Neuromodulation : journal of the International Neuromodulation Society
-
Occipital nerve stimulation (ONS), an established treatment for medically intractable headache syndromes, has lead migration rates quoted up to 24%. In a series of patients with ideal characteristics for this treatment modality, we describe an operative technique for ONS involving the novel use of narrow paddle electrodes: "S8 Lamitrode" (St. Jude Medical [SJM], St. Paul, MN, USA). ⋯ This is the first reported use of S8 Lamitrode electrode for ONS. This narrow electrode is suited for this role leading to minimal trauma during surgical placement, facilitates resolution of problems with lead migration, and optimizes effect with stimulation focused more in direction of the occipital nerves without skin involvement. To date, the SJM Genesis neurostimulation system, with percutaneous electrodes only, is CE mark approved in Europe for peripheral nerve stimulation of the occipital nerves for the management of pain and disability for patients diagnosed with intractable CM. Further developments and studies are required for better devices to suit ONS, thereby avoiding frequently encountered problems and which may clarify the role of paddle leads in ONS.
-
Letter Case Reports
Treatment of contact dermatitis associated with spinal cord stimulator pulse generator--technical note.
Expanded polytetrafluoroethylene sheets have been successfully used as a biologic barrier in the treatment of pacemaker contact dermatitis. ⋯ This technique is an effective way of treating contact dermatitis related to implantable pulse generators, without the need for explantation of the neuromodulation system.
-
Electrical spinal cord stimulators are routinely used in the thoracic spine for back and lower extremity pain. The anatomy of the cervical spine differs significantly from that of the thoracic spine and deserves special considerations if these implants are to be inserted safely in the neck. This paper explores the technical challenges of implanting paddle leads in the cervical spine and offers a novel technique for implantation. ⋯ A new technique is presented that allows easy and reliable implantation of cervical paddle leads in the neck with a low risk of iatrogenic complications.
-
Neurogenic bladder associated with spinal cord injury (SCI) often results in serious disruption of lower urinary tract function. Compared to conventional therapies, sacral neuromodulation (SNM) may offer an alternative, non-destructive treatment for SCI patients with bladder dysfunction. Understanding bladder reflex changes following SCI and the effects of SNM may yield new insights for innovative use of this promising technique. Using a SCI rat model developed in this study, we investigated: 1) the bladder responses with different grades of bladder filling in intact and SCI rats; and 2) the effects of acute SNM on bladder reflex responses in SCI rats. ⋯ The spinal rat model developed in this study was suitable to investigate the effect of sacral neural stimulation on micturition reflex. The results of present study demonstrated that the micturition reflex can be modulated by sacral neural stimulation.
-
Letter Case Reports
Coccygeal fracture pain cured by sacral neuromodulation: a case report.