Special Issue "Surgery for Spine Disease and Intractable Pain"

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Clinical Neuroscience".

Deadline for manuscript submissions: 30 November 2019.

Special Issue Editor

Guest Editor
Dr. Warren W. Boling Website E-Mail
Department of Neurosurgery, Loma Linda University Medical Center, 25455 Barton Road, 108A, Loma Linda, CA 92354, USA.
Interests: Spine Surgery; Spinal Disease; Surgical Treatment of Painful Conditions; Intractable Pain

Special Issue Information

Dear Colleagues,

Painful conditions and spinal disease are highly prevalent in society, resulting in a significant impact on the individual due to the disability of the condition and direct costs of treatment. Furthermore, society is affected by the indirect costs and a loss of productivity. In one study from Nordic countries, more than half of individuals reported back pain in the past 12 months (Ihlebaek, TH, et al., Scandinavian Journal of Public Health, 2006), and more than 20% of these individuals had a work absence due to back pain. The most common musculoskeletal pains reported are shoulder, low back, and chronic widespread pain (McBeth J, et al., Best Practice & Research Clinical Rheumatology, 2007), and the total cost of musculoskeletal related pain conditions in the USA has been estimated at $215 billion. Direct medical costs accounted for 41% of the total, and the remaining were indirect costs associated with the morbidity or mortality of the condition (Baldwin ML, Journal of Electromyography and Kinesiology, 2004). An additional burden of pain is found in cancer patients, among whom one half or more experience moderate to severe pain (Paice JA, Oncology, 2018). In the United States, 1,735,350 new cancer cases are projected to occur in 2018, whereas the lifetime probability of being diagnosed with invasive cancer in the United States is over 37% (Siegel RL, et al, Cancer statistics, 2018). Data from National Hospital Ambulatory Medical Care Survey identified that headache or pain in the head was the fifth leading cause of visits to the Emergency Department overall and the third leading patient-reported reason for ED visits for women aged 15–64 (Smitherman TA, et al, Headache, 2013).

The burden of painful conditions and spinal disease is enormous. However, the current opioid crisis has demonstrated the serious limitations of medical therapy for the treatment of pain, which means that more urgently then ever our patients need effective and safe surgical options to lessen the disability and reduce the burden of intractable pain. This Special Issue of Brain Sciences will be devoted to investigations and reviews of surgical treatments and approaches that are available today or may soon become available to effectively treat intractable pain and spinal conditions.

Dr. Warren W. Boling
Guest Editor

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Keywords

  • pain
  • spine and spinal disease
  • surgery
  • intractable pain

Published Papers (7 papers)

