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Symptomatic Lumbar Canal Stenosis—A Review and Primer on Surgical Decision Making

Teaser: 

Sager Hanna MB, BCh, BAO, 1 Perry Dhaliwal MD, MPH, FRCSC,2

1Section of Neurosurgery and Section of Orthopedic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba.
2Assistant Professor of Neurosurgery, Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba.

CLINICAL TOOLS

Abstract: Lumbar canal stenosis is an anatomical term used to describe narrowing of the spinal canal either congenitally or from age-related degenerative changes. It refers to a structural finding that may or may not be symptomatic. A decrease in canal diameter can lead to compression of the neural components, causing a constellation of symptoms. Family physicians should familiarize themselves with the various presentations of canal narrowing and the available diagnostic and treatment options.
Key Words: lumbar spinal stenosis, neurogenic claudication, back pain, radiculopathy.

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1. Lumbar spinal stenosis is commonly caused by age-related degenerative changes involving the intervertebral discs, ligamentum flavum and facet joints.
2. Patients with lumbar spinal stenosis may present with neurogenic claudication or radiculopathy.
3. The primary care provider needs to distinguish between symptomatic lumbar spinal stenosis and other common mimics.
4. Surgical treatment is principally decompression of the neural elements with the possible addition of fusion of the affected levels.
1. Degenerative changes in the lumbar spine can lead to various symptoms such as low back pain, lumbar radiculopathy, neurogenic claudication, and cauda equina syndrome.
2. Imaging of the lumbar spine should be ordered when there is a high clinical suspicion of lumbar spinal canal stenosis based on the history and physical examination.
3. Initial management of patients presenting with lumbar canal stenosis involves non-operative modalities like pharmacological therapy, physiotherapy, lifestyle modifications, patient education and image-guided injections.
4. Surgical decompression for symptomatic lumbar spinal stenosis, with or without fusion, is generally indicated when symptoms significantly interfere with daily activity and non-operative treatment has failed after 3-6 months.
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Related Terms: Back Health, lumbar spinal stenosis, neurogenic claudication, back pain, radiculopathy

Collodion Baby

Teaser: 

Dylan Hollman,1Ou Jia (Emilie) Wang,2 Joseph M. Lam, MD, FRCPC,3

1Faculty of Medicine, University of Alberta.2 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
3Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Collodion baby, estimated to occur in 1 in 100,000 newborns, is a visually striking clinical presentation seen in neonates that is often a sign of an underlying autosomal recessive congenital ichthyosis. The baby is wrapped in a taut, translucent membrane, which is often compared to plastic wrap, saran wrap, a cocoon, or armour. A formal clinical diagnosis is often not reached until shedding of the membrane reveals the underlying phenotype. This can be isolated or associated with other structural and systemic congenital abnormalities. Patients may require ongoing monitoring and sometimes surgical intervention. Collodion baby is a rare and challenging condition that requires multimodal management including dermatologic care, infection prevention, nutritional support, developmental monitoring, and procedural interventions, if needed.
Key Words: Collodion baby, ichthyosis, neonate, newborn, pediatrics, dermatology.

