Michael D. Osborne

The Effect of Ankle Disk Training on Muscle Reaction Time in Subjects with a History of Ankle Sprain

The purpose of this study was to determine whether 8 weeks of ankle disk training alters ankle muscle onset latency of patients with a history of lateral ankle sprain. The training was completed by eight minimally symptomatic subjects with a history of nonrehabilitated, unilateral, inversion ankle sprain sustained between 6 and 16 months before entry into the study. Ankle inversion perturbations monitored by fine-wire electromyography were performed in four lower extremity muscles (anterior tibialis, posterior tibialis, peroneus longus, and flexor digitorum longus) of all subjects on both the injured (experimental) and noninjured (control) legs. Testing was performed at study entry and after 8 weeks of ankle disk training on the previously injured ankle. Results revealed a statistically significant decrease in the anterior tibialis onset latency in both the experimental (67.6 ± 20.3 to 51.7 ± 17.6) and control (65.5 ± 9.8 to 53.8 ± 23.7) ankles after the training period. These findings indicate that muscle onset latency decreases in specific ankle muscle groups after ankle disk training in previously injured ankles. Both the experimental and control ankles demonstrated a significant change, which raises the question as to whether a proprioceptive cross-training effect occurred.

Prevention and Treatment of Ankle Sprain in Athletes

The frequent nature of ankle sprains and persistent disability that often ensues has lead to considerable medical costs. As prevention of disease and injury becomes an increasingly important part of the practice of medicine today, we strive to understand and identify interventions that optimally reduce the frequency of ankle sprain and re-injury. In doing so, considerable morbidity and unnecessary medical expenditures may potentially be averted. The prophylactic use of ankle braces is fairly common. Recent critical evaluation of their effectiveness supports their use for at least 6 months following injury in athletes who have sustained a moderate or severe sprain; however, their role in primary prevention of ankle sprain is less evident. Functional ankle rehabilitation is the mainstay of acute ankle sprain treatment and in recent reviews has been deemed preferable to immobilisation or early surgery for initial treatment of acutely injured ankles. Furthermore, certain components of ankle rehabilitation, such as proprioceptive exercises, have been found to protect the joint from re-injury. Multifaceted ankle sprain prevention programmes that incorporate a variety of strategies for injury reduction are also effective in sprain prevention, although the relative importance of each component of such programmes warrants further investigation. Surgery for ankle sprain is principally reserved for patients who fail a comprehensive non-operative treatment programme and can be highly successful in treating chronic functional instability. This paper examines the current literature regarding common ankle sprain prevention strategies and provides a review of appropriate treatment schemes.

Spinal Cord Stimulator—Trial Lead Migration Study

OBJECTIVES Investigate whether percutaneous spinal cord stimulator (SCS) leads migrate significantly during a 3-day trial, and determine whether the skin anchoring method influences lead migration. MATERIAL AND METHODS Twenty patients were prospectively enrolled. Ten leads were anchored with suture and tape and 10 were anchored with tape only. A standardized X-ray protocol of lead position was obtained immediately following lead placement and upon completion of the trial. RESULTS Using a standardized method, SCS leads were measured and movement was calculated. The average movement for leads anchored with tape only was 8.72 mm (SD=5.77), inferiorly; while movement for leads anchored with suture and tape was 24.49 mm (SD=11.3), inferiorly. A t-test revealed a significant difference between the groups (t=3.9, P=0.001). CONCLUSIONS Percutaneous SCS trial electrodes migrate significantly, inferiorly, during a 3-day trial. Anchoring the trial electrodes to the skin with a suture and tape results in significantly greater inferior migration when compared with anchoring the lead with tape only.

Device–Device Interference of a Bipolar Spinal Cord Stimulator With a Bipolar Implantable Cardioverter‐Defibrillator

To the Editor: Spinal cord stimulation has been effectively used for various pain conditions (1–4). In older patients with a high prevalence of coexisting pain conditions and cardiac pathology, there is an increasing trend of simultaneous use of spinal cord stimulation along with implantable cardioverter-defibrillators (ICD). However, safe concomitant use has not adequately withstood the test of time. We report a case of device–device interference between a bipolar spinal cord stimulator and bipolar ICD, and a subsequent successful application of peripheral nerve field stimulation for successful pain control in combination with ICD without interference.

Radiofrequency neurotomy for a patient with deep brain stimulators: proposed safety guidelines.

