Deep Brain Stimulation

Deep brain stimulation involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that regulate abnormal impulses. Or, the electrical impulses can affect certain cells and chemicals within the brain. The amount of stimulation in deep brain stimulation is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire that travels under your skin connects this device to the electrodes in your brain.

Deep brain stimulation is used to treat a number of neurological conditions, such as:

• Essential tremor
• Parkinson's disease
• Dystonia

Why It's Done

Deep brain stimulation is an established treatment for movement disorders, such as essential tremor, Parkinson's disease, and dystonia, and more recently, obsessive-compulsive disorder. This treatment is usually reserved for people who aren't able to get control of their symptoms with medications.

Risks

Although deep brain stimulation is generally safe, any type of surgery has the risk of complications. Also, the brain stimulation itself may cause side effects.

Surgery risks

Complications of surgery may include:

• Bleeding in the brain (hemorrhage)
• Stroke
• Infection
• Breathing problems
• Nausea
• Heart problems
• Incision scarring

Possible side effects after surgery

Side effects associated with deep brain stimulation may include:

• Seizure
• Infection
• Headache
• Insomnia
• Memory problems
• Temporary pain and swelling at the implantation site

A few weeks after the surgery, the device will be turned on and the process of finding the best settings for you begins. This process may take several months. Some settings may cause side effects, but these often improve with further adjustments of your device.

Possible side effects of stimulation

• Numbness or tingling sensations
• Muscle tightness of the face or arm
• Speech problems
• Balance problems
• Lightheadedness
• Unwanted mood changes, such as mania and depression

Results

Deep brain stimulation won't cure your disease, but it may help lessen your symptoms. If deep brain stimulation works, your symptoms will improve significantly, but they usually don't go away completely. In some cases, medications may still be needed for certain conditions. Deep brain stimulation isn't successful for everyone. There are a number of variables involved in the success of deep brain stimulation. It's important to talk with your doctor before surgery about what type of improvement you can expect for your condition.

Diskectomy

Diskectomy is a surgical procedure to remove the damaged portion of a herniated disk in your spine. A herniated disk can irritate or compress nearby nerves and cause pain, numbness or weakness. These symptoms can affect your neck or back or may radiate down your arms or legs. Diskectomy works best on radiating symptoms. It's less helpful for actual back pain or neck pain. Most people who have back pain or neck pain find relief with more-conservative treatments, such as pain medications or physical therapy.

Your doctor may suggest diskectomy if conservative, nonsurgical treatments haven't worked or if your symptoms worsen. There are several ways to perform a diskectomy. Many surgeons now prefer minimally invasive diskectomy, which uses small incisions and a tiny video camera for viewing.

Why It's Done

A diskectomy is performed to relieve the pressure a herniated disk (also called slipped, ruptured or bulging disk or disk prolapse) places on a spinal nerve. A herniated disk occurs when some of the softer material inside the disk pushes out through a crack in the tougher exterior.

Your doctor may recommend diskectomy if:

• You have trouble standing or walking because of nerve weakness
• Conservative treatment, such as medication or physical therapy, fails to improve your symptoms after six weeks
• A disk fragment lodges in your spinal canal, pressing on a nerve
• Pain radiating into your buttocks, legs, arms or chest becomes too much to manage

Risks

Diskectomy is considered a safe procedure. But as with any surgery, diskectomy carries a risk of complications. Potential complications include:

• Bleeding
• Infection
• Leaking spinal fluid
• Injury to blood vessels or nerves in and around the spine
• Injury to the protective layer surrounding the spine

Results

Diskectomy reduces herniated disk symptoms in most people who have clear signs of nerve compression, such as radiating pain. However, diskectomy may not be a permanent cure, because it doesn't do anything to reverse the process that allowed the disk to become herniated in the first place. To avoid re-injuring your spine, your doctor may recommend weight loss, a low-impact exercise program, and ask that you limit some activities that involve extensive or repetitive bending, twisting or lifting.

Laminectomy

Laminectomy is surgery that creates space by removing the lamina — the back part of the vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves.

This pressure is most commonly caused by bony overgrowths within the spinal canal, which can occur in people who have arthritis in their spines.

Laminectomy is generally used only when more-conservative treatments — such as medication, physical therapy or injections — have failed to relieve symptoms. Laminectomy may also be recommended if symptoms are severe or worsening dramatically.

Why It's Done

Bony overgrowths within the spinal canal can narrow the space available in your spinal cord and nerves. This pressure can cause pain, weakness or numbness that can radiate down your arms or legs. Laminectomy is usually better at relieving these types of radiating symptoms than it is at relieving actual back pain.

