Chronic Pain Due to Postsurgical Intra-abdominal Adhesions: Therapeutic Options

Andrés, José De; Perotti, Luciano; Palmisani, Stefano; Pérez, Vicente Luis Villanueva; Asensio-Samper, Juan Marcos; Fabregat-Cid, Gustavo

doi:10.1007/978-1-4939-1992-5_8

Cited by 3 publications

(3 citation statements)

References 42 publications

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“…The primary reasons for opting for this method include the need for high cervical SCS, desire to avoid neural injury, adhesions resulting from previous spinal surgery, the need for optimal pain distribution coverage, and the placement of the electrode in an extremely caudal location. 19 20 21 22 23 24 25 26 Most rationales for using the retrograde technique were either extremely cephalad or caudal location of lead placement. 19 21 23 25 Case reports, including our case that used the retrograde technique due to postsurgical adhesions or fibrosis, were rare.…”

Section: Discussionmentioning

confidence: 99%

“…19 20 21 22 23 24 25 26 Most rationales for using the retrograde technique were either extremely cephalad or caudal location of lead placement. 19 21 23 25 Case reports, including our case that used the retrograde technique due to postsurgical adhesions or fibrosis, were rare. 20 24 Our case was unique in terms of retrograde placement of surgical electrode while the remaining single case report used percutaneous leads for pain treatment.…”

Section: Discussionmentioning

confidence: 99%

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Retrograde Epidural Spinal Cord Stimulation for the Treatment of Intractable Neuropathic Pain Following Spinal Cord and Cauda Equina Injuries: A Case Report and Literature Review

Lee,

ShakerKhavidaki,

Sitthinamsuwan

et al. 2024

Asian J Neurosurg

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Spinal cord stimulation (SCS) offers an alternative treatment for refractory pain resulting from various etiologies. Generally, SCS electrodes are inserted in an anterograde fashion, moving from caudal to rostral direction. However, there are instances where anterograde placement is unfeasible due to technical limitations. We present the use of retrograde surgical electrode placement in SCS for a patient with extensive epidural fibrosis at the site intended for electrode insertion. A 48-year-old female suffering from refractory neuropathic pain caused from injuries to the conus medullaris and cauda equina opted for SCS. During the SCS trial procedure, challenges emerged when attempting percutaneous electrode insertion at the site of a prior T12 laminectomy. However, the trial stimulation resulted in significant pain relief. For the permanent placement of the stimulator, utilizing a surgical electrode centered at T11 vertebral level, a considerable amount of epidural fibrosis was encountered at the entry of the spine, particularly at the T12 vertebral level. To avoid dural injury and ensure accurate electrode positioning, a retrograde technique for surgical electrode was employed via partial laminectomies at the T9-T10 level. The final electrode positioning was in accordance with the preoperative plan, well-centered at the T11 vertebral level. The patient experienced sustained relief from neuropathic pain over the long term. Retrograde epidural SCS is a suitable option for cases characterized by extensive epidural fibrosis resulting from a previous spinal surgery or when the anterograde placement of the electrode is unattainable due to aberrant vertebral anatomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Retrograde Epidural Spinal Cord Stimulation for the Treatment of Intractable Neuropathic Pain Following Spinal Cord and Cauda Equina Injuries: A Case Report and Literature Review

Lee,

ShakerKhavidaki,

Sitthinamsuwan

et al. 2024

Asian J Neurosurg

View full text Add to dashboard Cite

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“…The fact that there is scant evidence relating adhesions to chronic abdominal pain does not detract from the imperative to reduce adhesion formation. Although evidence of benefit from pharmacological agents, barrier preparations instilled into the abdominal cavity or systemic anti‐inflammatory agents is lacking, there is good evidence that minimally invasive surgery is associated with reduced adhesion formation. Intuitively, the principles of any careful surgery should include limiting tissue damage and the amount of devascularized or foreign material (sutures, drains, etc.)…”

mentioning

confidence: 99%