Surg Neurol
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A systematic, strict appraisal was made of 100 patients, after preliminary clinical trials suggested that some patients with pain could be helped by peripheral nerve stimulation. Transcutaneous stimulation of different nerve trunks was done with a special electrical stimulation device with various selected electrical parameters. More than half of the patients experienced some relief; in many, this effect was obtained by stimulating nerves distant from the area of referred pain. ⋯ A few patients had response decay, gain or worsening. Results differ to some degree from previous reports. The results seem encouraging for the treatment of certain forms of intractable pain.
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Serious questions are raised as to whether electrical control of pain is related to stimulation of the dorsal columns per se or the conduction of the electrical impulse via the cerebrospinal fluid to the ventrolateral columns. Percutaneous on-surface spinal cord stimulation is advocated as an accurate screening method before implantation. Of 27 patients who underwent dorsal column stimulator implants, the last three patients also underwent ventral column stimulator implants. Results in the patients with both implants tend to predict much better results with the possibility that ventral column stimulation alone is sufficient.
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A percutaneous technique is described for implanting a dorsal or ventral column stimulator for pain control with minimal surgical trauma. If the patient does not respond to percutaneous on-surface spinal stimulation, a percutaneous cordotomy can be carried out, as the needle is already in the correct position. Stimulation of the cord at the C1-2 level can be used for treatment of trigeminal neuralgia.
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A series of 120 patients with pain syndromes of varying sources were subjected to peripheral nerve electrical stimulation. Transcutaneous, percutaneous and depth electrode stimulation methods were employed. ⋯ The remaining 62 patients obtained no relief. Pain sources are correlated with treatment results.