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Related Concept Videos

Spinal Nerves: Plexus II01:21

Spinal Nerves: Plexus II

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The plexuses of the lower body include the lumbar, sacral, and coccygeal plexuses, which innervate the abdomen, pelvis, legs, and coccygeal region. These plexuses control the transmission of sensory information and coordinate motor functions of the lower body.
The Lumbar Plexus
The lumbar plexus is situated within the lumbar region of the back and is primarily formed by the first four lumbar spinal nerves (L1 to L4). This plexus extends its branches into several nerves, including the...
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Spinal Nerves: Anatomy01:23

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Spinal nerves are pivotal conduits in the nervous system, bridging the central nervous system (CNS) with the peripheral nervous system (PNS). These nerves enable a complex communication network between the brain, spinal cord, and the rest of the body, facilitating sensory input, motor output, and autonomic functions.
There are 31 bilateral pairs of spinal nerves, each emerging from the spinal cord through the intervertebral foramina—openings between adjacent vertebrae. These nerves are...
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Spinal Nerves: Plexus I01:22

Spinal Nerves: Plexus I

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Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
The Cervical Plexus
The cervical plexus, formed by the anterior rami of the first four...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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6. Persistent spinal pain syndrome type 2.

Johan van de Minkelis1,2, Laurens Peene3, Steven P Cohen4,5

  • 1Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.

Pain Practice : the Official Journal of World Institute of Pain
|April 15, 2024
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Summary
This summary is machine-generated.

Persistent Spinal Pain Syndrome type 2 (PSPS-2) diagnosis relies on patient history, exams, and imaging. Interventional treatments like pulsed radiofrequency, adhesiolysis, and spinal cord stimulation show promise when conservative methods fail.

Keywords:
back painevidence‐based medic

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Area of Science:

  • Neurosurgery
  • Pain Management
  • Spinal Surgery

Background:

  • Persistent Spinal Pain Syndrome type 2 (PSPS-2), previously known as Failed Back Surgery Syndrome, involves chronic pain post-spinal surgery.
  • Etiology includes procedural errors, technical failures, biomechanical changes, and complications.
  • Diagnosis integrates patient history, physical examination, and medical imaging.

Purpose of the Study:

  • To review and summarize the current literature on the diagnosis and treatment of PSPS-2.
  • To evaluate the evidence for various therapeutic interventions for PSPS-2.

Main Methods:

  • Comprehensive literature search on PSPS-2 diagnosis and treatment.
  • Synthesis and summarization of retrieved studies.

Main Results:

  • Conservative treatments (exercise, therapy) have low-quality evidence for PSPS-2 efficacy.
  • Pharmacological treatment evidence is very limited.
  • Interventional options like pulsed radiofrequency (PRF), epidural adhesiolysis, and spinal endoscopy show potential benefits.
  • Spinal cord stimulation (SCS) is effective for neuropathic limb pain and potentially axial pain in selected PSPS-2 patients.

Conclusions:

  • PSPS-2 diagnosis is established through clinical assessment and imaging.
  • Conservative interventions lack robust evidence.
  • PRF, adhesiolysis, and SCS offer higher evidence levels and safety, warranting consideration after conservative treatment failure.