Neuromodulation : journal of the International Neuromodulation Society
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Spinal cord stimulation (SCS) has become a mainstay in the continuum of care for patients suffering from chronic neuropathic pain of the trunk and limbs. Options for placing these devices have included a percutaneous method of using an epidural needle to place a cylindrical (percutaneous) lead to stimulate the spinal cord, or an open laminotomy method for placing a paddle lead at the location of the surgical decompression of the laminae. Both of these methods have been successful in a high percentage of patients, but neither have been ideal. Limitations of the percutaneous leads have been inefficiency of power delivery, inability to achieve desired depth of stimulation in the spinal cord, occasional lead migration and difficulty covering complex pain patterns. Limitations of the paddle lead have been the need for surgical laminotomy, inability to steer the lead once placed, limits on placement in the vicinity of the surgical decompression, and a perceived risk of increased bleeding and trauma to the tissue. These factors have led many minimally invasive spine specialists to seek new options for SCS. This paper presents the initial US experience with a newly approved device to place both paddle leads, and multi-lead arrays into the epidural space via a percutaneous Seldinger-guided approach through a single needle placement. We will both describe the technique and review the outcomes of some of the early cases. ⋯ This paper describes the initial US cases of the placement of a paddle lead via a minimally invasive percutaneous method, as well as complex cylindrical arrays with a single needle entry to the epidural space. The device functioned successfully and presented a safe option for placing paddle leads and complex arrays.
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Clinical Trial
Continuous versus intermittent spinal cord stimulation: an analysis of factors influencing clinical efficacy.
Spinal cord stimulation (SCS) has, for decades, been shown to be successful in a variety of chronic neuropathic pain syndromes. However, there is a paucity of reports in the literature comparing different stimulation patterns. The impact of different stimulation patterns upon outcome remains to be determined, as well as how the latter is influenced by the duration of the post-SCS pain-free interval. ⋯ Our data showed an equal effectiveness of SCS in the intermittent and in the continuous stimulation mode. The duration of the post-SCS pain-free interval may be predictive for the choice of the most effective individual stimulation pattern and deserves further investigation.
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Multicenter Study Clinical Trial
A prospective, open-label, multicenter study to assess the efficacy of spinal cord stimulation and identify patients who would benefit.
To identify patients likely to benefit from spinal cord stimulation (SCS). ⋯ SCS may improve pain management and QOL.
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In able-bodied participants, it is possible to induce a sense of perceptual embodiment in an artificial hand using a visual-tactile illusion. In amputee patients, electrical stimulation of sensory afferents using transcutaneous electrical nerve stimulation (TENS) has been shown to generate somatic sensations in an amputee's phantom limb(s). However, the effects of TENS on the perceptual embodiment of an artificial limb are not known. Our objective was to investigate the effects of TENS on the perceptual embodiment of an artificial limb in fully intact able-bodied participants. ⋯ Our findings provide initial evidence that TENS paresthesia can be projected into an artificial limb, and this can enhance the sense of perceptual embodiment of an artificial hand. Further exploratory studies involving an amputee population are warranted.
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Complications associated with intrathecal pumps may be linked to the surgical procedure, the implanted device, or the medication itself. ⋯ Inadvertent injection into the subcutaneous pocket rather than the reservoir is rare but very dangerous as the drug cannot be retrieved and massive doses are involved. Signs and symptoms of systemic overdose with drugs commonly used in implanted drugs delivery system should be well known to ensure early diagnosis and treatment.