Progress in neurological surgery
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Subcutaneous occipital nerve region stimulation is becoming an important part of the overall treatment regimen for a number of chronic headache syndromes refractory to nonsurgical, medical management. A combination of improved device technology and methodology, further understanding about appropriate indications and achievement of on-label FDA status should support continued use and success of this neuromodulation modality.
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Recently, there has been a tremendous evolution in the field of neurostimulation, both from the technological point of view and from development of the new and different indications. In some areas, such as peripheral nerve stimulation, there has been a boom in recent years due to the variations in the surgical technique and the improved results documented by in multiple published papers. ⋯ The confusion arises when attempting to describe peripheral nerve stimulation and subcutaneous stimulation. Peripheral nerve stimulation, in its pure definition, involves implanting a lead on a nerve, with the aim to produce paresthesia along the entire trajectory of the stimulated nerve.
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Although commonly used in clinical practice, peripheral nerve stimulation (PNS) for treatment of chronic pain is performed mainly with devices developed and marketed for spinal cord stimulation applications. This may be one of the reasons why PNS approach is marked by a very high complication rate, as the anatomy of peripheral nerves and the surrounding soft tissues is quite different from epidural spinal space for which the current devices are designed. ⋯ Based on the literature data and the analysis of the author's experience with PNS procedures it appears that although the rate of complications is relatively high, the morbidity associated with PNS approach is very minor and most problems may be resolved with simple re-operations, usually on outpatient basis. The reduction in complication rate is expected to occur when the hardware used in PNS procedures is appropriately adapted for PNS applications.
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Peripheral nerve stimulation (PNS) is an established neuromodulation approach that has been successfully used for the treatment of various painful conditions since the early 1960s. This review provides a comprehensive summary of relevant publications on PNS dividing its history into three distinct periods. The milestones of the field are related to the development of procedures, equipment and indications. As the most rapidly growing segment of operative neuromodulation, PNS continues to evolve as current and emerging clinical indications become matched by basic and clinical research, technological developments and procedural refinements.
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Treatment of chronic back and leg pain in patients with failed back surgery syndrome (FBSS) remains problematic as none of the currently available approaches are universally successful in achieving lasting pain control. Spinal cord stimulation (SCS) is very effective for controlling radicular pain but rarely provides adequate control of pain in the lower back. ⋯ Because PNS does not control neuropathic pain due to lumbosacral radiculopathy involving the lower extremities, we developed a hybrid technique of SCS and PNS that offers potential control of both axial pain in the lumbar area and radicular pain to the lower extremities. This chapter presents our results and the possible mechanisms of action.