The Journal of Spinal Surgery

Register      Login

VOLUME 6 , ISSUE 2 ( April-June, 2019 ) > List of Articles

Original Article

Acupuncture-like TENS (AL-TENS) as a Quantitative Measure for the Feasibility of Intrathecal Sodium Nitroprusside Superfusion in Paraplegics for Physiological Recovery—A Pilot Study (13 Cases)

Vinod K Tewari, Neeraj Seth, Devesh Johari, Rakesh Shukla, Hari K Das Gupta

Keywords : Acupuncture-like TENS, Intrathecal sodium nitroprusside, Paraplegias, The 10,000 fold effect

Citation Information : Tewari VK, Seth N, Johari D, Shukla R, Gupta HK. Acupuncture-like TENS (AL-TENS) as a Quantitative Measure for the Feasibility of Intrathecal Sodium Nitroprusside Superfusion in Paraplegics for Physiological Recovery—A Pilot Study (13 Cases). J Spinal Surg 2019; 6 (2):44-48.

DOI: 10.5005/jp-journals-10039-1214

License: CC BY-NC 4.0

Published Online: 01-09-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background and introduction: Intrathecal sodium nitroprusside (ITSNP) has shown marked recovery in various causes of paraplegias after proper surgical decompression of the spinal cord and stabilization of vertebra. Until now, we were unable to predict paraplegias’ recovery post-ITSNP bedside effectively, either by clinical or by any investigatory modality (somato sensory-evoked potential (SSEP) and motor-evoked potential (MEP)).1 We present our work on the grading system and predictability for paraplegics using acupuncture-like TENS (AL-TENS) with ITSNP in various thoracolumbosacral cases. AL-TENS causes pain relief by well-known gate theory at the spinal cord by activating A-alpha nerve fibers which activates A-delta fibers for muscle spindle, and then pain fibers are inhibited by Renshaw cells at the spinal cord. The present work uses this cascade of various transmissions of nerves via a normal or damaged (complete or partial) spinal cord and utilizing this pathway to predict the feasibility of ITSNP in paraplegics. Our hypothesis works on this fact that the various nerves passing through the spinal cord and toward the brain can be utilized to use the quantitative measure for spinal cord injured patients and their recovery. Aims/study design: The aim of the study is to prognosticate the post-ITSNP effect by AL-TENS in thoracolumbosacral paraplegia cases in the pre-ITSNP phase, a prospective study. Materials and methods: Thirteen paraplegia patients (11 male patients and 3 females, and 3 complete paraplegias and 10 partial paraplegias) with zone of partial preservation (ZPP) cases were considered in whom pre-ITSNP-AL-TENS and post-ITSNP-TENS have been done. The mean time for superfusion was 9.69 months. ITSNP was administered at a dosage of 0.2 mg/kg body weight at the L3/4 level using a 20G LP needle. Pre- and post-ITSNP was monitored by AL-TENS. Results: Post-ITSNP-AL-TENS showed 23.84% benefit overall and 23.32% in American Spinal Injury Association (ASIA) grading in thoracolumbosacral paraplegia cases. Complete paraplegia cases did not show any change while partial paraplegias (with ZPP) showed 31% recovery in post-ITSNP-TENS and 33.34% in ASIA grading. Thus, AL-TENS showed a favorable modality to predict the ITSNP feasibility in thoracolumbosacral paraplegia cases. If pre- ITSNP-TENS showed 8 mAmp or more, there will be no response to ITSNP. This effect of post-ITSNP-TENS has increased to 34.96% after 24 hours. After 1 week, it became 39.19% and after 21 days, it had reached 44.16%. Conclusion: ITSNP with the help of TENS done in paraplegic cases helped us to prognosticate the future outcome.


PDF Share
  1. Tewari VK, Husain M, et al. The 10,000-Fold-Effect-Retrograde Neurotransmission- A Newer Concept for Paraplegias Physiological Revival-Use of Intrathecal Sodium Nitroprusside. J Evol Med Dent Sci 2014;3(26):7270–7285. DOI: 10.14260/jemds/2014/2891.
  2. Charlton J. Core Curriculum for Professional Education in Pain, 3rd edn. Seattle: IASP Press; 2005. pp. 93–96.
  3. Walsh D. TENS. Clinical applications and related theory, 1st edn. New York: Churchill Livingstone; 1997.
  4. Johnson MI. Transcutaneous Electrical Nerve Stimulation. Kitchen S. Electrotherapy: Evidence-Based Practice. Edinburgh: Churchill Livingstone; 2002. pp. 259–286.
  5. Johnson MI, Jones I. Transcutaneous electrical nerve stimulation. Physical Therapy Reviews 1998;3:73–93. DOI: https://doi.org/10.1093/bjaceaccp/mkp021.
  6. Charlton J. Core Curriculum for Professional Education in Pain, 3rd edn. Seattle: IASP Press; 2005. pp. 93–96.
  7. Johnson MI. Acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) in the management of pain. Phys Ther Rev 1998;3:73–93.
  8. Sluka KA, Walsh D. Transcutaneous electrical nerve stimulation: Basic science mechanisms and clinical effectiveness. J Pain 2003;4(3):109–121.
  9. Johnson M. Transcutaneous Electrical Nerve Stimulation: Mechanisms, Clinical Application and Evidence. Rev Pain 2007 Aug;1(1):7–11. DOI: 10.1177/204946370700100103.
  10. Tewari VK, Bhosale V, et al. Intracarotid Sodium Nitroprusside on Fifth Post Ischemic Stroke Day in Middle Cerebral Artery Occlusion Rat Model. J Clin Diagn Res August 2017;11(8):AF01–AF04. DOI: 10.7860/JCDR/2017/28085.10504.
  11. Spranger M. Superoxide Dismutase Activity in Serum of Patients With Acute Cerebral Ischemic Injury; Correlation With Clinical Course and Infarct Size. Stroke 1997;28:2425–2428.
  12. Bayir H, Kagan VE, et al. Enhanced Oxidative Stress in iNOS-Deficient Mice after Traumatic Brain Injury: Support for a Neuroprotective Role of iNOS. J Cereb Blood Flow Metab 2005 Jun;25(6):673–684. DOI: 10.1038/sj.jcbfm.9600068.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.