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Collodion baby is both a diagnosis and a clinical manifestation in newborns who commonly have autosomal recessive congenital ichthyosis.
A highly compromised skin barrier puts the patient at a high risk of both hypo-/hyperthermia, dehydration, poor growth, infection and several other organ-specific complications. Due to these increased risks, admission to the neonatal intensive care unit is necessary to facilitate close monitoring and access to a highly humidified incubator.
The collodion membrane (CM) is shed within 3 to 4 weeks, revealing the underlying ichthyosis. Special investigations can be undertaken before the membrane sheds such as a skin biopsy or blood work. These investigations can provide clinical clues to an earlier diagnosis. If the patient is stable, it is reasonable to wait for the membrane shedding to reveal an underlying diagnosis.
Petroleum-based moisturizers can protect the skin as the membrane peels off.
The most common underlying diagnoses of collodion baby are congenital ichthyosiform erythroderma and lamellar ichthyosis. However, an estimated 10% of patients will have near normal-appearing skin, referred to as self-improving collodion ichthyosis.
Skin barrier dysfunction can lead to significantly higher transepidermal water loss and poor temperature regulation. A highly humidified incubator (minimum 60%) can help reduce water loss and assist in adequate temperature regulation.
Other keys to management include close observation for signs of infection, dehydration, electrolyte imbalance and/or poor feeding/decreased growth velocity.
Topical petroleum-based lubricants should be applied multiple times per day while medicated ointments should be avoided due to risk of systemic toxicity.
Complications involving the lungs (chest constriction or respiratory distress), eyes (ectropion or keratitis) and ears (obstruction, conductive and sensorineural hearing loss) may also be seen. In these instances, consultations with pulmonology, ophthalmology or otorhinolaryngology may be necessary for comprehensive care.
Skin biopsy prior to membrane shedding is generally unhelpful but may provide disease-specific histological findings if done after the collodion sheds.
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Related Terms: Dermatology, Collodion baby, ichthyosis, neonate, newborn, pediatrics, dermatology
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Scoliosis Screening: A Review of Current Evidence, Worldwide Practices, and Recommendations for Implementation Across Canada

Teaser: 

Caitlyn Dunphy, MPT, 1 Marie Anne Keenan, BSc candidate,2 Hunter Cole David Arulpragasam, BSc candidate,3 Jean Albert Ouellet, MD, FRCS(C),4 Kevin Smit, MD, FRCS(C),5 Ron El-Hawary, MD, MSc, FRCS(C),6 Andrea Mary Simmonds, MD, MHSc, FRCS(C),7

1BC Children’s Hospital Orthopaedic Spine Clinic.
2University of Victoria, Research Student, Department of Orthopaedic Surgery, BC Children’s Hospital.
3University of Toronto, Research Student, Department of Orthopaedic Surgery, BC Children’s Hospital.
4McGill University Health Centre/ Shriners Hospital for Children - Canada.
5Pediatric Orthopedic Surgeon, CHEO, Associate Professor, Faculty of Medicine, University of Ottawa, Surgeon Scientist, CHEO Research Institute.
6Professor of Surgery (Orthopedics, Neurosurgery) Professor of Biomedical Engineering, Faculty of Medicine, Dalhousie University Chief of Pediatric Orthopedic Surgery, IWK Health.
7 Paediatric Spine & Orthopaedic Trauma Surgeon, British Columbia Children’s Hospital Clinical Assistant Professor, UBC Department of Orthopaedics.

CLINICAL TOOLS

Abstract: There is a lack of consensus about the merits of scoliosis screening and whether it is a beneficial strategy for both the patients and the healthcare system. With mounting concerns about long wait times across Canada for surgical correction of scoliosis, interest has grown in maximizing non-operative care. We have investigated the history of scoliosis screening and the controversies surrounding implementation of screening in a Canadian setting. We propose an optimal screening strategy.
Key Words: Scoliosis, scoliosis screening, early detection, conservative strategies.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

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Screening can facilitate early diagnosis and treatment of scoliosis.
Early diagnosis of scoliosis increases opportunities for successful conservative treatment.
Conservative strategies may prevent the need for surgical intervention.
Scoliosis screening may improve access to care and reduce health care costs.
Early detection of scoliosis through school screenings is recommended for initiating timely and effective conservative treatments, such as bracing and physical therapy. This can significantly reduce the need for surgical interventions and associated healthcare costs.
A standardized, evidence-based screening protocol should be developed and implemented across all Canadian schools. This protocol should include clear guidelines on the use of screening tools, referral criteria, and follow-up procedures to ensure consistency and accuracy in detecting scoliosis.
School nurses, physical education teachers, and other relevant personnel should receive adequate resources and support for proper training in scoliosis screening.
Educational campaigns must raise awareness about the signs of scoliosis and the importance of school screenings for early detection among parents, teachers, and the general public.
Ongoing research and evaluation of the screening program should be conducted to assess its effectiveness, cost-benefit ratio, and impact on health outcomes.
Collaboration between healthcare providers, educators, policymakers, and scoliosis advocacy groups is essential to create a comprehensive and sustainable screening program.
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Related Terms: Back Health, Scoliosis, scoliosis screening, early detection, conservative strategies

