Dr Antony Thomas - Neurosurgeon

Concussion

is a heterogeneous mild traumatic brain injury (mTBI) characterized by a variety of symptoms, clinical presentations, and recovery trajectories.
By thematically classifying the most common concussive clinical presentations into concussion 5 subtypes:
1-headache/Migraine (most common Subtype)
2-cognitive,
3-ocular-motor,
4- vestibular(high in pediatric), and
5-anxiety/mood and 2 associated conditions (cervical strain and sleep disturbance)

primary dysfunction of specific cognitive abilities following injury including: attention; impaired reaction time; speed of processing/performance; working memory; new learning; memory storage; memory retrieval; organization of thoughts and behavior a Patients diagnosed with this subtype have the following: difficulty with visual activities (screen time, reading, near work, driving, etc); asthenopia (eye strain) and eye fatigue; problems with visual focus including changing focus from near to far and back (assessed for as convergence distance, accommodation, and reading issues); photophobia; blurred vision or double vision; frontal headaches or eye pain/pressure behind the eyes; vision-derived nausea; difficulty judging distances; difficulty tolerating complex visual environments; and significant exacerbation of premorbid visual impairment. mood-related symptoms including the following: nervousness, feeling more emotional, hypervigilance, ruminative thoughts, feelings of being overwhelmed; depressed mood with sadness, feeling more emotional, anger, hostility/irritability, loss of energy, fatigue, and feelings of hopelessness Sleep disturbance refers to the difficulty initiating and/or maintaining quality sleep and
Sleep disturbance refers to the difficulty initiating and/or maintaining quality sleep and may include excessive sleepiness, hyper-somnolence, or insomnia.

Reference: Concussion Guidelines Step 2: Evidence for Subtype Classification,DOI:10.1093/neuros/ nyz332, LUMBA-BROWN ET AL, Neurosurgery. 86(1):2-13, January 2020. (http://creativecommons.org/licenses/ by-nc-nd/4.0/) Congress of Neurological Surgeons 2019.

www.neurosurgeryonline.com.

https://junhanchin.com/b/RfPDt

Cervical Radiculopathy (Pinched Nerve)

Cervical radiculopathy (also known as “pinched nerve”) is a condition that results in radiating pain, weakness and/or numbness caused by compression of any of the nerve roots in your neck. Most cases of cervical radiculopathy go away with nonsurgical treatment.

Cervical myelopathy

results from compression of the spinal cord in the neck (cervical area of the spine).

Symptoms of cervical myelopathy may include problems with fine motor skills, pain or stiffness in the neck, loss of balance, and trouble walking.

When considering a referral to a spinal clinic, it is important to remember that there is not clear evidence of surgical treatment for cervical radiculopathy providing better long-term outcomes than non-operative measures, but it may provide some benefit in a very carefully selected population. In a small prospective randomised control trial comparing ACDF and physiotherapy with physiotherapy alone in patients referred to a secondary care clinic, over 90% of patients treated with ACDF and physiotherapy rated their symptoms as at least ‘better’ over long-term follow-up compared with around 60% of patients in the non-surgical group, suggesting benefit of surgical intervention.

Non-specific neck pain is common and can be managed conservatively. Although less common, those with an isolated radiculopathy can be initially managed in a similar manner to those with non-specific neck pain with referral to a routine outpatient spinal clinic (or for MRI) if conservative measures fail. However, patients with much rarer cervical myelopathy, presenting with bilateral neurology, gait disturbance, or bowel or bladder problems (with or without neck pain), should be discussed urgently with the on-call spinal or orthopaedic team. These conditions highlight the importance of meticulous clinical assessment to discern red-flag diagnoses from much more commonly occurring muscular and positional causes of simple neck pain.

https://bjgp.org/content/68/666/44

https://www.hopkinsmedicine.org/health/conditions-and-diseases/cervical-myelopathy

Pre op MRI and Post op xrays post surgery ACDF
of a patient completely relieved of their above symptoms

Being a Neurosurgeon..

2024 Scoliosis Awareness T-Shirt contest is now open
The winners of this contest will have their design featured on the Setting Scoliosis Straight Foundation (SSSF) T-Shirts store, be recognized in the SSSF newsletter and social media, and will receive a free t-shirt with their design on it along with a classic SSSF T-shirt!

How to Sign Up and Submit Your Design
Please sign up by clicking on the Sign Up button below and include your first and last name, email address, phone number, and a description of your inspiration. You can send your design to [email protected] anytime from June 24, 2024. Make sure your files are named appropriately – please include your name in the file names.

https://fundraise.givesmart.com/form/9dFH6w?vid=1675zz

MANAGING CHRONIC PAIN:

RADIOFREQUENCY ABLATION FOR THE

LUMBAR FACET AND SACROILIAC JOINT

Technique overview, treatment options, cooled radiofrequency, clinical evidence, patient feedback, Q&A session

Dr. Andrea Tinnirello

Department of Anaesthesiology and Pain Medicine,

ASST Franciacorta, Ospedale di Iseo, Italy

9 JULY 2024
18:30-20:00CET

Radiofrequency Ablation for the Lumbar Facet and Sacroiliac Joint.

