For those with thoracic scoli due to a syrinx in the spine (from syringomyelia and Chiari), is there anything special we need to keep in mind? I had decompression surgery over 10 years ago & the syrinx basically fully compressed per MRI.

Cassie,

Oddly, it usually means you need to strengthen the right side. My guess is the left side of your spine where you are referring to us the convex part of your curve. The reason those muscles are in pain is because they are the work horses and are currently overworked. Those need to chill out and the the sleepy right side needs to start doing some work. Feel the right side of your back. Is it smaller than the left side? My guess is yes. On the shop page of spiralspine.com you can see Analyzing Scoliosis, my latest book, and a training video with the same title. Both will teach you about your back and which side you should work and why.

Blessings,

Erin Myers


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Computed tomographic angiography showing aortic dissection at the descending aorta with a highly compressed true lumen (white arrow) and false lumen (FL) resembling a normal aorta. Findings have been detected at the same level as the left parasternal long-axis view (A) and subcostal view (B) by point-of-care ultrasonography.

Computed tomographic angiography showing aortic dissection at the abdominal aorta below the renal artery branch points (A), and the external and internal iliac arteries (B). White arrows show highly compressed true lumen. FL, false lumen.

CTA findings revealed that our patient had a highly compressed true lumen and enlarged false lumen. Because of this form of aortic dissection, there was potential to misidentify the enlarged false lumen as a normal aorta on POCUS. Although the dissection of the aortic arch was relatively clear of the true lumen from CTA, given that evaluation of the aortic arch from the suprasternal notch view using ultrasonography is not so easy for EPs,6 we could not visualise adequate findings.

Thanks for sharing your workflow - what you are doing makes perfect sense, and I understand the desire for smaller files. Consider this though - the native recording in the camera is probably something like 25mbps with 4:2:0 color, inter-frame recording. Very highly compressed. From that compressed file, you then need to make highly-compressed deliverables.

Trigeminal neuralgia, also called tic doulourex, is a rare neurological disease that causes sudden, severe, brief, stabbing recurrent episodes of facial pain in one or more branches of the trigeminal nerve. It is usually caused when the trigeminal nerve is being compressed by an artery or a vein, but can also be present with no apparent cause. It is sometimes misdiagnosed as a dental or jaw problem or as a psychological disorder. Once correctly diagnosed, there are several medical and surgical treatment options to reduce or relieve the debilitating pain caused by this disease. Patients with trigeminal neuralgia are given high priority in scheduling their evaluation.

Microvascular decompression (MVD), also known as the Jannetta procedure, is the most common surgical procedure for the treatment of trigeminal neuralgia. This is an open surgical approach where a small incision is made behind the ear, a small hole is drilled in the skull, and, under microscopic visualization, the trigeminal nerve is exposed. In most cases, there is a blood vessel (typically an artery, but sometimes a vein) compressing the trigeminal nerve. By moving this blood vessel away from the nerve and interposing a padding made of Teflon felt, the pain is nearly always relieved. While MVD is considered to be the most invasive surgery for TN, it is also the best procedure for fixing the underlying problem that usually causes TN: vascular compression. MVD also causes the least damage to the trigeminal nerve and provides, on average, the longest pain-free periods and the best chance of being permanently off medication. MVD has a long-term success rate of approximately 80% as a stand-alone treatment. The procedure requires an average hospital stay of two days, and four to six weeks to return to normal daily activities.

No one can promise that any surgery for trigeminal neuralgia will be successful for all patients, and there is always the chance that pain will recur at a later date; however, MVD is the best chance at relieving the underlying problem behind trigeminal neuralgia pain.

Radiosurgery (Gamma Knife) treatment for trigeminal neuralgia is the least invasive surgical option. In fact, it is technically not surgery at all. The Gamma Knife is a device that delivers precise, controlled beams of radiation to targets inside the skull, including the brain and associated nerves. For trigeminal neuralgia treatment, the radiation beams are aimed at the trigeminal nerve where it enters the brainstem. Gamma Knife treatment does not target the root cause of trigeminal neuralgia, but instead damages the trigeminal nerve to stop the transmission of pain signals. The procedure requires little or no anesthesia, and is performed on an outpatient basis. This procedure provides significant pain control or reduction in approximately 80+% of patients, but response is usually slower than for other treatments. Patients may respond within 4 to 6 weeks post-treatment; however, some patients require as much as 3 to 8 months for the full response. Most patients remain on full doses of medication for at least 3-6 months after treatment and we do not typically start to taper TN medications until pain relief has been achieved.

Patients are not put to sleep for this procedure as it causes minimal pain and discomfort. The treatment requires use of a frame that is attached to the head with pins. There is mild pin site pain for approximately 1-2 days following treatment.

No one can promise that any surgery for trigeminal neuralgia will be successful for all patients; Gamma Knife treatment "scrambles" the pain pathways, but there is always a chance that the pain can recur at a later date.

No one can promise that any surgery for TN will be successful for all patients; radiofrequency rhizotomy "scrambles" the pain pathways, but there is always a chance that the pain can recur at a later date.

If the problem does turn out to be neck related, perhaps a physical therapist can help. It's best to see a spine surgeon who will do some imaging such as an MRI. Even if that doesn't find anything, a physical therapist who also does myofascial release can help a problem like this. Tightness in muscles, spasms and tight fascia can compress nerves which can cause palpitations. Nerves exit the spinal cord between every vertebrae to go everywhere in the body, and if those nerves are affected by tight neck muscles, they can be compressed. That can happen to me, but I also have asthma that contributes when allergies cause inflammation, and other spine patients have said the same thing that they have had palpitations related to the neck. ff782bc1db

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