Is Spinal Cord Stimulation an Effective Treatment Option for Discogenic Pain?

Introduction: In a prospective observational study conducted in an urban pain management center, we evaluated whether spinal cord stimulation (SCS) is effective in relieving discogenic pain of IDD origin. Methods: Thirteen patients with intractable discogenic low back pain were enrolled. Four patients never underwent permanent implantation due to insurance denial, medical reasons or failed trial and served as a control group. Nine patients underwent SCS implantation (treatment group). All patients were followed for 12 months and assessed at each interval for pain (NRS), disability (ODI), and opioid use. Results: Nine patients completed the SCS trial with > 50% pain relief. The pretrial NRS score was 7.8 ± 0.5 mm in treated patients vs. 6.5 ± 1.7 mm in control patients. At 3, 6 and 12 months, the NRS was reduced to 2.9 ± 0.7 mm, 1.7 ± 0.5 mm, and 2.9 ± 0.5 mm, respectively in treated patients. NRS was unchanged in the control patients (6.5 ± 1.9 mm). The ODI score prior to the SCS trial in treated patients was 53.1 ± 3.4% vs. 54.0 ± 20.5 in control patients. At 3, 6 and 12 months the ODI scores were 39.0 ± 8.0%, 38.7 ± 4.6%, and 41.1 ± 3.9%, respectively in the treated patients, and 48.5 ± 29.5 at 12 months in control patients. In 6 patients receiving opioids prior to the SCS trial, average consumption was reduced by 69% (P = 0.036) over 12 months of therapy as compared with a 54% increase in the control patients. SCS usage was stable over the 12‐month study. Conclusions: The current study indicates that SCS may provide effective pain relief, improve disability, and reduce opioid usage in patients with discogenic pain.     

Giant Cell Arteritis and Spinal Cord Compression: An Overlap Syndrome?

We describe 2 patients with spinal cord compression that occurred in the course of biopsy-proven giant cell arteritis (GCA). One case was due to an epidural tumorlike inflammatory lesion, the other to a concentric inflammatory thickening of the meninges. Both patients were highly corticodependent; they had low-titer anti-neutrophil cytoplasmic antibodies but no antimyeloperoxidase or antiproteinase 3 autoantibodies. The diagnosis was established by surgical biopsy. The histological pattern was reminiscent of Wegener granulomatosis. Both patients experienced relapse, despite high doses of corticosteroids, and experienced remission after the introduction of cyclophosphamide. Intravenous immunoglobulin perfusions were added for 1 patient. To our knowledge, spinal cord compression by a spinal pseudotumor or inflammatory meningitis has not been reported in the course of GCA. An overlap syndrome between GCA and Wegener granulomatosis is discussed.     

Spinal Cord Injury With a Narrow Spinal Canal: Utilizing Torg’s Ratio Method of Analyzing Cervical Spine Radiographs

A 65-year-old inebriated mancrashed his car and presented with spinal shock and neurogenic shock from a cervical spinal cord injury without cervical spine fracture or dislocation. The lateral cervical spine radiography was initially read as normal, except for degenerative disk disease; however, Torg’s ratio method of analyzing cervical spinal canal sagittal width indicated the spinal canal was congenitally narrow. Magnetic resonance imaging confirmed this and showed bulging and herniation of multiple invertebral disks between C2 and C7. This case illustrates the value of using Torg’s ratio method of analyzing lateral cervical spine radiographs. Although Torg’s method has not been prospectively validated, it may be useful to identify patients at risk for cervical spinal cord injuries without fractures or dislocations. An abnormal Torg’s ratio may be the only clue to the fact that the patient is at higher risk of spinal cord injury when the patient’s history or examination is questionable because of head injury, drug intoxication, or therapeutic sedation and paralysis.     

Plasma Leptin and Reduced FEV1 and FVC in Chronic Spinal Cord Injury

Background

Adipose tissue produces leptin, which is pro-inflammatory, and adiponectin, which has anti-inflammatory properties. Participants with chronic spinal cord injury (SCI) have increased body fat and are at increased risk for respiratory illness.

Protective Effects of Intracord Transplantation of pSVPoMcat Modified Schwann Cells on Spinal Cord Injury

Internationally,we first constructed 21.5kμuman myelin basic protein microgene(transiently called microgene pSVPoMcat) induced by Po－5’－flanking and proved this gene could enhance the function and prolond the living time of Schwann cells (SC).Intraspinal implantation of the gene modified SC could inhibit cell apoptosis and promote regeneration of the spinal cord after its injury.We further observed the effect of intraspinal implantation of the gene modified SC on the injured spinal cor…     

Impact of Regular Physical Activity on Adipocytokines and Cardiovascular Characteristics in Spinal Cord–Injured Subjects

Objective

To investigate the relationship of carotid artery intima-media thickness (IMT) and cardiac structure and function with adipocytokines in sedentary (S-SCI) and physically active (PA-SCI) subjects with spinal cord injury (SCI).

