Spinal Cord Stimulation Research Articles

Biofilm-mediated antibiotic tolerance in Staphylococcus aureus from spinal cord stimulation device-related infections.

Staphylococcus aureus is a predominant cause of infections in individuals with spinal cord stimulation (SCS) devices. Biofilm formation complicates these infections, commonly requiring both surgical and antibiotic treatments. This study explored the biofilm matrix composition and antimicrobial susceptibility of planktonic and biofilm-growing S. aureus isolates from individuals with SCS-related infections. Whole-genome sequencing (WGS) examined genotypes, virulome, resistome, and the pan-genome structure. The study also analyzed biofilm matrix composition, early surface adhesion, hemolytic activity, and antibiotic-susceptibility testing. WGS revealed genetic diversity among isolates. One isolate, though oxacillin susceptible, contained the mecA gene. The median number of virulence factor genes per isolate was 58. All isolates harbored the biofilm-related icaA/D genes. When assessing phenotypic characteristics, all strains demonstrated the ability to form biofilms in vitro. The antimicrobial susceptibility profile indicated that oxacillin, rifampin, and teicoplanin showed the highest efficacy against S. aureus biofilm. Conversely, high biofilm tolerance was observed for vancomycin, trimethoprim/sulfamethoxazole, and levofloxacin. These findings suggest that S. aureus isolates are highly virulent and produce robust biofilms. In cases of suspected biofilm infections caused by S. aureus, vancomycin should not be the primary choice due to its low activity against biofilm. Instead, oxacillin, rifampin, and teicoplanin appear to be more effective options to manage SCS infections.IMPORTANCESCS devices are increasingly used to manage chronic pain, but infections associated with these devices, particularly those caused by Staphylococcus aureus, present significant clinical challenges. These infections are often complicated by biofilm formation, which protects bacteria from immune responses and antibiotic treatments, making them difficult to eradicate. Understanding the genetic diversity, virulence, and biofilm characteristics of S. aureus isolates from SCS infections is critical to improving treatment strategies. Our study highlights the need to reconsider commonly used antibiotics like vancomycin, which shows reduced activity against biofilm-growing cells. Identifying more effective alternatives, such as oxacillin, rifampin, and teicoplanin, provides valuable insight for clinicians when managing biofilm-related S. aureus infections in patients with SCS implants. This research contributes to the growing evidence that biofilm formation is crucial in treating device-related infections, emphasizing the importance of tailoring antimicrobial strategies to the biofilm phenotype.

The Utilization of Blockchain for Data Security for the Chronic Pain Physician.

The COVID-19 pandemic accelerated the surge in medical data utilization, notably impacting chronic pain management given its enormous economist cost. While the collection and use of data enhances research and care quality, data exchange risks compromising integrity and privacy, exemplified by the Change Healthcare cyberattack. Here, we review the potential of blockchain for the utilization for cybersecurity in the healthcare system with an emphasis on the field of chronic pain. Blockchain technology emerges as a potential solution, offering decentralized, secure, and immutable data management. Blockchain ensures transparency, integrity, and data privacy, which is crucial in healthcare. Smart contracts may offer automated, secure management of implantable neuromodulation devices such as spinal cord stimulators and intrathecal pumps. Blockchain's potential in pharmaceutical supply chain integrity is exemplified in preliminary efforts ensuring that the medication retrieved by the patient is indeed the intended medication. Despite limitations such as speed of transactions, blockchain presents innovative avenues for healthcare security and quality improvement, necessitating further development for widespread implementation. Blockchain's applicability is not only applicable to chronic pain management, but can be used in medicine as a whole.

Social media users’ perspectives of spinal cord stimulation: an analysis of data sourced from social media

ObjectivesTo identify Reddit users’ viewpoints and inquiries about spinal cord stimulation (SCS) for chronic back pain using Reddit databases.MethodsWe performed a qualitative analysis of public, anonymous threads and comments from...

