Preliminary percutaneous dorsal column stimulation prior to permanent implantation

1972 ◽  
Vol 37 (2) ◽  
pp. 242-245 ◽  
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.

Dorsal column stimulation for control of pain

1972 ◽  
Vol 36 (5) ◽  
pp. 590-597 ◽  
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.

Distribution of activity in spinal pathways evoked by experimental dorsal column stimulation

1975 ◽  
Vol 42 (3) ◽  
pp. 290-295 ◽  
Author(s):  
Heinrich Bantli ◽  
James R. Bloedel ◽  
Donlin M. Long ◽  
Phudhiphorn Thienprasit
Keyword(s):  
Rhesus Monkeys ◽  
Dorsal Column ◽  
Electrode Position ◽  
Content Type ◽  
Spinal Pathways ◽  
Therapeutic Value ◽  
Stimulus Parameters ◽  
Different Characteristics ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ Experiments were performed in rhesus monkeys to determine the distribution of activity evoked in spinal pathways by dorsal column stimulation. It was shown that many pathways in both the dorsal and ventral quadrants of the cord can be activated either directly or transsynaptically by stimulation with electrodes of the type implanted clinically. Moreover, the transsynaptically evoked responses recorded in each quadrant had somewhat different characteristics. Therefore, since the activation of each group of pathways may have differing effects in modifying the perception of noxious stimuli, the authors believe that changes in electrode position and stimulus parameters may be important in obtaining the therapeutic value of spinal cord stimulation for relief of pain.

Phantom limb pain

1975 ◽  
Vol 42 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Karl D. Nielson ◽  
John E. Adams ◽  
Yoshio Hosobuchi
Keyword(s):  
Phantom Limb Pain ◽  
Dorsal Column ◽  
Phantom Limb ◽  
Phantom Pain ◽  
Limb Pain ◽  
Content Type ◽  
Successful Series ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ Good to excellent relief of phantom pain is reported in 5 of 6 patients by the use of dorsal column stimulation. Follow-up periods are 7 to 25 months. One failure occurred despite excellent pain relief; this patient could not tolerate application of the DCS apparatus to his chest wall. The authors review the physiology involved and some less successful series reported by others.

Supraspinal interactions resulting from experimental dorsal column stimulation

1975 ◽  
Vol 42 (3) ◽  
pp. 296-300 ◽  
Author(s):  
Heinrich Bantli ◽  
James R. Bloedel ◽  
Phudhiphorn Thienprasit
Keyword(s):  
Spinal Cord ◽  
Mechanism Of Action ◽  
Rhesus Monkeys ◽  
Conduction Block ◽  
Dorsal Column ◽  
Content Type ◽  
Spinal Cord Dorsal ◽  
Ascending Pathways ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ Experiments were performed on rhesus monkeys to examine the hypothesis that stimulation with dorsal column electrodes of the type implanted clinically could alter the responses evoked in supraspinal nuclei through pathways in the ventral quadrant of the spinal cord. Dorsal column stimulation did produce changes in responses evoked in supraspinal nuclei; this effect could not be ascribed to a conduction block in ascending pathways. These results suggest that the mechanism of action of the dorsal column stimulator need not be dependent on interactions in the dorsal horn.

Complications of dorsal column stimulation

1978 ◽  
Vol 48 (1) ◽  
pp. 64-68 ◽  
Author(s):  
Anselmo Pineda
Keyword(s):  
Pain Control ◽  
Dorsal Column ◽  
Physiological Mechanisms ◽  
Content Type ◽  
Technical Developments ◽  
Technical Complications ◽  
Late Failure ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ The complications associated with 92 dorsal column stimulator implants are reported. They were of two types, technical and functional. In all there were 58 significant complications. Most technical complications were correctable but complications difficult to correct occurred in 26 patients. Late failure in stimulation was observed in 32 implants that had given excellent pain control for periods ranging from months to years. Improvements in the results of this procedure may be achieved by future technical developments and by clarification of physiological mechanisms.