Spinal Cord Stimulation for Failed Back Surgery Syndrome: to Trial or Not to Trial?

Spinal cord stimulation (SCS) is a recommended therapy to treat failed back surgery syndrome (FBSS). A trial period is practiced to enhance patient selection. However, its fundamental evidence is limited, especially concerning long-term benefit and therapy safety. We compared the long-term (5.3 ± 4.0 years) clinical outcome and therapy safety of a trialed and nontrialed implantation strategy, including multidimensional variables and pain intensity fluctuations over time. A multicenter cohort analysis was performed in 2 comparable groups of FBSS patients. Regarding eligibility, patients had to be treated with SCS for at least 3 months. While the Trial group comprised patients who underwent an SCS implantation after a successful trial, the No-Trial group encompassed patients who underwent complete implantation within 1 session. The primary outcome measures were pain intensity scores and complications. The Trial and No-Trial groups consisted of 194 and 376 patients (N = 570), respectively. A statistically but not clinically significant difference in pain intensity (P = .003; effect = 0.506 (.172–.839)) was found in favor of the Trial group. No interaction between a time dependency effect and pain intensity was noted. Whereas trialed SCS patients were more likely to cease opioid usage (P = .003; OR = .509 (.326–.792)), patients in the No-Trial group endured fewer infections (P = .006; proportion difference = .43 (.007–.083)). Although the clinical relevance of our findings should be proven in future studies, this long-term real-world data study indicates that patient-centered assessments on whether an SCS trial should be performed have to be investigated. According to the current ambiguous evidence, SCS trials should be considered on a case-by-case basis.PerspectiveThe currently available comparative evidence, together with our results, remains ambiguous on which SCS implantation strategy might be deemed superior. An SCS trial should be considered on a case-by-case basis, for which further investigation of its clinical utility in certain patient populations or character traits is warranted.     

Spinal Cord Stimulation in the Treatment of Cancer-Related Pain: “Back to the Origins”

Spinal cord stimulation (SCS) has been used in the treatment of chronic pain for more than 40 years. The most common indication for SCS in the USA is failed back surgery syndrome (FBSS). Interestingly, the first two spinal cord stimulators ever implanted were in patients suffering from bronchogenic carcinoma and pelvic cancer, respectively. While cancer accounts for millions of deaths each year in the USA, pain is often the first sign of malignancy. An increasing number of people suffer from cancer-related pain each year and many receive suboptimal relief. Given the demonstrated value of spinal cord stimulation in the treatment of neuropathic pain, spinal cord stimulation should be considered "earlier" as an adjunct to the treatment of cancer-related pain. In addition, with the improving survival rates associated with advances in cancer treatment, spinal cord stimulation may help reduce the risk of development of chronic neuropathic pain in survivors.     

An Exploration of Modifiable Risk Factors for Depression After Spinal Cord Injury: Which Factors Should We Target?

Bombardier CH, Fann JR, Tate DG, Richards JS, Wilson CS, Warren AM, Temkin NR, Heinemann AW, for the PRISMS Investigators. An exploration of modifiable risk factors for depression after spinal cord injury: which factors should we target?ObjectiveTo identify modifiable risk factors for depression in people with spinal cord injury (SCI).DesignCross-sectional survey.SettingOutpatient and community settings.ParticipantsCommunity-residing people with SCI (N=244; 77% men, 61% white; mean age, 43.1y; 43% with tetraplegia) who were at least 1 month postinjury.InterventionsNot applicable.Main Outcome MeasuresDepression severity (Patient Health Questionnaire-9 [PHQ-9]), physical activity (International Physical Activity Questionnaire [IPAQ]), pleasant and rewarding activities (Environment Rewards Observation Scale [EROS]), and self-efficacy to manage the effects of SCI (Modified Lorig Chronic Disease Self-Management Scale).ResultsGreater depression severity was associated with being 20 to 29 years of age, not completing high school, not working or attending school, and being ≤4 years post-SCI. After controlling for demographic and injury characteristics (adjusted R²=.13), lower EROS scores (change in adjusted R²=.34) and lower self-efficacy (change in R²=.13) were independent predictors of higher PHQ-9 scores. Contrary to predictions, physical activity as measured by the IPAQ did not predict depression severity.ConclusionsOur findings suggest that having fewer rewarding activities, and to a lesser extent, having less confidence in one's ability to manage the effects of SCI are independent predictors of greater depression severity after SCI. Interventions such as behavior activation, designed to increase rewarding activities, may represent an especially promising approach to treating depression in this population.     

