Title : EMG guided chemodenervation for post-laminectomy syndrome
Abstract:
Post-laminectomy syndrome is reported to range from 20 to 60%. The etiology of post-laminectomy syndrome is stated to be variable but multiple treatment modalities focus on nerve blocks or nerve ablation. Patients requiring a laminectomy procedure commonly have secondary chronic muscle spasms which are likely to persist despite a successful surgical procedure. Relief of the secondary chronic spasm and pain will lead to an increased overall success rate for the surgical procedure. It has been demonstrated that the CMECD procedure that makes use of EMG guidance and the off-label use of phenoxybenzamine successfully resolves chronic muscle spasm and resulting chronic pain with a single procedure. The procedure consists of identifying sites of spontaneous electrical activity (SEA) in the muscle which correspond to areas of chronic ischemia secondary to unresolved chronic muscle spasm. The injectate includes Lidocaine and dexamethasone to mitigate short-term and medium-term discomfort from the procedure. Lidocaine also immediately resolves the SEA allowing mapping of the areas successfully treated which facilitates identification of areas yet needing to be treated. Pain resolution is immediate allowing the treated individual to try various movements to illicit other adjacent or distal sites of pain. Local discomfort at the sites of injection may persist for up to one week but typically lasts 3-4 days. Phenoxybenzamine creates a covalent bond on the alpha-adrenergic receptor resulting in a functional duration of action of 2-3 months as the receptors have to be replaced slowly over time. Individuals treated with the CMECD® procedure do not demonstrate recurrence of muscle spasm or pain unless the original or similar overuse injury is repeated. The CMECD® procedure use is unrestricted and can be quickly learned and the phenoxybenzamine/dexamethasone injectate to which Lidocaine is added can be obtained from New Jersey pharmacy and shipped within the United States. Phenoxybenzamine can also be obtained from a US manufacturing source and shipped worldwide.
