Neuromodulation : journal of the International Neuromodulation Society
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The objectives of this study were to assess the effectiveness of cervical spinal cord stimulation in the management of intractable pain syndromes affecting the upper limb and face and to assess the reliability of a specific electrode system in this mobile environment. Forty-one patients, aged 26-76 years (median 48) with neuropathic or ischemic pain underwent the cervical epidural implantation of identical dual two-contact paddle (four contacts per system) laminectomy electrodes. Follow-up (from 5 months to 11 years, 3 months; median 4 years, 7 months) was by multiple consultations carried out by the surgeon and/or in a nurse-led specialist clinic. ⋯ Lead fracture rate was 15% of the original (11% of the total including replacements) and only 7% (5%) became dislodged. We conclude that the electrode system described provides reliable and sustained cervical cord stimulation. The outcomes are comparable with thoracic cord stimulation for neuropathic and ischemic syndromes.
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The objective of this research was to demonstrate the potential of using peroneal nerve activity to derive timing control for stimulation in foot drop correction and to attempt recording and stimulation through the same electrode. Two subjects were implanted with cuff electrodes on the peroneal nerve. ⋯ The switching circuit successfully allowed for simultaneous recording and stimulation through the same cuff electrode. We conclude that the peroneal nerve can potentially be used to record sensory information for derivation of a stimulator control signal in a foot drop application, while at the same time being stimulated to activate foot dorsiflexors.
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Cervicogenic headache and cervicobrachialgia are frequent diagnoses of chronic cervical pain. After failure of conservative treatment, an interventional approach may be indicated in the absence of any indication for causal surgical treatment. The pulsed radiofrequency (PRF) technique exposes the nerve to a high-frequency electric field while the temperature of the electrode tip does not exceed 42°C. ⋯ Satisfactory pain relief of at least 50% was achieved in 13 of 18 (72%) patients at 8 weeks. More than one year after treatment, six patients (33%) continue to rate treatment outcome as good or very good. No side effects were reported. j.
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Spinal cord stimulation (SCS) was performed to test the hypothesis that pain relief data during acute (15 minute intraoperative) and prolonged (5 day) SCS screening have equivalent predictive value for long-term successful SCS control of chronic low back pain and/or lower extremity pain. A retrospective series of patients with chronic low back and/or lower extremity pain underwent either percutaneous or open (ie, laminectomy) SCS implantation during which acute intraoperative followed by prolonged screening trials for percentage pain relief (%PR) were performed. Data were analyzed for (a) correlation between positive predictive value (PPV) of acute and prolonged SCS screening for %PR and (b) PPV of acute vs. prolonged screening %PR for long-term SCS %PR. ⋯ After permanent SCS implantation, at mean follow-up = 9.4 ± 1.5 months, acute and prolonged SCS screening %PR PPV's were each statistically significant for predicting long-term SCS relief of chronic pain (n = 31/38, PPV = 82% and n = 31/36, PPV = 86%, SRCC = 0.462 and 0.433, respectively, p < 0.01). We conclude that successful pain relief during acute SCS screening is highly correlated with successful prolonged SCS screening of chronic low back and/or lower extremity pain relief. Acute and prolonged SCS screening appear to have equivalent predictive value for successful long-term SCS control of chronic low back and/or lower extremity pain. These preliminary results suggest potential justification for eliminating prolonged and retaining acute (intraoperative) SCS screening for selection of permanent SCS implantation candidates.