Study on Long-Terms Survival and Gene Expression of pSVPoMcat Genetically Modified Schwann Cell in the Rat Spinal Cord Injure

Study on plasticity of centra nervous system (CNS) suggested that CNS of mammals can be renewed and the regeneration process of injured neuron shows a trend toward differentiation and development stage, which are actually recapitulation of early neuron development differentiation of embryo. On the basis of the microgene of MBP with Po－5'－flanking firstly established by the ours (named for pSVPoMcat temporarily) in the wold, we transferred it to SC by Cation Lipid in order to proved tha…     

Home-Based Exercise Enhances Health-Related Quality of Life in Persons With Spinal Cord Injury: A Randomized Controlled Trial

Objective

To assess the influence of a home-based exercise intervention on indices of health-related quality of life (HRQOL) in persons with spinal cord injury (SCI).

‘I Feel Free’: the Experience of a Peer Education Program with Fijians with Spinal Cord Injury

This paper examined the experiences of people with spinal cord injury and related neurological conditions (collectively referred to as SCI) who participated in a peer education program in Fiji and explored their perceptions of its impact on their community participation.The study used an exploratory qualitative design, involving nine people with SCI. Data were obtained via semi-structured interviews, six months after the initial peer education program delivered by the first author and another Australian wheelchair user. Three themes described participants’ experiences and perceptions of the peer education program. The world closes down illustrated the way that physical environments and community attitudes were unsupportive of participants’ fulfilling life roles. Seeing the possibilities described the participants’ experiences of learning from peers and beginning to imagine new possibilities. The final theme, Opening up the world, identified their perception of the peer education program’s impact, as their worlds opened up, and they resumed previously abandoned responsibilities and activities. Participants valued contact with peer educators as much as they did the content taught. Their greater sense of confidence, communication skills and wheelchair use contributed to participants’ increased sense of community participation.     

Wrist Accelerometry for Physical Activity Measurement in Individuals With Spinal Cord Injury—A Need for Individually Calibrated Cut-Points

Objective

To create and compare individual and group-based cut-points for wrist accelerometry that correspond to moderate-to-vigorous physical activity (MVPA) in people with spinal cord injury (SCI).

Long-Term Antidepressant Treatment Inhibits Neuropathic Pain-Induced CREB and PLCγ-1 Phosphorylation in the Mouse Spinal Cord Dorsal Horn

The effect of long-term administration of imipramine, a tricyclic antidepressant, on the phosphorylation status of cyclic adenosine monophosphate–responsive element-binding protein (CREB), mitogen-activated protein kinase family members, and phospholipase γ-1 (PLCγ-1) was investigated in the dorsal horn of the spinal cord following peripheral nerve lesion. Nerve injury induced an ipsilateral long-lasting increased phosphorylation of CREB and PLCγ-1 but not extracellular signal–regulated kinase (ERK_1,2), p38, and c-Jun N-terminal kinase. Daily administration of imipramine (5, 10, or 30 mg/kg) for 21 days progressively reduced both tactile-induced neuropathic pain hypersensitivity and thermal hyperalgesia. After withdrawal of treatment, the antinociceptive effect of imipramine was gradually abolished but still remained for at least 3 weeks. Conversely, no analgesic effect was observed with short-term imipramine treatment. Moreover, imipramine therapy reversed nerve injury–induced CREB and PLCγ-1 phosphorylation but had no effect on ERK_1,2, p38, and c-Jun N-terminal kinase activity. These results indicate that long-term administration of imipramine may prevent some of the harmful changes in the spinal cord dorsal horn following nerve injury. However, imipramine analgesic effect takes time to develop and mature, which might explain in part why the clinical analgesic effect of tricyclic antidepressants develops with a delay after the beginning of treatment. Our data also provide evidence that prolonged imipramine treatment may induce antinociception in neuropathic pain conditions because of its action on the PLCγ-1/CREB-signaling pathway.     

Development of a Sexual Needs Rehabilitation Framework in Women Post–Spinal Cord Injury: A Study From Iran

Objective

To develop a sexual needs rehabilitation framework in women after spinal cord injury (SCI).

Self-Efficacy and Pressure Ulcer Prevention After Spinal Cord Injury—Results From a Nationwide Community Survey in Switzerland (SwiSCI)

Background

Pressure ulcers (PUs) are a common and severe health condition in persons with spinal cord injury (SCI). Skin-care strategies for PU prevention are usually provided during initial rehabilitation. However, individuals with SCI often do not perform these strategies continuously, especially after discharge. The influence of psychological factors such as general self-efficacy (GSE) on the performance of PU prevention behavior has not yet been sufficiently explored.

Gait Training in Acute Spinal Cord Injury Rehabilitation—Utilization and Outcomes Among Nonambulatory Individuals: Findings From the SCIRehab Project

Objectives

To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI).