Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1995
Significance of the spinal cord position in spinal cord stimulation.
The effects of the antero-posterior and medio-lateral positions of the spinal cord in the dural sac on the perception threshold and paresthesia coverage in spinal cord stimulation were analyzed. The distributions of the dorsal cerebrospinal fluid (CSF) layer thickness, measured from transverse MR scans of normal subjects at various spinal levels, were used to calculate the distributions of threshold voltages for the stimulation of spinal nerve fibers by a computer model. ⋯ The effects of an asymmetrical electrode position with respect to the spinal cord midline were also analyzed by computer modeling. It is concluded that a lateral asymmetry of less than 1 mm gives a significant reduction of perception threshold and may result in unilateral paresthesiae.
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Acta Neurochir. Suppl. · Jan 1995
Comparative StudySpinal cord stimulation versus spinal infusion for low back and leg pain.
The relative roles of spinal cord stimulation and the spinal infusion of opioids in the treatment of chronic, non-cancer lower body pain remains unclear. This report contains a retrospective analysis of patients with chronic lower body, neuropathic pain and treated over a 5 year period. Unilateral leg and/or buttock pain was treated initially with spinal stimulation and bilateral leg or mainly low back pain was treated initially with spinal infusions. 26 patients received spinal stimulation. ⋯ The review indicates that spinal infusions may be best for bilateral or axial pain that has not responded to spinal stimulation. Clonidine appears to be an alternative in high-dose morphine patients. New diamond-shaped electrode and dual quadripolar arrays appear to be very helpful for back, buttock, and/or bilateral leg pain patterns.
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Acta Neurochir. Suppl. · Jan 1995
Long-term clinical, electrophysiological and urodynamic effects of chronic intrathecal baclofen infusion for treatment of spinal spasticity.
Seventeen patients with severe disabling spinal spasticity were selected and treated by chronic intrathecal baclofen infusion using an implanted programmable pump. Nine patients were tetraparetic, seven were paraplegic and one paraparetic. Patients were regularly followed for 5 to 69 months (mean 37.5 months). ⋯ Twelve patients with neurogenic bladder dysfunction were also evaluated by a clinically oriented questionnaire and by quantitative urodynamic recordings, before and after pump implantation. In patients with normal micturition, this was not changed by intrathecal baclofen. In patients with spastic bladder, intrathecal baclofen produced a decrease of detrusor hypertonia and hyperactivity in 50% of cases, with reduction of leakage and increase in functional bladder capacity.
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Acta Neurochir. Suppl. · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialSpinal cord stimulation versus reoperation for failed back surgery syndrome: a prospective, randomized study design.
Retrospectively reported results of spinal cord stimulation compare favorably with those of neurosurgical treatment alternatives for the treatment of failed back surgery syndrome, including reoperation and ablative procedures. There has been no direct prospective comparison, however, between SCS and other techniques for pain management. Therefore, we have designed a prospective, randomized comparison of spinal cord stimulation and reoperation in patients with persistent radicular pain, with and without low back pain, after lumbosacral spine surgery. ⋯ The primary outcome measure is the frequency of crossover to the alternative procedure, if the results of the first have been unsatisfactory after 6 months. Results for the first 27 patients reaching the 6-month crossover point show a statistically significant (p = 0.018) advantage for spinal cord stimulation over reoperation. Many other potentially important outcome measures will now be followed long-term as a larger overall study population accumulates.
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Acta Neurochir. Suppl. · Jan 1995
Cortical stimulation for central neuropathic pain: 3-D surface MRI for easy determination of the motor cortex.
Motor cortex electric stimulation has been reported to be effective for the treatment of central post-stroke pain and trigeminal neuropathic pain. Five patients with pain due to injury of the trigeminal nerve and with abnormalities of facial sensibility, as well as two patients suffering of a post-stroke thalamic pain, were subjected to stimulation applied epidurally on the motor cortex. Quadripolar electrodes were implanted under local anaesthesia and the precise location of the motor cortex was determined on three-dimensional surface MRI the day prior to surgery. In our experience, correct topographic localization of the electrode on the motor cortex seems to be crucial to obtain pain reduction.