Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1995
Treatment of the failed back surgery syndrome due to lumbo-sacral epidural fibrosis.
The failed back surgery syndrome (FBSS) is a severe, long-lasting, disabling and relatively frequent (5-10%) complication of lumbosacral spine surgery. Wrong level of surgery, inadequate surgical techniques, vertebral instability, recurrent disc herniation, and lumbo-sacral fibrosis are the most frequent causes of FBSS. The results after repeated surgery on recurrent disc herniations are comparable to those after the first intervention, whereas repeated surgery for fibrosis gives only 30-35% success rate, and 15-20% of the patients report worsening of the symptoms. ⋯ We classified the patients reporting at least 50% pain relief and satisfaction with result as successful, and 56% of the patients fell in that category. 10 out of 34 patients were able to resume their work. The success rate was significantly higher in females (73%) than in males, and in radicular rather than axial pain. Our data have led us to consider SCS as a first choice treatment in FBSS due to lumbo-sacral fibrosis.
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Acta Neurochir. Suppl. · Jan 1995
Long-term clinical, electrophysiological and urodynamic effects of chronic intrathecal baclofen infusion for treatment of spinal spasticity.
Seventeen patients with severe disabling spinal spasticity were selected and treated by chronic intrathecal baclofen infusion using an implanted programmable pump. Nine patients were tetraparetic, seven were paraplegic and one paraparetic. Patients were regularly followed for 5 to 69 months (mean 37.5 months). ⋯ Twelve patients with neurogenic bladder dysfunction were also evaluated by a clinically oriented questionnaire and by quantitative urodynamic recordings, before and after pump implantation. In patients with normal micturition, this was not changed by intrathecal baclofen. In patients with spastic bladder, intrathecal baclofen produced a decrease of detrusor hypertonia and hyperactivity in 50% of cases, with reduction of leakage and increase in functional bladder capacity.
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Acta Neurochir. Suppl. · Jan 1995
Severe peripheral ischemia after vasospasm may be prevented by spinal cord stimulation. A preliminary report of a study in a free-flap animal model.
Electric spinal cord stimulation (SCS) is at present used in many centers to treat ischemic pain and ischemia in peripheral vascular disease. The most promising results have been obtained in cases where a vasospastic component is dominating. The knowledge concerning the mechanisms behind these effects has been scanty, but recent experimental studies indicate that suppression of sympathetic activity and the release of vasoactive substances may be important. ⋯ Some few trials with pharmacologically induced spasm by topical application of noradrenaline onto the feeding vessel also followed the same pattern. In conclusion, SCS seems to be able to reduce vasospasm, especially if the treatment is given before the ischemic period. This approach may supply an animal model for further studies of possible mechanisms behind the microcirculatory effects of SCS.
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Acta Neurochir. Suppl. · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialSpinal cord stimulation versus reoperation for failed back surgery syndrome: a prospective, randomized study design.
Retrospectively reported results of spinal cord stimulation compare favorably with those of neurosurgical treatment alternatives for the treatment of failed back surgery syndrome, including reoperation and ablative procedures. There has been no direct prospective comparison, however, between SCS and other techniques for pain management. Therefore, we have designed a prospective, randomized comparison of spinal cord stimulation and reoperation in patients with persistent radicular pain, with and without low back pain, after lumbosacral spine surgery. ⋯ The primary outcome measure is the frequency of crossover to the alternative procedure, if the results of the first have been unsatisfactory after 6 months. Results for the first 27 patients reaching the 6-month crossover point show a statistically significant (p = 0.018) advantage for spinal cord stimulation over reoperation. Many other potentially important outcome measures will now be followed long-term as a larger overall study population accumulates.
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Acta Neurochir. Suppl. · Jan 1995
Significance of the spinal cord position in spinal cord stimulation.
The effects of the antero-posterior and medio-lateral positions of the spinal cord in the dural sac on the perception threshold and paresthesia coverage in spinal cord stimulation were analyzed. The distributions of the dorsal cerebrospinal fluid (CSF) layer thickness, measured from transverse MR scans of normal subjects at various spinal levels, were used to calculate the distributions of threshold voltages for the stimulation of spinal nerve fibers by a computer model. ⋯ The effects of an asymmetrical electrode position with respect to the spinal cord midline were also analyzed by computer modeling. It is concluded that a lateral asymmetry of less than 1 mm gives a significant reduction of perception threshold and may result in unilateral paresthesiae.