Neuromodulation : journal of the International Neuromodulation Society
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The goal of the study was to assess the efficacy of interaction between spinal cord stimulation (SCS) and peripheral nerve field stimulation (PNFS) and to evaluate a new spinal-peripheral neuromodulation method for low back pain. ⋯ Simultaneous use of SCS and PNFS increase efficacy of both methods for axial back pain. The new SPN method showed great potential in providing coverage for back pain.
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Spinal cord stimulator (SCS) infections are common (2.5-13%) and may cause harm. It is unclear if a screening trial with definitive leads presents an increased infection risk. ⋯ Our infection rate (4.8%) compared favorably with our previous survey (7.5%). The reduced number of SCS infections is likely to be due to: strict asepsis, double layer hydrocolloid dressing during the trial, prophylactic antibiotics, operator experience, and patient education. Two-stage procedures with extended trials do not seem to increase the incidence of SCS infections.
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Spinal cord stimulation (SCS) activates the thalamus, which may be involved in generation of seizures. SCS may therefore influence seizure susceptibility. We investigated the effect of SCS on seizure susceptibility when performed at low frequency (4 Hz) and a frequency in the typical range of SCS treatment (54 Hz). ⋯ Low-frequency SCS is proconvulsive in rats. Further research needs to investigate if this also applies to humans.
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Comparative Study
Awake vs. asleep placement of spinal cord stimulators: a cohort analysis of complications associated with placement.
Patients will typically undergo awake surgery for permanent implantation of spinal cord stimulation (SCS) in an attempt to optimize electrode placement using patient feedback about the distribution of stimulation-induced paresthesia. The present study compared efficacy of first-time electrode placement under awake conditions with that of neurophysiologically guided placement under general anesthesia. ⋯ Non-awake surgery is associated with fewer failure rates and therefore fewer re-operations, making it a viable alternative. Any benefits of awake implantation should carefully be considered in the future.