Percutaneous epidural dorsal column stimulation

1976 ◽  
Vol 45 (4) ◽  
pp. 459-460 ◽  
Author(s):  
Bernard J. Zumpano ◽  
Richard L. Saunders
Keyword(s):  
Dorsal Column ◽  
Electrode Placement ◽  
Content Type ◽  
X Ray ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ The authors describe a method of epidural electrode placement and electrically induced paresthesia localization without x-ray guidance.

Pain reduction in amputees by long-term spinal cord stimulation

1980 ◽  
Vol 52 (3) ◽  
pp. 346-350 ◽  
Author(s):  
Jörg-Ulrich Krainick ◽  
Uwe Thoden ◽  
Traugott Riechert
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Pain Reduction ◽  
Dorsal Column ◽  
Content Type ◽  
Follow Up Study ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ This follow-up study analyzes the results of dorsal column stimulation instituted between 1972 and 1974 for the relief of pain in 84 patients, including 64 amputees. Good results decreased from 52.4% after 2 years of stimulation to 39% after 5 years. Special therapeutic problems in amputees are discussed.

Minimally invasive implantation of epidural spinal cord neurostimulator electrodes by using a tubular retractor system

2004 ◽  
Vol 100 (6) ◽  
pp. 1119-1121 ◽  
Author(s):  
Matthew R. Johnson ◽  
Daniel J. Tomes ◽  
John S. Treves ◽  
Lyal G. Leibrock
Keyword(s):  
Spinal Cord ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Intractable Pain ◽  
Tubular Retractor ◽  
Content Type ◽  
Novel Technique ◽  
Pain Syndromes ◽  
Hospital Stays ◽  
Fine Print

✓ The authors describe a novel technique for the implantation of multipolar epidural spinal cord neurostimulator electrodes with the aid of a tubular retractor system. Spinal cord neurostimulation is used as a neuroaugmentive tool for treating chronic intractable pain syndromes. Minimally invasive placement of the multipolar neurostimulator electrodes may allow for shorter hospital stays and less postoperative pain associated with the incision.

Evaluation of Dorsal Column Stimulation in the Treatment of Chronic Pain

Neurosurgery ◽  
1978 ◽  
Vol 3 (3) ◽  
pp. 373-379 ◽  
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.

Treatment of severe retromastoid pain secondary to C1–2 arthrosis by using cervical fusion

2000 ◽  
Vol 92 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Langsto T. HOLLY ◽  
Ulrich Batzdorf ◽  
Kevin T. Foley
Keyword(s):  
Nonoperative Management ◽  
Facet Joint ◽  
Complete Relief ◽  
Intractable Pain ◽  
Cervical Fusion ◽  
Content Type ◽  
Fusion Procedure ◽  
Nonoperative Therapy ◽  
Radicular Symptoms ◽  
Fine Print

Object. In this report the authors review their 5-year experience in the diagnosis and management of nine patients with severe retromastoid pain secondary to C1–2 arthrosis. Patients with symptomatic joints unresponsive to nonoperative therapy underwent cervical fusion procedures. Methods. The mean age of the patients was 71 years, and the onset of prior symptoms ranged from 6 months to 18 years. All patients suffered similar discrete nonneuropathic pain without radicular symptoms ipsilateral to the diseased facet joint. Four patients experienced relief from pain with the use of nonoperative therapy. Five patients continued to experience intractable pain and underwent C1–2 fusion. The follow-up period ranged from 6 to 26 months. The cervical fusion procedure was successful in treating the retromastoid pain in all patients. In patients who underwent surgery, complete relief of pain was demonstrated in four and significantly reduced in the fifth. Conclusions. The authors have drawn several conclusions. First, C1–2 arthrosis has a rather unique presentation and is a potential cause of upper posterior neck and head pain predominantly in elderly patients. Second, nonoperative management significantly improved the pain in nearly half of their patients and should be the first line of treatment. Last, C1–2 fusion was successful in treating the pain in patients in whom nonoperative management had failed to resolve symptoms.

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