Cervical myelopathy

results from compression of the spinal cord in the neck (cervical area of the spine).

Symptoms of cervical myelopathy may include problems with fine motor skills, pain or stiffness in the neck, loss of balance, and trouble walking.

MRI scans are the preferred diagnostic method for cervical myelopathy, but other methods can also be used to help rule out other conditions.

Cervical myelopathy is best treated with spine decompression surgery

Symptoms of Cervical Myelopathy

Cervical myelopathy produces two types of symptoms: the ones you may feel in the neck, and the ones appearing elsewhere in the body at or below the compressed area of the spinal cord.

The neck symptoms may include:

Neck pain

Stiffness

Reduced range of motion

As the disease progresses, one may experience shooting pain that originates in the neck and travels down the spine.

Other cervical myelopathy symptoms may include:

Weakness in the arms and hands

Numbness or tingling in the arms and hands

Clumsiness and poor coordination of the hands

Difficulty handling small objects, like pens or coins

Balance issues

https://www.hopkinsmedicine.org/health/conditions-and-diseases/cervical-myelopathy

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is lack of uniformity in the treatment of CSDH amongst surgeons in terms of various treatment strategies. Clinical presentation may vary from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast-enhanced computed tomography scan. Magnetic resonance imaging (MRI) scan is more sensitive in the diagnosis of bilateral isodense CSDH, multiple loculations, intrahematoma membranes, fresh bleeding, hemolysis, and the size of capsule. Contrast-enhanced CT or MRI could detect associated primary or metastatic dural diseases. Although definite history of trauma could be obtained in a majority of cases, some cases may be secondary to coagulation defect, intracranial hypotension, use of anticoagulants and antiplatelet drugs, etc., Recurrent bleeding, increased exudates from outer membrane, and cerebrospinal fluid entrapment have been implicated in the enlargement of CSDH. Burr-hole evacuation is the treatment of choice for an uncomplicated CSDH. Most of the recent trials favor the use of drain to reduce recurrence rate

Patient with bilateral CSDH treated successfully with bilateral burr holes/craniectomy and subdural drain

Extradural haematomas (EDH) occur in approximately 2% of all head injuries but account for a significant proportion of fatal head injuries with mortality rates ranging from 1.2 to 33%.

The expeditious surgical evacuation of EDH is associated with an excellent prognosis and is considered the most cost-effective operation performed by neurosurgeons

Patient who did well with post op scans below.

Head injuries

How to assess if a head injury is serious?

What you need to do next?

Should I be worried?

What other symptoms of a head injury might occur?

Aftercare for a head injury?

Head injuries This leaflet provides advice for assessing a person who has had a head injury, and aftercare following a head injury.

Brain Aneurysm Foundation

30 Years Later - Looking Back With the BAF Founders

Monday, June 17th at 3:30 PM (EDT)

https://us02web.zoom.us/meeting/register/tZAkfu2pqjwuH9ReuORet3r7rAjqFbvUSVsX #/registration

GRIEF SUPPORT GROUP

Wednesday, June 26th at 5 PM (EDT)

Join our monthly Grief Support Group, facilitated by licensed counselors

https://us02web.zoom.us/meeting/register/tZMld-iqrzwpH9Pn9RPEEoJ6VvvvOhkzqMhd #/registration

https://www.bafound.org/

Home - Brain Aneurysm Foundation Join Our Advocacy Efforts! Ask Your Legislator to Support Ellie's Law Advocate Here Our Mission To promote early detection of brain aneurysms by providing knowledge and raising awareness of the signs, symptoms and risk factors. Work with the medical communities to provide support networks for patien...

Brain Tumor

WHAT YOU SHOULD KNOW When cells in the brain grow and multiply out of control, they can form a tumor which may be malignant (cancerous) or benign (not cancerous). We treat both malignant and benign tumors in the brain. Malignant brain tumors contain cancer cells and tend to grow rapidly and invade healthy brain tissue. Many of these are treatable and new therapies can help patients live longer and preserve quality of life.

THERE ARE 120 MORE THAN DIFFERENT TYPES OF BRAIN TUMORS
Brain tumors occur mostly in children younger than 15 years and in adults older than 65.
The chance of developing a malignant brain tumor is LESS THAN 1%
Benign brain tumors do not contain cancer cells. They rarely invade nearby tissue or spread to other parts of the body. Although a benign tumor is not cancerous, it still needs treatment because it can press on the brain as it grows in the skull.

