Neuromodulation : journal of the International Neuromodulation Society
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Review Meta Analysis
Incidence of Neuraxial and Non-neuraxial Hematoma Complications From Spinal Cord Stimulator Surgery: Systematic Review and Proportional Meta-Analysis.
The goal of this meta-analysis was to estimate the incidence of total hematomas, neuraxial hematomas, and non-neuraxial hematomas in patients who underwent temporary spinal cord stimulator (SCS) lead trial placement and permanent implantation of SCS leads and internal pulse generator (IPG). ⋯ The overall incidence of hematomas in patients with temporary SCS trial lead placement and permanent SCS/IPG implantations is less than 1%. Furthermore, the incidence of neuraxial hematomas is less than 0.5%, which is of particular interest given the potential devastating consequences of this complication. The results of this study can be used to inform patients and implanting physicians on hematoma complications from SCS and highlight that the benefits of SCS outweigh the hematoma risks if anticoagulation is appropriately managed perioperatively.
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Randomized Controlled Trial Multicenter Study
Multiphase Spinal Cord Stimulation in Participants With Chronic Back or Leg Pain: Results of the BENEFIT-02 Randomized Clinical Trial.
This study aimed to assess the safety and effectiveness of a new charge-distributed multiphase stimulation paradigm during an extended spinal cord stimulation (SCS) trial. ⋯ The Clinicaltrials.gov registration number for the study is NCT03594266.
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Review
Cervical Spinal Cord Stimulation for the Treatment of Headache Disorders: A Systematic Review.
Chronic headache remains a major cause of disability and pain worldwide. Although the literature has extensively described pharmacologic options for headache treatment and prophylaxis, there remains a paucity of data on the efficacy of neuromodulation interventions for treatment of headache unresponsive to conventional pharmacologic therapy. The primary aim of this review was to appraise the literature for the efficacy of cervical spinal cord stimulation (cSCS) in treating any intractable chronic headache, including migraine headaches (with or without aura), cluster headache, tension headache, and other types of headaches. ⋯ Our review suggests promising data from observational studies that cSCS may be helpful in decreasing frequency and intensity of chronic intractable headache. Future well-powered, randomized controlled trials are needed.
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Randomized Controlled Trial Multicenter Study
Treatment of Refractory Low Back Pain Using Passive Recharge Burst in Patients Without Options for Corrective Surgery: Findings and Results From the DISTINCT Study, a Prospective Randomized Multicenter Controlled Trial.
Spinal cord stimulation (SCS) is effective for relieving chronic intractable pain conditions. The Dorsal spInal cord STImulatioN vs mediCal management for the Treatment of low back pain study evaluates the effectiveness of SCS compared with conventional medical management (CMM) in the treatment of chronic low back pain in patients who had not undergone and were not candidates for lumbar spine surgery. ⋯ The Clinicaltrials.gov registration number for the study is NCT04479787.
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Randomized Controlled Trial
Epidural Laterality and Pain Relief With Burst Spinal Cord Stimulation.
Burst spinal cord stimulation (SCS) can achieve excellent clinical reduction of pain, alongside improvements in function, quality of life, and related outcomes. Good outcomes likely depend on good lead placement, thereby enabling recruitment of the relevant neural targets. Several competing approaches exist for lead implantation, such as the use of single vs bilateral leads and leads lateralized vs placed at midline. The objective of this study was to examine the relationship between paresthesia locations and pain relief with burst SCS in a prospective double-blind crossover design. ⋯ When burst stimulation is delivered to spinal targets that can generate paresthesias contralateral to the side of worst pain, suboptimal therapy is achieved. Thus, attention to laterality and pain coverage is critical for successful therapy, and it may be important to carefully consider lead implantation techniques.