OBJECTIVE To discuss the potential risks inherent to performing radiofrequency procedures in patients with deep brain neurostimulators, and to propose safety guidelines. DESIGN Case report. SETTING Tertiary care teaching hospital. SUBJECT A 67-year-old male with intractable back pain due to advanced lumbar spondylosis, with a history of advanced Parkinsons Disease requiring two deep brain stimulators. INTERVENTION Radiofrequency neurotomy lumbar facet joints. RESULTS No atypical symptoms were reported during the procedure that would indicate iatrogenic injury from radiofrequency effect on the deep brain neurostimulators. The subjects back pain was relieved by 70% for greater than 6 months bilaterally. DISCUSSION There are several theoretical concerns when using radiofrequency therapies on patients with neurostimulators. Our patient did not experience any known adverse events during or subsequent to the procedure. This article presents our proposed safety guidelines for using radiofrequency neurotomy on patients with deep brain stimulators. CONCLUSIONS Radiofrequency medial branch neurotomy was performed on a patient with two deep brain stimulators with a satisfactory clinical outcome, and no adverse sequelae. Additional study is warranted regarding the safety and compatibility of brain neurostimulators and radiofrequency interventions.

The Effectiveness of an Intensive Interdisciplinary Pain Rehabilitation Program in the Treatment of Post-Laminectomy Syndrome in Patients Who Have Failed Spinal Cord Stimulation

Introduction Post-laminectomy syndrome (PLS) patients who have previously undergone spinal cord stimulation and failed to have significant improvement create a unique challenge for ongoing pain management. We hypothesize that, following successful completion of intensive, interdisciplinary pain rehabilitation (IPR), this patient population can achieve a significant reduction in pain, improvement in mood, functional levels, and self-efficacy. Materials and methods A retrospective chart review was conducted comparing the following for patients prior to enrollment in the IPR program and upon completion: numeric rating scale (NRS) pain scores; functional status via the six-minute walk test; mood via the Center for Epidemiologic Studies Depression Scale (CES-D), Multidimensional Pain Inventory (MPI) Life control scores and MPI Interference, and the Pain Catastrophizing Scale (PCS); and self-efficacy via the Pain Self-Efficacy Questionnaire (PSEQ). Results Forty-three patients met inclusion criteria, with 17 males and 26 females and a mean age of 64 years. Patients demonstrated a statistically significant increase in six-minute walk test distance of 104 m, a decrease in average NRS pain score of 1.4 points, an increase in average MPI life control by 8.3 points, a decrease average MPI interference by 5.3 points, an increase in average Short Form-36 by 6.5 points, an increase in average PCS by 4.4 points, and an increase in average PSEQ score of 18.1. Their average mood via CES-D improved by 4.2 points. Conclusions Intensive, interdisciplinary pain rehabilitation provides an effective therapeutic modality for patients with post-laminectomy syndrome who have failed spinal cord stimulation by decreasing pain levels and by increasing functional status and self-efficacy.

Poster 261: Cooled Radiofrequency Neurotomy for Sacroiliac Joint Pain: A Retrospective Case Review

Arthrocare. Objective: To determine if morphologic changes occur in the lumbar multifidus muscles, facet joints, and intervertebral disks after medial branch radiofrequency neurotomy (RFN). Design: Retrospective review of medical records and magnetic resonance imaging (MRI). Setting: University spine center. Participants: 27 subjects treated with lumbar RFN who had both preand posttreatment MRIs completed at a single institution. Interventions: All preand posttreatment MRIs were evaluated to determine the cross-sectional area (CSA) of the lumbar multifidus muscles 1 segmental level above the most cephalad RFN lesion (“non-treatment” levels) as well as 1 segmental level below each RFN lesion (“treatment” levels). Bilateral facet joint degeneration (Weishaupt classification) and disk degeneration (Pfirrmann classification) were graded from L1-2 through L5-S1. Main Outcome Measures: The mean preto posttreatment changes in multifidus CSA as well as rates of deterioration of facet and disk degeneration were compared between treatment and nontreatment levels. Results: Average subject age was 55.6 years, and 16/27 were women. Timing of the MRIs before and after the RFN treatment was a mean 12.7 and 7.5 months, respectively. The mean preto posttreatment change in multifidus CSA demonstrated a trend toward greater atrophy in treatment levels than non-treatment levels ( 0.579 cm versus 0.286 cm; P .0773). There was no statistical difference in the rates of deterioration in the facet joints observed at treatment and nontreatment levels (6.76% versus 9.74%, respectively; P .6322). Finally, treatment levels demonstrated a significantly greater amount of disk deterioration from the preto post-MRIs relative to non-treatment levels (14.89% versus 4.55%; P .0489). Conclusions: The impact of RFN on multifidus function, morphology, and segmental anatomy is unknown. This preliminary retrospective study indicates that measurable morphologic changes do occur after RFN. These findings require validation in a prospective controlled study.