Neuroplasticity and brain tumors
¿Qué es la Neuroplasticidad? La neuroplasticidad es la capacidad que tienen algunas zonas del sistema nervioso para adaptarse a nuevas situaciones, ya sea fisiológicas (ser
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Some painful spinal disorders are spinal/vertebral tumors, vertebral fractures or, the most common one, degenerative spine disease, also known as spondylosis (or popularly, osteoarthritis of the spine). Spinal pain syndromes are divided into two main groups, since they have different origins, and the treatment also differs: radicular and axial pain. The first one presents as a pain that radiates to the arms or legs (popularly known as sciatica) and has a clear cause, which is the compression of a nerve root due to spondylosis.
The second pain syndrome is of mechanical characteristics and is located on the center of the spine (popularly known as lower back pain). In turn, there are different subdivisions within these two main classifications: primary nociceptive pain, neuropathic pain, disc syndrome, facet syndrome, mixed pain, myofascial pain, etc.
Differentiation of one or another pain by a specialist is essential, since each of these scenarios has a different treatment. The application of the wrong treatment can lead to unsatisfactory initial clinical improvement, leading to chronic pain, which over time it can become resistant to treatments.
After a thoughtful evaluation, a therapeutic option, whose primary objective is to resolve the pain, is proposed. Nevertheless, the neurological structures and the musculoskeletal balance of the spine should be always preserved.
In case of overweight, a proper diet by a specialist is essential to accompany the above treatments. Finally, the patient must adopt a lifestyle change, opting for a weekly exercise routine (2-3 times per week) and avoiding a sedentary lifestyle.
If after three months these combined therapies fail to control the pain, minimally invasive procedures (second therapeutic step) will be considered neuromodulation techniques: facet radiofrequency, neurological radicular or myofascial blocks, discolysis techniques, dorsal root ganglion radiofrequency, etc.
Surgery here will have a dual effect: protection of the affected neurological structure and resolution of the pain. On other occasions the pain comes from vertebral instability that puts the patient at risk of neurological injury, in which case surgery will also be considered.
On many occasions, surgery will have as a primary objective decompress the neurological structures using the surgical microscope; while in other situations it will be necessary to use implants to stabilize or fuse vertebral segments.
In short, painful disorders of the cervical or lumbar spine should be carefully evaluated by a specialist (neurosurgeon, pain clinic specialist or spinal traumatologist), for their correct identification and early treatment to protect the neurological structures and avoid chronic pain.
These techniques should be understood as an aid to mitigate pain and to be able to continue complying with the first therapeutic step.
When performed by a specialist, these techniques generally have a very low complication rate and can be very effective in selected cases.
Este initial approach This initial approach (first and second therapeutic steps) is generally used in cases of mild radicular pain without neurological involvement, axial pain or myofascial pain, as long as “alarm signs or symptoms” requiring invasive initial treatment are ruled out. When there is evidence of neurological compression, spinal surgery (third therapeutic step) will be the initial option to solve the compression and avoid a permanent neurological injury.
Stenosis (narrowing) of the spinal canal, whether cervical or lumbar, consists of the narrowing of the space through which the neurological structures travel. When compression occurs at the cervical level, balance and gait may also be affected, which are early signs of myelopathy (involvement of the spinal cord). These situations usually require surgical decompression more frequently than other spinal disorders. Stenosis can occur at different levels: in the central spinal canal (where the spinal cord and all neurological roots circulate), in the intervertebral foramina (junction holes through which these roots exit) or in the intervertebral recesses (transitional spaces between the central spinal canal and foramina). The correct location of the point of stenosis will increase the chances for surgical success.
Spondylolisthesis is the name given to the fact that one vertebra slides over another, usually forward (anterolisthesis).The body’s weight exerts an axial load on the vertebrae which, together with a particular anatomy of the sacrum –where it presents a marked inclination (high pelvic incidence) -, causes this disorder. There are several types of spondylolisthesis, the most common being degenerative spondylolisthesis with glacial instability This situation frequently occurs more frequently at the level of the fourth and fifth lumbar vertebrae (L4-L5) and reflexes a vertebral instability that may or may not be accompanied by neurological compression. This scenario must be carefully assessed.
All the spinal disorders described in the previous chapters can cause neurological deterioration, being the first manifestation what is known as radicular pain. It is estimated that neurological pain maintained for more than 6-8 months significantly increases the risk of this pain to become neuropathic. For this reason, spinal disorders and radicular pain must be efficiently treated.
Neuropathic pain is a very difficult situation to treat and often becomes resistant to treatment.
Symptoms such as needle sensation (paresthesias), painful sensation after touching the skin (allodynia), loss of sensation (hypoalgesia), swelling of the area (vegetative reaction) might be the first signs of neuropathic pain. Once this occurs, the usual treatments should be replaced by specific therapies including neuromodulation.
¿Qué es la Neuroplasticidad? La neuroplasticidad es la capacidad que tienen algunas zonas del sistema nervioso para adaptarse a nuevas situaciones, ya sea fisiológicas (ser
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La neuromodulació és un camp de recerca clínico-quirúrgica que té com a objectiu restablir la funció normal de determinats circuits patològics (majoritàriament circuits del moviment o circuits relacionats amb el dolor). Aquest objectiu es pot aconseguir mitjançant l’ús de teràpies poc invasives que actuen directament sobre el nucli o nervi afectat i que en un percentatge no menyspreable dels casos poden ser molt efectives. Algunes d’aquestes teràpies inclouen fàrmacs neuromoduladors, tècniques de radiofreqüència o l’implant d’elèctrodes d’estimulació cerebral, medul·lar o radicular.
La valoració per un equip multidisciplinar és important per poder escalonar els tractaments, des dels menys invasius (fàrmacs) fins als més invasius (cirurgies), passant per teràpies intermèdies.
És important reconèixer que no tots els tipus de dolors són tributaris de teràpies de neuromodulació, i la correcta selecció del pacient és la millor garantia per obtenir un resultat clínic satisfactori.
Neuromodulation is a clinical-surgical research field whose objective is to restore the normal function of pathological circuits (mostly movement circuits or pain-related circuits). This objective can be achieved using minimally invasive therapies applied to the affected nucleus or nerve, which in a non-negligible percentage of cases will be very effective. Some of these therapies include neuromodulatory medication, radiofrequency techniques or the implantation of electrodes for stimulation of the brain, spinal cord, or nerve roots.
The assessment by a multidisciplinary team is important so that the treatment can be “staggered” from the least invasive (medication) to the most invasive (surgery), passing through intermediate therapies.
It is important to know that not all kind of pains are tributaries of neuromodulation therapies, being the correct selection the best guarantee to obtain a satisfactory result.
La neuromodulación es un campo de investigación clínico-quirúrgica cuyo objetivo es restablecer la función normal de determinados circuitos patológicos (mayoritariamente circuitos del movimiento o circuitos relacionados con el dolor). Este objetivo puede ser logrado mediante el uso de terapias poco invasivas que actúan directamente sobre el núcleo o nervio afectado y que en un porcentaje no despreciable de los casos pueden ser muy efectivas. Algunas de estas terapias incluyen fármacos neuromoduladores, técnicas de radiofrecuencia o el implante de electrodos de estimulación cerebral, medular o radicular.
La valoración por un equipo multidisciplinar es importante para poder escalonar los tratamientos, desde los menos invasivos (fármacos) hasta los más invasivos (cirugías), pasando por terapias intermedias.
Es importante conocer que no todos los tipos de dolores son tributarios de terapias de neuromodulación, siendo la correcta selección del paciente la mejor garantía para obtener un resultado clínico satisfactorio.
