Neuromodulation : journal of the International Neuromodulation Society
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Previous studies demonstrated significant improvement in mean pain scores and quality of life (QOL) scales in patients with chronic pain who underwent spinal cord stimulation (SCS). However, the number of individuals who experience relevant improvements in QOL, termed the meaningful clinical improvement (MCI), is not known. The present study investigated changes in pain measurements based on MCI after SCS. ⋯ The identification of determinants for MCI is a challenge to improve the accuracy of prognostic models in SCS for patients with chronic pain. Our results, if confirmed in other populations with a larger sample size, have implications for patients with chronic pain who are candidates for SCS treatment.
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Placement of spinal cord stimulation (SCS) paddles under general anesthesia using intraoperative neuromonitoring (IONM) has been shown to be associated with equivocal or superior clinical outcomes in comparative studies. The value of IONM in percutaneous permanent SCS placement has not been demonstrated. ⋯ Permanent percutaneous implantation of a SCS system using IONM with general anesthesia demonstrates results within range to those in the literature. Patients demonstrated statistically significant improvement in outcomes and opioid use was reduced in 71% of patients who were using opioids at baseline. We recommend its use in patients with morbid obesity, sleep apnea, and considerable anxiety. Further research is warranted to define the possible future role for percutaneous SCS implantation under IONM.
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Using computer simulation, we investigated the effect of electrode polarity on neural activation in spinal cord stimulation and propose a new strategy to maximize the activating area in the dorsal column (DC) and, thus, paresthesia coverage in clinical practice. ⋯ The results suggest that the activating area in the DC is maximized by using the dual-guarded cathode both in single- and dual-lead stimulation modes. However, DC nerve fibers are preferentially stimulated when the guarded cathode is used. According to these results, the new electrode programming strategy that we propose for clinical practice first uses the dual-guarded cathode, but, if the DR nerve fibers are activated, it then uses guarded cathode polarity.
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Data on the treatment of the vegetative state (VS) with cervical spinal cord stimulation (cSCS) are limited and prognostic factors are inconclusive. In this study, we present our experience of treating 12 VS patients with cSCS and discuss the prognostic factors. ⋯ cSCS should be a glimmer of hope for VS patients. Patients whose N20 is elicited or whose CT/MRI or PET demonstrates multifocal abnormalities are more likely to benefit from cSCS, whereas those with an IAA etiology have a lower likelihood of recovery after cSCS.
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The impact of spinal cord stimulation (SCS) on serum levels of metalloproteinase-2 (MMP-2) and metalloproteinase-9 (MMP-9) was assessed in a group of patients with failed back surgery syndrome (FBSS). The study was to give new insights into the SCS mechanism of action and the role of MMP-2 and MMP-9 in the development of NP. ⋯ MMPs may play a role in the development of FBSS. SCS increases the already elevated MMP-2 serum levels which are associated with neuroinflammatory processes in FBSS patients.