Neuromodulation : journal of the International Neuromodulation Society
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Subcutaneous stimulation (peripheral nerve field stimulation) is a novel neuromodulation modality that has increased in its utilization during the last 10 years. It consists of introducing a lead in the subdermal level to stimulate the small nerve fibers in that layer. Unlike other neuromodulation techniques including direct peripheral nerve stimulation, spinal cord stimulation, or deep brain stimulation, the precise target is not identified. ⋯ In this small series, we demonstrate a novel concept using a radiofrequency stimulation probe to identify the appropriate depth to place the lead. Reproducibility of results will add clarity to the accumulating data and hopefully increase the chances of adequate stimulation coverage and pain relief.
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Spinal cord stimulation (SCS) is frequently used to treat chronic, intractable back, and leg pain. Implantation can be accomplished with percutaneous leads or paddle leads. Although there is an extensive literature on SCS, the long-term efficacy, particularly with paddle leads, remains poorly defined. Outcome measure choice is important when defining therapeutic efficacy for chronic pain. Numerical rating scales such as the NRS-11 remain the most common outcome measure in the literature, although they may not accurately correlate with quality of life improvements and overall satisfaction. ⋯ Patients with CRPS and FBSS have a high degree of satisfaction, indexed as willingness to undergo the same procedure again for the same outcome at a mean follow-up of approximately four years. The percentage of satisfaction with the SCS system is disproportionally greater than the percentage of patients reporting 50% pain relief, particularly among patients with FBSS. This suggests that the visual analog scale may not be the optimal measure to evaluate long-term outcomes in this patient population.
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Case Reports
Cortical evoked potentials used for placement of a laminotomy lead array: a case report.
We describe a technique for placement of a cervical spinal cord electrode under general anesthesia using the contacts as cortical evoked potential stimulating electrodes. ⋯ This technique allows for intraoperative testing under general anesthesia in laminotomy lead placement to localize the optimal position of the lead.
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In this paper we review the literature on failed back surgery syndrome (FBSS) and use principles of Safety, Appropriateness, Fiscal Neutrality, and Effectiveness (SAFE) to determine the appropriate place for spinal cord stimulation (SCS) for the treatment of FBSS. ⋯ Based on this review and analysis of the safety, appropriateness, cost-effectiveness, and efficacy of treatments for the pain of FBSS, relegating SCS to a last resort therapy is no longer justifiable. SCS should be considered before submitting a patient to either long-term systemic opioid therapy or repeat spinal surgery for chronic pain resulting from FBSS.