ARE YOU AT RISK? Brain tumors are relatively rare. They can occur at any age but are most common in children and older adults. You may have an increased risk for developing a brain tumor if you have one of these factors:
Prior radiation treatment for other medical conditions such as leukemia.
Certain genetic conditions in your family.
About 5% of brain tumors are linked to:
Neurofibromatosis Von Hippel-Lindau disease Tuberous sclerosis Li-Frameni syndrome

SYMPTOMS TO TELL YOUR DOCTOR
Persistent daily headaches, Changes in speech, vision or hearing, Problems balancing or walking, Changes in mood, personality or ability to concentrate Confusion or difficulty with memory, Muscle jerking or twitching (seizures or convulsions) Numbness, weakness or tingling in arms or legs

Our expertise with the latest approaches and technology allows us to provide the highest level of cancer care for brain tumors.

Register for FREE

Patient Line Webinar:

Living with scoliosis
Friday, 28 June 2024 at 17:00 CET

Register now for free!

Aim
The aim of this webinar is to equip patients and their families with comprehensive information about living with scoliosis. It seeks to build confidence in the available treatments and help patients manage their spinal condition positively. Additionally, this webinar aims to raise awareness about scoliosis, coinciding with Scoliosis Awareness Month in June.

Key Learning Objectives
Impact of Scoliosis on Sports and Activities

Understand in which sports and other physical activities you can participate even with scoliosis.

Available Treatment Options

Learn about the different treatments for scoliosis, including non-surgical and surgical options.

Expected Outcomes after Surgery

Discover what you can expect in terms of recovery and improvement after having surgery for scoliosis.

Long-term Effects of Surgery on your Life

Find out how having scoliosis surgery can impact your future activities and overall quality of life.

Zoom registration site.

https://engn-pt.zoom.us/webinar/register/WN_9cVrXXbQRhq7gt9fzJflMA #/registration

https://www.eurospine.org/events/patient-line-webinar-living-with-scoliosis/

Information for patients with spine conditions explained in a clear, reliable and trustworthy way.

https://www.eurospine.org/patients/

https://drathomasneurosurgeon.co.za/

Transcranial magnetic stimulation, or TMS, is a non-invasive procedure.

A coil is placed against the scalp, and it delivers magnetic pulses to the brain.

The brain is made up of cells called neurons, which talk to each other through connections called synapses.

When a TMS machine delivers repeated magnetic pulses, it changes how efficiently neurons communicate.

TMS’s magnetic waves non-invasively reach areas near the brain’s surface called the cortex.

For example, we often target the dorsolateral prefrontal cortex, which is involved in depression

The conditions TMS has full approval to treat may vary from country to country. TMS has approval from the U.S. Food and Drug Administration (FDA) to treat four conditions:

Major depressive disorder (MDD) (including treatment-resistant depression).
Obsessive-compulsive disorder (OCD).
Migraines.
Smoking cessation.
In addition to the approved conditions, research is ongoing to see if it can treat other conditions. These include, but aren’t limited to:

Addictions.
Alzheimer’s disease.
Bipolar disorder.
Borderline personality disorder (BPD).
Chronic pain.
Eating disorders.
Essential tremor.
Fibromyalgia.
Parkinson’s disease.
Post-traumatic stress disorder (PTSD).
Schizophrenia.
Stroke complications.
Tinnitus and auditory hallucinations.

Traumatic brain injury...

TMS (Transcranial Magnetic Stimulation): What It Is Transcranial magnetic stimulation uses a magnet to influence brain electrical activity. It’s effective in treating depression and other mental health conditions.

https://www.thinkfirstnevada.org/

Traumatic brain and spinal cord injury is a leading cause of disability and death among children and young adults.
Many of these injuries are preventable.
ThinkFirst seeks to educate people of all ages, communities, organizations and policy makers about risky behavior and injury, with the aim of changing behavior. At ThinkFirst of Northern Nevada, we teach people to “Use your mind to protect your body.”

Explore this website for safety tips, to learn more about injuries and to find ways to help.

