Articles: surgery.
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Objectives. The development of multicontact electrodes and programmable, implanted pulse generators has increased the therapeutic success of spinal cord stimulation (SCS) by enhancing the ability to capture and maintain pain/paresthesia overlap. This study sought to determine if interleaved stimulation and/or frequency doubling improves pain/paresthesia overlap in patients with failed back surgery syndrome. Methods. Using a patient-interactive computer system that quantifies SCS performance and presents stimulation settings in randomized, double-blind fashion, we compared the effect on pain/paresthesia overlap of interleaved stimulation (rapidly interleaved pulse trains using two different contact combinations) vs. standard treatment with a single contact combination, controlling for frequency doubling. ⋯ We found no significant effect for electrode configuration (single or dual), pulse width matching, or phase angle. Conclusions. The statistically significant advantages we observed for SCS with interleaved stimulation are explained, at least in part, by the effects of frequency doubling. These findings have important implications for the design and adjustment of pulse generators.
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Clin. Orthop. Relat. Res. · Oct 2007
Comparative StudyThe accuracy of computer-assisted percutaneous iliosacral screw placement.
The benchmark fluoroscopic technique of iliosacral screw insertion is disadvantaged by its reliance on ionizing radiation and presentation of dynamic information in only one plane. Multiplane targeting requires interpolation, which may be associated with inherent errors. Computer-assisted surgery enables surgeons to monitor their screw trajectory in 3-D space. ⋯ With both techniques, two of the 10 tracks penetrated the sacral cortex in dysplastic pelvices. A fluoroscopic computer-assisted surgery technique appears as accurate as the standard fluoroscopic technique but no more so. Caution is recommended in dysplastic pelvices.
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Objectives. To assess the mode-of-use of implanted programmable infusion pumps in patients with nonmalignant, chronic low-back pain. Materials and Methods. Charts from 101 consecutive eligible patients were analyzed retrospectively. Data were extracted relating to patient demographics, pump mode of infusion and flow rate, and medications used. ⋯ For patients attaining constant-flow treatment, mean time from implantation to start of such treatment was 2.7 months. Discussion. The results suggest that many patients with nonmalignant low-back pain could be implanted with a constant-flow pump when their programmable device needs replacing or, in some cases, at the start of intrathecal treatment. This would reduce costs and the requirement for surgery.
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The Journal of urology · Oct 2007
Comparative StudyCombined inguinal hernia repair with prosthetic mesh during transperitoneal robot assisted laparoscopic radical prostatectomy: a 4-year experience.
Inguinal hernias are detected in 20% to 30% of patients undergoing radical prostatectomy. We report our experience with concomitant transperitoneal robot assisted laparoscopic radical prostatectomy and intraperitoneal inguinal herniorrhaphy using prosthetic mesh. ⋯ Concurrent repair of inguinal hernias during transperitoneal robot assisted laparoscopic radical prostatectomy using prosthetic mesh is technically feasible and effective, and without increased complications or morbidity.