Neuromodulation : journal of the International Neuromodulation Society
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Objectives. Prospective studies using specific outcome measures for the treatment of complex regional pain syndromes (CRPS) using spinal cord stimulation are lacking in the literature. The current prospective study followed 19 patients with the objective of analyzing such patients using specific outcome measures including the McGill Pain Rating Index, the Sickness Impact Profile, Oswestry Disability, Beck Depression Inventory, and Visual Analog Scale Scores. ⋯ The Beck Depression Inventory trended toward significant improvement. Conclusions. Patients with CRPS benefit significantly from the use of spinal cord stimulation, based on average follow-up of 7.9 months.
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Introduction. Interventional modalities for pain treatment are reserved for patients failing multidisciplinary pain management, including psychological, physical, pharmacological, and anesthetic techniques. Objective. ⋯ Conclusion. SCS was safe for implantation in our case study of a pregnant woman. This may constitute a new indication for SCS in patients otherwise successfully managed with non-interventional modalities for pain control.
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Objective. Over the past two decades, with the increasing use of spinal instrumentation to treat deformity, surgical restoration has become more frequent. A complication of surgical reconstruction for adult scoliosis, the iatrogenic flat back syndrome, has been described. ⋯ Given the unpredictability of spinal osteotomy to address this pain, a possible alternative treatment strategy is presented. This involves the use of selective pharmaceutical therapy and spinal cord stimulation. Based on the response of this patient to spinal cord stimulation, it is a possible that a component of this persistent pain is neuropathic, despite the fact that preoperative imaging studies failed to disclose a significant compressive lesion.
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Objective. The conventional technique used to stimulate the lumbar dermatomes is by stimulation of the dorsal columns of the spinal cord. Until recently, stimulation of nerve roots had not been successfully accomplished. ⋯ Lumbar and sacral NRS trials resulted in adequate paresthesia coverage and effective pain relief in all 5 patients. Further clinical trials to evaluate long-term success rates and safety are indicated. Detailed mapping studies are needed to evaluate the relationship between electrode placement and paresthesia patterns as well as the optimal stimulation parameters.
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A multicenter study was initiated to evaluate the performance of the transverse tripolar system for spinal cord stimulation. Computer modeling had predicted steering of paresthesia with a dual channel stimulator to be the main benefit of the system. The quantitative analysis presented here includes the results of 484 tests in 30 patients. ⋯ The results show that with the transverse tripolar system steering of the paresthesia is possible, although optimal steering requires proper placement of the electrode with respect to the spinal cord. Therefore, with this steering ability as well as a larger therapeutic stimulation window as compared to conventional systems, we expect an increase of the long-term efficacy of spinal cord stimulation. Moreover, in view of the stimulation-induced paresthesia patterns, the system allows selective stimulation of the medial dorsal columns.