Sensory-substitution based sound perception using a spinal computer–brain interface

Sensory substitution offers a promising approach to restore lost sensory functions. Here we show that spinal cord stimulation (SCS), typically used for chronic pain management, can potentially serve as a novel auditory sensory substitution device. We recruited 13 patients undergoing SCS implantation and translated everyday sound samples into personalized SCS patterns during their trial phase. In a sound identification task—where chance-level performance was 33.3%—participants (n=8\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$n=8$$\\end{document}) achieved a mean accuracy of 72.8% using only SCS input. We observed a weak positive correlation between stimulation bitrate and identification accuracy. A follow-up discrimination task (n=5\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$n=5$$\\end{document}) confirmed that reduced bitrates significantly impaired participants’ ability to distinguish between consecutive SCS patterns, indicating effective processing of additional information at higher bitrates. These findings demonstrate the feasibility of using existing SCS technology to create a novel neural interface for a sound prosthesis. Our results pave the way for future research to enhance stimulation fidelity, assess long-term training effects, and explore integration with other auditory aids for comprehensive hearing rehabilitation.

Preventing technique-related complications in spinal cord stimulation trials: The Dural Substitute Confetti technique. A retrospective monocentric analysis.

Spinal Cord Stimulation (SCS) is an established therapy for chronic pain, employing screening trials to identify suitable candidates before implantation. However, complications arising from both technique and medical factors present challenges to this practice. This study introduces the Dural Substitute Confetti technique, which addresses technique-related complications during SCS implantation by preventing scar-induced lead migration or breakage and reducing operating times. We conducted a retrospective analysis on 174 patients treated with SCS trials from 2017 to 2022 at our institution. Of these, 85.1% proceeded to permanent implantation. During trial surgery, synthetic dural substitutes (DS) were used to protect leads, which remained connected to an external pulse generator (EPG) for 20-28 days (mean 21.4 days). Utilizing the DS Confetti technique, leads were easily dissected from the DS during the second surgery and connected to an internal pulse generator (IPG). We compared complications and surgical times before and after the introduction of this technique in 2017. Following the complete SCS trial, patients experienced over 50% pain relief, with an implant-to-trial ratio of 85.1% and a mean follow-up of 52 months. No technique-related complications occurred during the trial period post-2017, while the pre-2017 group had a 3.9% lead migration rate due to scarring, necessitating re-implantation. The average surgery duration decreased from 54 min pre-2017 to 32 min post-2017. Medical-related complications included infections (2.1%) and wound dehiscence (1.3%). The DS Confetti technique prevents scar adhesion formation during screening trials, thereby facilitating and expediting the definitive SCS implantation. Additionally, it may also reduce the risk of lead migration and iatrogenic damage, potentially lowering technique-related complications.

Non-responders to high frequency spinal cord stimulation.

Non-responders to high frequency spinal cord stimulation.

A central and peripheral dual neuromodulation strategy in pain management of zoster-associated pain.

Spinal cord stimulation (SCS) has shown effectiveness in relieving zoster-associated pain (ZAP), but some patients still experience moderate or severe pain after SCS treatment. This study aims to evaluate the impact of SCS combined with dorsal root ganglion (DRG) pulsed radiofrequency (PRF) as a dual neuromodulation strategy on the prognosis of ZAP. The clinical records of patients diagnosed with ZAP who underwent SCS (SCS group) or SCS combined with PRF (SCS + PRF group) at The Third Xiangya Hospital, Central South University, were retrospectively analyzed to compare the effectiveness of the two treatment approaches for ZAP. Outcome measures included changes in Visual Analog Scale (VAS) scores before and after neuromodulation treatment, response rates, and incidence of progression to postherpetic neuralgia (PHN).13 SCS patients and 15 SCS + PRF patients were analyzed. Admission VAS scores were similar (P = 0.934). Upon discharge, no significant differences in VAS or response rates were observed (P > 0.05). However, at 6-month follow-up, the SCS + PRF group had lower VAS scores (1.53 ± 1.06 vs. 3.23 ± 1.50, P < 0.001) and a lower proportion of residual moderate pain (P = 0.041). None in the SCS + PRF group progressed to PHN in the acute/subacute phases, differing significantly from the SCS group (P = 0.038).Therefore, SCS combined with DRG PRF is feasible and effective in the treatment of ZAP. This dual neuromodulation strategy may be a more appropriate regimen for the treatment of ZAP.

