Epidural “dorsal column” stimulation for chronic intractable pain: Eight-year followup

Preliminary percutaneous dorsal column stimulation prior to permanent implantation

Journal of Neurosurgery ◽

10.3171/jns.1972.37.2.0242 ◽

1972 ◽

Vol 37 (2) ◽

pp. 242-245 ◽

Cited By ~ 49

Author(s):

Yoshio Hosobuchi ◽

John E. Adams ◽

Philip R. Weinstein

Keyword(s):

Dorsal Column ◽

Screening Procedure ◽

Intractable Pain ◽

Content Type ◽

Dorsal Column Stimulation ◽

Fine Print

✓ Percutaneous dorsal column stimulation was done as a screening procedure in 34 candidates before implantation of a permanent dorsal column stimulator for the treatment of intractable pain. This procedure was useful in forecasting the tolerance of the patient to the “vibratory sensation” produced by a dorsal column stimulator, and the efficacy of the device in relieving pain. Eight patients termed the “vibratory sensation” intolerable. Sixteen found it unpleasant but preferable to the pain, and two found it actually pleasant.

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Evaluation of Dorsal Column Stimulation in the Treatment of Chronic Pain

Neurosurgery ◽

10.1097/00006123-197811000-00008 ◽

1978 ◽

Vol 3 (3) ◽

pp. 373-379 ◽

Cited By ~ 1

Author(s):

Ronald F. Young

Keyword(s):

Chronic Pain ◽

Pain Relief ◽

Dorsal Column ◽

Electrode Placement ◽

Intractable Pain ◽

Technical Problems ◽

Electrode Implantation ◽

Complete Pain Relief ◽

Cord Injury ◽

Dorsal Column Stimulation

Abstract Dorsal column stimulation (DCS) was used in the treatment of chronic intractable pain in 51 patients. Twenty-five of the patients had back and leg pain secondary to the treatment of intervertebral disc disease; 11 had postoperative pain after general or thoracic surgical procedures. The remainder suffered pain related to multiple sclerosis, spinal cord injury, carcinoma, and peripheral vascular disease. Pain had been present for a mean of 24 months. Thirty-seven patients underwent DCS electrode placement by open laminectomy, and 11 had percutaneous epidural DCS electrode placement. Three patients first underwent epidural DCS electrode implantation and subsequently had DCS electrode implantation by laminectomy. No major complications were noted, although multiple lesser complications required 33 additional operative procedures for correction. Follow-up periods ranged from 12 to 67 months, with a mean of 38 months. Immediately after implantation. 47% of the patients reported that they had essentially complete pain relief, but 3 years later this had decreased to 8%. No patient followed for 4 years or longer reported complete pain relief. Thirty-three per cent of the patients discontinued the regular use of narcotics for pain relief after DCS electrode implantation. Unfortunately, only 16% were able to return to gainful employment or full physical activity after DCS. Based on these data and a review of the literature, the following conclusions are made: (a) assessment of success in the treatment of chronic pain is strongly dependent on the criteria used for patient evaluation: (b) with the criteria of this report, DCS is a relatively ineffective treatment for chronic pain; (c) epidural percutaneous DCS systems are no more effective than are those placed by laminectomy, and, because of technical problems with epidural systems (mainly lead breakage and migration), the latter may actually be less effective; and (d) at present DCS seems to play a minor role in the treatment of chronic intractable pain.

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Dorsal column stimulation for control of pain

Journal of Neurosurgery ◽

10.3171/jns.1972.36.5.0590 ◽

1972 ◽

Vol 36 (5) ◽

pp. 590-597 ◽

Cited By ~ 159

Author(s):

Blaine S. Nashold ◽

Harry Friedman

Keyword(s):

Dorsal Column ◽

Intractable Pain ◽

Direct Stimulation ◽

Content Type ◽

Burning Pain ◽

Preoperative Selection ◽

Long Term Effect ◽

Dorsal Column Stimulation ◽

Self Stimulation

✓ Thirty patients with chronic intractable pain have had dorsal column implants and a trial of subsequent electrical self-stimulation to relieve the pain. Burning pain originating from damage to the CNS was most often relieved, while chronic bone, joint, and disc pain responded less well. Patients with severe psychiatric factors should be excluded, but preoperative selection is still difficult because of the lack of objective clinical tests. The long-term effect of the implant on the tissues of the dorsal column is still unknown and requires further evaluation. Although relief of pain has been reported for as long as 3 years, much longer follow-ups are necessary to evaluate the efficiency of this system in patients with chronic pain. Direct stimulation of the spinal cord raises a number of interesting questions in regard to perception and sensory phenomena in man but, as yet, there are no answers as to how dorsal column stimulation effects its relief of pain.

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Spinal Epidural Neurostimulation for Treatment of Acute and Chronic Intractable Pain

Neurosurgery ◽

10.1227/00006123-197909000-00007 ◽

1979 ◽

Vol 5 (3) ◽

pp. 344-348 ◽

Cited By ~ 34

Author(s):

Robert R. Richardson ◽

Edir B. Siqueira ◽

Leonard J. Cerullo

Keyword(s):

Pain Relief ◽

Dorsal Column ◽

Therapeutic Modality ◽

Intractable Pain ◽

Significant Pain ◽

Long Term Follow Up ◽

Post Traumatic ◽

Spinal Epidural ◽

Dorsal Column Stimulation

Abstract Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Nashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

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Quick Reference: Chapter 1: The Musculoskeletal System: The Hand and Upper Extremity

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.sepoct03 ◽

2000 ◽

Vol 5 (5) ◽

pp. 4-5

Keyword(s):

Dorsal Column ◽

Persistent Pain ◽

Illness Behavior ◽

Abnormal Illness Behavior ◽

Organ Systems ◽

Spinal Cord Dorsal ◽

Objective Basis ◽

Dorsal Column Stimulation ◽

Underlying Pathology

Abstract Spinal cord (dorsal column) stimulation (SCS) and intraspinal opioids (ISO) are treatments for patients in whom abnormal illness behavior is absent but who have an objective basis for severe, persistent pain that has not been adequately relieved by other interventions. Usually, physicians prescribe these treatments in cancer pain or noncancer-related neuropathic pain settings. A survey of academic centers showed that 87% of responding centers use SCS and 84% use ISO. These treatments are performed frequently in nonacademic settings, so evaluators likely will encounter patients who were treated with SCS and ISO. Does SCS or ISO change the impairment associated with the underlying conditions for which these treatments are performed? Although the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not specifically address this question, the answer follows directly from the principles on which the AMA Guides impairment rating methodology is based. Specifically, “the impairment percents shown in the chapters that consider the various organ systems make allowance for the pain that may accompany the impairing condition.” Thus, impairment is neither increased due to persistent pain nor is it decreased in the absence of pain. In summary, in the absence of complications, the evaluator should rate the underlying pathology or injury without making an adjustment in the impairment for SCS or ISO.

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