scholarly journals Spinal Anesthesia and Minimal Invasive Laminotomy for Paddle Electrode Placement in Spinal Cord Stimulation: Technical Report and Clinical Results at Long-Term Followup

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
S. Sarubbo ◽  
F. Latini ◽  
V. Tugnoli ◽  
R. Quatrale ◽  
E. Granieri ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Anesthesia ◽  
Spinal Cord Stimulation ◽  
Clinical Results ◽  
Minimal Invasive ◽  
Electrode Placement ◽  
Test Stimulation ◽  
Score Improvement ◽  
Postoperative Control ◽  
Electrode Positioning

Object. We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients’ discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results.Methods. 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients’ satisfaction rate were recorded during the followup and compared to preoperative values.Results. No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%.Conclusions. Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement.

Implantation of Laminotomy Electrodes for Spinal Cord Stimulation in Spinal Anesthesia with Intraoperative Dorsal Column Activation

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1150-1154 ◽  
Author(s):  
Göran Lind ◽  
Björn A. Meyerson ◽  
Jaleh Winter ◽  
Bengt Linderoth
Keyword(s):  
Spinal Cord ◽  
Spinal Anesthesia ◽  
Spinal Cord Stimulation ◽  
Motor Block ◽  
Dorsal Column ◽  
Thoracic Vertebrae ◽  
Afferent Pathways ◽  
Plate Electrode ◽  
Test Stimulation ◽  
Patient Reported

Abstract OBJECTIVE To optimize the technique of implanting laminotomy plate electrodes for spinal cord stimulation and to minimize the discomfort of the patients during surgery. This operation is often performed while the patient is under local anesthesia, which is very stressful for the patient, or under general anesthesia, which precludes the use of test stimulation. An alternative approach is to perform the implantation with a spinal anesthetic and to examine whether stimulation-induced paresthesiae can still be evoked to guide the positioning of the electrode. METHODS Spinal anesthesia was induced by bupivacaine (12.5–20 mg), which produced complete motor block and anesthesia up to a midthoracic level. After a single-level laminotomy (thoracic vertebrae 9–11) a four-pole plate electrode was inserted into the epidural space. Stimulation was applied with commonly used parameters, and the electrode was positioned so that the paresthesiae covered the painful region. RESULTS In 19 patients (20 procedures) with different forms of neuropathic pain, implantation of laminotomy plate electrodes could be performed under spinal anesthesia without problems. In all patients, it was possible to evoke paresthesiae, the distribution of which could be reproduced postoperatively. The paresthesia thresholds during surgery were only moderately higher than those recorded after implantation (mean, 3.1 versus 2.1 V, respectively). During an interview after the intervention, no patient reported that he or she had experienced surgery as painful or uncomfortable. CONCLUSION Implantation of laminotomy electrodes can be performed conveniently with spinal anesthesia because it minimizes discomfort for the patient and enables the use of intraoperative test stimulation to guide the positioning of the electrode. In spite of the total motor block and anesthesia, paresthesiae representing the activation of the dorsal columns can be evoked and are well perceived, and the thresholds are not abnormally high. This observation supports the notion that the subarachnoidal anesthetic agent acts predominantly on the spinal rootlets rather than on the spinal afferent pathways.

Spinal Cord Stimulation Electrode Design: A Prospective, Randomized, Controlled Trial Comparing Percutaneous with Laminectomy Electrodes: Part II–Clinical Outcomes

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 990-996 ◽  
Author(s):  
Richard B. North ◽  
David H. Kidd ◽  
Loredana Petrucci ◽  
Michael J. Dorsi
Keyword(s):  
Spinal Cord ◽  
Controlled Trial ◽  
Clinical Results ◽  
Failed Back Surgery Syndrome ◽  
Electrode Placement ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract OBJECTIVE: Spinal cord stimulation, in use for more than 30 years, has evolved into an easily implemented technique involving percutaneous or laminectomy electrode placement. In a randomized comparison of four-contact percutaneous and four-contact insulated laminectomy electrodes placed at the same level in the dorsal, epidural midline, quantitative measures of stimulator performance revealed significant technical advantages for the laminectomy electrodes. Our prospective, randomized, controlled trial compares clinical results in these same patients. METHODS: Impartial third parties followed our series of 24 patients with failed back surgery syndrome to gather clinical outcome data. We defined “success” as at least 50% sustained relief of pain and patient satisfaction with the result of treatment. RESULTS: At a mean follow-up of 1.9 years, 10 of 12 patients receiving the laminectomy electrode and 5 of 12 patients receiving the percutaneous electrode reported a successful outcome (P < 0.05). Follow-up at a mean of 2.9 years showed that this result was maintained in 5 of 12 patients with the laminectomy electrode and 3 of 12 with the percutaneous electrode (not statistically significant). Many patients reported improvements in most activities of daily living, and loss of function was rare. In addition, 9 patients with laminectomy electrodes and 4 with percutaneous electrodes reducted or eliminated analgesic intake (P < 0.05), and 2 returned to work. No electrode migration was observed. CONCLUSION: Laminectomy electrode placement, although more invasive than percutaneous placement, yields significantly better clinical results in patients with failed back surgery syndrome at mean 1.9 years follow-up. In our small sample, however, the statistical significance of this advantage disappeared at mean 2.9 years follow-up.

