Functional_Outcome and Complications Flashcards
SCS primary measure
- Sustained reduction of pain w more than 50% on VAS
SCS secondary measures
- Improved QoL
- Reduced pain med requirements
- increased functional cap /return to work
SCS- Success after 96mo in a variety of indications?
74%
SCS- overall risk of device-related complications?
32%
SCS - complications (4+4less common)
- lead migration 13%
- lead breakage 9.1%
- infection 3.5%
- hardware malfunction 2.9%
- unwanted stimulation 2.4%
- less common complications;
*CSF leak,
*radicular pain, intermittent
*pacemaker interference,
*neurologic deficit.
Where in the highest risk for lead migration after SCS?
*cervical stimulators
*percutaneous stimulators
How is infection after SCS treated?
Electrode and/or IPG removal
and
antibiotics
DREZ lesions . 3 great risks/compl
Dorsal root entry zone lesions
1. CSF leak - bedrest 3 days rek.
2. Ipsilateral weakness (corticospinal tract)
3. loss of proprioception (dorsal columns)
(2. and 3. Occur in 10%. half of which is permanent.)
DREZ
Komplikationsrisker vid cordotomy 6st
- ataxi 20%
- ipsilateral pares 5%, 3% permanent
- bladder dysfunction 10%, 2% permanent
- dysesthesi 8%
- sleep induced apnea (Ondines) 0.3% unilat, 3% bilat.
- Death (resp failure) 0.3% unilat. 1.6% bilat.
Outcome cordotomy
Sign. painrelief
* at discharge 94%
* at 1 year 60%
* at 2 years 40%
Outcome comissural myelotomy
60% of patients have complete pain relief, 28% partial, 8% none.
complications to intrathecal/epidural pain lines
- meningitis rare
- respiratory failure rare
- CSF fistual may occur
- Spinal H/A may occur
- Disconnection or dislodgment - risk of failed pain relief.
Outcome from intrathecal or epidural pain relief
cancer pain significantly improved by up to 90%. Successrate for neuropathic pain 25-50%
Outcome for intraventricular narcotics
70% successfull pain control at 2 mo and thereafter diminishing effect due to tolerance.
