Neuromodulation : journal of the International Neuromodulation Society
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Neuromodulation with spinal cord stimulation has become an increasingly employed intervention for treatment of a variety of neuropathic pain states. As prevalence increases, so does the incidence of complications. Currently, there is sparse literature describing spinal cord stimulation lead placement and stimulation characteristics in the subdural space. In this case report we describe subdural lead placement and the associated stimulation parameters, and provide evidence-based support to initiate a dialog to further reduce procedural morbidity and mortality. ⋯ Evidence suggesting subdural lead placement include the lack of cerebrospinal-fluid despite lavage, the absence of post-dural puncture headache, the recent evidence of intentional and reproducible subdural anesthesia, and the conductive properties of the dural spinal elements. It can be argued that subdural lead placement may occur unrecognized more frequently than originally anticipated.
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Case Reports
Ultrasound-guided caudad epidural access for the lumbosacral neurostimulation: case report and technical note.
This is a case report and description of a new ultrasound-guided caudad epidural needle placement for percutaneous stimulation of the lumbosacral roots. ⋯ Spinal sonography is a promising imaging method to facilitate percutaneous caudad epidural access.
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Neurostimulation is widely accepted for the treatment of refractory Parkinson's disease, essential tremor, and chronic pain. The presence of a cardiovascular implantable electronic device (CIED) might be considered a contraindication for neurostimulators due to the possible interaction between the two devices. The purpose of this study is to report the feasibility and safety of concomitant use of neurostimulators and CIED, and to review surgical and clinical precautions needed to avoid possible interference between the two systems. ⋯ The concomitant use of neurostimulator(s) and permanent pacemaker(s) can be safely performed. Permanent pacemaker should not be considered a general contraindication for neurostimulation therapy. Current literature lacks evidence to determine the safety of concomitant use of neurostimulator(s) and implantable cardioverter defibrillator(s).
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Idiopathic overactive bladder, urgency-frequency syndromes, interstitial cystitis, pudendal neuralgia, vulvodynia, prostadynia, and coccygodynia have been effectively treated with sacral nerve root modulation. This is most commonly performed with placement of electrodes via a transforaminal approach, predominately to the S3 foramen. This approach is limited by a high lead migration rate and the limitations of stimulating a single nerve root. Beginning in the 1990s, some centers began pursuing retrograde percutaneous placement from the lumbar spine, but adoption of this technique was limited by the technical difficulty of the approach. ⋯ The "laterograde" modification of cephalocaudal approach appears to be technically less difficult method for accomplishing sacral nerve root stimulator electrode placement over multiple roots.