Neuromodulation : journal of the International Neuromodulation Society
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Objectives. Spinal cord stimulation has been used extensively for failed back surgery syndrome, although dominant axial low back pain is difficult to treat effectively with this modality. The use of a surgically placed, double, quadripolar lead may result in better paresthesia of the low back, therefore enhancing outcomes in this difficult to treat population. Materials and Methods. Accordingly, this prospective study was designed to assess the effectiveness of placing such a lead at the T8-T10 level under general anesthesia without intraoperative testing for concordancy of paresthesia distribution. ⋯ The ability to lead a more active and social life was increased and 85% of patients said they would undergo spinal cord stimulation again. Placing the lead higher in the spinal canal (T8) resulted in a tendency for better paresthesia coverage of the low back when compared to lower lead placements. Conclusions. Placing a double quadripolar paddle lead under general anesthesia resulted in good clinical outcome similar to other implant techniques.
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Objectives. Vertebral fractures are the most common consequences of severe osteoporosis. The chronic pain from collapse of osteoporotic vertebrae affects quality of life (QoL) and autonomy of patients. The management of pain with oral or transdermal opiates can cause severe side-effects. ⋯ The mean morphine dose during the spinal trial was 11.28 mg/day, 7.92 mg/day at pump implantation, and 16.32 mg/day at one-year follow-up. Conclusions. Our results show that intrathecal administration of morphine efficiently relieves the symptoms of pain and improves QoL. Continuous intrathecal administration of morphine appears to be an alternative therapy to conventional analgesic drug delivery and has advantages in those patients who have severe side-effects with systemic administration of analgesics.
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We present here a technique to mitigate the complication of multiple needle entries into the thecal sac when attempting to place an intrathecal catheter into the thecal sac. Our technique of injecting radio-opaque contrast material after entering the epidural space and before entering the thecal sac allows for visualization of the thecal sac within the spinal canal, thus obviating the technique of "fell and pop" to enter the sac. In our hands, this technique has improved outcomes for our patients and has decreased the incidence of post dural puncture headache, neural trauma and technical failures.
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Introduction. Intractable pain in the affected arm is a common sequel to severe traction lesions of the brachial plexus. Its management presents a challenge. Existing interventional therapies are not effective for the intractable pain from brachial plexus traction lesions, in the long term. ⋯ Methods. We report here a single case report of the successful management of intractable pain of uncertain pathology following traction injury of the shoulder and brachial plexus with the percutaneous implantation of a permanent stimulating electrode via a stimulating needle to the brachial plexus using the posterior route at the interscalene level. Results. Stimulation of the brachial plexus in this one patient has resulted in excellent pain control and unexpected beneficial sensory and motor changes in the arm of the patient. Conclusions. We cautiously conclude that percutaneous implantation of a stimulating electrode to the brachial plexus via a stimulating needle is a relatively simple procedure when compared to surgical implantation and, as shown in our case, very effective.