scholarly journals Sensory restoration by epidural stimulation of the lateral spinal cord in upper-limb amputees

eLife ◽  
2020 ◽  
Vol 9 ◽  
Author(s):  
Santosh Chandrasekaran ◽  
Ameya C Nanivadekar ◽  
Gina McKernan ◽  
Eric R Helm ◽  
Michael L Boninger ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Sensory Feedback ◽  
Limb Amputation ◽  
Stimulus Amplitude ◽  
Major Barrier ◽  
Somatosensory Feedback ◽  
Upper Limb Amputation ◽  
Epidural Spinal Cord Stimulation ◽  
Stimulation Of

Restoring somatosensory feedback to people with limb amputations is crucial to improve prosthetic control. Multiple studies have demonstrated that peripheral nerve stimulation and targeted reinnervation can provide somatotopically relevant sensory feedback. While effective, the surgical procedures required for these techniques remain a major barrier to translatability. Here, we demonstrate in four people with upper-limb amputation that epidural spinal cord stimulation (SCS), a common clinical technique to treat pain, evoked somatosensory percepts that were perceived as emanating from the missing arm and hand. Over up to 29 days, stimulation evoked sensory percepts in consistent locations in the missing hand regardless of time since amputation or level of amputation. Evoked sensations were occasionally described as naturalistic (e.g. touch or pressure), but were often paresthesias. Increasing stimulus amplitude increased the perceived intensity linearly, without increasing area of the sensations. These results demonstrate the potential of SCS as a tool to restore somatosensation after amputations.

scholarly journals Sensory restoration by epidural stimulation of dorsal spinal cord in upper-limb amputees

2019 ◽  
Author(s):  
Santosh Chandrasekaran ◽  
Ameya C. Nanivadekar ◽  
Gina P. McKernan ◽  
Eric R. Helm ◽  
Michael L. Boninger ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Limb Amputation ◽  
Neural Pathways ◽  
Dorsal Spinal Cord ◽  
Epidural Stimulation ◽  
Epidural Spinal Cord Stimulation ◽  
Dorsal Spinal ◽  
Median Change ◽  
Stimulation Of

Restoring somatosensory feedback to people with limb amputations is crucial for improving prosthesis acceptance and function. Epidural spinal cord stimulation is a commonly used clinical procedure that targets sensory neural pathways in the dorsal spinal cord to treat pain conditions. A similar approach could be developed as a clinically translatable means to restore somatosensation in amputees. We show that epidural stimulation of the dorsal spinal cord evoked sensory percepts, perceived as emanating from the amputated arm and hand, in four people with upper-limb amputation. After an initial caudal movement immediately following the implantation, the leads stabilized, exhibiting a median migration of <5 mm (each electrode contact is 3 mm long) over the remainder of the study in all the subjects. This was reflected in the consistent locations of evoked percepts in the hand across four subjects throughout the period of implantation, which lasted up to 29 days. The median change in the centroid location was 1.2 to 35.3 mm and the median change in percept area was 0 to 40%. While most of the evoked percepts were paresthetic in nature, a subset was described as naturalistic (e.g. touch or pressure) in three subjects. Modulating the stimulus amplitude affected the perceived intensity of the sensation in all subjects. A variety of sensory percepts were evoked in all subjects irrespective of the level of amputation or the time since amputation, suggesting the approach is amenable to a diverse population of amputees.

scholarly journals Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110040
Author(s):  
Kuen Su Lee ◽  
Yoo Kyung Jang ◽  
Gene Hyun Park ◽  
In Jae Jun ◽  
Jae Chul Koh
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Therapeutic Potential ◽  
Case Series ◽  
Limb Amputation ◽  
Intractable Pain ◽  
Limb Pain ◽  
Cord Injury ◽  
Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

A small contact burn injury requiring upper limb amputation

Burns ◽  
2000 ◽  
Vol 26 (7) ◽  
pp. 656-658 ◽  
Author(s):  
R.J.I Colville ◽  
R.B Berry
Keyword(s):  
Upper Limb ◽  
Burn Injury ◽  
Limb Amputation ◽  
Upper Limb Amputation

scholarly journals Elective amputation of the upper limb is an option in the treatment of traumatic injuries of the brachial plexus?

2017 ◽  
Vol 75 (9) ◽  
pp. 667-670 ◽  
Author(s):  
Mário Gilberto Siqueira ◽  
Roberto Sérgio Martins ◽  
Carlos Otto Heise ◽  
Luciano Foroni
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Limb Amputation ◽  
Brachial Plexus Palsy ◽  
Traumatic Injuries ◽  
Upper Limb Amputation ◽  
Pros And Cons ◽  
Post Traumatic ◽  
Active Patients

ABSTRACT The treatment of complete post-traumatic brachial plexus palsy resulting in a flail shoulder and upper extremity remains a challenge to peripheral nerve surgeons. The option of upper limb amputation is controversial and scarcely discussed in the literature. We believe that elective amputation still has a role in the treatment of select cases. The pros and cons of the procedure should be intensely discussed with the patient by a multidisciplinary team. Better outcomes are usually achieved in active patients who strongly advocate for the procedure.

Neuroma in Bilateral Upper Limb Amputation

Orthopedics ◽  
2008 ◽  
Vol 31 (12) ◽  
pp. 1-3 ◽  
Author(s):  
Mansoor Soroush ◽  
Ehsan Modirian ◽  
Mohamadreza Soroush ◽  
Mahdi Masoumi
Keyword(s):  
Upper Limb ◽  
Limb Amputation ◽  
Upper Limb Amputation
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