Pityriasis Alba

Teaser: 

Ou Jia (Emilie) Wang,1 Joseph M. Lam, MD, FRCPC,2

1 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Pityriasis alba is a common, benign skin condition that primarily affects children and adolescents, characterized by hypopigmented patches and scaly plaques on the face and other areas of the body. It is likely a manifestation of post-inflammatory hypopigmentation from subtle or subclinical inflammation. Diagnosis is typically based on history and clinical presentation. Management involves the use of emollients and low-potency topical steroids to improve skin hydration, reduce inflammation, and alleviate symptoms such as pruritus. Pityriasis alba typically becomes less apparent as the patients age, but reassurance and symptomatic relief are critical components to managing the condition.
Key Words: Pityriasis alba, atopy, hypersensitivity, scaling, hypopigmentation, asymptomatic.

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Pityriasis alba presents as patches and plaques of hypopigmentation, which is more identifiable in darker skin types (Fitzpatrick skin types III to VI).
Pityriasis alba is a benign and self-limiting skin condition that often improves with time.
Pityriasis alba is often associated with atopic dermatitis and the atopic triad.
Diagnosis of pityriasis alba is made on history and exam and the exclusion of other conditions (e.g. fungal infections, atopic dermatitis, and psoriasis). Skin biopsy, laboratory tests, and Wood’s lamp examination are not necessary, but can be performed if other conditions are suspected.
The hypopigmentation in pityriasis alba does not result from reduction in melanocyte count.
Patient reassurance, education and lifestyle management is often sufficient, but emollients, low-potency topical steroids, and topical calcineurin can also be used.
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Related Terms: Dermatology, Pityriasis alba, atopy, hypersensitivity, scaling, hypopigmentation, asymptomatic
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Back and Neck Pain, Pain Clinics and Interventional Pain Management in Canada

Teaser: 

Arani Kulamurugan,1 Pranjan Gandhi,2 Markian Pahuta,3 Mohammad Zarrabian,4 Daipayan Guha,5

1Michael DeGroote School of Medicine, McMaster University, Hamilton, ON.
2Michael DeGroote School of Medicine, McMaster University, Hamilton, ON.
3Department of Surgery, Division of Orthopaedics, McMaster University, Hamilton, ON.
4Department of Surgery, Division of Orthopaedics, McMaster University, Hamilton, ON.
5Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON.

CLINICAL TOOLS

Abstract: This paper examines the role of pain clinics in Canada, focusing on non-surgical interventions to manage cervical and lumbar degenerative pathologies. These pathologies have a substantial impact on health care and the economy. Since non-interventional management strategies are often insufficient, pain clinics can be effective in providing image-guided injections to reduce symptoms and rates of surgery. Given the challenges of access and long wait times for treatment, the expansion of pain clinics may be an interim solution to improve outcomes and alleviate the burden on Canadian healthcare.
Key Words: radiculopathy, myelopathy, back pain, neck pain, pain clinic.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

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1. Identifying the specific type of back pain guides the choice of treatment, enhancing patient outcomes.
2. Interventional strategies have demonstrated significant benefits when combined with traditional medical and physical therapies.
3. Axial pain, radiculopathy, neurogenic claudication and myelopathy have distinct symptoms and relief mechanisms, making accurate diagnosis critical.
4. Improving the distribution and accessibility of multidisciplinary pain management services will improve the outcomes for patients with chronic pain.
Differentiating Pain Syndromes: It is essential to distinguish among axial neck/back pain, radicular pain, neurogenic claudication and myelopathy to institute proper back pain management. Axial pain is worsened by physical activity, radicular pain is limb dominant, neurogenic claudication is exacerbated by prolonged standing and relieved by sitting, and myelopathy produces upper motor neuron findings in both upper and lower limbs.
Role of Pain Clinics: Offering a wide range of services, pain clinics are cost-effective and improve quality of life and functionality through interventional pain management, mental health support, and physical therapy.
Barriers to Accessing Care: Access to multidisciplinary pain treatment facilities in Canada is limited by long wait times and significant regional variability.
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Related Terms: Back Health, radiculopathy, myelopathy, back pain, neck pain, pain clinic

