scholarly journals Cervical Spinal Cord Stimulation: An Analysis of 23 Patients with Long-term Follow-up

2012 ◽  
Vol 3;15 (3;5) ◽  
pp. 203-212 ◽  
Author(s):  
Tilman Wolter
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Lower Limb ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Head Movements ◽  
Limb Pain ◽  
Pain Scores ◽  
Stimulation Parameters

Background: For more than 3 decades, spinal cord stimulation has successfully been employed to treat neuropathic pain. Cervical spinal cord stimulation, despite now being standard in many hospitals, has only rarely been subjected to a critical review within the literature. Objectives: The aim of this study was to determine the efficacy of cervical spinal cord stimulation (SCS) in a representative clinical sample. We also wanted to evaluate how factors such as stimulation parameters, unwanted paresthesia of the trunk and legs, and changes in paresthesia status due to head movement and how they affect SCS effectiveness. Study design: Retrospective study. Setting: Academic university interdisciplinary pain center. Methods: We reviewed the records of patients who had been treated at our institution with cervical neurostimulators from November 1, 2001 through October 31, 2011. Information regarding age, gender, diagnosis, age at time of implantation, duration of disease, lead position, hardware in use, revision operations, and stimulation parameters were recorded. In addition, a short telephone interview was conducted, which contained the following items: pain scores on the numeric analog scale (NAS) with and without stimulation, time intervals of stimulation, paresthesia coverage, changes in paresthesia coverage by head movements, unwanted paresthesia of the trunk and legs, treatment satisfaction, and medication intake. Results: Twenty-three patients were treated. Eighteen patients proceeded to an implantable pulse generator (IPG) implant. In one patient, the system was removed after 4 years despite optimal function, because the patient was no longer experiencing pain. Average NAS pain scores were 6.8 (range 5.5 - 10.0, standard deviation [SD] 1.7) without, and 2.8 (range 0 - 7.5, SD 2.2) with neurostimulation. Fourteen revisions (5 due to lead dislocation, 5 due to lead breakage and 4 IPG revisions) were necessary in 9 of the 18 patients during a mean follow-up of 6.2 years. Most patients reported complete paresthesia coverage. Four patients reported unwanted paresthesia of the trunk or lower limb and 11 patients reported changes in paresthesia with head movements. In both instances, pain reduction was not affected. Limitations: Retrospective study. Conclusions: Cervical spinal cord stimulation appears to be effective in the treatment of neuropathic upper limb pain. Complications are not significantly more frequent than in SCS for lower limb pain. Changes in paresthesia with head movements and unwanted paresthesia did not affect the outcome. Key words: Spinal cord stimulation, cervical, neuropathic pain, clinical efficacy, paresthesia, paresthesia coverage, changes in paresthesia, brachial plexus lesion, nerve root avulsion, stimulation parameters

Burst Spinal Cord Stimulation

Neurosurgery ◽  
2010 ◽  
Vol 66 (5) ◽  
pp. 986-990 ◽  
Author(s):  
Dirk De Ridder ◽  
Sven Vanneste ◽  
Mark Plazier ◽  
Elsa van der Loo ◽  
Tomas Menovsky
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Visual Analog Scale ◽  
Spinal Cord Stimulation ◽  
Short Form ◽  
Burst Stimulation ◽  
Analog Scale ◽  
Tonic Stimulation ◽  
Better Than

Abstract INTRODUCTION Spinal cord stimulation is commonly used for neuropathic pain modulation. The major side effect is the onset of paresthesia. The authors describe a new stimulation design that suppresses pain as well as, or even better than, the currently used stimulation, but without creating paresthesia. METHODS A spinal cord electrode (Lamitrode) for neuropathic pain was implanted in 12 patients via laminectomy: 4 at the C2 level and 7 at the T8–T9 level for cervicobrachialgia and lumboischialgia, respectively (1 at T11 at another center). During external stimulation, the patients received the classic tonic stimulation (40 or 50 Hz) and the new burst stimulation (40-Hz burst with 5 spikes at 500 Hz per burst). RESULTS Pain scores were measured using a visual analog scale and the McGill Short Form preoperatively and during tonic and burst stimulation. Paresthesia was scored as present or not present. Burst stimulation was significantly better for pain suppression, by both the visual analog scale score and the McGill Short Form score. Paresthesia was present in 92% of patients during tonic stimulation, and in only 17% during burst stimulation. Average follow-up was 20.5 months. CONCLUSION The authors present a new method of spinal cord stimulation using bursts that suppress neuropathic pain without the mandatory paresthesia. Pain suppression seems as good as or potentially better than that achieved with the currently used stimulation. Average follow-up after nearly 2 years (20.5 months) suggests that this stimulation design is stable.

