Neuromodulation : journal of the International Neuromodulation Society
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Percutaneous retrograde lead insertion for sacral nerve root stimulation is a newly described technique being applied to a variety of pain disorders. The success of the procedure rests in a defined epidural space such that there is unimpeded progression of the lead into the desired location. It is hypothesized that any condition that results in anatomic compromise of the epidural space would prevent the success of the procedure. ⋯ In another patient, repeated attempts at passing the epidural lead distal to the congenital defect were unsuccessful, and the percutaneous procedure was aborted. In conclusion, we have found that the diagnosis of spina bifida occulta, or any other condition in which the epidural space is anatomically disrupted, is a relative contraindication for this procedure. Preoperative roentograms of the lumbar spine may be helpful in avoiding technical difficulties due to this diagnosis.
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Systems that use electrical stimulation to activate paralyzed muscles, called "neuroprostheses", have restored important functional capabilities to many people with neurologic disorders such as spinal cord injury or stroke. However, the clinical benefits derived from neuroprostheses have been limited by the quality of control of posture and movement that has been achieved. ⋯ Three important challenges in FNS control systems research and development are identified: 1) to obtain an improved understanding of the biomechanical system that we are trying to control and how it is controlled by the intact neural system, 2) to develop new control system technology with a particular focus on strategies that mimic those used by biologic systems, and 3) to integrate the knowledge and technologies into useful systems that meet the needs of neuroprosthesis users. The outlook for the future includes many interesting problems; yet more importantly, it includes relevant clinical benefits to be gained through the application of biomechanical models and advanced control systems techniques in neuroprostheses.