Pediatric Scabies

Teaser: 

Ou Jia (Emilie) Wang,1 Joseph M. Lam, MD, FRCPC,2

1 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Scabies, caused by the Sarcoptes scabiei var. hominis mite, is a common and highly contagious skin infestation that manifests with symptoms of intense itching and a generalized pruritic papular eruption. Crusted scabies, a severe form of the infestation, is more commonly seen in immunocompromised individuals. Scabies can affect individuals of all ages and is typically transmitted through close and prolonged skin-to-skin contact. Diagnosis relies heavily on clinical examination, with scabies preparation at multiple sites guided by dermoscopy. Management involves both treating the condition and preventing its spread to others, with the primary treatment being the application of topical scabicide medications to the entire body. Environmental decontamination measures are crucial in controlling the spread of scabies. Prompt diagnosis and treatment are essential to prevent complications and transmission to others.
Key Words: scabies, classic scabies, crusted scabies, infestations, pruritus, hypersensitivity reactions.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

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A large range of prevalence exists with scabies and scabies is not reportable in Canada. It disproportionately affects individuals living in poverty and crowded conditions.
A definitive diagnosis of scabies can be made through visualization through microscopy of skin scrapings and tape samples or through dermoscopy.
Treatment of patients and close contacts and environmental measures must be taken to prevent further spread and infestation.
In scabies infestation, the female mite burrows under the skin and triggers a hypersensitivity reaction with symptoms of pruritus and inflammation.
Classic scabies is more common, while crusted scabies is rarer and more severe.
First-line treatment is topical 5% permethrin cream head to toe including the scalp in infants and young children and from the neck down in adults with retreatment in one week.
Environmental decontamination is important to preventing reinfestation.
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Related Terms: Dermatology, scabies, classic scabies, crusted scabies, infestations, pruritus, hypersensitivity reactions
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Current Concepts in Spinal Cord Injury: Pearls for Primary Care Management

Teaser: 

Karlo M. Pedro, MD,1 Francois Dantas, MD,2 Peyton Lawrence, MD,3 Michael G. Fehlings, MD, PhD,4

1Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
2Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
3Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
4Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Institute of Medical Science, University of Toronto, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada.

CLINICAL TOOLS

Abstract: Traumatic spinal cord injury (tSCI) is a devastating condition that can lead to severe and permanent sensory, motor, and autonomic dysfunction, significantly impacting an individual’s ability to function independently. Recent demographic changes have resulted in a notable increase in tSCI among the elderly, with falls emerging as the primary cause. Early recognition and prehospital management are crucial, emphasizing restriction of spinal motion and timely transfer to specialized centres. Since the time from injury to surgery significantly affects outcomes, decompression should not be delayed and offered in a timely manner to all tSCI patients. Additionally, emergent trauma care including conducting a thorough neurological assessment, maintaining adequate blood pressure and adopting a multidisciplinary approach, is essential for optimizing neurological outcomes and addressing long-term complications.
Key Words: Early surgery, geriatric trauma, neurotrauma, traumatic spinal cord injury.