Unaltered Responses of Distal Motor Neurons to Non-Targeted Thoracic Spinal Cord Stimulation in Chronic Pain Patients.

Spinal cord stimulation (SCS) represents an established interventional pain therapeutic; however, the SCS effects of SCS waveforms on motor neuron recruitment of the lower limbs of chronic pain patients remain largely unknown. We investigated these effects by performing isometric ankle-dorsal flexions at varying force levels under four SCS conditions: SCS Off (1week), burst SCS (40Hz), SCS Off (acute), and tonic SCS (130Hz). Muscle activity was recorded via high-density surface electromyography (64-electrode grid) on the tibialis anterior muscle. Motor unit action (MUs) potentials were analyzed for recruitment and de-recruitment thresholds, discharge rate, inter-spike interval, and common synaptic input. In this prospective study, we included nine patients (five females; four males; mean age 59years) with chronic pain treated with thoracic (Th7-Th8) epidural spinal stimulation. A total of 97 MUs were found for 15% maximal voluntary torque (MVT) and 83 for 30%MVT, an average of 10.8±3.7 for 15%MVT and 10.4±3.5 for 30%MVT. While a few subject-specific variations were observed, our study suggests that the different SCS frequencies applied do not significantly influence motor unit discharge characteristics in the TA muscle among the participants (p values at 15%MVT were 0.586 (Chi2=1.933), 0.737 (Chi2=1.267), 0.706 (Chi2=1.4) and 0.586 (Chi2=1.933), respectively. The p values of the Friedman test at 30%MVT were 0.896 (Chi2=0.6), 0.583 (Chi2=1.95), 0.896 (Chi2=0.6) and 0.256 (Chi2=4.05). No significant difference was found for the different stimulation types for the delta (0-5Hz), alpha (5-12Hz), and beta (15-30Hz) bands at both force levels. In summary, we did not observe any changes in motor unit oscillatory activity at any low and high bandwidths, indicating that SCS using different waveforms (tonic/burst) does not significantly influence motor neuron recruitment for non-motor individuals with chronic pain.

Post Dural Puncture Headache After Spinal Cord Stimulator Lead Insertion Successfully Treated with Occipital Nerve Blocks

Post Dural Puncture Headache After Spinal Cord Stimulator Lead Insertion Successfully Treated with Occipital Nerve Blocks

Spinal Cord Stimulation with implantation of Surgical Leads is a sufficient salvage therapy for patients suffering from persistent spinal pain syndrome – a retrospective single-center experience

