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FUNCTIONAL > Repetera-utvalda > Flashcards

Repetera-utvalda Flashcards

1
Q

2 major Indications for SCS

A
  • Failed back surgery syndrome
  • Complex regional pain syndrome
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2
Q

SCS mindre vanliga indikationer

A
  • DM neuropathy
  • Refractory angina pectoris
  • Intercostal neuralgia (ex efter thoracothomy)
  • Postherpetic pain
  • Painful limb ischemia from inoperable peripheral vascular disease
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3
Q

SCS - “functional indications”

A
  • bladderdysfunction
  • dystonia
  • spastic hemiparesis
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4
Q

DBS - pain indication

A
  • deafferentation pain syndromes
  • nociceptive pain syndromes
    (*) cluster headaches
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5
Q

Types of electrical stimulation for pain modulation

A

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

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

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6
Q

Intracranial ablative procedures for pain

A
  • Cingulotomy bilaterally
  • stereotactic mesencephalotomy - for unilateral head, neck, face and UE pain.
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7
Q

Spinal ablative surgical procedures (7)

A
  • 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
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8
Q

When is cordotomy used?

A

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

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9
Q

When is comissural myelotomy used?

A

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

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10
Q

What is a DREZ lesion?

A

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.

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11
Q

What is comissural myelotomy?

A

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.

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11
Q
A
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12
Q

When is commissural myelotomi an option?

A

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

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13
Q

When is DREZ indicated?

A

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.

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14
Q

What parts can be difficult to reach w SCS?

A

Midline truncal stimulation between neck and low back pain.

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15
Q

SCS: Var ska elektroder placeras för posterior column stimulation och hur upplevs det?

A

De läggs alltid i dorsal epidural space and give a tingling paresthesia overlaying the area of pain.

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16
Q

What are the two ways to introduce electrodes in SCS?

A
  • Tuohy needles, inserted via puncture
  • Paddles, inserted via laminotomy.
17
Q

How is the effect/success of an SCS determined?

A

ALWAYS several day trial period with an external generator before the patient fill out a VAS.
Success= more than 50% pain reduction.

18
Q

SCS: What does IPG mean?

A

implanted pulse generator.

19
Q

DBS: for deafferentation pain syndromes

A
  • sensory thalamus: VPM or VPL
    For chronic neuropathic pain, 40-50% reduction in 20-60% of patients.
20
Q

DBS: for nociceptive pain syndromes

A

PVG (perivenricular grey matter)
PAG (periaqueductal grey matter)

Response rate about 20%

21
Q

DREZ lesion

A

laminectomy over involved segments.
Microscope. Find rootlets above and below.
Lesions created IPSILATERAL to the avulsed nerve root/s.
Radiofrequency current -75 degreeds celsius 15s per lesion (or knife blade).

22
Q

What is cordotomy?

A

Interruption of lateral spinothalamic tract fibers in the SC.

23
Q

How much painrelief is needed in an intrathecal vs an epidural administration?

A

5-10 x more in intrathecal.

24
Q

According to Patric Blomstedt and Marwan Hariz, which are the two preferred targets for DBS in Parkinsons disease?

A
  1. The subthalamic nucleus
  2. Globus Pallidus interna
25
Q

Which is the ONE absolute preferred target for Parkinssons disease and why is it not always ok to use?

A

The STN - Subthalamic nucleus.
Not always ok if the pt is too old, with cognitive decline or relevant depression. The patient cannot either have medically resistant axial symptoms, such as balance and gait disturbance.

26
Q

Which are the preferred targets for tremors?

A

zona inserta and Vim.

27
Q

What is the most common side effect of DBS regardless of brain target?

A

Dysarthria

28
Q

With progression of Parkinssons disease, some features of the disease become less responsive to DBS. What symtoms?

A

The nondopaminergic axial features.

29
Q

shunt or ETV?

A
  1. AGE?
    under 1 mo -0%
    1 - 6 mo -10%
    6mo-1year - 20%
    1y - 10 y - 40%
    over 10 y - 50%
  2. Type of hcph?
    * post infectious - 0%
    * MMC, non-tectal tumor, post IVH - 20%
    * aq-stenosis, tectal tumor - 30%
  3. Previous shunt?
    yes - 0%
    no - 10%
30
Q

The ETV success score is validated for predicting chance of success 6 months after ETV surgery. What does it mean to score 40% or less on the scale?

A

It means a very low chance of success.

31
Q

What does it mean to have a score over 80% in the ETV success score?

A

A better chance to succeed with ETV than shunting from the outset.

32
Q

What is the overall successrate for ETV in non-tumoral aqueduct stenosis pt?

A

60-94%.

33
Q

What 2 nerves from the median nerve needs to be looked out for?

A
  1. Palmar cutaneous branch.
  2. Recurrent motor branch to the thumb.
34
Q

Elecrtrodiagnostic criteria for the ulnar neuropathy at the elbow?

A

Not all criteria need to be present and a needle EMG is not needed.
* Absolute MN conduction velocity under 50m/s from elbow to above elbow.
* Drop of conduction velocity with more than 10m/s in the underarm compared to above elbow.
* Amplitude of compound motor action potential normally decreases by distance, but a drop of more than 20% is abnormal.

mer sägs men detta är core.

35
Q

Where is the ski incision in a ulnar decompression?

A

around and below the medial condyle.

36
Q

What is a pancoast tumor?

A

most often due to bronchogenic ca.
Situated close to the brachial plexus
* Atrophy of hand muscles
* Horner syndrome
Radiating pain.

37
Q

How can preganglionic injuries be differentiated from postganglionic?

A

-proximal or distal to the dorsal root ganglion-
Pre ganglionic:
* horner syndrome
* Wing scapula - long thoracic nerve injury –serratus anterior
* Rhomboid paralysis - dorsal scapular nerve
* PSeudomeningocele on MRI associated to root avulsion and associated neuropathic pain.

EMG - cannot be done until 3 weeks after injury to get a any findings.

38
Q

What does EMG find to suggest preganglionic injury?

A
  • Denervation potentials in paraspinal muscles due to loss of neural input. The posterior ramus of of the spinal nerve originates just distal to the dorsal root ganglion.
  • Normal sensory nerve action potential - SNAP- preganglionic injuries leave the dorsal ganglion sensory bodies and the distal axon intact. A normal SNAP can therefore be recorded proximally EVEN IN AN ANESTHETIC REGION!
39
Q

Which is the most common lack of function due to a birth brachial plexus injury?

A

Upper plexus injuries. C5 and C6 and sometimes C7 too.

40
Q

What is a surgical option for birth upper plexus injuries (C5-7)

A

Nerve transfer if no antigravity in deltoid, bicep or tricep at 3 mo age.

41
Q

What structures are enclosed in the area of a thoracic outlet syndrome?

A
  • The subclavian artery and vein
  • brachial plexus.

FUNCTIONAL (13 decks)

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