scholarly journals Intraoperative electrophysiological monitoring for C1–2 spinal cord stimulation

2017 ◽  
Vol 26 (2) ◽  
pp. 183-189 ◽  
Author(s):  
Laura M. Muncie ◽  
Nathaniel R. Ellens ◽  
Emeline Tolod-Kemp ◽  
Claudio A. Feler ◽  
John S. Winestone
Keyword(s):  
Spinal Cord ◽  
General Anesthesia ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Pain Syndrome ◽  
Dorsal Column ◽  
Patient Comfort ◽  
Retrospective Case ◽  
Cervical Stimulation ◽  
Endotracheal Anesthesia

OBJECTIVE This study is a retrospective case series involving C1–2 spinal cord stimulation in patients with complex regional pain syndrome (CRPS) under general endotracheal anesthesia. Currently, C1–2 paddle lead placement is an accepted practice, which provides effective cervical stimulation to ameliorate upper-extremity and sometimes lower-extremity symptoms experienced by patients with CRPS. However, this technique must be performed under general endotracheal anesthesia rather than in an awake or semiconscious state due to intraoperative safety concerns and patient comfort. The authors aim to provide additional data to support the following novel technique: the use of somatosensory evoked potential (SSEP) diminution data to assist with proper midline placement of C1–2 leads under general anesthesia. METHODS SSEP median nerve (MN) and posterior tibial nerve (PTN) data were collected from 6 patients undergoing placement of C1–2 leads under general anesthesia. Fluoroscopy was used as an initial guide for proper anatomical midline placement. This was followed by the activation of the spinal cord stimulator and simultaneous collection of primarily MN SSEPs as well as PTN SSEPs for physiological midline placement. Unilateral and bilateral reductions in SSEPs assisted with the correct lateralization of the lead to ensure effective postoperative coverage according to the patient's individual preoperative symptoms. RESULTS Six patients were monitored using SSEPs and repeatable, reliable MN and PTN baseline responses were obtained from all. A reduction in amplitude ranging from 5% to 87% was observed, confirming inhibition of dorsal column conduction, and an average pain relief of 63% at short-term and 64% at long-term follow-up was recorded with 6 of 6 and 5 of 6 patients responding, respectively. CONCLUSIONS Intraoperative SSEP collision study testing appears to be a safe technique to monitor placement of C1–2 paddle leads intraoperatively under general anesthesia.

A Retrospective Case Series of High-Frequency Spinal Cord Stimulation (HF10-SCS) in Neurogenic Bladder Incontinence

2018 ◽  
Vol 17 (1) ◽  
pp. 14-20 ◽  
Author(s):  
Simon Schieferdecker ◽  
Clemens Neudorfer ◽  
Faycal El Majdoub ◽  
Mohammad Maarouf
Keyword(s):  
Spinal Cord ◽  
Neurogenic Bladder ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series

scholarly journals Comparison of FDA-Approved Electrical Neuromodulation Techniques for Focal Neuropathic Pain: A Narrative Review of DRG, HF10, and Burst Neuromodulation

2021 ◽  
pp. E407-E423
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Dorsal Root ◽  
Case Reports ◽  
Case Series ◽  
Dorsal Column ◽  
Small Sample

BACKGROUND: Evidence suggests that dorsal root ganglion stimulation (DRGS) is a more effective treatment for focal neuropathic pain (FNP) compared with tonic, paresthesia-based dorsal column spinal cord stimulation (SCS). However, new advancements in waveforms for dorsal column SCS have not been thoroughly studied or compared with DRGS for the treatment of FNP. OBJECTIVES: The purpose of this review was to examine the evidence for these novel technologies; to highlight the lack of high-quality evidence for the use of neuromodulation to treat FNP syndromes other than complex regional pain syndrome I or II of the lower extremity; to emphasize the absence of comparison studies between DRGS, burst SCS, and high-frequency SCS; and to underscore that consideration of all neuromodulation systems is more patient-centric than a one-size-fits-all approach. STUDY DESIGN: This is a review article summarizing case reports, case series, retrospective studies, prospective studies, and review articles. SETTING: The University of Miami, Florida. METHODS: A literature search was conducted from February to March 2020 using the PubMed and EMBASE databases and keywords related to DRGS, burst SCS, HF10 (high-frequency of 10 kHz), and FNP syndromes. All English-based literature from 2010 reporting clinical data in human patients were included. RESULTS: Data for the treatment of FNP using burst SCS and HF10 SCS are limited (n = 11 for burst SCS and n = 11 for HF10 SCS). The majority of these studies were small, single-center, nonrandomized, noncontrolled, retrospective case series and case reports with short follow-up duration. To date, there are only 2 randomized controlled trials for burst and HF10 for the treatment of FNP. LIMITATIONS: No studies were available comparing DRGS to HF10 or burst for the treatment of FNP. Data for the treatment of FNP using HF10 and burst stimulation were limited to a small sample size reported in mostly case reports and case series. CONCLUSIONS: FNP is a complex disease, and familiarity with all available systems allows the greatest chance of success. KEY WORDS: Dorsal root ganglion, high frequency, burst, spinal cord stimulation, neuromodulation, focal neuropathic pain

scholarly journals Sensor driven-position adaptive versus conventional spinal cord stimulation in failed back surgery syndrome: a retrospective case series

