Joe Ordia

Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: long-term results from a randomized, multicenter, double-blinded, controlled study.

Background Recent studies evaluated short-term efficacy and safety of peripheral nerve stimulation (PNS) of the occipital nerves for managing chronic migraine. We present 52-week safety and efficacy results from an open-label extension of a randomized, sham-controlled trial. Methods In this institutional review board-approved, randomized, multicenter, double-blinded study, patients were implanted with a neurostimulation system, randomized to an active or control group for 12 weeks, and received open-label treatment for an additional 40 weeks. Outcomes collected included number of headache days, pain intensity, migraine disability assessment (MIDAS), Zung Pain and Distress (PAD), direct patient reports of headache pain relief, quality of life, satisfaction and adverse events. Statistical tests assessed change from baseline to 52 weeks using paired t-tests. Intent-to-treat (ITT) analyses of all patients (N = 157) and analyses of only patients who met criteria for intractable chronic migraine (ICM; N = 125) were performed. Results Headache days were significantly reduced by 6.7 (±8.4) days in the ITT population (p < 0.001) and by 7.7 (±8.7) days in the ICM population (p < 0.001). The percentages of patients who achieved a 30% and 50% reduction in headache days and/or pain intensity were 59.5% and 47.8%, respectively. MIDAS and Zung PAD scores were significantly reduced for both populations. Excellent or good headache relief was reported by 65.4% of the ITT population and 67.9% of the ICM population. More than half the patients in both cohorts were satisfied with the headache relief provided by the device. A total of 183 device/procedure-related adverse events occurred during the study, of which 18 (8.6%) required hospitalization and 85 (40.7%) required surgical intervention; 70% of patients experienced an adverse event. Conclusion Our results support the 12-month efficacy of PNS of the occipital nerves for headache pain and disability associated with chronic migraine. More emphasis on adverse event mitigation is needed in future research. Trial registration: Clinical trials.gov (NCT00615342).

Continuous intrathecal baclofen infusion by a programmable pump in 131 consecutive patients with severe spasticity of spinal origin.

We began this study to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the treatment of severe spasticity of spinal cord origin.

The treatment of medically intractable trigeminal autonomic cephalalgia with supraorbital/supratrochlear stimulation: a retrospective case series.

Introduction:  This is a retrospective case series of five patients with intractable trigeminal autonomic cephalalgia (TAC) who were implanted with a supraorbital/supratrochlear neuromodulation system.

Subcutaneous Peripheral Nerve Stimulation With Paddle Lead for Treatment of Low Back Pain: Case Report

Introduction. Peripheral nerve stimulation has become a useful tool in neuromodulation in the treatment of chronic and intractable pain syndromes. Method. While most of the reports in the literature describe the use of a subcutaneously placed small diameter cylindric lead, we present a case report of a 37‐year‐old man who did not have adequate axial back stimulation with such a lead. Conclusion. He had excellent stimulation and reduction of his pain after the device was replaced with an insulated subcutaneous paddle lead.

Analysis of adverse events in the management of chronic migraine by peripheral nerve stimulation.

In this study, we analyze device‐ and procedure‐related adverse events (AEs) from a recent prospective, multicenter, double‐blinded controlled study that utilized peripheral nerve stimulation (PNS) of occipital nerves for management of chronic migraine.

Continuous Intrathecal Baclofen Infusion Delivered by a Programmable Pump for the Treatment of Severe Spasticity Following Traumatic Brain Injury

The aim of this study was to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the chronic treatment of severe spasticity due to traumatic brain injury (TBI). Eight patients with severe spasticity following TBI, refractory to oral baclofen or who experienced intolerable side effects, were screened. The first five patients were enrolled in a research protocol that was approved by the Institutional Review Board for Human Research at Boston University Medical Center. The other three patients were evaluated after the FDA approved the therapy for spasticity of cerebral origin.