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Falls are increasingly becoming the primary cause of traumatic spinal cord injury, particularly among the elderly population, underscoring the need for heightened awareness and proactive preventive measures.
Early recognition and appropriate prehospital management, including prompt transfer to specialized trauma centers, are crucial in saving the injured spine.
Neuroprotective strategies, such as maintaining adequate spinal cord perfusion and implementing early surgical decompression, are essential for attenuating the secondary injury cascade.
Multidisciplinary care is imperative for restoring functional independence, with a comprehensive approach addressing not only physical rehabilitation but also social, mental, and spiritual needs in patients with tSCI.
With an aging population and more fall-related mechanisms, the most common form of spinal cord injury (SCI) is an incomplete cervical SCI called central cord injury where the arms and hands are more affected than the legs. These patients usually have pre-existing degenerative changes and can experience cord contusion in the absence of a cervical fracture.
“Time is spine” is a key principle which guides spinal cord injury management. Most patients with a SCI require surgery, optimally within 24 hours after injury. Expeditious workup and referral/transfer of patients with a SCI to a specialized spine facility is important.
Be aware that 10-15% of patients with one spine fracture will have a second non-contiguous spine fracture. The presence of a spine fracture in one area should prompt a full spine CT.
Hemodynamic management of patients with a spinal cord injury is important to maintain cord perfusion. Mean arterial pressure should be maintained at greater than 80 mm Hg.
Methylprednisolone (a potent ant-inflammatory corticosteroid) and riluzole (a sodium-glutamate antagonist) are options in treating patients with an acute spinal cord injury and are optimally given within 8-12 hours after injury.
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Related Terms: Back Health, Early surgery, geriatric trauma, neurotrauma, traumatic spinal cord injury

Xerosis and Ichthyosis: A Brief Review

Teaser: 

Manish Toofany,1 Joseph M. Lam, MD, FRCPC,2

1 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Xerosis is a common skin condition that becomes more prevalent with age and is a prominent feature in ichthyosis. It primarily resulting from abnormalities in the stratum corneum, influenced by factors like natural moisturizing factors, lipid synthesis, and genetic pathologic variants. The diagnosis of xerosis and ichthyosis is usually made clinically, though specific investigations may aid in the diagnosis of specific ichthyoses. Both conditions can have a considerable negative impact on the quality of life of patients. Management includes moisturization and taking preventive measures to maintain skin health and to prevent xerosis.
Key Words: xerosis, ichthyosis, stratum corneum, natural moisturizing factors.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

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Xerosis is a common condition worldwide and it is a prominent feature of both syndromic and non-syndromic ichthyoses.
Both xerosis and ichthyosis can have a considerable negative impact on the quality of life of patients.
The diagnosis of xerosis and inherited ichthyoses is based on history, clinical manifestations, associated abnormalities, and family history, but several specific investigations may aid in the diagnosis of syndromic ichthyoses.
Managing xerosis includes applying topical moisturizers with key components like lipids and humectants while proactive preventive measures are vital for preventing triggers of the condition.
Understanding and addressing triggers such as temperature, low humidity, sunlight exposure, and environmental conditions like air conditioning or heating can be essential in managing xerosis effectively.
Evaluating the overall severity of xerosis and ichthyosis may include the use of established tools like the Dermatology Life Quality Index (DLQI) and the newer Ichthyosis Scoring System (ISS) to assess their impact on patients’ quality of life.
Identifying signs such as brittle hair, neurological abnormalities, and palmoplantar keratoderma can be suggestive of syndromic ichthyoses. These indicators are valuable for recognizing these rare conditions and guiding further examination or evaluation.
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Related Terms: Dermatology, xerosis, ichthyosis, stratum corneum, natural moisturizing factors
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Cervical Disc Arthroplasty: A Movement-Sparing Surgical Option in Cervical Disc Degeneration

Teaser: 

Simon Harris, MA, MB, BChir, FRCSC,

Orthopaedic Spine Surgeon, Trillium Health Partners, Mississauga, Ontario.

CLINICAL TOOLS

Abstract: Degeneration of the cervical discs is a common problem and can cause compression of cervical nerve roots and/or the spinal cord. This in turn may lead to permanent neurological injury, disability and socioeconomical impact for the patient. Surgical management typically includes either an Anterior Cervical Decompression and Fusion (ACDF) or a Posterior Decompression with or without fusion or laminoplasty. Over the past 20 years, Cervical Disc Arthroplasty (CDA) has been an increasingly viable alternative to the “Gold Standard” ACDF, after failure of conservative management in the appropriately selected patient. Single and multilevel CDA has a growing body of evidence to support its equivalency - and even superiority - to ACDF in long-term clinical outcomes.
Key Words: Cervical degenerative disc disease; Cervical Disc Replacement; Cervical Disc Arthroplasty; Radiculopathy; Myelopathy.

