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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Low back pain is very common and often considered a part of normal pregnancy. Because the pain is always attributed to pregnancy, referral to a specialist is often delayed. We describe a young woman who developed low back pain and signs of progressive spinal cord compression at 33 weeks' gestation of her second pregnancy. Magnetic resonance imaging of the thoracic spine showed a collapsed T11 vertebral body and a large paraspinal and intraspinal tumor compressing on the spinal cord from the right. Emergent surgical decompression and removal of the tumor mass was done. Pathological examination revealed metastatic adenocarcinoma and subsequently, a palpable nodule was found in the left breast, which, on biopsy, proved to be an invasive lobular carcinoma.
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PMID:Low back pain in a pregnant woman. 1547 80

Patients undergoing major spinal surgery may experience significant postoperative pain. Epidural analgesia has previously been shown to be safe and effective and may confer some advantages over opioid-based postoperative analgesia. We discuss the case of a 47-yr-old female patient undergoing the prolonged anterior component of a lower thoracic/upper lumbar spine correction involving the stripping of the diaphragm from the lower thoracic spine and retraction of the left lower lobe of the lung. Despite initially planning opioid-based postoperative analgesia, a joint anaesthetic and surgical decision was made to use epidural analgesia in an attempt to avoid potential postoperative respiratory complications. Because of the surgical anatomy of the correction, the catheter was inserted via the T11 intervertebral foramen. A bolus of bupivacaine 0.25% intraoperatively with a postoperative infusion of bupivacaine 0.167% with diamorphine 0.1 mg ml(-1) provided excellent analgesia. The technique was associated with no postoperative complications.
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PMID:Epidural analgesia after spinal surgery via intervertebral foramen. 1561 2

Dorsal epidural migration of an extruded disc fragment is an infrequent event, especially in the thoracic spine. An uncommon case involving a 55-year-old man is presented, with a 1-month history of paraparesis and thoracolumbar pain. Magnetic resonance imaging demonstrated a dorsally located, extramedullary mass at the T10-T11 intervertebral level. The lesion was suspected to be a tumor. The patient underwent a T10-T11 laminectomy. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was found. The pathologic diagnosis was inflammatory tissue and disc material. Six months after the operation, the patient remained asymptomatic, and radiologic control showed no residual mass. Although rare, a sequestered disc fragment should be included in the differential diagnosis of an enhancing posterior extramedullary thoracic mass. Preoperative diagnosis of such pathology is difficult because the clinical signs and radiologic images may not entirely exclude other more common thoracic spinal lesions, especially tumors.
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PMID:Dorsal extradural thoracic disc fragment: a diagnostic challenge. 1630 48

Spinal cord stimulation (SCS) is a treatment given to patients with drug-resistant neuropathic pain, in particular pain resulting from peripheral nerve injury. However, the reasons why some patients develop neuropathic pain and why SCS is not effective in all patients with this chronic pain are not fully understood. The present study compares the response to SCS and the yield of neuropathic animals in variants of the spared nerve injury (SNI) model introduced by Decosterd and Woolf (I. Decosterd, C.J. Woolf, Spared nerve injury: an animal model of persistent peripheral neuropathic pain, Pain 87 (2000) 149-158). Sprague-Dawley rats were prepared with various types of lesions of different branches of the sciatic nerve and then tested for paw mechanical hypersensitivity. A miniature electrode system for SCS was implanted at the T10-T11 vertebral level. Stimulation was applied in awake, freely moving animals with parameters comparable to those employed clinically. Suppression of paw hypersensitivity was considered a positive response to SCS. The incidence of mechanical hypersensitivity ("allodynia") in the different models was: SNI 53%; peroneal axotomy 45%; tibial axotomy 68%; tibial tight ligation 73% and partial tibial tight ligation 50%. "Mirror phenomena" with contralateral paw hypersensitivity was present in about 20% of the animals. The response to SCS differed between models with the lowest response rate in the original SNI model (8%) while the others demonstrated rates in the order of 40-50%. There was a tendency that the efficacy of SCS in suppressing allodynia was inversely related to the severity of hypersensitivity. In conclusion, modifications of the SNI model provide a reproducible incidence of neuropathic hypersensitivity and an increased responsiveness to SCS. These variants may prove suitable for future research on the mechanisms involved in pain relief with SCS.
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PMID:Response to spinal cord stimulation in variants of the spared nerve injury pain model. 1653 65