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Research

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Open AccessCommunication
Adjunct Diagnostic Value of Transcranial Magnetic Stimulation in Mucopolysaccharidosis-Related Cervical Myelopathy: A Pilot Study
Brain Sci. 2019, 9(8), 200; https://doi.org/10.3390/brainsci9080200 - 14 Aug 2019
Abstract
Background: Cervical myelopathy (CM) is a common cause of morbidity and disability in patients with mucopolysaccharidosis (MPS) and, therefore, early detection is crucial for the best surgical intervention and follow-up. Transcranial magnetic stimulation (TMS) non-invasively evaluates the conduction through the cortico-spinal tract, also [...] Read more.
Background: Cervical myelopathy (CM) is a common cause of morbidity and disability in patients with mucopolysaccharidosis (MPS) and, therefore, early detection is crucial for the best surgical intervention and follow-up. Transcranial magnetic stimulation (TMS) non-invasively evaluates the conduction through the cortico-spinal tract, also allowing preclinical diagnosis and monitoring. Methods: Motor evoked potentials (MEPs) to TMS were recorded in a group of eight patients with MPS-related CM. Responses were obtained during mild tonic muscular activation by means of a circular coil held on the “hot spot” of the first dorsal interosseous and tibialis anterior muscles, bilaterally. The motor latency by cervical or lumbar magnetic stimulation was subtracted from the MEP cortical latency to obtain the central motor conduction time. The MEP amplitude from peak to peak to cortical stimulation and the interside difference of each measure were also calculated. Results: TMS revealed abnormal findings from both upper and lower limbs compatible with axonal damage and demyelination in six of them. Notably, a subclinical cervical spinal disease was detected before the occurrence of an overt CM in two patients, whereas TMS signs compatible with a CM of variable degree persisted despite surgery in all treated subjects. Conclusions: TMS can be viewed as an adjunct diagnostic test pending further rigorous investigations. Full article
(This article belongs to the Special Issue Surgery for Spine Disease and Intractable Pain)
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Open AccessArticle
Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Comparison of Dose Protocols
Brain Sci. 2019, 9(6), 134; https://doi.org/10.3390/brainsci9060134 - 10 Jun 2019
Abstract
Purpose: A variety of treatment plans including an array of prescription doses have been used in radiosurgery treatment of trigeminal neuralgia (TN). However, despite a considerable experience in the radiosurgical treatment of TN, an ideal prescription dose that balances facial dysesthesia risk with [...] Read more.
Purpose: A variety of treatment plans including an array of prescription doses have been used in radiosurgery treatment of trigeminal neuralgia (TN). However, despite a considerable experience in the radiosurgical treatment of TN, an ideal prescription dose that balances facial dysesthesia risk with pain relief durability has not been determined. Methods and Materials: This retrospective study of patients treated with radiosurgery for typical TN evaluates two treatment doses in relation to outcomes of pain freedom, bothersome facial numbness, and patient satisfaction with treatment. All patients were treated with radiosurgery for intractable and disabling TN. A treatment dose protocol change from 80 to 85 Gy provided an opportunity to compare two prescription doses. The variables evaluated were pain relief, treatment side-effect profile, and patient satisfaction. Results: Typical TN was treated with 80 Gy in 26 patients, and 85 Gy in 37 patients. A new face sensory disturbance was reported after 80 Gy in 16% and after 85 Gy in 27% (p = 0.4). Thirteen failed an 80 Gy dose whereas seven failed an 85 Gy dose. Kaplan–Meier analysis found that at 29 months 50% failed an 80 Gy treatment compared with 79% who had durable pain relief after 85 Gy treatment (p = 0.04). Conclusion: The 85 Gy dose for TN provided a more durable pain relief compared to the 80 Gy one without a significantly elevated occurrence of facial sensory disturbance. Full article
(This article belongs to the Special Issue Surgery for Spine Disease and Intractable Pain)
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Open AccessArticle
Cellular Changes in Injured Rat Spinal Cord Following Electrical Brainstem Stimulation
Brain Sci. 2019, 9(6), 124; https://doi.org/10.3390/brainsci9060124 - 28 May 2019
Abstract
Spinal cord injury (SCI) is a major cause of disability and pain, but little progress has been made in its clinical management. Low-frequency electrical stimulation (LFS) of various anti-nociceptive targets improves outcomes after SCI, including motor recovery and mechanical allodynia. However, the mechanisms [...] Read more.
Spinal cord injury (SCI) is a major cause of disability and pain, but little progress has been made in its clinical management. Low-frequency electrical stimulation (LFS) of various anti-nociceptive targets improves outcomes after SCI, including motor recovery and mechanical allodynia. However, the mechanisms of these beneficial effects are incompletely delineated and probably multiple. Our aim was to explore near-term effects of LFS in the hindbrain’s nucleus raphe magnus (NRM) on cellular proliferation in a rat SCI model. Starting 24 h after incomplete contusional SCI at C5, intermittent LFS at 8 Hz was delivered wirelessly to NRM. Controls were given inactive stimulators. At 48 h, 5-bromodeoxyuridine (BrdU) was administered and, at 72 h, spinal cords were extracted and immunostained for various immune and neuroglial progenitor markers and BrdU at the level of the lesion and proximally and distally. LFS altered cell marker counts predominantly at the dorsal injury site. BrdU cell counts were decreased. Individually and in combination with BrdU, there were reductions in CD68 (monocytes) and Sox2 (immature neural precursors) and increases in Blbp (radial glia) expression. CD68-positive cells showed increased co-staining with iNOS. No differences in the expression of GFAP (glia) and NG2 (oligodendrocytes) or in GFAP cell morphology were found. In conclusion, our work shows that LFS of NRM in subacute SCI influences the proliferation of cell types implicated in inflammation and repair, thus providing mechanistic insight into deep brain stimulation as a neuromodulatory treatment for this devastating pathology. Full article
(This article belongs to the Special Issue Surgery for Spine Disease and Intractable Pain)
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Open AccessPerspective
Disseminated Coccidioidomycosis to the Spine—Case Series and Review of Literature
Brain Sci. 2019, 9(7), 160; https://doi.org/10.3390/brainsci9070160 - 07 Jul 2019
Abstract
Coccidioidomycosis is a fungal infectious disease caused by the Coccidioides species endemic to Southwestern United States. Symptomatic patients typically present as community-acquired pneumonia. Uncommonly, in about 1% of infections, hematogenous extra pulmonary systemic dissemination involving skin, musculoskeletal system, and meninges occur. Disseminated spinal [...] Read more.
