Surg Neurol
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Results of a series of dorsal column stimulation implants in 76 patients are tabulated and correlated to implant location, type of electrodes used and pain causes; complications are also discussed.
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Sixty-nine patients with chronically incapacitating pain were treated with an implantable stimulator over the posterior columns of the spinal cord. Evaluations at 24, 30 and 34 months showed a progressive decrease in the number of patients considered to have an excellent result. Evaluation of 60 patients with pain of benign origin after implantation of the stimulating device showed only ten patients who could be considered to have an excellent result on the basis of their own report of pain relief. The most common failure of the stimulating devices was failure of stimulation into a painful part.
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Comparative Study
A comparison between anterior and posterior spinal implant systems.
In four patients with intractable pain from metastatic cancer, application of current through electrodes placed on the anterior surface of the cord produced analgesia and pain relief below the level of implant without the development of paresthesias. Application of current through electrodes placed on the dorsal columns in these patients also relieved pain, but to a lesser degree and with the development of associated paresthesias. In one patient, application of current from anterior electrodes to posterior electrodes produced a zone of dissociated sensory loss. While it is simpler to implant electrodes over the dorsal columns, the anterior location may be superior when currents are to be applied for the pain relief in the lower lumbar and sacral dermatomes.
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Results are reviewed of dorsal column electrical stimulation for chronic pain in a series of 80 patients. In the light of the experience gained from this series, indications and patient suitability for this form of therapy are discussed. Complications occurring after implantation are tabulated.
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Dorsal column stimulators (DCS) have been implanted in 130 patients with various chronic pain syndromes at the University of California, San Francisco, between 1969 and 1973. Preoperative psychiatric evaluation and percutaneous dorsal column stimulation testing were of value in rejecting those patients most likely to have unsatisfactory long-term results with DCS. Best results occurred in patients with phantom limb or peripheral nerve pain and worst results in patients with paraplegic pain, documented arachnoiditis, pancreatitis and arthritis. The need is stressed for careful preoperative selection and for close, prolonged postoperative care in a situation permitting access to multidisciplinary facilities for patient care.