Neuromodulation : journal of the International Neuromodulation Society
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Introduction. Spinal cord stimulation (SCS) is an effective treatment option for neuropathic pain. However, because of the obvious procedural issues, SCS is unable to reach certain areas, such as the face, thorax, coccyx, the cervico-dorsal and lumbar areas, and the sacral, abdominal, and inguinal regions. On the other hand, these areas are easily reached by subcutaneous field stimulation. ⋯ As a result of pain reduction, the patients' quality of life improved. There were no adverse events reported except for early electrode array displacement in two of our patients. Conclusion. When SCS is not appropriate for certain neuropathic pain syndromes, subcutaneous field stimulation may be used with some degree of efficacy.
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Objectives. The increased rigidity and spasms implicit to patients being treated with baclofen provide a potential source of drug delivery system-related complications. Placement of the intrathecal catheter from the far-lateral paraspinal approach has been advocated to avoid catheter fracture as previously reported with a midline approach. A thin fascial layer and increased muscle bulk laterally could increase motion of catheters placed in this position. ⋯ Mean time to catheter revision following implantation was 7 ± 2 months. Conclusions. Spinal catheter migration from the subarachnoid space can occur with intrathecal baclofen infusion systems. Alternative methods for spinal catheter placement warrant further study.
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In current medical literature, most reported complications during spinal cord stimulation (SCS) concern technical problems, such as malfunction, migration or breakage of the lead, or internal pulse generator dysfunction, while reports about side-effects caused by SCS are rare. In this clinical report, we describe uncommon and unexplained gastrointestinal (GI) side-effects of constipation, abdominal pain, and distension during SCS in a patient suffering for chronic neuropathic pain caused by failed back surgery syndrome. These GI symptoms disappeared after suspension of SCS and were reduced if the stimulation settings were reduced below paresthesia threshold. The symptoms experienced by our patient could be related to a functional and reversible block of parasympathetic outflow in the GI system since SCS may involve not only dorsal horn structures but also somatic and visceral sensory afferents to these structures in an unpredictable way.
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Background. Buerger disease is a nonatherosclerotic, segmental, occlusive and recurrent inflammatory vascular disorder that affects small and medium-sized arteries and veins of the upper and lower extremities. Case reports. We report two cases of Buerger disease. Medical History. Smoking habit. ⋯ Following all of the above treatments, Synergy(®) spinal cord (ECP) stimulator with two electrodes (Quad PISCES(©) ) placed at the level of T9-T10. Results. There has been a reduction in pain of about 80% and an improvement of intermittent claudication (one of the patients no longer claudicates, whereas the other patient claudicates at 400 m). Conclusion. Neurostimulation of the posterior funiculi could be considered not only as palliative care but also as a therapeutic option.