Progress in neurological surgery
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Treatment of chronic back and leg pain in patients with failed back surgery syndrome (FBSS) remains problematic as none of the currently available approaches are universally successful in achieving lasting pain control. Spinal cord stimulation (SCS) is very effective for controlling radicular pain but rarely provides adequate control of pain in the lower back. ⋯ Because PNS does not control neuropathic pain due to lumbosacral radiculopathy involving the lower extremities, we developed a hybrid technique of SCS and PNS that offers potential control of both axial pain in the lumbar area and radicular pain to the lower extremities. This chapter presents our results and the possible mechanisms of action.
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Occipital nerve stimulation may provide pain relief for patients with otherwise refractory primary headache disorders. While this treatment modality remains an off-label use of spinal cord stimulator technology, a growing body of literature documents surgical techniques, stimulation parameters, complications, and outcome of this novel form of neuromodulation. ⋯ A discussion of stimulation parameters used for occipital stimulation will be included. Prospective, blinded studies of occipital nerve stimulation may clarify the role of occipital stimulation in chronic headache management.
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Neuromodulation practitioners increasingly recognize the potential for peripheral nerve field stimulation (PNfS) to treat pain originating from the trunk. Conditions resulting in truncal pain that may respond to PNfS include cervical and lumbar postlaminectomy syndrome, inguinal neurapraxia, post-herpetic neuralgia, and post-thoracotomy pain. The focus of this chapter is to review the mechanism of action in PNfS, patient selection factors, programming strategies, and technical considerations.
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Recently, there has been a tremendous evolution in the field of neurostimulation, both from the technological point of view and from development of the new and different indications. In some areas, such as peripheral nerve stimulation, there has been a boom in recent years due to the variations in the surgical technique and the improved results documented by in multiple published papers. ⋯ The confusion arises when attempting to describe peripheral nerve stimulation and subcutaneous stimulation. Peripheral nerve stimulation, in its pure definition, involves implanting a lead on a nerve, with the aim to produce paresthesia along the entire trajectory of the stimulated nerve.
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Peripheral nerve stimulation (PNS) is an established neuromodulation approach that has been successfully used for the treatment of various painful conditions since the early 1960s. This review provides a comprehensive summary of relevant publications on PNS dividing its history into three distinct periods. The milestones of the field are related to the development of procedures, equipment and indications. As the most rapidly growing segment of operative neuromodulation, PNS continues to evolve as current and emerging clinical indications become matched by basic and clinical research, technological developments and procedural refinements.