , Electrodos Implantados , Mano/fisiología , Nervio Mediano/fisiología , Adulto , Retroalimentación , Mano/inervación , Fuerza de la Mano/fisiología , Humanos , Masculino , Microelectrodos , Movimiento/fisiología , Telemetría , Silla de Ruedas
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