First experience with chronic epidural spinal cord stimulation in Khanty-Mansi autonomous okrug — clinical observations

Purpose of the work. The article is devoted to the first experience of epidural stimulation in the Khanty-Mansiysk Autonomous Okrug at the budgetary institution Surgut Clinical Trauma Hospital. Clinical examples are presented for two main indications for the application of this technique (disease of the operated spine, a consequence of spinal cord injury in combination with chronic neuropathic pain syndrome). Research methods. An assessment of the intensity of pain syndrome was given according to a visual analogue scale, the Pain Detect questionnaire; indicators of anxiety, depression on the HADS scale; quality of life according to the Oswestry questionnaire for a follow-up period of 6-12 months in patients with chronic epidural stimulation. Results. A positive assessment of the action during test neurostimulation was 63.3% (38 patients). Of the established permanent systems, a good result was achieved and persisted for 12 months or more in 96% (24 patients). It was necessary to change the stimulation parameters in 13% (3 patients). Revision of permanent systems was performed in 20% (5 patients), due to the progression of the degenerative-dystrophic process of the spine, damage and migration of system elements. Conclusions. Chronic epidural spinal cord stimulation has established itself as a personalized, highly effective, minimally invasive and safe method of treating chronic neuropathic pain syndromes. Multicomponent corrective action is of scientific interest and requires further study.

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Spinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications

Brain Sciences ◽

10.3390/brainsci8080138 ◽

2018 ◽

Vol 8 (8) ◽

pp. 138 ◽

Cited By ~ 19

Author(s):

Ivano Dones ◽

Vincenzo Levi

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

Therapeutic Option ◽

Neural Pathways ◽

Chronic Neuropathic Pain ◽

Pain Medications ◽

Epidural Spinal Cord Stimulation ◽

Pain Therapists ◽

Effective Drugs

The origin and the neural pathways involved in chronic neuropathic pain are still not extensively understood. For this reason, despite the wide variety of pain medications available on the market, neuropathic pain is challenging to treat. The present therapeutic alternative considered as the gold standard for many kinds of chronic neuropathic pain is epidural spinal cord stimulation (SCS). Despite its proved efficacy, the favourable cost-effectiveness when compared to the long-term use of poorly effective drugs and the expanding array of indications and technical improvements, SCS is still worldwide largely neglected by general practitioners, neurologists, neurosurgeons and pain therapists, often bringing to a large delay in considering as a therapeutic option for patients affected by neuropathic chronic pain. The present state of the art of SCS in the treatment of chronic neuropathic pain is here overviewed and speculations on whether to use a trial period or direct implant, to choose between percutaneous leads or paddle electrodes and on the pros and cons of the different patterns of stimulation presently available on the market (tonic stim, high-frequency stim and burst stim) are described.

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

Journal of Neurophysiology ◽

10.1152/jn.00020.2021 ◽

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.

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BOLD FMRI OF BRAIN ACTIVATION IN RESPONSE TO DIFFERENT SPINAL CORD STIMULATION PARADIGMS IN A RAT MODEL OF CHRONIC NEUROPATHIC PAIN

10.26226/morressier.5ab3c881a874c60026559420 ◽

2018 ◽

Author(s):

Koen Meuwissen

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Rat Model ◽

Spinal Cord Stimulation ◽

Brain Activation ◽

Chronic Neuropathic Pain ◽

Bold Fmri

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Faculty Opinions recommendation of Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1098590.554694 ◽

2007 ◽

Author(s):

Nanna Finnerup

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Chronic Neuropathic Pain ◽

Cord Injury

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1-kHz high-frequency spinal cord stimulation alleviates chronic refractory pain after spinal cord injury: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00451-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Chiaki Yamada ◽

Aiko Maeda ◽

Katsuyuki Matsushita ◽

Shoko Nakayama ◽

Kazuhiro Shirozu ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Cervical Vertebrae ◽