Post-surgical spine syndrome

Dear Sir, It is our view that the diagnostic terms post laminectomy syndrome (ICD-9 code 722.8) or failed back syndrome[1,4,8] are inaccurate, misleading, can be construed as disparaging, and should be discarded. We propose that these terms should be replaced with Post-surgical Spine Syndrome (PSSS). Implicit in the terms is that pain and disability following spinal surgery is the result of failed or unsuccessful surgery. Not infrequently, patients report that following surgery, “my leg pain is gone, but my back still hurts.” A significant number of these patients have facet arthropathy,[2] which was likely present before surgery. As pointed out by Wilkinson,[8] degenerated disk collapses, causes misalignment of the facet joint, which can result in facet pain. Diagnostic facet medial branch injections may help to determine who may benefit from radiofrequency rhizotomy.[5–7] Discectomy may lead to a further collapse of the disk and cause foraminal stenosis and secondary nerve root compression.[6] The other flaw in the terms is the anatomical inaccuracy. There are other varieties of spine surgery than laminectomy. These include discectomy, anterior interbody fusion, posterior interbody fusion, pedicle screw, and other forms of arthrodesis. Furthermore, new techniques are constantly evolving. The proposed term of Post-surgical Spine Syndrome encompasses all forms of spinal surgery. It also covers the pathological conditions that existed prior to surgery, as well as conditions that may be related to the surgery, such as nerve root compression or injury, epidural fibrosis, arachnoiditis, adjacent level degeneration, and spinal instability. If accepted, the new descriptions for the existing ICD-9 codes will be as follows: 722.80 Post-surgical spine syndrome, unspecified region 722.81 Post-surgical spine syndrome, cervical region 722.82 Post-surgical spine syndrome, thoracic region 722.83 Post-surgical spine syndrome, lumbar region When ICD-10 officially replaces ICD-9, the code for all PSSS will be M96.1. The incidence of PSSS may be reduced by a meticulous neurological examination and careful patient selection.[3,7,8] The facet and sacroiliac joints should always be examined, particularly when the pain is predominantly in the lower back, or when it radiates only to the thigh or groin and not below the knee. Patients who have mild or no neurological deficits and whose radiographic or electrophysiological studies show minimal nerve root compression may benefit from a diagnostic selective nerve root injection, before making a surgical decision. Finally, referred visceral pain from the pelvic or abdominal organs should also be excluded by a comprehensive examination. Adherence to these simple guidelines can result in a significant reduction in the pain and suffering, as also the enormous financial cost of PSSS.[3]

Neurologic function seven years after crowbar impalement of the brain

The management of impalement injuries to the brain presents formidable problems. A 39-year-old man was impaled by a crowbar which penetrated the brain. The prompt rescue and resuscitation, thorough surgical debridement, control of intracranial pressure and rehabilitation are described.

Percutaneous Lumbar Decompression With SpineJet Hydrosurgery in the Treatment of Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy.

Introduction Lumbar spinal stenosis with symptomatic neurogenic claudication is a frequently encountered clinical entity which requires endoscopic or open spine surgery once the patients fail to respond to conservative therapies. In this case report we present a novel minimally invasive decompression technique using a fluid jet device (HydroCision Inc, Billerica, MA, USA) for a patient with symptomatic spinal stenosis secondary to ligamentum flavum hypertrophy. To our knowledge this approach has never been described in the medical literature. Case Presentation An 85 years old patient presented because of intractable right leg pain with minimal activities. She was diagnosed with significant right foraminal stenosis and she failed conservative non-invasive therapies. Conclusions Percutaneous lumbar hydro decompression can be a promising method for the treatment of the patients with lumbar spinal stenosis and neurogenic claudication secondary to ligamentum flavum hypertrophy.

Managing loss of intrathecal baclofen efficacy: Review of the literature and proposed troubleshooting algorithmAuthors Respond:

We congratulate Boster et al.1 for proposing a troubleshooting algorithm for loss of intrathecal baclofen (ITB) efficacy. The catheter accounts for most of the problems with ITB. We are concerned that the algorithm excludes contrast study, and indium scan, for assessing catheter function. The authors recommend catheter replacement if catheter access port (CAP) aspiration is negative or inconclusive. The result is likely to be some unnecessary surgeries. Vender et al.2(p14) cautioned, “often, a functional catheter will not aspirate CSF. This does not prove that a catheter occlusion exists.” CAP aspiration is …