Laminectomy versus Percutaneous Electrode Placement for Spinal Cord Stimulation

Neurosurgery ◽  
2000 ◽  
Vol 46 (2) ◽  
pp. 399-406 ◽  
Author(s):  
Alan T. Villavicencio ◽  
Jean-Christophe Leveque ◽  
Linda Rubin ◽  
Ketan Bulsara ◽  
John P. Gorecki
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Electrode Placement

New Trends in Neuromodulation for the Management of Neuropathic Pain

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 690-704 ◽  
Author(s):  
Kenneth M. Aló ◽  
Jan Holsheimer
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Clinical Results ◽  
Intractable Pain ◽  
Long Term Effects ◽  
Long Term Outcomes ◽  
Dorsal Columns ◽  
Painful Area ◽  
Electronic Field

Abstract SINCE ITS FIRST application in 1967, the methodology and technology of spinal cord stimulation for the management of chronic, intractable pain have evolved continuously. Despite these developments and improved knowledge of the effects of spinal anatomy and epidural contact configuration on paresthesia coverage, the clinical results of spinal cord stimulation—particularly the long-term effects—are still unsatisfactory in many patients. This dissatisfaction has come primarily from the failure of single-electrode configurations to provide consistent paresthesia coverage of the entire painful area. Therefore, new approaches were developed during the late 1990s that attempted to selectively cover one or more dermatomes with paresthesia as well as to provide sequential stimulation of different anatomic sites. These approaches have been applied both intraspinally and extraspinally by stimulating either the spinal nerves or the dorsal columns. To target parts of the latter, different methods have been developed and tested using either two-dimensional contact configurations or electronic field steering. These developments hold promise for improving long-term outcomes as well as increasing the number of pain conditions that can be treated with neuromodulation therapy. In this review, the history, theoretical basis, and evolution of these methodologies, as well as the ways in which they represent new trends in neuromodulation, are discussed.

scholarly journals Spinal cord stimulation in multiple sclerosis: clinical results.

1980 ◽  
Vol 43 (1) ◽  
pp. 1-14 ◽  
Author(s):  
L S Illis ◽  
E M Sedgwick ◽  
R C Tallis
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Clinical Results

Epidural spinal cord stimulation as an intervention for motor recovery after motor complete spinal cord injury

2021 ◽  
Author(s):  
Jan T Hachmann ◽  
Andrew Yousak ◽  
Josephine J Wallner ◽  
Parag N. Gad ◽  
V. Reggie Edgerton ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Stimulation ◽  
Large Diameter ◽  
Motor Units ◽  
Clinical Results ◽  
Neural Pathways ◽  
Epidural Stimulation ◽  
Cord Injury ◽  
Epidural Spinal Cord Stimulation

Spinal cord injury (SCI) commonly results in permanent loss of motor, sensory, and autonomic function. Recent clinical studies have shown that epidural spinal cord stimulation may provide a beneficial adjunct for restoring lower extremity and other neurological functions. Herein, we review the recent clinical advances of lumbosacral epidural stimulation for restoration of sensorimotor function in individuals with motor complete SCI and we discuss the putative neural pathways involved in this promising neurorehabilitative approach. We focus on three main sections: review recent clinical results for locomotor restoration in complete SCI; discuss the contemporary understanding of electrical neuromodulation and signal transduction pathways involved in spinal locomotor networks; review current challenges of motor system modulation and future directions towards integrative neurorestoration. The current understanding is that initial depolarization occurs at the level of large diameter dorsal root proprioceptive afferents that when integrated with interneuronal and latent residual supraspinal translesional connections can recruit locomotor centers and augment downstream motor units. Spinal epidural stimulation can initiate excitability changes in spinal networks and supraspinal networks. Different stimulation parameters can facilitate standing or stepping, and it may also have potential for augmenting myriad other sensorimotor and autonomic functions. More comprehensive investigation of the mechanisms that mediate the transformation of dysfunctional spinal networks to higher functional states with a greater focus on integrated systems based control system may reveal the key mechanisms underlying neurological augmentation and motor restoration after severe paralysis.

scholarly journals “Please mind the gap”: successful use of ultrasound-assisted spinal anesthesia for urgent cesarean section in a patient with implanted spinal cord stimulation system for giant chest wall arteriovenous malformation – a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bruno Antonio Zanfini ◽  
Salvatore De Martino ◽  
Luciano Frassanito ◽  
Stefano Catarci ◽  
Francesco Vitale di Maio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Chest Wall ◽  
Spinal Cord Stimulation ◽  
Pregnant Patient ◽  
Safe Site ◽  
Case Presentation ◽  
Stimulation System

Abstract Background The use of Spinal Cord Stimulation (SCS) system to treat medically refractory neuropathic pain is increasing. Severe neuropathic pain can be found in giant chest wall arteriovenous malformations (AVMs), exceedingly rare and debilitating abnormalities, rarely reported during pregnancy. Case presentation We present a report of a pregnant patient with implanted Spinal Cord Stimulation (SCS) system because of painful thoracic AVM scheduled for an urgent cesarean section in which we used lumbar ultrasound (US) to rule out the possibility to damage SCS electrodes and to find a safe site to perform spinal anesthesia. Conclusions The use of lumbar US to find a safe site for a lumbar puncture in presence of SCS system in a patient affected by painful thoracic AVM makes this case a particularly unique operative challenge and offers a new possible use of ultrasound to detect a safe space in patients with SCS implant.

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