Neuromodulation : journal of the International Neuromodulation Society
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Objectives. Recent publications on dual program spinal cord stimulation (SCS) system demonstrate more flexible electrode programming, which helps to steer paresthesias towards all of the affected areas including the low back area. Materials and Methods. The following data were retrospectively sought from 20 nonrandomized failed back surgery patients at two centers treated by a dual quadripolar surgically implanted SCS lead: pain and paresthesia, VAS ratings, medication use, sleep patterns, daily activities, hardware problems, and willingness to repeat the procedure. The data were analyzed by the Wilcoxon signed rank test (p value < 0.05). ⋯ The number of patients taking benzodiazepines decreased. Sixty percent reported increased participation in social activities. Conclusions. This dual program surgical SCS technique is simple, respects patients' autonomy, and provides adequate analgesia with an increase in quality of life.
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Objectives. Electric peripheral nerve stimulation (PNS) is a neuromodulatory therapy in pain patients. The efficacy of this neurosurgical pain treatment is controversial because its antinociceptive effect in humans has not been objectively proven so far. Materials and Methods. Noxious infrared laser stimulation of the left hand dorsum evoked cortical potentials (LEP) by selective excitation of Aδ-fiber nociceptors in 15 healthy volunteers under control and PNS conditions. ⋯ Results. During PNS, LEP amplitudes (p < 0.001) and laser intensity ratings (p < 0.05) significantly decreased, and LEP latencies significantly increased (p < 0.05). Under control conditions LEP and intensity ratings remained unchanged. Conclusions. The electrophysiologic data provide evidence that electric stimulation of peripheral Aβ-fibers reliably suppresses Aδ-fiber nociceptive processing in human volunteers.
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To compare various novel and conventional systems for locomotion, a 25-year-old man was studied with motor complete spinal cord injury at the T4/5 level. He used various devices in the community, and changes in speed, physiological cost index (PCI), and oxygen consumption were measured periodically. Speed was fastest with a conventional manual wheelchair (nearly 120 m/min in a 4-min test). ⋯ Walking with FES and ankle-foot orthoses (AFO) was slowest (3.5 m/min) and had the highest PCI. In conclusion, the leg-propelled wheelchair provides a more efficient method of locomotion. A new stance-controlled KAFO with FES may provide a more acceptable walking system, but must be tested on other subjects.
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A new neuroimplant system, namely the Tulgar implant, developed to solve the practical problems encountered with the presently available implants, was tested as a spinal cord stimulator in ten sheep. The response of living tissue and technical performance of the new system were evaluated. ⋯ Animal tests showed that the new system could reliably be implantable in the living tissue. Intra-operative radicular stimulation of the right dorsal root in T13-L1 levels, by means of burst mode of signals, resulted in observable contractions of hip muscles in the right upper leg.
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Implantation of an intrathecal infusion pump is now accepted as a valuable technique to treat chronic pain. The most frequently reported complications associated with it are catheter fractures or migrations, usually resulting in a recurrence of pain and the onset of withdrawal symptoms. ⋯ The unusual complication of intradural catheter migration responsible for sciatica is presented here. Treatment consisted of catheter replacement, leading to immediate disappearance of the sciatica.