ThinkFirst Northern Nevada – Brain and Spinal Cord Injury Awareness Promoting Safety and Reducing the Risk for Injury through Education Helmets given away to date Students we've reached with our presentations Our ThinkFirst Teens Programs Traumatic brain and spinal cord injury is a leading cause of disability and

Spasticity is a common complication of spinal cord injury resulting from hyperexcitability of stretch reflexes in a patient with upper motor neuron lesion.1 Muscle spasm and increased tone may disturb sitting balance, interfere with self-care activities; endanger transfers in those who have a complete spinal cord injury.1 It is often necessary to treat spasticity when it interferes with balance, mobility functional independence and activities of daily living. Baclofen (beta4 chlorophenyl gamma-amino butyric-acid) is commonly considered the treatment of choice for control of spasticity after spinal cord injury among other commonly prescribed oral medications. Orally administered baclofen may become ineffective in severe spasticity because of limitation of the dosage by systemic side effects and failure to reach the site of action at the spinal cord level in sufficient concentration. Continuous intrathecal infusion of baclofen has been shown to be a safe and effective treatment for severe spasticity of spinal cord origin and has become increasingly accepted.2 Nevertheless, concern for baclofen tolerance remains an issue.3 Tolerance is defined as a phenomenon manifested by an escalation of the dose required producing a previously obtained effect or by the decrement of the effect produced by a given dose of the drug.3 Baclofen is an agonist of gamma-amino-butyric-acid-B (GABA-B) receptors, which are very superficial in the spinal cord.3 A theory as to why tolerance develops for drugs, which exert their physiologic effects by interaction with specific receptors, is that repeated administration of the agonist causes either a reduction in the receptor number or an uncoupling of the receptor to effector molecules. This results either way in an increase in the concentration of a given agent necessary to achieve the functional occupancy in order to evoke a given effect.3

When spasticity is refractory to oral agents, it may be treated effectively with chronic intrathecal infusion of baclofen into the cerebrospinal fluid.4 Continuous infusion of morphine into the cerebrospinal fluid has also been used to treat spasticity.4 A primary site of action of spinal epidural or intrathecal morphine is in the neuron pool of the dorsal horn.5 Morphine by systemic or spinal administration is receptor specific and affects primarily the multisynaptic reflexes associated with A delta or C fibre stimulation or little or no effect on the monosynaptic segmental reflex.5 Hence in addition to blocking afferent pain transmission, the reflex arc contributing to spasticity might also be inhibited.5

Treatment of spasticity in a spinal cord-injured patient with intrathecal morphine due to intrathecal baclofen tolerance – a case report and review of literature - Spinal Cord Study design: Case report. Objective: To report treatment of spasticity in a spinal cord-injured person with intrathecal morphine after the person developed tolerance to intrathecal baclofen. Method: Spasticity in a 36-year-old man with T6 complete paraplegia was treated with increasing doses of int...

Harnessing Intrathecal Baclofen:

A Triumph Over Pain and Spasticity Painful spastic hemiplegia following a stroke poses significant challenges for patients striving for optimal pain relief.

Please see a published case report, highlighting the transformative potential of intrathecal baclofen in managing both spasticity and pain.

Spasticity is a common neurological sequelae of stroke that affects 25.3% of patients [1], with direct repercussions on their sensory and motor functionality, significantly reducing quality of life when it is associated with chronic pain. As a motor disorder characterized by a velocity-dependent increase in muscle tone or tonic stretch reflexes associated with hypertonia [2], spasticity is a type of upper motor neuron syndrome that manifests clinically as an increase in tonic stretch reflexes, causing weakness, reduced motor control, pain, spasms, and abnormal posture [3-5]. The treatment of hemiplegia after a stroke is essential, and rehabilitation [6], as well as other interventions [7,8], offer interesting results on the motor skills of the affected muscle groups. However, the painful nature and the sensory alterations that accompany spastic hemiplegia continue to represent a therapeutic challenge that does not always reach goals [9], especially because the neuroplastic changes secondary to the pain syndrome complicate its treatment when they become chronic and are not treated promptly.

Intrathecal Baclofen Infusion Pump for the Treatment of Painful Spastic Hemiplegia: A Case Report Painful spastic hemiplegia is a common sequel to a stroke in which patients rarely achieve optimal levels of pain control. Herein, we report the case of a 62-year-old woman with painful spasticity secondary to an ischemic stroke of 15 years' evolution ...

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Rhizotomy: What Every Patient Needs to Know

https://inspiredspine.com/2024/03/rhizotomy-what-every-patient-needs-to-know/

Cervical spine trauma C6/7 listhesis
Difficult xray visualization , Reduced with Traction then
ACDF C6/7
New technique of using cage with screws to strengthen construct applied and plates.

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MIS TLIF

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Latest Expandable cage technology

Why would you have it done any other way?
Faster recovery, better outcomes, least damage to surrounding tissues

Pre.op MRI
One year follow up Xrays ,
Clinically doing well

https://inspiredspine.com/2024/03/at-home-remedies-for-lower-back-hip-pain/

At-Home Remedies for Lower Back & Hip Pain

At-Home Remedies for Lower Back & Hip Pain - Inspired Spine Finding Relief from Lower Back & Hip PainLower back pain is the most commonly experienced form of back pain, affecting about 25% of American adults. While these aches and pains can be annoying and inconvenient, they can also lower your quality of life and affect your sense of independence.When it co...