Robert E Jacobson

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Oral Squamous Cell Carcinoma Found Inline with the Fields of Repeat Stereotactic Radiosurgery for Recurrent Trigeminal Neuralgia

Cureus (2018)

Aldo Berti Michelle Granville Robert E Jacobson

A case of an extremely healthy, active, 96-year-old patient, nonsmoker, is reviewed. He was initially treated for left V1, V2, and V3 trigeminal neuralgia in 2001, at age 80, with stereotactic radiosurgery (SRS) with a dose of 80 Gy to the left retrogasserian trigeminal nerve. He remained asymptomatic for nine years until his trigeminal pain recurred in 2010. He was first treated medically but was intolerant to increasing doses of carbamazepine and gabapentin. He underwent a second SRS in 2012 with a dose of 65.5 Gy to the same retrogasserian area of the trigeminal nerve, making the total cumulative dose 125.5 Gy. In late 2016, four years after the 2nd SRS, he was found to have invasive keratinizing squamous cell carcinoma in the left posterior mandibular oral mucosa. Keratinizing squamous cell carcinoma is seen primarily in smokers or associated with the human papillomavirus, neither of which was found in this patient. A review of his two SRS plans shows that the left lower posterior mandibular area was clearly within the radiation fields for both SRS treatments. It is postulated that his cancer developed secondary to the long-term radiation effect with a very localized area being exposed twice to a focused, cumulative, high-dose radiation. There are individual reports in the literature of oral mucositis immediately after radiation for trigeminal neuralgia and the delayed development of malignant tumors, including glioblastoma found after SRS for acoustic neuromas, but there are no reports of delayed malignant tumors developing within the general radiation field. Using repeat SRS is an accepted treatment for recurrent trigeminal neuralgia, but physicians and patients should be aware of the potential effects of higher cumulative radiation effects within the treatment field when patients undergo repeat procedures.

Trigeminal Nerve

Mucositis

10.7759/cureus.2054

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Citations (1)

An Unusual Vertical T12 Fracture Extending into the T12-L1 Disc in a Patient with Diffuse Idiopathic Spondylotic Hyperostosis: A Case Study Using Vertebroplasty to Stabilize the Fracture

Cureus (2019)

Jason Hartman Michelle Granville Aldo Berti Robert E Jacobson

Osteoporotic spinal fractures are seen above previous spinal instrumentation and also found in patients with diffuse idiopathic spondylotic hyperostosis (DISH). In both situations, there is marked spinal rigidity with a limited mobile spinal section that is vulnerable to motion and subsequent fracture with no or minimal trauma especially when there is concurrent osteoporosis. This is an unusual case where the patient developed a vertical anterior avulsion type fracture of T12 through a large bridging spondylotic ventral spur of bone, resulting in severe positional pain above a previous lumbar instrumented fusion. While being managed conservatively with bracing, sequential follow-up magnetic resonance imaging (MRI) and computed tomography (CT) scans showed progressive development of vacuum changes, both in the linear fracture and the adjacent intra-discal space. Vacuum changes are a strong radiologic sign of spinal instability. Because of age and not wanting to undergo further extensive fusion, he was treated with intra-discal and transpedicular placement of bone cement with the resolution of his pain.

Hyperostosis

Burst fracture

10.7759/cureus.4477

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Citations (2)

Transverse axial tomography of the spine

Journal of neurosurgery (1975)

Robert E Jacobson Fredie P. Gargano Hubert L. Rosomoff

✓ The authors describe the technique of transverse axial tomography of the spine and give a detailed description of the axial anatomy of the normal lumbar spine from L-4 to the sacrum. They demonstrate a specific repetitive pattern of intraosseous and articular segments, and stress the importance of the articular processes in shaping the vertebral canal and the intervertebral foramina. The authors believe axial tomography to be a simple, noninvasive radiological technique that allows cross-sectional visualization of the vertebral canal and articular processes in the living patient.

Axial skeleton

10.3171/jns.1975.42.4.0406

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Citations (32)

Transverse axial tomography of the spine

Journal of neurosurgery (1975)

Robert E Jacobson Fredie P. Gargano Hubert L. Rosomoff

✓ The authors describe the diagnostic value of transverse axial tomography in developmental lumbar stenosis, spondylosis, facetal hypertrophy, and other abnormalities that can constrict the spinal canal.

