Mazin Al Tamimi

A case report of subcutaneous peripheral nerve stimulation for the treatment of axial back pain associated with postlaminectomy syndrome.

Objective.  This article aims to present a case of the use of an alternative form of neuromodulation for the treatment of axial back pain associated with postlaminectomy syndrome.

Subcutaneous peripheral nerve stimulation treatment for chronic pelvic pain.

Two cases of chronic pelvic pain of unknown etiology with symptoms referable to the low abdominal wall are presented. These patients are often difficult to manage because of multiple causes and multiple pathways for pain transmission from the pelvis. In these cases, the patients’ complaints were refractory to medication management, as well as diagnostic and therapeutic nerve blockade. After careful evaluation, a successful trial of peripheral nerve stimulation was followed by permanent implantation of low abdominal subcutaneous leads and a pulse generator device. The patients reported excellent relief of their chronic pelvic pain. The use of neuromodulation via peripheral stimulation deserves further investigation as an alternative to spinal cord stimulation for chronic pelvic pain.

A case series of pulsed radiofrequency treatment of myofascial trigger points and scar neuromas.

INTRODUCTION Pulsed radiofrequency (PRF) current applied to nerve tissue to treat intractable pain has recently been proposed as a less neurodestructive alternative to continuous radiofrequency lesioning. Clinical reports using PRF have shown promise in the treatment of a variety of focal, neuropathic conditions. To date, scant data exist on the use of PRF to treat myofascial and neuromatous pain. METHODS All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain within our practice were evaluated retrospectively for technique, efficacy, and complications. Trigger points were defined as localized, extremely tender areas in skeletal muscle that contained palpable, taut bands of muscle. RESULTS Nine patients were treated over an 18-month period. All patients had longstanding myofascial or neuromatous pain that was refractory to previous medical management, physical therapy, and trigger point injections. Eight out of nine patients experienced 75-100% reduction in their pain following PRF treatment at initial evaluation 4 weeks following treatment. Six out of nine (67%) patients experienced 6 months to greater than 1 year of pain relief. One patient experienced no better relief in terms of degree of pain reduction or duration of benefit when compared with previous trigger point injections. No complications were noted. DISCUSSION Our review suggests that PRF could be a minimally invasive, less neurodestructive treatment modality for these painful conditions and that further systematic evaluation of this treatment approach is warranted.

Successful treatment of chronic neuropathic pain with subcutaneous peripheral nerve stimulation: four case reports.

Introduction. Chronic pain is a prevalent medical condition in the general population and is one of the most common reasons patients visit their primary care doctors. When the pain is resistant to the common treatment modalities, it presents a challenge for the physician and may have profound consequences for the quality of life of the patient. Methods. We present four case reports in which subcutaneous peripheral nerve stimulation was successfully used to treat chronic neuropathic pain after all other treatment efforts had failed. Results. In all cases, the patients underwent a trial of peripheral nerve stimulation with good results. The patients reported decreased use of pain medications, increased quality of life, and high satisfaction with the procedure results. Conclusion. The use of subcutaneous peripheral nerve stimulation as a viable treatment alternative in certain cases of chronic neuropathic pain should continue to be rigorously evaluated.

Spinal Cord Stimulation as Alternative Treatment for Chronic Post‐Herniorrhaphy Pain

Objective:  Our goal was to determine the efficacy of spinal cord stimulation for patients with intractable post‐herniorrhaphy pain which conventional treatment failed to ameliorate.

Intraneural Posterior Interosseous Nerve Lipoma with Complete Paralysis: Case Report and Review of the Literature

An intraneural posterior interosseous nerve (PIN) lipoma is a rare entity consisting of two types and only two previously reported cases. Treatment involves total excision for the well-encapsulated “true intraneural lipomas” type and subtotal resection for the other type, fibrolipomatous hamartomas of the nerve. We present the management and surgical treatment of a case that illustrates a variation of the traditional posterolateral surgical approach for the complete excision of an intraneural PIN lipoma—contrary to the more commonly used anterior approach in literature—along with a literature review of intraneural PIN lipomas.

Osteodiskitis of Lumbar Spine Due to Migrated Fractured Inferior Vena Cava Filter

BACKGROUND Venous thromboembolism can be a significant cause of morbidity in the trauma population. Medical and surgical specialties have been pushing the indication for prophylactic filter placement. CASE DESCRIPTION A 36-year-old man presented with axial lower back pain with a radicular right L2 component after lifting a heavy object. He had a history of penetrating brain trauma 3 years prior, with placement of a prophylactic inferior vena cava filter. His radiograph, computed tomography, and magnetic resonance imaging of the lumbar spine showed fracture of his filter, with migration of the fractured fragment through the inferior vena cava and into the L2-L3 disk space, and surrounding bony lysis and severe osteodiskitis. He was treated medically with intravenous and then oral antibiotics and improved clinically and radiographically. CONCLUSIONS Conservative use of filter devices and early retrieval once their indication expires are paramount to avoid unnecessary complications.

Dermoid cysts of the conus medullaris: Clinical review, case series and management strategies

BACKGROUND The management of dermoid cysts can be tedious as they have a tendency to recur, and respond poorly to chemotherapy and radiation. Management is especially difficult for tumors involving highly eloquent areas such as the conus medullaris. OBJECTIVE We aim to provide a summary of the pathology, clinical presentation, and operative management strategies of dermoid cysts involving the conus medullaris. METHODS Two clinical cases of dermoid cysts of the conus are presented, as well as a commented surgical video. RESULTS A 33 year-old man with a history of cystic conus medullaris tumor presented with progressive low back pain and loss of bowel and bladder function. His magnetic resonance imaging (MRI) scan showed recurrence of his tumor with tethering of the spinal cord. He was taken for a midline myelotomy that drained yellowish keratinous fluid and decompressed the cyst. No aggressive attempt at complete resection of the cyst wall was undertaken. He made a complete recovery after surgery. A 25 year-old woman with a history of dermoid cyst of the conus that was previously treated surgically, presented with lower extremity weakness and debilitating pain. Her MRI showed significant recurrence of the cystic lesion. She was taken for a midline myelotomy and improved after surgery with complete resolution of her symptoms. CONCLUSION Dermoid cysts of the conus medullaris are challenging to treat. Surgical control and restraint are key, especially when patients are young and could potentially fully recover and remain in remission for a period of years.