Neuromodulation : journal of the International Neuromodulation Society
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Spinal cord stimulation (SCS) is an effective technique for the relief of neuropathic pain. Biologic complications are more prevalent within the first 3 months after implantation, are generally minor and reversible, and do not affect patients' acceptance of the treatment. Technically, hardware-related complications are uncommon and occur more frequently in the first 2 years following implantation of the device than after. ⋯ Areas covered by this article include patient positioning, the appropriate use of imaging, insertion of percutaneous and surgical leads, intraoperative stimulation, lead choice and suturing, considerations pre- and postimplantation, stimulation settings and regimens, implantable pulse generator positioning, and control of infections. It is hoped that these guidelines may help physicians to improve their SCS implantation technique and thereby improve the outcomes of the therapy. These guidelines should be of special value for newer centers starting SCS therapy for their patients.
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We present a case of a female patient suffering from type I complex regional pain syndrome (CRPS) who developed "mirror imaging" of her CRPS and was successfully treated with dual spinal cord stimulation (SCS) in the paraforaminal epidural space. This patient initially had unilateral pain that was unsuccessfully treated with midline SCS and single-lead lateral epidural lead placement "paraforaminally." One year later, because we believed that paraforaminal stimulation would preferentially stimulate primary sensitized afferents innervating the painful area, we reperformed SCS with two leads positioned laterally and paraforaminally close to the roots within the epidural space. After repositioning and after 1 year of paraforaminal stimulation, there was significant improvement in the patient's symptoms, resolving all unilateral and "mirrored" symptoms. We conclude that paraforaminal stimulation may be a valid therapeutic option for the treatment of CRPS.
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Objectives. To examine the effect of using a common peroneal stimulator on an even and an uneven surface, and to compare measures with perceived response to stimulation. Method. Participants had a drop-foot caused by a stroke (N = 13) or multiple sclerosis (N = 7) and had used a common peroneal stimulator for > 3 months prior to the study. Walking speed and physiological cost index (PCI) were recorded under four conditions: with and without stimulation over an even and an uneven surface. ⋯ A correlation between perceived benefit of stimulation and a measured decrease in PCI was detected. Conclusion. Stimulation may be particularly beneficial for the more difficult task of walking on an uneven surface. Perceived benefit was related to a reduction in effort of walking, not in increased speed.
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Objective and Importance. Several previous reports have documented cord compression resulting from the formation of an intrathecal inflammatory mass in patients using intrathecal drug delivery systems. We present the first reported case of an intramedullary abscess and intrathecal inflammatory mass associated with an intrathecal drug delivery system. Clinical Presentation. A 47-year-old man was transferred to our institution from an outside hospital with a 3-week history of the inability to ambulate or move his legs. ⋯ The abscess was linked to infection with Streptococcus anginosus. Conclusion. Generally, inflammatory masses forming along the catheter tip are not associated with infections. We report the first case of an intramedullary abscess associated with an intrathecal drug delivery pump.