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mert Akbas ◽  
Haitham Hamdy Salem ◽  
Tamer Hussien Emara ◽  
Bora Dinc ◽  
Bilge Karsli
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Failed Back Surgery Syndrome ◽  
Retrospective Case ◽  
Treatment Groups ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Group 2 ◽  
Group 1

Abstract Background Failed back surgery syndrome (FBSS) is a common problem affecting 20–40% of cases undergoing spine surgeries. Spinal cord stimulation (SCS) has been shown to be an efficient and relatively safe treatment in managing many intractable chronic pain syndromes. Objectives This study compares the efficacy and safety of MR-compatible sensor driven-position adaptive SCS and conventional SCS in treating FBSS. Methods This is a retrospective case series of 120 consecutive FBSS patients who underwent SCS between February 2011 and March 2018. Pain levels, analgesic/opioid use, and sleep problems were assessed before and 3 months after the procedure in patients who received either conventional SCS (group 1; n = 62) or sensor-driven position adaptive SCS (group 2; n = 34). The degree of patient satisfaction, the change in the activities of daily living (ADLs) together with the rate of complications were compared in both treatment groups. Results The two treatment groups were homogenous at baseline. Patients in both groups improved significantly regarding pain, opioid consumption, sleep, and ADLs. The magnitude of improvement was statistically higher in group 2. An absolute reduction of 6 points on the VAS in patients who received position adaptive SCS vs a 3.3 point reduction in conventional SCS cases (p < 0.0001). Half of the patients in group 2 (n = 17) showed excellent satisfaction after the procedure versus 14.5% of cases in group 1 (n = 9). Conclusion SCS is an efficient and reliable treatment in FBSS. MR-compatible sensor driven-position adaptive SCS can be a more effective treatment in this patient group.

The Effect of Pulse Width and Contact Configuration on Paresthesia Coverage in Spinal Cord Stimulation

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. 1452-1461 ◽  
Author(s):  
Jan Holsheimer ◽  
Jan R. Buitenweg ◽  
John Das ◽  
Paul de Sutter ◽  
Ljubomir Manola ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Pulse Width ◽  
Dorsal Column ◽  
Intractable Pain ◽  
Perception Threshold ◽  
Stimulus Pulse ◽  
Contact Configuration ◽  
Significant Extension ◽  
Cervical Stimulation

Abstract BACKGROUND: In spinal cord stimulation for the management of chronic, intractable pain, a satisfactory analgesic effect can be obtained only when the stimulation-induced paresthesias cover all painful body areas completely or partially. OBJECTIVE: To investigate the effect of stimulus pulse width (PW) and contact configuration (CC) on the area of paresthesia (PA), perception threshold (VPT), discomfort threshold (VDT), and usage range (UR) in spinal cord stimulation. METHODS: Chronic pain patients were tested during a follow-up visit. They were stimulated monopolarly and with the CC giving each patient the best analgesia. VPT, VDT, and UR were determined for PWs of 90, 210, and 450 microseconds. The paresthesia contours at VDT were drawn on a body map and digitized; PA was calculated; and its anatomic composition was described. The effects of PW and CC on PA, VPT, VDT, and UR were tested statistically. RESULTS: Twenty-four of 31 tests with low thoracic stimulation and 8 of 9 tests with cervical stimulation gave a significant extension of PA at increasing PW. In 14 of 18 tests (low thoracic), a caudal extension was obtained (primarily in L5-S2). In cervical stimulation the extension was predominantly caudal as well. In contrast to VPT and VDT, UR is not significantly different when stimulating with any CC. CONCLUSION: PA extends caudally with increasing PW. The mechanism includes that the larger and smaller dorsal column fibers have a different mediolateral distribution and that smaller dorsal column fibers have a smaller UR and can be activated only when PW is sufficiently large. A similar effect of CC on PA is unlikely as long as electrodes with a large intercontact distance are applied.

Patient Outcomes and Spinal Cord Stimulation: A Retrospective Case Series Evaluating Patient Satisfaction, Pain Scores, and Opioid Requirements

Pain Practice ◽  
2015 ◽  
Vol 16 (7) ◽  
pp. 899-904 ◽  
Author(s):  
Rebecca A. Sanders ◽  
Susan M. Moeschler ◽  
Halena M. Gazelka ◽  
Tim J. Lamer ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Patient Satisfaction ◽  
Patient Outcomes ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Retrospective Case ◽  
Pain Scores ◽  
Retrospective Case Series
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