A six-month-old, intact female, Miniature Pinscher was admitted with signs of progressive neurological deficits in the hind legs, an elevated rectal temperature, and spinal pain of 48 hours duration. A myelogram was performed which demonstrated a dorsal, left sided compressive lesion extending from T11-T13. A left-sided hemilaminectomy was performed from T11-T13. A friable, poorly organized, pale tan and red mass was identified within the epidural space. Cytopathological and histopathological analyses of the mass demonstrated marked, subacute, suppurative cellulitis. A culture of the purulent material revealed beta haemolytic Streptococcus sp.
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PMID:Spinal epidural abscess in a juvenile dog. 1659 51

The role of surgical debridement and internal fixation in treatment of vertebral osteomyelitis has been evolving. The standard surgical approach to thoracolumbar vertebral osteomyelitis requiring extensive thoracotomy or retroperitoneal exposure carries significant associated morbidity and postoperative pain. Minimally invasive thoracoscopic spine surgery is designed to improve postoperative morbidity associated with the traditional open surgery. We report a case of a 70-year-old man who developed T11-T12 pyogenic vertebral osteomyelitis 3 months after undergoing posterior laminectomy and microsurgical excision of a herniated thoracic disc. The patient underwent minimally invasive thoracoscopic radical debridement and anterior spinal reconstruction and fusion. Patients with vertebral osteomyelitis may benefit from the decreased postoperative morbidity that is associated with minimally invasive thoracoscopic spinal surgery.
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PMID:Thoracoscopic debridement and stabilization of pyogenic vertebral osteomyelitis. 1771 69

We report a case of reconstruction of a dysplasic thoracic spine with vascularized fibula in Recklinghausen's disease. We present the case of a thirteen-year-old lady with neurofibromatosis type 1 who developed a dystrophic thoracic kyphoscoliosis. A T9 compression due to a severe scaloping of the thoracic spine caused an important deformation and a medullar compression (with dorsal pain, right sciatica and a pyramidal syndrome). The surgery consisted in medullar liberation by a T9-T10 corporectomy and an osteosynthesis with arthrodesis T3-L3. A free vascularized fibula bone graft, with an end-to-end anastomosis on a thoracic pedicle, was realized to fill the T8-T11 spinal defect. All the symptoms decreased after surgery and the patient could walk normally few months later. At one-year follow-up the radiographs showed a stable montage and a solid bony fusion. Analysing the literature, vascularized bone graft can be recommended to fill the bony spinal defect due to surgery in cases of tumor, infection, trauma or severe scoliosis. Compared to non-vascularized grafts, which are exposed to resorption, fatigue fracture and then instability, the vascularized fibula grafts provide a rapid fusion, a biomechanically stable and long-standing support with low risks of infection.
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PMID:[Use of a vascularized fibula for spinal reconstruction in neurofibromatosis]. 1794 79