Lateral recess

Vertebral canal

10.3171/jns.1975.42.4.0412

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Citations (44)

Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia

Cureus (2018)

Aldo Berti George Ibars Xiaodong Wu Alex N. Sabo Michelle Granville

Stereotactic radiosurgery (SRS) has evolved as an accepted treatment for medication resistant trigeminal neuralgia. Initial results are very good but follow-up over three to five years shows a gradual return of pain in up to 50% of treated patients, often requiring further treatment. The results with repeat SRS using the isocentric Gamma Knife (GK) (Elekta, Stockholm, Sweden), especially in patients having initially good results, are very similar to the outcomes after the initial treatment although there is an increased risk of residual facial numbness secondary to the additional radiation dose to the trigeminal nerve. However, after 2000, non-isocentric SRS systems began to be used for treating trigeminal neuralgia including the CyberKnife (CK) (Accuray, Sunnyvale, California) as well as various linear accelerator (LINAC) based systems. This report specifically examines a series of recurrent trigeminal cases treated by the same group of physicians with the CK system. Similar doses and locations on the trigeminal nerve and/or the root entry zone were used for both initial and repeat SRS treatment regardless of system used. Although there are numerous series reporting the use of GK for recurrent treatment for recurrent trigeminal neuralgia, there are no series reviewing the results and long-term effectiveness using CK for repeat SRS for recurrent trigeminal pain. We reviewed 23 cases that had initial treatment for trigeminal neuralgia either surgically or with SRS with either the GK or CK and then a later second procedure only with CK. The follow-up after the second CK SRS ranged from three to 13 years found that the results are very similar to the multiple reports in the literature describing second or third SRS treatments with the GK. Results of repeat radiosurgery treatment of recurrent trigeminal neuralgia appear to be independent of the system used and are primarily based on proper target and dose to the trigeminal nerve.

Cyberknife

Trigeminal Nerve

10.7759/cureus.2598

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Citations (13)

Bipolar Radiofrequency Facet Ablation of the Lumbar Facet Capsule: An Adjunct to Conventional Radiofrequency Ablation for Pain Management

Cureus (2017)

Robert E Jacobson Ovidiu Palea Michelle Granville

Radiofrequency facet ablation (RFA) has been performed using the same technique for over 50 years. Except for variations in electrode size, tip shape, and change in radiofrequency (RF) stimulation parameters, using standard, pulsed, and cooled RF wavelengths, the target points have remained absolutely unchanged from the original work describing RFA for lumbar pain control. Degenerative changes in the facet joint and capsule are the primary location for the majority of lumbar segmental pathology and pain. Multiple studies show that the degenerated facet joint is richly innervated as a result of the inflammatory overgrowth of the synovium. The primary provocative clinical test to justify an RFA is to perform an injection with local anesthetic into the facet joint and the posterior capsule and confirm pain relief. However, after a positive response, the radiofrequency lesion is made not to the facet joint but to the more proximal fine nerve branches that innervate the joint. The accepted target points for the recurrent sensory branch ignore the characteristic rich innervation of the pathologic lumbar facet capsule and assume that lesioning of these recurrent branches is sufficient to denervate the painful pathologic facet joint. This report describes the additional targets and technical steps for further coagulation points along the posterior capsule of the lumbar facet joint and the physiologic studies of the advantage of the bipolar radiofrequency current in this location. Bipolar RF to the facet capsule is a simple, extra step that easily creates a large thermo-coagulated lesion in this capsule region of the pathologic facet joint. Early studies demonstrate bipolar RF to the facet capsule can provide long-term pain relief when used alone for specific localized facet joint pain, to coagulate lumbar facet cysts to prevent recurrence, and to get more extensive pain control by combining it with traditional lumbar RFA, especially when RFA is repeated.

Facet (psychology)

Joint capsule

Capsule

Pulsed radiofrequency

10.7759/cureus.1635

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Citations (10)

Low Volume Vertebral Augmentation with Cortoss® Cement for Treatment of High Degree Vertebral Compression Fractures and Vertebra Plana

Cureus (2017)

Robert E Jacobson Michelle Granville Jesse Hatgis Aldo Berti

This is a retrospective analysis of a consecutive series of patients undergoing vertebroplasty and vertebral augmentation in an outpatient setting for high degree osteoporotic vertebral fractures or vertebra plana using consistently low volumes (less than 3 cc) of Cortoss® cement, rather than polymethylmethacrylate (PMMA). The results in these patients demonstrate that it is both technically feasible to do vertebroplasty on these patients and using a low volume hydrophilic silica-based cement is effective in providing diffuse vertebral body fill with minimal complications. There was no increased risk of complications, such as cement leakage, displacement of bone fragments, or progression of the angulation. Specifically, with over a 24-month follow-up, the preoperative collapse or angulation did not worsen and none of the patients developed adjacent level fractures or required further surgery at the involved vertebral level.

