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September 12, 1986

Use of Extracorporeal Shock-Wave Lithotripsy in Quadriplegic Patients

JAMA. 1986;256(10):1295. doi:10.1001/jama.1986.03380100069016

To the Editor.—  The indications for extracorporeal shock-wave lithotripsy treatment of renal stones continue to evolve. In the recent report by Riehle et al,1 quadriplegic patients were not treated. We have had experience with eight chronic quadriplegics (of 647 patients) between August 1985 and February 1986. The neurologic impairment was due to trauma in six patients, cerebral palsy in one, and brain-stem infarct in one. Criteria for treatment included no active pressure ulcers, sufficient limb mobility that positioning in the treatment chair could be accomplished, and no contraindication to spinal or epidural anesthesia.Four patients had bilateral staghorn calculi, two had unilateral partial staghorn stones, and two had unilateral small-volume radiopaque stones. Ten kidneys have been treated to date. A total of 18 treatments (one to four per kidney) were performed. Epidural or spinal anesthesia was used in all the spinal cord-injured patients to obviate the risk of autonomic