Coccidioidomycosis is a fungal infectious disease caused by the Coccidioides species endemic to Southwestern United States. Symptomatic patients typically present as community-acquired pneumonia. Uncommonly, in about 1% of infections, hematogenous extra pulmonary systemic dissemination involving skin, musculoskeletal system, and meninges occur. Disseminated spinal infection is treated with antifungal drugs and/or surgical treatment. A retrospective review of medical records at our institution was done between January 2009 to December 2018 and we present three cases of spinal coccidioidomycosis and review the current literature. Disseminated coccidioidomycosis can lead to spondylitis that can present as discitis or a localized spinal or paraspinal abscess. Spinal coccidioidomycosis is typically managed with antifungal treatments but can include surgical treatment in the setting poor response to medical therapy, intractable pain, presence of neurological deficits due to compression, or structural spinal instability. Full article
(This article belongs to the Special Issue Surgery for Spine Disease and Intractable Pain)
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Open AccessCase Report
Self Manipulated Cervical Spine Leads to Posterior Disc Herniation and Spinal Stenosis
Brain Sci. 2019, 9(6), 125; https://doi.org/10.3390/brainsci9060125 - 29 May 2019
Abstract
The authors report a case in which a 38-year-old male who presented himself to the emergency department with a chief complaint of cervical neck pain and paresthesia radiating from the right pectoral region down his distal right arm following self-manipulation of the patient’s [...] Read more.
The authors report a case in which a 38-year-old male who presented himself to the emergency department with a chief complaint of cervical neck pain and paresthesia radiating from the right pectoral region down his distal right arm following self-manipulation of the patient’s own cervical vertebrae. Initial emergency department imaging via cervical x-ray and magnetic resonance imaging (MRI) without contrast revealed no cervical fractures; however, there was evidence of an acute cervical disc herniation (C3–C7) with severe herniation and spinal stenosis located at C5–C6. Immediate discectomy at C5–C6 and anterior arthrodesis was conducted in order to decompress the cervical spinal cord. Acute traumatic cervical disc herniation is rare in comparison to disc herniation due to the chronic degradation of the posterior annulus fibrosus and nucleus pulposus. Traumatic cervical hernias usually arise due to a very large external force causing hyperflexion or hyperextension of the cervical vertebrae. However, there have been reports of cervical injury arising from cervical spinal manipulation therapy (SMT) where a licensed professional applies a rotary force component. This can be concerning, considering that 12 million Americans receive SMT annually (Powell, F.C.; Hanigan, W.C.; Olivero, W.C. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery 1993, 33, 73–79.). This case study involved an individual who was able to apply enough rotary force to his own cervical vertebrae, causing severe neurological damage requiring surgical intervention. Individuals with neck pain should be advised of the complications of SMT, and provided with alternative treatment methods, especially if one is willing to self manipulate. Full article
(This article belongs to the Special Issue Surgery for Spine Disease and Intractable Pain)
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Open AccessFeature PaperCase Report
Benign Giant Cell Lesion of C1 Lateral Mass: A Case Report and Literature Review
Brain Sci. 2019, 9(5), 105; https://doi.org/10.3390/brainsci9050105 - 08 May 2019
Cited by 1
Abstract
Primary osseous tumors of the spinal column account for approximately 1% of the total number of spinal tumors found in the pediatric patient population. The authors present a case of a C1 benign giant cell lesion that was incidentally found in a 15-year-old [...] Read more.
Primary osseous tumors of the spinal column account for approximately 1% of the total number of spinal tumors found in the pediatric patient population. The authors present a case of a C1 benign giant cell lesion that was incidentally found in a 15-year-old patient. A transoral biopsy was performed followed by treatment with denosumab, with definitive management in the form of transoral tumor resection with subsequent occiput-cervical three posterior instrumented fusion. The patient tolerated all of the procedures well, as there were no post-operative complications, discharged home neurologically intact and was eager to return to school when assessed during a follow-up visit in clinic. Osteolytic lesions affecting the cervical spine are rare in the pediatric population. It is of utmost importance to have sufficient background knowledge in order to formulate a differential diagnosis, as well as an understanding of principles underlying surgical techniques required to prevent occipital-cervical instability in this patient population. The information presented will guide surgical decision-making by identifying the patient population that would benefit from neurosurgical interventions to stabilize the atlantoaxial junction, in the context of rare osteolytic conditions affecting the cervical spine. Full article
(This article belongs to the Special Issue Surgery for Spine Disease and Intractable Pain)
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Open AccessCase Report
Endogenous Neurostimulation and Physiotherapy in Cluster Headache: A Clinical Case
Brain Sci. 2019, 9(3), 60; https://doi.org/10.3390/brainsci9030060 - 12 Mar 2019
Abstract
Objective: The aim of this paper is to describe the progressive changes of chronic cluster headaches (CHs) in a patient who is being treated by a multimodal approach, using pharmacology, neurostimulation and physiotherapy. Subject: A male patient, 42 years of age was diagnosed [...] Read more.
Objective: The aim of this paper is to describe the progressive changes of chronic cluster headaches (CHs) in a patient who is being treated by a multimodal approach, using pharmacology, neurostimulation and physiotherapy. Subject: A male patient, 42 years of age was diagnosed with left-sided refractory chronic CH by a neurologist in November 2009. In June 2014, the patient underwent a surgical intervention in which a bilateral occipital nerve neurostimulator was implanted as a treatment for headache. Methods: Case report. Results: Primary findings included a decreased frequency of CH which lasted up to 2 months and sometimes even without pain. Besides this, there were decreased levels of anxiety, helplessness (PCS subscale) and a decreased impact of headache (HIT-6 scale). Bilateral pressure pain thresholds (PPTs) were improved along with an increase in strength and motor control of the neck muscles. These improvements were present at the conclusion of the treatment and maintained up to 4 months after the treatment. Conclusions: A multimodal approach, including pharmacology, neurostimulation and physiotherapy may be beneficial for patients with chronic CHs. Further studies such as case series and clinical trials are needed to confirm these results. Full article
(This article belongs to the Special Issue Surgery for Spine Disease and Intractable Pain)
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