General Responses to Questions Regarding Acute Pressure Stimulation of Sciatic Nerve for Pain Relief

Background: Failed back surgery syndrome is a common clinical entity for which spinal cord stimulation has been found to be an effective mode of analgesia, but with variable success rates. Objective: To determine if focal stimulation of the dorsal columns with a transverse tripolar lead might achieve deeper penetration of the electrical stimulus into the spinal cord and therefore provide greater analgesia to the back. Design: Case report. Methods: We describe a 42-year-old female with failed back surgery syndrome that had greater back pain than leg pain. The tripolar lead configuration was achieved by placing percutaneously an octapolar lead in the spinal midline followed by 2 adjacent quadripolar leads, advanced to the T7-T10 vertebral bodies. Results: Tripolar stimulation pattern resulted in more than 70% pain relief in this patient during the screening trial, while stimulation of one or 2 electrodes only provided 20% pain relief. After implantation of a permanent tripolar electrode system with a single rechargeable battery, the pain relief was maintained for one year. Conclusion: This is case report describing a case of a patient with chronic low back pain with a diagnosis of failed back surgery syndrome in which transverse tripolar stimulation using an octapolar and 2 quadripolar leads appeared to be beneficial. The transverse tripolar system consists of a central cathode surrounded by anodes, using 3 leads. This arrangement may contribute to maximum dorsal column stimulation with minimal dorsal root stimulation and provide analgesia to the lower back. Key words: Epidural, low back pain, spinal cord stimulation, failed back surgery syndrome, tripolar stimulation

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Mechanical sensitivity of group III and IV afferents from posterior articular nerve in normal and inflamed cat knee

Journal of Neurophysiology ◽

10.1152/jn.1986.55.4.635 ◽

1986 ◽

Vol 55 (4) ◽

pp. 635-643 ◽

Cited By ~ 144

Author(s):

P. Grigg ◽

H. G. Schaible ◽

R. F. Schmidt

Keyword(s):

Sciatic Nerve ◽

Knee Joint ◽

Conduction Velocity ◽

Mechanical Stimulation ◽

Dorsal Root ◽

Receptive Fields ◽

Group Iv ◽

Mechanical Sensitivity ◽

Group Iii ◽

Stimulation Of

Recordings were performed from sciatic nerve or dorsal root filaments in 28 cats to study single group III (conduction velocity 2.5-20 m/s) and group IV (conduction velocity less than 2.5 m/s) units supplying the knee joint via the posterior articular nerve (PAN). In seven of these cats the knee joint had been inflamed artificially. Recordings from sciatic nerve filaments revealed responses to local mechanical stimulation of the joint in only 3 of 41 group IV units and in 12 of 18 group III units from the normal joint. In the inflamed joint 14 of 36 group IV units and 24 of 36 group III units were excited with local mechanical stimulation. In recordings from dorsal root filaments (normal joint) 4 of 11 group IV units and 7 of 13 group III units were activated by stimulating the joint locally. In the normal joint four group IV units (recorded from dorsal root filaments) responded only to rotations against the resistance of the tissue, whereas the majority of the fibers did not respond even to forceful movements. Group III units with local mechanosensitivity in the normal joint reacted strongly or weakly to movements in the working range of the joint or only to movements against resistance of the tissue. In the inflamed joint, group IV fibers (recorded in sciatic nerve filaments) with detectable receptive fields responded strongly to gentle movements or only to movements against resistance of tissue. Some did not react to movements. Group III units reacted strongly or weakly to gentle movements or only to movements against resistance of the tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

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