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Neurostimulation Applied to Back Pain

For those suffering from chronic back pain, going about daily activities can be difficult and painful. Depending on the causes and severity, medication and physical therapy may help, but a strategy that tends to see more effectiveness is neurostimulation.

Roughly the size of a stopwatch, a neurostimulator is a surgically implanted device that delivers mild electrical impulses to the epidural area of one’s spine through medical wires, or “leads.” These signals create a tingling sensation in the area of the back that is causing the patient’s back pain. Relief comes due to neurostimulation modulating the signals of pain before they reach the brain, much like rubbing a sore spot after bumping into a table, only no initial pain is felt.

The neurostimulator is placed underneath the skin, most commonly on the abdomen. Special medical wires then extend from the device delivering stimulation. Appearing as just a small bump, neurostimulators make no noise, and are very easy to control.

Controlling the level of stimulation is as easy as pressing a button. Through a handheld programmer, patients are able to adjust the strength and location depending on daily activities. For example, exercise and physical activity may demand stronger stimulation than times in which patients are sleeping, or simply relaxing.

Neurostimulation is an effective way to reduce chronic pain for several areas of the body, depending on the source of one’s pain, which can greatly improve patients’ daily activities and overall quality of life. Those who have seen success experience anywhere from 50% to 70% less pain depending on the provider, and a reduced need for anti-inflammatory medications. Additional bonuses of successful implants include no damage to the spinal cord, easy adjustability, and the option to have the implant turned off.

However, there are risks that come with having a neurostimulator surgically implanted, much like all pain treatments. Common side effects of this procedure include little to no stimulation due to movement of the leads, stimulation in wrong areas of the body (also due to lead movement), pain at the site of the implant, and transmission problems between the implant and the handheld programmer. Some side effects may be more serious though.

Like most surgeries, the risk of infection is present. Hematomas and fluid is also prone to leaking where the stimulator was implanted. Further complications may require additional surgery to relocate, repair, or replace specific parts of the device, and in rare cases, spinal cord injury may occur due to incorrect placement.

 
As mentioned before, depending on one’s severity and causes of back pain, neurostimulation may be the best option in relieving symptoms. Therapy sessions are available for those that wish to test this strategy before having surgery, so speaking with your physician about whether or not this is the right decision for you is highly suggested.

Benn Willcox arthrodesis

The Successes of CBA’s in Arthrodesis

Within the next decade, the number of arthrodesis procedures is expected to continue to increase due to aging populations and complex combinations of diseases in individuals. The goals of arthrodesis procedures are to decrease pain, increase mobility, and improve one’s overall quality of life.

Arthrodesis typically focuses on the reversal of disability associated with arthritis, trauma, diabetes, instability, or misalignment in joints, and successful procedures can depend on numerous risk factors. Considerations you should take into account beforehand include levels of tobacco or alcohol abuse, osteoporosis, use of anti-inflammatory drugs, age, and weight.

The quantity of autograft is sometimes limited, and the bone quality can be poor. This is especially common in older patients and those with a combination of physical difficulties. A second surgery may be required to reduce pain and improve mobility in these individuals, though a variety of bone graft substitutes have since been developed. These new developments range from synthetic matrices, to bone marrow aspirates, though, until recently, none of these substitutes consisted of bone-forming cells.

Breaking down cellular bone allografts (CBA’s), they biologically provide three properties that are necessary for proper bone formation. These include osteoconductive scaffolds, osteoinductive growth factors, and osteogenic cells. Orthofix’s Trinity Elite is a cryopreserved CBA that contains at least 500,000 living cells per CC, the donors of which are strictly screened by MTF based on multiple criteria like age and overall health. In the end, less than 3% of donors are accepted, showing how high the standards are for those that wish donate.

In order to measure CBA’s effects in arthrodesis procedures, a clinical trial was performed for 103 patients undergoing foot and/or ankle arthrodesis, of which were enrolled at 10 institutions and at least 18 years of age. The patients varied for their needs to undergo the procedure, ranging from arthritis, to deformities, to degenerative joint disease. 92 of these individuals successfully completed their 6-month follow-ups after the procedures were done, the primary endpoint being successful fusion after this time, following CT scans that confirmed such findings.

 
To simulate real life scenarios, patients considered high-risk were not excluded from the study. The use of CBA’s did not raise any concerns in terms of safety seeing as there were no adverse effects or infections in those that participated either. Statistically significant improvements in pain and function were noted at the end of the study, which notably improved throughout the entire process, thus showing the success CBA’s have in arthrodesis procedures.

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