Major abdominal surgery, and also radical cystectomy, is followed by a delayed return of bowel function attributable to postoperative ileus (POI), which, in addition, stands out as one of the most frequent complications that causes increased length of stay (LOS). Some variability exists in the definition of POI since time to return of peristalsis and time to first passage of flatus, which are commonly referred to as indicators of bowel activity, have their own weaknesses, observer dependent and time dependent, among other variables. A number of causes have been recognized to induce or maintain the condition of ileus. Some among them are part of the perioperative period. The practices of mechanical bowel preparation (MBP) and of fasting before surgery have been challenged and can be safely abandoned. The perception of pain is an acknowledged promoter of POI; therefore, providing complete pain control constitutes the rationale in favor of administering anesthesia and analgesia combined, both in the form of concurrent general and epidural anesthesia (i.e., at the thoracic level, T9, T11), and represents the mainstay of intraoperative measures. Hypovolemia is also associated with an increased risk of POI. The use of nasogastric tubing (NGT) has been associated with increased pulmonary complications; moreover, bowel resection can be performed safely without postoperative NGT. Early postoperative provision of artificial nutrients has shown beneficial effects, both in the form of total parenteral and enteral nutrition (PEN, EN). We devised a perioperative care regimen, adopting a multimodality approach aimed at minimizing the effects of the above listed factors to ascertain if they could contribute to preventing or reducing POI and the complications associated with radical cystectomy and intestinal urinary diversion. In addition, we investigated the impact of early artificial nutrition, combining PEN and EN via a jejunal nutrition cannula. Time to return of bowel movements, time to reinstitution of a regular diet, presence and duration of POI, and incidence and nature of complications constituted the study end points. Of 143 consecutive patients, 107 who underwent radical cystectomy with intestinal urinary reconstruction were able to be evaluated for results and complications. The male to female ratio was 86:21, the mean age was 74 years, and more than two-third belonged to the American Society of Anesthesiologists categories II and III. Pathologic stages of disease were bladder confined in 48 patients, locally advanced in 33, and extravesical in 26. Urinary diversion with intestine consisted in the configuration of heterotopic reservoirs in 39 patients, orthotopic substitution in 38, and uretero-ileo-cutaneostomy in 30. Bowel movements returned after a median time of 2 days (range, 1-6), and the median time to reinstitution of a regular diet was 4 days (range, 3-9). POI beyond postoperative day 4 was observed in 17.7% of the patients. Overall, a total of 28 patients (26.1%) experienced complications, specifically, medical complications in 19 patients and surgical complications leading to relaparotomy in 11. The mortality rate was 3.7%. No effects were observed on postoperative protein depletion, despite the provision of early artificial nutrition. Our results suggest that a short median time of return of both peristalsis and flatus, and to regular diet resumption with a low incidence of POI, can be obtained in the majority of patients with a perioperative regimen aimed at reducing the effect of some of the causes associated with induction or maintenance of POI. Further studies of multimodality perioperative care plans, similar to that used in the present study, are required.
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PMID:Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus. 1796 14

Thoracic splanchnic nerves conduct pain sensation from the abdominal organs around the celiac ganglion. Splanchnicectomy is the procedure used mainly for the control of intractable visceral pain. Forty-six human posterior thoracic walls were dissected. The formation pattern, course, and incidence of communication of the thoracic splanchnic nerves were investigated. The greater splanchnic nerves (GSNs) were formed by nerve branches from the T4-T11 thoracic sympathetic ganglia and the most common type was formed by T5-T9 (21.7%). The uppermost branches originated from T4-T9 while the lowermost branches emanated from the T7-T11. Two to seven ganglia contributed to the GSNs. In 54.3% of the specimens, at least one ganglion in the GSN-tributary ganglionic array did not branch to the GSN. The lesser splanchnic nerves (LSNs) were formed by the nerve branches of the T8-T12 thoracic sympathetic ganglia and the most common type was formed by T10 and T11 (32.6%). One to five ganglia were involved in the LSNs. The least splanchnic nerves (lSNs) were composed of branches from the T10-L1 thoracic sympathetic ganglia and the most common type was composed of nerve branches from T11 and T12 or from T12 only (each 30.4%). One to three ganglia were involved in the lSNs. In 54.3% of the specimens, interconnection between the GSNs and the LSNs existed, bringing the possible bypass around the transection of the GSNs. The splanchnic nerves that appear in textbooks occurred in a minority of our specimens. We provided expanded anatomical data for splanchnicectomy in this report.
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PMID:Anatomy of thoracic splanchnic nerves for surgical resection. 1828 63

Osteoblastoma (OB) is a rare primary benign bone tumor. It generally occurs in the axial skeleton, where it preferentially involves the neural arch. The peak incidence of this neoplasm is in the first two decades of life. Female/male ratio is 2:1. It is important to differentiate OB from osteoid osteoma, a very similar bone tumor. Neuroradiological imaging are diagnostics in most of the cases. This article describes a 18-year-old female affected from a thoracic osteoblastoma stemming from T9 lamina and extending to T11, with a diameter of about 2.5 cm. The patient complained of dorsal pain with progressive weakness to lower limbs. A dorsal approach was performed with a right partial T9 and T11 right laminectomy with total T10 right laminectomy. The mass was totally removed by a limited approach, with no consequent instability and no reason for any stabilization. OB is rare benign bone neoplasm that generally affect the posterior elements of the spine. Surgery is the treatment of choice in this kind of lesions: total removal is effective with no recurrence. When the lesion is placed in the cervical and thoracic spine the goal is to decompress spinal cord and reach the stability of the spine.
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PMID:Limited approach to a thoracic spine osteoblastoma. 1898 87


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