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.

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.

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.

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.

Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression

1988 ◽  
Vol 68 (4) ◽  
pp. 559-565 ◽  
Author(s):  
Ian F. Pollack ◽  
Peter J. Jannetta ◽  
David J. Bissonette
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Microvascular Decompression ◽  
Pain Control ◽  
Symptom Control ◽  
Sensory Loss ◽  
Content Type ◽  
Cranial Nerve Dysfunction ◽  
Ablative Procedures ◽  
Fine Print

✓ Thirty-five patients with trigeminal neuralgia (TN) bilaterally underwent posterior fossa microvascular decompression (MVD) between 1971 and 1984. They comprised 5.0% of a larger series of 699 patients with TN who underwent MVD during that interval. Compared to the subgroup of 664 patients with only unilateral symptoms, the population with bilateral TN included a greater percentage of females (74% vs. 58%, p < 0.1), a higher rate of “familial” TN (17% vs. 4.1%, p < 0.001), and an increased incidence of additional cranial nerve dysfunction (17% vs. 6.6%, p < 0.05) and hypertension (34% vs. 19%, p < 0.05). Of the 35 patients with bilateral TN, 10 underwent bilateral MVD (22 procedures) and 25 underwent unilateral MVD (30 procedures). In the latter patients, pain on the nonoperative side was well controlled with medication alone or had previously been treated by ablative procedures. Good or excellent pain control was achieved after one MVD was performed in 40 of the 45 sides treated (89%), and was maintained 1, 5, and 10 years after surgery in 82%, 66%, and 60%, respectively, based on life-table analysis. Six of 10 patients with recurrent symptoms underwent repeat unilateral MVD. Good or excellent long-term pain control was maintained in all six. With these repeat procedures included, symptom control at 1, 5, and 10 years after initial surgery was maintained in 87%, 78%, and 78% of the treated sides, respectively. Overall, 26 of 35 patients (74%) maintained good or excellent pain relief throughout the duration of the study (mean follow-up period 75 months) without resumption of regular medication usage. Although preoperative neurological deficits resulting from previous ablative procedures were seen in the majority of patients before MVD, no patient developed new major trigeminal sensory loss or masseter weakness after MVD. Operative mortality was zero. The results indicate that posterior fossa MVD is an effective and relatively safe treatment for the majority of patients with bilateral “idiopathic” TN, avoiding the risks of bilateral trigeminal nerve injury seen with other approaches.

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.

Patterns of failure after single-dose radiosurgery for spinal metastasis

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 402-405 ◽  
Author(s):  
Samuel Ryu ◽  
Jack Rock ◽  
Mark Rosenblum ◽  
Jae Ho Kim
Keyword(s):  
Single Dose ◽  
Pain Control ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Tumor Control ◽  
Effective Treatment Option ◽  
Patterns Of Failure ◽  
Content Type ◽  
Spinal Radiosurgery ◽  
Fine Print

Object. Single-dose radiosurgery for solitary spinal metastases can achieve rapid and durable pain control. This study was conducted to determine the patterns of failure after spinal radiosurgery. Methods. Forty-nine patients with 61 solitary spinal metastases underwent radiosurgery between May 2001 and May 2003. Single-dose radiosurgery (10–16 Gy) was delivered only to the involved spinal segments. The authors undertook a retrospective review of clinical notes, including patient questionnaires and radiological studies (computerized tomography or magnetic resonance imaging), to analyze patterns of failure following radiosurgery with regard to the pain and tumor control. Complete and partial pain relief was achieved in 85% of the lesions treated. Relapse of pain at the treated site was noted in 7%. Radiologically, lesions progressively metastasized to the immediately adjacent spines in 5%. These patients also had progressive primary and/or other systemic metastatic diseases. Conclusions. Spine-related pain control/reduction was excellent. Tumor recurrence at the treated segment and progression to the immediately adjacent region were rare. The results support the use of spinal radiosurgery as an effective treatment option for solitary spinal metastasis.

Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation

2004 ◽  
Vol 100 (4) ◽  
pp. 597-605 ◽  
Author(s):  
Nicolas Massager ◽  
José Lorenzoni ◽  
Daniel Devriendt ◽  
Françoise Desmedt ◽  
Jacques Brotchi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Pain Relief ◽  
Radiation Dose ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Pain Control ◽  
High Dose ◽  
Content Type ◽  
Idiopathic Trigeminal Neuralgia ◽  
Fine Print

Object. Gamma knife surgery (GKS) has emerged as a suitable treatment of pharmacologically resistant idiopathic trigeminal neuralgia. The optimal radiation dose and target for this therapy, however, remain to be defined. The authors analyzed the results of GKS in which a high dose of radiation and a distal target was used, to determine the best parameters for this treatment. Methods. The authors evaluated results in 47 patients who were treated with this approach. All patients underwent clinical and magnetic resonance imaging examinations at 6 weeks, 6 months, and 1 year post-GKS. Fifteen potential prognostic factors associated with favorable pain control were studied. The mean follow-up period was 16 months (range 6–42 months). The initial pain relief was excellent (100% pain control) in 32 patients, good (90–99% pain control) in seven patients, fair (50–89% pain control) in three patients, and poor (< 50% pain control) in five patients. The actuarial curve of pain relief displayed a 59% rate of excellent pain control and a 71% excellent or good pain control at 42 months after radiosurgery. Radiosurgery-induced facial numbness was bothersome for two patients and mild for 18 patients. Three prognostic factors were found to be statistically significant factors for successful pain relief: a shorter distance between the target and the brainstem, a higher radiation dose delivered to the brainstem, and the development of a facial sensory disturbance after radiosurgery. Conclusions. To optimize pain control and minimize complications of this therapy, we recommend that the nerve be targeted at a distance of 5 to 8 mm from the brainstem.

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