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Cervical radiculopathy symptoms include pain, paresthesia, numbness, and weakness in a recognised dermatomal and myotomal pattern.
First-line conservative treatment for cervical radiculopathy includes physiotherapy, analgesia, and non-steroidal anti-inflammatories.
Cervical disc replacement is an evidence-supported intervention for upper extremity radiculopathy that has failed conservative treatment.
Many designs of cervical disc arthroplasty are currently available for implantation in North America.
Cervical degenerative disc disease is a common radiographic finding present in both the symptomatic and asymptomatic population.
Axial neck pain, in the absence of red flag symptoms is best managed with an active physiotherapy program and pain management strategies.
Cervical disc arthroplasty is an evidence-supported surgical option to address central or foraminal cervical stenosis at the disc level.
1 or 2-level cervical disc arthroplasty has a lower re-operation rate than anterior cervical decompression and fusion.
Cervical disc arthroplasty procedure can be performed through a 4cm incision in the front of the neck.
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Related Terms: Back Health, cervical degenerative disc disease, cervical disc replacement, cervical disc arthroplasty, radiculopathy, myelopathy

Neuromodulation for the Management of Chronic Pain After Spinal Surgery

Teaser: 

Vishal Varshney MD FRCPC,1 Jill Osborn PhD, MD, FRCPC,2 Philippe Magown PhD, MD, FRCSC,3 Scott Paquette MEd, MD, FRCSC,4 Ramesh Sahjpaul MD, MSc, FRCSC,5

1Department of Anesthesia, Providence Healthcare, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
2Department of Anesthesia, Providence Healthcare, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
3Department of Surgery, Section of Neurosurgery, University of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada.
4Department of Anesthesia, Providence Healthcare, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
5Department of Anesthesia, Providence Healthcare, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia,  Department of Surgery, University of British Columbia, Vancouver, BC, Canada.

CLINICAL TOOLS

Abstract: Chronic neuropathic pain is associated with substantial disability and societal economic impact. Formerly called Failed Back Surgery Syndrome, and now labelled as Chronic Pain after Spinal Surgery by the ICD-11, this entity represents persistent neuropathic leg pain following structurally corrective spinal surgery, often refractory to pharmacological and interventional management,. In appropriately selected patients where medical management has been unsuccessful, the minimally invasive surgical technique of spinal cord stimulation can reduce disability and pain. Technological advances continue to improve this approach with greater success, lessened morbidity, and expanding indications.
Key Words: chronic pain after spinal surgery, failed back surgery syndrome, neuropathic pain, spinal cord stimulation, neuromodulation.

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1. Managing chronic pain after spinal surgery is a challenging and requires combined pharmacological and interventional options.
2. Spinal cord stimulation is a modality with strong evidence to supports its efficacy in the management of patients with chronic pain after spinal surgery.
3. The workup of patients with chronic pain after spinal surgery must include multi-tier pharmacological approaches, psychological optimization, and structural spinal assessment from a multidisciplinary group of clinicians.
Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system1. Spontaneous features include burning pain and tightness with unpredictable lancinating features.
The mechanism of spinal cord stimulation involves multiple sites within the central and peripheral nervous system. SCS can influence levels of cerebrospinal fluid neurotransmitters including increases in GABA, serotonin, Substance-P, norepinephrine, acetylcholine, and adenosine, and decreases in glutamate and aspartate.
The differential target multiplexed (paresthesia-free) spinal cord stimulation programs appear superior to the older standard paresthesia-based approach.
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Related Terms: Back Health, failed back surgery syndrome, neuropathic pain, spinal cord stimulation, neuromodulation, chronic pain after spinal surgery