ObjectivePersistent spinal pain syndrome (PSPS) poses a significant medical challenge, often leading to diminished quality of life for affected individuals. In response to this clinical dilemma, Spinal Cord Stimulation (SCS) has emerged as a promising intervention aimed at improving the functional outcomes and overall well-being of patients suffering from these debilitating syndrome. In case a therapy with percutaneous lead fails, e.g. due to a dislocation, surgical lead can be used as a stable alternative. This is resulting in a more invasive procedure and does not allow for intraoperative monitoring. The aim of the study is to investigate the efficacy and safety of the use of surgical leads, as there have been only a few case series published so far. MethodsWe included PSPS patients that gave consent to a SCS therapy and were treated with Surgical Leads. Outcome scores concerning the quality of life (SF-36), pain related disability (Oswestry disability index [ODI]), sleeping quality (Pittsburgh Sleep Quality Index [PSQI]), and pain intensity (NRS) were obtained prior surgery and at outpatient visits after permanent implantation. ResultsIn this study, 36 patients were implanted with a Surgical Lead SCS system. One patient developed a new neurological deficit characterized by left-sided leg paresis attributable to postoperative hemorrhage, and another patient experienced a wound infection. These complications contributed to an overall morbidity rate of 5.6%. In overall 5 patients (20.8%) the electrodes were explanted within the first month. Follow-up data of 24 subjects with a median time of 21 [15-47] months were available. The mean pain intensity at rest and in motion was reduced. Further pain depending disability improved from a median ODIpreop=38 [30-57]% to ODIfollow-up =21 [9-35]% (p<0.01). Additionally the Sleeping Quality and the Quality of Life improved concerning the physical (Median PCS preop=22.5 [20.4-30.4] vs. PCSfollow-up = 41.8 [35.2-47.0], p < 0.01).) and mental (Median MCSpreop=45.4 [31.1-55.5] vs. MCSfollow-up=58.1 [47.6-59.8], p=0.018). component. ConclusionSCS with surgical leads is a safe secondary technique to treat PSPS, where treatment with percutaneous leads fail. The results show a promising long-term effect concerning pain intensity and functional outcome.

Quantification of porcine lower thoracic spinal cord morphology with intact dura mater using high-resolution μCT.

Spinal cord stimulation (SCS) is approved by the Food and Drug Administration for treating chronic intractable pain in the back, trunk, or limbs through stimulation of the dorsal column. Numerous studies have used swine as an analog of the human spinal cord to better understand SCS and further improve its efficacy. We performed high-resolution imaging of the porcine spinal cord with intact dura mater using micro-computed tomography (μCT) to construct detailed 3-dimensional (3D) visualizations of the spinal cord and characterize the morphology of the dorsal and ventral rootlets. We obtained spinal cords from Yorkshire/Landrace crossbred swine (N=7), stained samples with osmium tetroxide, and performed μCT imaging of the T12-T15 levels at isotropic voxel resolutions ranging from 3.3 to 50μm. We measured the anatomical morphology using the 3D volumes and compared our results to measurements previously collected from swine and human spinal cords via microdissection techniques in prior literature. While the porcine thoracic-lumbar spinal cord is a popular model for SCS, we highlight multiple notable differences compared to previously published T8-T12 human measurements including rootlet counts (porcine dorsal/ventral: 12.2±2.6, 26.6±3.4; human dorsal/ventral: 5.3±1.3, 4.4±2.4), rootlet angles (porcine ventral-rostral: 161±1°, ventral-caudal: 155±6°, dorsal-rostral: 148±9°, dorsal-caudal: 142±6°; human ventral-rostral: 170±3°, ventral-caudal: 22±10°, dorsal-rostral: 171±3°, dorsal-caudal: 15±7°), and the presence and count of dorsal rootlet bundles. Detailed measurements and highlighted differences between human and porcine spinal cords can inform variations in modeling and electrophysiological experiments between the two species. In contrast to other approaches for measuring the spinal cord and rootlet morphology, our method keeps the dura intact, reducing potential artifacts from dissection.

Comparative Efficacy of Spinal Cord Stimulation in the Management of Acute Pain and Chronic Pain Related to Failed Back Surgery Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Comparative Efficacy of Spinal Cord Stimulation in the Management of Acute Pain and Chronic Pain Related to Failed Back Surgery Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

A Case Report of Successful Off-Label Neuromodulation for Concurrent Refractory Sacroiliac Pain and Phantom Limb in a Hip Disarticulation Patient

Hip disarticulation is a morbid procedure for those whose bony or soft tissues are unable to be salvaged. It involves extensive resection, and the patient featured in this report expressed mechanical pain from their sacroiliac joint (SIJ) as well as phantom limb pain (PLP). Spinal cord stimulation is known to assist with neuropathic pain syndromes, and SIJ fusion is effective in these cases of multifactorial pain. This report presents a successful off-label use of thoracic spinal cord stimulation in a complex pain condition consisting of coexisting PLP and mechanical SIJ pain in a hip disarticulation patient.