Intrathecal Clonidine and Baclofen Enhance the Pain-Relieving Effect of Spinal Cord Stimulation

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. 173-181 ◽  
Author(s):  
Gastón Schechtmann ◽  
Göran Lind ◽  
Jaleh Winter ◽  
Björn A. Meyerson ◽  
Bengt Linderoth
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Animal Experiments ◽  
Pain Reduction ◽  
Saline Control ◽  
Similar Data ◽  
Intrathecal Clonidine

Abstract OBJECTIVE Spinal cord stimulation (SCS) is a well-established treatment for neuropathic pain; nevertheless, 40% of patients fail to obtain satisfactory pain relief and in many patients, the effect tends to diminish with time. Based on animal experiments, intrathecal baclofen was previously introduced clinically to enhance suboptimal SCS effects. Later animal experiments demonstrated similar data for clonidine. The aim of this study was to elucidate whether intrathecal clonidine or baclofen enhances the effect of SCS in neuropathic pain patients in whom the pain relieving-effect of SCS is inadequate. METHODS A randomized, double-blind, placebo-controlled clinical trial was conducted with 10 patients experiencing neuropathic pain with insufficient pain relief with SCS alone. Clonidine, baclofen, and saline (control) were intrathecally administered by bolus injections in combination with SCS. RESULTS Seven of 10 patients reported significant pain reduction when SCS was combined with active drugs. The mean visual analog scale ratings were reduced by more than 50% with either drug combined with SCS. Four patients previously treated with SCS alone later underwent implantation of a pump for long-term administration of clonidine or baclofen. In the 2 patients with clonidine pumps with a mean follow-up of 15 months, the combined therapy produced pain reduction of 55% and 45%, respectively. The corresponding effect with baclofen was 32% and 82%, respectively, at 7 months follow-up. CONCLUSION A trial with clonidine and baclofen combined with SCS may be warranted in patients who do not obtain satisfactory pain relief with SCS alone or experienced a decreasing therapeutic effect.

Bit-colour mapping of seps during spinal cord stimulation (SCS) in chronic lower limb pain due to PVD

Pain ◽  
1990 ◽  
Vol 41 ◽  
pp. S83
Author(s):  
P. Cisotto ◽  
S. Cusumano ◽  
P.L. Longatti ◽  
G. Trincia ◽  
A. Carteri
Keyword(s):  
Spinal Cord ◽  
Lower Limb ◽  
Spinal Cord Stimulation ◽  
Limb Pain ◽  
Lower Limb Pain

scholarly journals Neuromodulation of the Cervical Spinal Cord in the Treatment of Chronic Intractable Neck and Upper Extremity Pain: A Case Series and Review of the Literature

2007 ◽  
Vol 2;10 (3;2) ◽  
pp. 305-311
Author(s):  
Ricardo Vallejo
Keyword(s):  
Spinal Cord ◽  
Upper Extremity ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Case Series ◽  
Low Back ◽  
Limb Pain ◽  
Fusion Surgery ◽  
Upper Limb Pain ◽  
Pain Patients

Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upper extremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70–90%) reductions in pain, including axial neck pain and upper extremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upper extremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upper extremity pain. Key words: spinal cord stimulator, cervical, neck pain, radicular pain, axial pain, headache, leg pain

scholarly journals SPINAL CORD STIMULATION IN TREATMENT OF THE NEUROPATHIC PAIN SYNDROMES: INITIAL EXPERIENCE

2010 ◽  
Vol 16 (2) ◽  
pp. 68-71
Author(s):  
D. A. Rzaev ◽  
V. V. Rudenko ◽  
I. L. Pudovkin ◽  
A. P. Tatarintsev ◽  
D. S. Godanyuk
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Pulse Generator ◽  
Initial Experience ◽  
Pain Syndromes ◽  
Chronic Pain Syndromes

In the article initial experience of spinal cord stimulation for chronic pain syndromes is described. The trial was done for 62 patients, in 52 cases trial was successful and subcutaneous pulse generator were implanated. Maximal follow-up is 26 months. The level of pain evaluates at VAS. Permanent pain-relieve results were achieved in 46 patients (74,2%). These results correspond to literature data.

Stimulation Parameters Define the Effectiveness of Burst Spinal Cord Stimulation in a Rat Model of Neuropathic Pain

2014 ◽  
Vol 18 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Nathan D. Crosby ◽  
Melanie D. Goodman Keiser ◽  
Jenell R. Smith ◽  
Martha E. Zeeman ◽  
Beth A. Winkelstein
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Rat Model ◽  
Spinal Cord Stimulation ◽  
Stimulation Parameters
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