Neuromodulation : journal of the International Neuromodulation Society
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Case Reports
Treatment of chronic chest wall pain in a patient with Loeys-Dietz syndrome using spinal cord stimulation.
Spinal cord stimulation (SCS) has been used with increased frequency for the treatment of intractable pain including chronic chest pain. ⋯ SCS provides an effective, alternative treatment option for select patients with Loeys-Dietz syndrome who underwent repair of pectus excavatum with subsequent chronic chest wall pain who have failed conservative treatment. SCS may provide pain relief with advantages over conservative treatments and more invasive techniques.
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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.