Vertebra

Vertebral Compression Fracture

Bone cement

10.7759/cureus.1058

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Citations (17)

Evaluation and Interventional Management of Pain After Vertebral Augmentation Procedures

Cureus (2017)

Jesse Hatgis Michelle Granville Robert E Jacobson

A small subset of patients who underwent successful vertebral compression fracture (VCF) augmentation procedures may develop subsequent pain requiring spinal injections. In a retrospective analysis, we determined whether the pain was related to the original fracture site or to another area within the lumbar or thoracic spine. The pain occurred either at the same/adjacent level and/or non-adjacent level as the VCF. Interventional treatments primarily targeted the facet joints, specifically in the form of facet joint blocks and/or radiofrequency ablation to the medial branches. The pattern of facet injections relative to the original fracture level was studied. Additionally, the elapsed time between the vertebral augmentation and the subsequent interventional blocks was also evaluated.A total of 56 patients sustained VCFs. 12 of these patients underwent interventional procedures after vertebral augmentation procedures. The level(s) of same/adjacent level and non-adjacent level pain were determined via physical examination and/or imaging studies. These levels were subsequently treated with interventional procedures primarily focused on the facet joints. The time period of the injections varied from two weeks status post-vertebral augmentation to as late as 304 weeks (5.8 years) status post-vertebral augmentation.We performed 25 vertebral augmentation procedures on these 12 patients. 15 lumbar, eight lower thoracic, and two mid-thoracic VCFs were augmented. 9/14 cases of blocks included those performed at non-adjacent levels, whereas 5/14 cases of blocks were performed only at the same and/or adjacent levels as the VCF. For the events in which thoracic VCFs were augmented, 6/7 (or 86%) had developed non-adjacent level pain in areas of the lumbar spine. The time from vertebral augmentation procedure to subsequent pain procedure ranged from two weeks to five plus years. The average time elapsed was 83 weeks. Only one case required blocks performed within the first six weeks after vertebral augmentation. In this case, the blocks included those at non-adjacent levels. A total of 4/12 cases (33%) had a block within 12 weeks of the original vertebral augmentation procedure. Lumbar spine imaging showed that at least 9/12 patients had pre-existing significant lumbar pathology at the time of fracture treatment. This may have contributed to the later development of pain.Pain after a successful vertebral augmentation is typically non-acute (i.e., beyond six weeks). Mechanisms other than the primary VCF are usually responsible for non-adjacent level pain, which are present a majority of the time on reviewing the patients' diagnostic studies. These mechanisms usually take many weeks to develop and subsequently elicit pain that requires additional interventional pain procedures. In our study, the pain is usually related to the pre-existing degenerative spondylosis and stenosis rather than the fracture site. This study shows that the facet joints in closely related lumbar degenerative changes are the cause of pain in this patient group. These procedures should be explored with pain after vertebral augmentation, especially in those patients with known or suspected spinal degeneration and/or poor biomechanics.

Facet (psychology)

Vertebral Compression Fracture

Interventional pain management

Thoracic vertebrae

10.7759/cureus.1061

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Citations (10)

Lumbar Spinal Stenosis and Nerve Root Entrapment Syndromes

Clinical Orthopaedics and Related Research (1976)

Carl C. Arnoldi Alex Brodsky J Cauchoix Henry Vernon Crock G. F. Dommisse

Arnoldi, C. C.; Brodsky, A. E.; Cauchoix, J.; Crock, H. V.; Dommisse, G. F.; Edgar, M. A.; Gargano, F. P.; Jacobson, R. E.; Kirkaldy-Willis, W. H.; Kurihara, A.; Langenskiöld, A.; Macnab, I.; McIvor, G. W.D.; Newman, P. H.; Paine, K. W.E.; Russin, L. A.; Sheldon, J.; Tile, M.; Urist, M. R.; Wilson, W. E.; Wiltse, L. L.Editor(s): KIRKALDY-WILLIS, W. K. M.A., M.D., F.R.C.S.(C AND E) AND G. W. D. MCIVOR, M.D., F.R.C.S.(C) Author Information

10.1097/00003086-197603000-00002

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Citations (162)

Baastrup’s Disease, Interspinal Bursitis, and Dorsal Epidural Cysts: Radiologic Evaluation and Impact on Treatment Options

Cureus (2017)

Jesse Hatgis Michelle Granville Robert E Jacobson

Baastrup’s disease or "kissing spines syndrome" was first described as a cause of lumbar pain before computerized tomography (CT) and magnetic resonance imaging (MRI) scanning existed. The diagnosis was based on x-ray studies, which showed that the spinous processes, especially in the lower lumbar spine, became approximated to each other and this was a generator of positional back pain. Biomechanically, the interspinous and supraspinous ligaments that are degenerated in Baastrup's disease normally contribute significantly to sagittal alignment. Ligamentous stenosis and anterolisthesis would be the expected pathology with deterioration of these ligaments and were initially described on CT and MRI in patients with symptoms similar to Baastrup's disease as isolated individual case reports. This review will highlight the relationship between the various clinical presentations, biomechanics, and overlap of Baastrup's disease with interspinous bursitis, segmental stenosis, and instability, presenting them as a disease continuum rather than as separate disease processes.

Bursitis

Back Pain

10.7759/cureus.1449

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Citations (11)