spinal stimulator dorsal column myelopathy

#Spinal stimulator dorsal column myelopathy skin

The prognosis is good for patients who obtain symptom relief with non-surgical treatment.Spinal cord stimulation (SCS) is a minimally invasive therapy used for the treatment of chronic neuropathic pain. Even though surgery is effective, it also has serious complications that can be life-threatening. The outcomes of these patients depend on the cause. The surgical intervention can be done via an anterior or posterior approach. It is now a general recommendation to surgically intervene earlier as opposed to a carefully waiting period. Surgery aims to increase the canal space, which will lessen/eliminate cord compression. In the setting of progression, surgical management merits strong consideration. It is clear that once the symptomatology has started its progression, these short-term alternatives will not be a definitive treatment. Non-surgical management should include anti-inflammatories, physical therapy, ultrasound modalities, and at times, corticosteroid injections, but these all supply temporary pain relief. The treatment depends on symptoms and the degree of spinal stenosis. The diagnosis and management of cervical myelopathy are with an interprofessional team that consists of a nurse practitioner, neurologist, neurosurgeon, orthopedic surgeon, physiotherapist, and physiatrist. The most common neurologic complication is recurrent laryngeal nerve palsy in 3% of patients. It is reported that 9% to 27% of patients will have a transient sore throat and dysphagia, usually resolving within 12 weeks. Posterior approaches possibly have higher infection rates compared to anterior.Īnterior cervical discectomy and fusion (ACDF) is performed via an anterior approach. One option is a laminectomy (ideally with preoperative lordosis greater than 10 degrees and absence of instability). Surgical intervention can involve either an anterior or posterior approach.Ī posterior approach is preferable in lordosis deformities and when the pathology occurs at the posterior aspect of the canal. The goal of surgery is to increase the canal space, which will lessen/eliminate cord compression. In the setting of progressive symptoms, surgical management should merit strong consideration. These short-term alternatives will not be definitive treatments for patients with progressive symptoms.

#Spinal stimulator dorsal column myelopathy skin

It is also important to examine the skin along the back and document the presence of tenderness to compression or any prior surgical scars. The clinician should evaluate not only strength but also sensation and reflexes. The key to a thorough exam is organization and patience. Radiating pain as the main issue has a much more predictable surgical outcome than a presentation of non-specific neck pain that is likely related to muscle fatigue and strain.Īll physical examinations should include an evaluation of the neurologic function of the arms, legs, bladder, and bowels. A presentation of radiating pain correlates with canal stenosis. Obtaining a history from the patient should focus on the timeline of pain, radiation of pain, and inciting events. Indicators of poor prognosis include bowel or bladder dysfunction and general weakness. Additionally, physicians should examine for a Lhermitte sign (provocative positions that create an electric shock-like sensation either down the back or into an extremity). Neck pain and radicular symptoms are also common. These may include hand clumsiness and a limited ability to perform fine motor tasks such as buttoning a shirt, combing hair, holding small objects, and differentiating coin sizes. In cases of lower extremity signs, patients typically ambulate with a wide-based gait and weakness. Patients presenting with cervical myelopathy predominately experience upper extremity symptoms.