Hidden influence? Unmasking conflicts of interest from randomized clinical trials on spinal cord stimulation for chronic pain

BackgroundRandomized clinical trials (RCTs) are considered the gold standard for evaluating the efficacy of healthcare interventions. However, conflicts of interest (COIs) can compromise the scientific integrity in these trials. This...

High-Frequency 10-kHz Spinal Cord Stimulation Provides Long-term (24-Month) Improvements in Diabetes-Related Pain and Quality of Life for Patients with Painful Diabetic Neuropathy.

The SENZA-PDN study evaluated high-frequency 10-kHz spinal cord stimulation (SCS) for the treatment of painful diabetic neuropathy (PDN). Over 24 months, 10-kHz SCS provided sustained pain relief and improved health-related quality of life. This report presents additional outcomes from the SENZA-PDN study, focusing on diabetes-related pain and quality of life outcomes. The SENZA-PDN study randomized 216 participants with refractory PDN to receive either conventional medical management (CMM) or 10-kHz SCS plus CMM (10-kHz SCS + CMM), allowing crossover after six months if pain relief was insufficient. Postimplantation assessments at 24 months were completed by 142 participants with a permanent 10-kHz SCS implant, comprising 84 initial and 58 crossover recipients. Measures included the Brief Pain Inventory for Diabetic Peripheral Neuropathy (BPI-DPN), Diabetes-Related Quality of Life (DQOL), Global Assessment of Functioning (GAF), and treatment satisfaction. Over 24 months, 10-kHz SCS treatment significantly reduced pain severity by 66.9% (P < .001; BPI-DPN) and pain interference with mood and daily activities by 65.8% (P < .001; BPI-DPN). Significant improvements were also observed in overall DQOL score (P < .001) and GAF score (P < .001), and 91.5% of participants reported satisfaction with treatment. High-frequency 10-kHz SCS significantly decreased pain severity and provided additional clinically meaningful improvements in DQOL and overall functioning for patients with PDN. The robust and sustained benefits over 24 months, coupled with high participant satisfaction, highlight that 10-kHz SCS is an efficacious and comprehensive therapy for patients with PDN.

Sustained relief with spinal cord stimulator despite anterior lead migration: a case report.

Lead migration is a common complication of spinal cord stimulation, although anterior migration is rare. While early studies suggested that anterior stimulation may produce analgesic effects, it is thought to be poorly tolerated due to abnormal paresthesia and muscle contractions due to its proximity to the corticospinal tract. This case report presents a unique case of sustained pain relief despite anterior lead migration, which suggests that anterior column stimulation may hold clinical significance for pain management. Further studies are needed to explore its analgesic mechanisms and potential therapeutic application. Strategies to prevent lead migration, particularly in the early postoperative period, are also crucial for optimizing outcomes.

Role of Spinal Cord Stimulation (SCS) in the Management of Failed Back Surgery Syndrome (FBSS) - a Comprehensive Literature Review

Role of Spinal Cord Stimulation (SCS) in the Management of Failed Back Surgery Syndrome (FBSS) - a Comprehensive Literature Review

ID: 334170 Case Report: Spinal cord stimulation in the treatment of central pain syndrome ()

ID: 334170 Case Report: Spinal cord stimulation in the treatment of central pain syndrome ()

Advances in Neuromodulation: Spinal Cord Stimulation

Advances in Neuromodulation: Spinal Cord Stimulation

ID: 323626 Outcomes in Spinal Cord Stimulation: Complications, Failures, and Response Rate to Reprogramming

ID: 323626 Outcomes in Spinal Cord Stimulation: Complications, Failures, and Response Rate to Reprogramming