Intractable Pain ◽

Target Area ◽

Positive Effects ◽

Cord Injury

Abstract Background Patients with spinal cord injury (SCI) frequently complain of intractable pain that is resistant to conservative treatments. Here, we report the successful application of 1-kHz high-frequency spinal cord stimulation (SCS) in a patient with refractory neuropathic pain secondary to SCI. Case presentation A 69-year-old male diagnosed with SCI (C4 American Spinal Injury Association Impairment Scale A) presented with severe at-level bilateral upper extremity neuropathic pain. Temporary improvement in his symptoms with a nerve block implied peripheral component involvement. The patient received SCS, and though the tip of the leads could not reach the cervical vertebrae, a 1-kHz frequency stimulus relieved the intractable pain. Conclusions SCI-related symptoms may include peripheral components; SCS may have a considerable effect on intractable pain. Even when the SCS electrode lead cannot be positioned in the target area, 1-kHz high-frequency SCS may still produce positive effects.

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Brain fMRI during orientation selective epidural spinal cord stimulation

Scientific Reports ◽

10.1038/s41598-021-84873-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Antonietta Canna ◽

Lauri J. Lehto ◽

Lin Wu ◽

Sheng Sang ◽

Hanne Laakso ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Pain Treatment ◽

Positive Impact ◽

Sensory Information ◽

Activation Patterns ◽

Promising Tool ◽

Cord Injury ◽

Epidural Spinal Cord Stimulation ◽

Brain Fmri

AbstractEpidural spinal cord stimulation (ESCS) is widely used for chronic pain treatment, and is also a promising tool for restoring motor function after spinal cord injury. Despite significant positive impact of ESCS, currently available protocols provide limited specificity and efficiency partially due to the limited number of contacts of the leads and to the limited flexibility to vary the spatial distribution of the stimulation field in respect to the spinal cord. Recently, we introduced Orientation Selective (OS) stimulation strategies for deep brain stimulation, and demonstrated their selectivity in rats using functional MRI (fMRI). The method achieves orientation selectivity by controlling the main direction of the electric field gradients using individually driven channels. Here, we introduced a similar OS approach for ESCS, and demonstrated orientation dependent brain activations as detected by brain fMRI. The fMRI activation patterns during spinal cord stimulation demonstrated the complexity of brain networks stimulated by OS-ESCS paradigms, involving brain areas responsible for the transmission of the motor and sensory information. The OS approach may allow targeting ESCS to spinal fibers of different orientations, ultimately making stimulation less dependent on the precision of the electrode implantation.

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The chronic neuropathic pain of spinal cord injury: Which efficiency of neuropathics stimulations?

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2008.12.010 ◽

2009 ◽

Vol 52 (2) ◽

pp. 180-187 ◽

Cited By ~ 22

Author(s):

D. Lagauche ◽

J. Facione ◽

T. Albert ◽

C. Fattal

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Chronic Neuropathic Pain ◽

Cord Injury

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Neuropathic pain syndrome as an occult manifestation of injury of the spinal cord after surgical repair of aortic coarctation

Cardiology in the Young ◽

10.1017/s1047951100009744 ◽

2000 ◽

Vol 10 (4) ◽

pp. 413-415 ◽

Cited By ~ 3

Author(s):

Luc M Beauchesne ◽

Angela Mailis ◽

Gary D Webb

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Aortic Coarctation ◽

Surgical Repair ◽

Rare Complication ◽

Pain Syndrome ◽

Neuropathic Pain Syndrome ◽

Cord Injury ◽

Unusual Symptoms ◽

Arterial Branch

AbstractInjury to the spinal cord injury with paraplegia, is a rare complication of surgical repair of aortic coarctation recognized immediately post-operatively. We present the case of a 41-year-old male undergoing surgery for restenosis at the site of a repair. Intra-operatively, he suffered inadvertent injury to an intercostal arterial branch during isolation of the aorta below the graft. Over the following months, he developed unusual symptoms involving the legs and genitourinary tract which, only after extensive investigations, were attributed to ischemic damage to the spinal cord related to the surgery. We suspect that similar syndromes reflecting injury to the spinal cord injury may be unrecognized following surgical repair of coarctation.

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