Neuromodulation : journal of the International Neuromodulation Society
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The aim of this work is to assess quality of treatment and to monitor drawbacks of SCS implantation systems through a National Observational Center. Data were obtained through a questionnaire sent by post or via telephone to each patient. All patients were affected by chronic-'vascular' and "neuropathic" pain. ⋯ We conclude that the methodology used is consistent with that of previous studies on nonmalignant chronic pain. The data obtained also reveal implantation hardware reliability, regardless of clinical outcome. A low percentage of complications and a high degree of patient satisfaction are also to be stressed.
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The purpose of this paper is to discuss which nerve fibers in the various quadrants of the spinal cord are immediately activated under normal conditions of spinal cord stimulation, ie, at voltages within the therapeutic range. The conclusions are based on both empirical and computer modeling data. The recruitment of dorsal column (DC) fibers is most likely restricted to Aβ fibers with a diameter ≥ 10.7 μm in a 0.20-0.25 mm layer under the pia mater and fibers of 9.4-10.7 μm in an even smaller outer layer when a conventional SCS lead is used. ⋯ The latter are presumably of proprioceptive origin and responsible for segmental reflexes and uncomfortable sensations. Furthermore, it is shown to be unlikely that, apart from dorsal roots and a thin outer layer of the DCs, any other spinal structures are recruited when stimulation is applied in the dorsal epidural space. Finally, anodal excitation and anodal propagation block are unlikely to occur with SCS.
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We began this study to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the treatment of severe spasticity of spinal cord origin. One hundred fifty two patients with severe spasticity of spinal origin, refractory to oral baclofen, or who experienced intolerable side-effects were given a test dose of ITB. Only those who had a satisfactory response were considered to be appropriate for pump implantation. ⋯ Superficial pump pocket infection, pocket erosion, cerebrospinal fluid (CSF) leak, post-spinal puncture headache, and meningitis were some of the procedure-related complications. Two pumps flipped and another pump valve was stuck. We conclude that long-term intrathecal baclofen by an implanted programmable pump is a safe and effective method of treating severe intractable spinal spasticity.