Spinal Cord Stimulation In Patients Research Articles

Improvement of microcirculatory blood flow under epidural spinal cord stimulation in patients with nonreconstructible peripheral arterial occlusive disease.

Epidural spinal cord stimulation (ESCS) has been suggested as a method to improve microcirculatory blood flow and to reduce the amputation rate in vascular patients. We studied the effects of ESCS on microcirculatory blood flow in 237 patients with nonreconstructible peripheral arterial occlusive disease. Clinical status was classified as Fontaine Stage 3 (ischemic rest pain) in 169 patients and as Fontaine Stage 4 (ulcers/gangrene) in 68 patients. After a mean follow-up period of 31.2 months, major pain relief (> 75%) was noticed in patients who retained their limbs. Sixty-four patients underwent major amputation despite ESCS. Clinical improvement was confirmed by the increase in transcutaneous oxygen (TcPO2).

Point of View: Prospective Outcome Evaluation of Spinal Cord Stimulation in Patients With Intractable Leg Pain

Point of View: Prospective Outcome Evaluation of Spinal Cord Stimulation in Patients With Intractable Leg Pain

Spinal Cord Stimulation for Chronic Low Back Pain

A systematic literature synthesis was performed to analyze the long-term risks and benefits of spinal cord stimulation for patients with failed back surgery syndrome. Relevant articles were identified through a MEDLINE search (January 1966-June 1994), bibliography reviews, searches of personal files, and literature supplied by a stimulator manufacturer. Two investigators independently reviewed each article to determine whether it met the following study inclusion criteria: 1) original data on return to work, pain, medication use, reoperations, functional disability, or stimulator use after permanent implantation of spinal cord stimulators in patients with chronic low back or leg pain despite previous back surgery; and 2) follow-up > or = 30 days for all patients. Articles were excluded if data from patients with other diagnoses were mixed with (and could not be separated from) data from patients with chronic low back or leg pain, or if their data were redundant with those reported in an included article. Articles written in languages other than English or French were excluded. Thirty-nine studies, all case studies, were analyzed. At follow-up (mean, 16 mo; range, 1-45 mo), an average of 59% of patients had > or = 50% pain relief (range, 15-100% of patients). Complications occurred in 42% of patients but were generally minor. It seems that approximately 50 to 60% of patients with failed back surgery syndrome report > 50% pain relief with the use of spinal cord stimulation at follow-up; the lack of randomized trials precludes conclusions concerning the effectiveness of spinal cord stimulation relative to other treatments, placebo, or no treatment.

Spinal cord stimulation in patients with non-reconstructible peripheral arterial occlusive disease: A twelve-year experience

Spinal cord stimulation in patients with non-reconstructible peripheral arterial occlusive disease: A twelve-year experience

Cervical and scalp recorded short latency somatosensory evoked potentials in response to epidural spinal cord stimulation in patients with peripheral vascular disease

Somatosensory evoked potential (SEP) studies were performed in 14 patients with peripheral vascular disease who received epidural spinal cord stimulation (SCS) for chronic pain relief of the lower limbs. Signals were amplified and filtered between 20–2000 Hz and 200–2000 Hz to better identify activities in the high frequency range. In 7 patients bit-colour maps were also computed. In all the patients a homogeneous short-latency scalp evoked potential with a prevalent diphasic shape (P1-N1) was recorded. In all our scalp records, even with the wide bandpass, small short-latency positive deflections were observed on the descending front of the first major positive wave and they were better defined as a series of up to 6 wavelets, preceding the major negative scalp wave in the tracings filtered through the narrow bandpass. They appeared in an interval ranging from 5.5 to 15.6 msec. Bit-colour maps showed consistent positive fields, with a maximum at the vertex, starting mainly at about 5.5 msec; in 3 patients, a prominent positivity between 8.5 and 10.5 msec was recorded followed by smaller components preceding the major positive-negative (Pl-Nl) complex. More synchronous volleys during direct SCS produced clear short-latency SEPs. Although they were of larger amplitude, we regarded them as corresponding to those described by previous authors obtained by stimulation of nerves of the lower limbs, and probably arising from subcortical structures.

A mechanism of cardiac pain suppression by spinal cord stimulation: implications for patients with angina pectoris.

