J Neurosurg Sci
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Chronic pain is a common condition that confers a substantial burden--physical, psychological, and economic--to individuals and society. There are a wide variety of interventions available for this condition. ⋯ For drug therapy, this review will focus on three classes of medications: antidepressants, opiates and antiepileptic medications. For device therapy, the utility of electrical stimulation to neural structures (dorsal column, peripheral nerve and deep brain) and intrathecal therapy for chronic pain will be described.
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Spinal cord stimulation has evolved since its inception. It has been used as a treatment option since 1967 with a concentration on chronic pain syndromes. ⋯ Focused attention is on evolving technology and the direction of the field. This focus leans on the technology to keep pace with the evolving clinical needs.
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Review Case Reports
Thoracic spinal stenosis and myelopathy: report of two rare cases and review of the literature.
The authors report two cases of thoracic spinal canal stenosis (SCS) and myelopathy. One is extremely unusual because of degenerative changes occurred in the upper thoracic spine. The other because of its multiple etiology among which calcification and ossification of the ligamentum flavum (OLF) in a Caucasian man. ⋯ Both patients showed a rapid post-operative recovery and regained autonomous walking within 1 month of surgery. Thoracic spinal cord stenosis is a rare and complex disorder because of differential diagnosis, neuroimaging features and treatment options. Regardless of its cause, prompt surgical decompression plays a key role in improving the functional outcome of myelopathy.
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Spinal trauma is a leading cause of destabilization of the vertebral column. Balloon kyphoplasty is one among several surgical treatment methods for restoring spinal stability. This series included 25 patients (10 [40%] males and 15 [60%] females) over the age of 50 years who had undergone balloon kyphoplasty for traumatic compression fracture and were retrospectively evaluated to determine the success of this technique in terms of restoration of spinal stabilization. ⋯ The study results suggest that balloon kyphoplasty may be used in the surgical treatment of vertebral compression fractures in selected cases.
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Occipital nerve stimulation may be effective for primary headache disorders. Four studies, including two double-blind show, stimulation-controlled studies that were performed for chronic migraine showed evidence of benefit. ⋯ In chronic cluster headache, several case series have shown improvement, which, combined with the safety of occipital nerve stimulation relative to deep brain stimulation, have led to published reports supporting this as the preferred surgical technique for chronic cluster headache. A few case reports suggest a possible benefit in short-lasting unilateral neuralgiform headache attacks with conjunctival injection tearing and short-lasting unilateral neuralgiform headache.