Surg Neurol
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Results are reviewed of dorsal column electrical stimulation for chronic pain in a series of 80 patients. In the light of the experience gained from this series, indications and patient suitability for this form of therapy are discussed. Complications occurring after implantation are tabulated.
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Serious questions are raised as to whether electrical control of pain is related to stimulation of the dorsal columns per se or the conduction of the electrical impulse via the cerebrospinal fluid to the ventrolateral columns. Percutaneous on-surface spinal cord stimulation is advocated as an accurate screening method before implantation. Of 27 patients who underwent dorsal column stimulator implants, the last three patients also underwent ventral column stimulator implants. Results in the patients with both implants tend to predict much better results with the possibility that ventral column stimulation alone is sufficient.
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Dorsal column stimulators (DCS) have been implanted in 130 patients with various chronic pain syndromes at the University of California, San Francisco, between 1969 and 1973. Preoperative psychiatric evaluation and percutaneous dorsal column stimulation testing were of value in rejecting those patients most likely to have unsatisfactory long-term results with DCS. Best results occurred in patients with phantom limb or peripheral nerve pain and worst results in patients with paraplegic pain, documented arachnoiditis, pancreatitis and arthritis. The need is stressed for careful preoperative selection and for close, prolonged postoperative care in a situation permitting access to multidisciplinary facilities for patient care.
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Although the basic efficacy of dorsal column stimulation (DCS) has been shown, its optimal use remains to be defined. Since 1970, a program designed to maximize clinical success with DCS has been under way at Temple University Health Sciences Center. This article reviews patients screening, operative technique, new instrumentation and postoperative adjustment in DCS. Clinical results and long-term impressions of 90 implants in 75 patients are reported.
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A number of patients with intractable pain were subjected to electrical stimulation of the nucleus ventralis posterolateralis. Positive results obtained support the theory according to which pain is caused by lack of proprioceptive stimuli reaching the thalamus. The implantation technique is discussed and improvements of electrodes and of the device are proposed. Optimal stimulation parameters are defined.