Clinical reports show that electrical stimulation of the spinal cord reduces symptoms of angina pectoris, but so far have not provided evidence on the mechanisms involved. The hypothesis for this study was that inhibition of spinothalamic tract transmission may account for this result. Extracellular potentials of 28 spinothalamic tract neurons were recorded in anaesthetized monkeys, and the effects of dorsal column stimulation were determined on activity evoked by cardiac and somatic stimuli. Dorsal column stimulation reduced the number of cell potentials evoked by electrical stimulation of cardiopulmonary sympathetic afferent fibres in 11 spinothalamic tract cells tested. Activity evoked by intracardiac injection of bradykinin was decreased by dorsal column stimulation in six of seven neurons that responded to chemical stimulation of afferents. Differential effects of dorsal column stimulation were correlated to the cell responses to somatic field stimulation. Dorsal column stimulation inhibited activity in 12 of 12 neurons which were excited only by noxious pinch of somatic fields, whereas eight of 16 neurons which were excited by innocuous brushing of somatic fields were unaffected or excited. Transection of the dorsal column showed that the pathway transmitting inhibitory impulses descended from the stimulation site to the spinothalamic tract neurons examined. Results of this study are consistent with the concept that spinal cord stimulation reduces pain by decreasing the firing of spinothalamic tract cells which are activated by small fibre afferents. The paresthesias associated with nerve stimulation techniques may result from activation of spinothalamic tract cells which are excited by large fibre afferents. The clinical decision to employ spinal cord stimulation in patients with angina should balance the obvious benefit of pain relief against the risk of depriving the patient of an important warning signal while active myocardial ischaemia is in progress.

Predictive Value of Transcutaneous Oxygen Tension Measurement in the Indication for Spinal Cord Stimulation in Patients with Peripheral Vascular Disease: Preliminary Results

Thirteen patients (12 males, 1 fe male, mean age 60.5 years) affected by peripheral vascular disease (21 lower limbs: 9 with intermittent clau dication and 12 with rest pain and/or necrosis smaller than 3 cm2) have been studied by means of transcuta neous oxygen tension (TcpO2) mea surements. They had been submitted to spinal cord stimulation (SCS) de vice implant from one day to twenty- two months previously. In 8 patients (15 limbs) implanted from one day to twenty-two months, the TcpO2 index was calculated to evaluate the neuro- stimulator effect on peripheral blood circulation. In 5 patients (6 limbs) studied before definitive implanta tion, preoperative and postoperative TcpO2 measurements were able to predict the SCS efficacy during the temporary trial period: when TcpO2 did not increase immediately (4 limbs), no result was achieved (am putation) ; a TcpO2 increase corre sponded to relief of symptoms (2 limbs). On the basis of this preliminary report, TcpO2 measurement could be useful for predicting SCS efficacy in vascular patients; the possibility of dividing the patients into responders and nonresponders to SCS by TcpO2 measurement represents an impor tant achievement in determining the indication for SCS implant.

Spinal cord stimulation in patients with a battered root syndrome.

Sixteen patients suffering from pain due to a "battered" root syndrome (BRS) [1] were treated with spinal cord stimulation (SCS). All patients had undergone spinal surgery and complained of severe intractable radicular pain. The myelograms revealed an amputated root, the computerized tomograms showed periradicular scar tissues, electromyograms and/or sensory evoked potentials showed pathological changes. Electrical root stimulation via an indwelling, Teflon-coated needle reduced pain significantly within 30 min (80-100 Hz, 0.2-0.3 V). Root blocks with 1 ml bupivacaine (0.5%) abolished the patient's pain completely. No patient revealed major psychosomatic or psychosocial problems. Employing this patient selection schedule, 75% of the patients were pain-free after a mean follow-up period of 16 months range 6-30.

Spinal cord stimulation in patients with a battered root syndrome

Spinal cord stimulation in patients with a battered root syndrome

Neurophysiological evaluation of chronic spinal cord stimulation in patients with upper motor neuron disorders.

Spinal cord stimulation was found to be an effective method for improving motor performance in patients with upper motor neuron disorders. Electromyographic analysis of segmental and suprasegmental activity was performed in 11 patients who had used spinal cord stimulation for more than 12 months. Neurophysiological analysis of electromyographic findings revealed improvement of volitional motor control and a reduction of spasticity in the examined muscles of the lower limbs in all patients.