functional _ användningsområde

Question 1

2 major Indications for SCS

Answer 1

• Failed back surgery syndrome
• Complex regional pain syndrome

Question 2

SCS mindre vanliga indikationer

Answer 2

• DM neuropathy
• Refractory angina pectoris
• Intercostal neuralgia (ex efter thoracothomy)
• Postherpetic pain
• Painful limb ischemia from inoperable peripheral vascular disease

Question 3

SCS - “functional indications”

Answer 3

• bladderdysfunction
• dystonia
• spastic hemiparesis

Question 4

DBS - pain indication

Answer 4

• deafferentation pain syndromes
• nociceptive pain syndromes
  (*) cluster headaches

Question 5

Types of pain procedures

Answer 5

• Electrical stimulation
• Direct drug admin
• Intracranial ablation
• Spinal ablations
• trigeminal compression
• Sympathectomy
• Periferal nerve procedures

Question 6

Types of electrical stimulation for pain modulation

Answer 6

DBS - thalamus (VPM, VPL), Periaqueductal grey matter, Periventricular grey matter

SCS- hela spinalkanalen. från C2-C5 o ned.

Question 7

Intracranial ablative procedures for pain

Answer 7

• Cingulotomy bilaterally
• stereotactic mesencephalotomy - for unilateral head, neck, face and UE pain.

Question 8

Spinal ablative surgical procedures (7)

Answer 8

• Cordectomy - open or percutaneous
• Commissural myelotomy - bilateral pain
• Punctate midline myelotomy - visceral cancer pain
• DREZ lesions - for SCI pain and deafferation pain from root avulsion.
• Dorsal rhizotomy
• Dorsal root ganglionecomy (extraspinal procedure)
• Sacral cordotomy. for pelvic pain if (förutsatt att) the patient have colostomy or ileostomy

Question 9

What is a DREZ lesion?

Answer 9

Dorsal root entry zone (DREZ) lesioning is a type of surgery for nerve pain that is used when conservative treatments have not alleviated the patient’s symptoms. This surgery may treat sensory nerve damage by destroying the area where damaged nerves join the central nervous system.

Question 10

When is DREZ indicated?

Answer 10

he dorsal root entry zone (DREZ) lesioning procedure is a treatment for severe pain caused by nerves that have been torn away (avulsed) from the spinal cord or, less commonly, by spinal cord injury. DREZ lesioning may be appropriate when nonoperative pain therapies have not provided relief.

Question 11

choice for unilateral pain, head, neck, UE

Answer 11

*DBS
*stereotactic mesencephalotomy
(trigeminus kompression)

Question 12

WHat is the main indication for Mesencephalic stereotaxy/ mesencephalotomy?

Answer 12

Management of cancer pain involving the head, neck, or upper extremities when all else has failed.

Question 13

Choice for unilateral pain at or below C5 dermatome in cancer pt where nothing else has helped

Answer 13

cordotomy

Question 14

What is Cordotomy?

Answer 14

a surgical procedure aimed at destroying the pain-conducting tracts of the spinal cord.

Question 15

Choice for bilateral or midline pain below diaphragm

Answer 15

1.spinal intratechal narcotics
2. commissural myelotomy

Question 16

What is comissural myelotomy?

Answer 16

Midline or commissural myelotomy is a procedure in which the decussating fibers of the spinothalamic tract are interrupted as they cross in the anterior white commissure of the spinal cord.

Question 17

When is commissural myelotomi an option?

Answer 17

In intractable pain associated with malignancy in the abdominal or pelvic region.

Question 18

Choice for bilateral or midline pain above diaphragm

Answer 18

intraventricular narcotics

Question 19

When is cordotomy used?

Answer 19

for unilateral aching pain below nipple (C5) in a terminally ill patient

Question 20

When is comissural myelotomy used?

Answer 20

for bilateral or midline pain primarily below thoracic level. Incl abdomen, pelvis, perineum and LE.