Neuromodulation : journal of the International Neuromodulation Society
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Cervicogenic headache and cervicobrachialgia are frequent diagnoses of chronic cervical pain. After failure of conservative treatment, an interventional approach may be indicated in the absence of any indication for causal surgical treatment. The pulsed radiofrequency (PRF) technique exposes the nerve to a high-frequency electric field while the temperature of the electrode tip does not exceed 42°C. ⋯ Satisfactory pain relief of at least 50% was achieved in 13 of 18 (72%) patients at 8 weeks. More than one year after treatment, six patients (33%) continue to rate treatment outcome as good or very good. No side effects were reported. j.
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Spinal cord stimulation (SCS) was performed to test the hypothesis that pain relief data during acute (15 minute intraoperative) and prolonged (5 day) SCS screening have equivalent predictive value for long-term successful SCS control of chronic low back pain and/or lower extremity pain. A retrospective series of patients with chronic low back and/or lower extremity pain underwent either percutaneous or open (ie, laminectomy) SCS implantation during which acute intraoperative followed by prolonged screening trials for percentage pain relief (%PR) were performed. Data were analyzed for (a) correlation between positive predictive value (PPV) of acute and prolonged SCS screening for %PR and (b) PPV of acute vs. prolonged screening %PR for long-term SCS %PR. ⋯ After permanent SCS implantation, at mean follow-up = 9.4 ± 1.5 months, acute and prolonged SCS screening %PR PPV's were each statistically significant for predicting long-term SCS relief of chronic pain (n = 31/38, PPV = 82% and n = 31/36, PPV = 86%, SRCC = 0.462 and 0.433, respectively, p < 0.01). We conclude that successful pain relief during acute SCS screening is highly correlated with successful prolonged SCS screening of chronic low back and/or lower extremity pain relief. Acute and prolonged SCS screening appear to have equivalent predictive value for successful long-term SCS control of chronic low back and/or lower extremity pain. These preliminary results suggest potential justification for eliminating prolonged and retaining acute (intraoperative) SCS screening for selection of permanent SCS implantation candidates.
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In an effort to improve the performance of implantable intrathecal drug delivery systems, a group of physicians experienced in the management of such devices reviewed surgical practices and principles that were associated with low catheter-related complication rates. Clinical study and postmarket data identified physicians whose patients experienced a relatively low rate of catheter-related complications. ⋯ Systemic antibiotic prophylaxis, attention to pump pocket location, and surgical wound closure techniques also were important in reducing the incidence of postoperative device-related complications. Their experience indicates that specific implantation techniques using a variety of catheters and accessories can be expected to reduce the incidence of complications after implantation of intrathecal drug administration systems.
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The objective of this research was to demonstrate the potential of using peroneal nerve activity to derive timing control for stimulation in foot drop correction and to attempt recording and stimulation through the same electrode. Two subjects were implanted with cuff electrodes on the peroneal nerve. ⋯ The switching circuit successfully allowed for simultaneous recording and stimulation through the same cuff electrode. We conclude that the peroneal nerve can potentially be used to record sensory information for derivation of a stimulator control signal in a foot drop application, while at the same time being stimulated to activate foot dorsiflexors.
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This is a retrospective study of four patients suffering from brachial plexus root avulsion of traumatic origin. Spinal cord stimulation was used to treat pain in all patients. ⋯ A stimulation trial was performed for 2 weeks and during this period the patients showed significant pain relief, so the system was permanently implanted. A significant difference of more than three points in the pain between the first and the last follow-up (0-9 months) on the Visual Analog Scale was obtained with a steady and progressive decrease of the pain scores.