Your doctor may recommend laminectomy if:

• Conservative treatment, such as medication or physical therapy, fails to improve your symptoms
• You have muscle weakness or numbness that makes standing or walking difficult
• You experience loss of bowel or bladder control

In some cases, laminectomy may be necessary as part of surgery to treat a herniated spinal disk. Your surgeon may need to remove part of the lamina to gain access to the damaged disk.

Risks

Laminectomy is generally a safe procedure. But as with any surgery, laminectomy carries a risk of complications.

Potential complications include:

• Bleeding
• Infection
• Blood clots
• Nerve injury
• Spinal fluid leak

Results

Most people report measurable improvement in their symptoms after laminectomy, but the benefit may lessen over time as the spine continues to age or if there is a recurrence of arthritis. Laminectomy is more likely to improve leg pain caused by a compressed nerve than back pain. Because laminectomy can't stop the buildup from osteoarthritis that caused the nerve compression in the first place from happening again, symptoms may come back over time.

Lumbar Puncture (Spinal Tap)

Lumbar puncture (spinal tap) is performed in your lower back, in the lumbar region. During lumbar puncture, a needle is inserted between two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluid — the fluid that surrounds your brain and spinal cord to protect them from injury.

A lumbar puncture can help diagnose serious infections, such as meningitis; other disorders of the central nervous system, such as Guillain-Barre syndrome and multiple sclerosis; or cancers of the brain or spinal cord. Sometimes doctors use lumbar puncture to inject anesthetic medications or chemotherapy drugs into the cerebrospinal fluid.

Why It's Done

Lumbar puncture may be done to:

• Collect cerebrospinal fluid for laboratory analysis
• Measure the pressure of your cerebrospinal fluid
• Inject spinal anesthetics, chemotherapy drugs or other medications
• Inject dye (myelography) or radioactive substances (cisternography) into cerebrospinal fluid to make diagnostic images of the fluid's flow

Information gathered from a lumbar puncture can help diagnose:

• Bleeding around the brain (subarachnoid hemorrhage)
• Certain cancers involving the brain or spinal cord
• Certain inflammatory conditions of the nervous system, such as multiple sclerosis and Guillain-Barre syndrome
• Serious bacterial, fungal and viral infections, including meningitis, encephalitis and syphilis

Risks

Though lumbar puncture is generally recognized as safe, it does carry some risks. These include:

• Post-lumbar puncture headache
• Back discomfort or pain
• Bleeding
• Brainstem herniation

A computerized tomography (CT) scan or MRI prior to a lumbar puncture can be obtained to determine if there is evidence of a space-occupying lesion that results in increased intracranial pressure. This complication is uncommon.

Results

The spinal fluid samples are sent to a laboratory for analysis. Lab technicians check for a number of things when examining spinal fluid, including:

• General appearance. Spinal fluid is normally clear and colorless. If it's cloudy, yellow or pink in color, it may indicate infection.
• Protein (total protein and the presence of certain proteins). Elevated levels of total protein — greater than 45 milligrams per deciliter (mg/dL) — may indicate infection or another inflammatory condition. Specific lab values may vary from medical facility to medical facility.
• White blood cells. Spinal fluid normally contains up to 5 mononuclear leukocytes (white blood cells) per microliter. Increased numbers may indicate infection. Specific lab values may vary from medical facility to medical facility.
• Sugar (glucose). A low glucose level in spinal fluid may indicate infection or another condition.
• Microorganisms. The presence of bacteria, viruses, fungi or other microorganisms can indicate infection.
• Cancer cells. The presence of abnormal cells in spinal fluid — such as tumor or immature blood cells — can indicate certain types of cancer.

Lab results are combined with information obtained during the test, such as spinal fluid pressure, to help establish a possible diagnosis.

Condition - Spinal Cord Injury

Spinal cord trauma refers to damage to the spinal cord. It may be caused due to the direct injury to the cord itself or indirectly from disease of the surrounding bones, tissues, or blood vessels.

Signs and Symptoms

Symptoms may vary depending on the location of the injury. An injury to spinal cord results into weakness and loss of feeling at, and below the injury. Its symptoms are:

• Increased muscle tone
• Loss or normal bowel and bladder control
• Numbness
• Sensory changes
• Pain
• Weakness, paralysis

Causes

Spinal cord trauma can be caused by a number of injuries to the spine, including:

• Assault
• Falls
• Gunshot wounds
• Industrial accidents
• Motor vehicle accidents
• Sports injuries (particularly diving into shallow water)

Treatment

Spinal cord injury is a kind of medical emergency that needs immediate medical attention. The goal of rehabilitation at Max Healthcare is to maximize the patient's functions and to help the patient return as an active participant in the community. Rehabilitation can help the patient gain the skills needed to be more self-sufficient.

Adaptive equipment, such as braces, walkers and communication devices, help patients and their families manage day-to-day challenges that accompany a spinal cord injury.