Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
Randomized Controlled Trial Clinical TrialImplantation of surgical electrodes for spinal cord stimulation: classical midline laminotomy technique versus minimal invasive unilateral technique combined with spinal anaesthesia.
The implantation of surgical electrodes is still considered painful and invasive. Is there a possibility to diminish these disadvantages by applying a less invasive implantation procedure at the thoracic level and eventually combine this approach with a less stressful paresthesia coverage testing in the intraoperatively awake patient? In this paper, the postoperative outcome of two surgical techniques to insert surgical plate electrodes at the thoracic level is compared. In a prospective single blind study. the Classical Midline Laminotomy technique (CML) is opposed to a Minimal Invasive unilateral Technique (MIT). ⋯ In all comparisons, the MIT group scored significantly better. It can be concluded that a minimal invasive unilateral technique has some advantages over midline laminotomy. Refinements of the implantation procedure are discussed, i.e minimal invasive unilateral technique in combination with spinal (intrathecal) anaesthesia, surgical hints and the technique's use in revision surgery for migrated electrodes.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialIntrathecal antispastic drug application with implantable pumps: results of a 10 year follow-up study.
Since 1986, more than 300 patients received an intrathecal baclofen (ITB) pump for the treatment of severe spasticity. Chronic ITB administration is a safe and effective method, which significantly decreases pathologically exaggerated muscle tone and improves the quality of life in most patients. This therapy is indicated in severe spasticity of cerebral or spinal origin that is unresponsive to oral antispastic medications. ⋯ In carefully selected patients who suffer from spasticity, pump implantation is a cost-effective treatment which improves their quality of life. In our series with a follow-up period of 10 years, the ITB dose remained constant and no development of tolerance was observed in most patients. Destructive procedures such as myelotomy are no longer performed in our department in order to treat spasticity.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialHardware failures in spinal cord stimulation (SCS) for chronic benign pain of spinal origin.
Spinal cord stimulation (SCS) has become an established clinical option for treatment of refractory chronic pain not related to cancer. Current hardware and implantation techniques for SCS are already highly developed and continuously improving, however equipment failures over the course of the long-term treatment are still encountered in a relatively high proportion of treated cases. ⋯ This review summarizes the experience of the authors with management of hardware failures and their causes in patients treated with SCS for chronic pain of benign origin. The published literature is critically surveyed and discussed.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialDrug-enhanced spinal stimulation for pain: a new strategy.
Neuropathic pain is notoriously difficult to manage and only a few classes of drugs may provide adequate benefits. Thus, in many cases spinal cord stimulation (SCS) is considered; however, in this group of patients, between 30-50% of the cases offered a percutaneous SCS trial may fail to obtain a satisfactory effect. Additionally, a certain number of patients with a good initial effect, report that after a period the benefits are reduced necessitating additional peroral drug therapy. ⋯ However, in a group of three patients with peroral baclofen therapy and SCS, complaints of side-effects were common and this therapy was terminated. Informal reports from collegues support the negative experience with additional peroral baclofen. In conclusion, in patients with neuropathic pain demonstrating inadequate response to SCS (small VAS reduction; short duration) a trial of intrathecal baclofen in combination with SCS may be warranted.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialFactors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate.
For patient selection, psychological factors like fear avoidance, depression, secondary gain or refusal to be weaned off narcotics should be avoided. Trial Stimulation is an important tool to reduce the rate of failed permanent implants, and to improve cost-effectiveness. The etiology of pain has a strong influence on the success rate. ⋯ The electrode fracture rate can be reduced by using the paramedian approach, the use of three wing silicone anchor placed immediately at the point of exit of the lead from the deep fascia and avoiding a hard plastic twist lock anchor. The displacements can be reduced by fixing the anchor to the deep fascia firmly, supplemented by the use of silicone glue, and by placing the implantable pulse generator (IPG) in the abdominal wall, instead of the gluteal region. The use of prophylactic antibiotics tends to reduce the infection rate.