Analysing the blood-stemming effect of Ankaferd Blood Stopper in medulla spinalis surgery

Background/aim: The aim of this study was to investigate the possible toxicity of the Ankaferd Blood Stopper (ABS) on the neural system. Materials and methods: Thirty Sprague Dawley rats were randomized into ABS (n: 15) and control (n: 15) groups. Following the anaesthetic induction, total laminectomy was performed to the lower thoracic, and upper lumbar areas in both groups and medulla spinalis was exposed. Two myelotomies were performed on the medulla spinalis. One millilitre ABS was applied to the incision site in the ABS group, and one millilitre 0.9% saline solution was applied in the control group. Rats were observed for 15 days regarding general behaviour, neurological signs, mobility, and signs of infection. Sixteen days later, all rats were decapitated under anaesthesia. Medulla spinalis was removed en bloc from all rats and was stained with Heamatoxylin & Eosin and luxol fast blue. Results: There was no significant difference between the ABS group and the control group regarding oedema, gliosis, the intensity of inflammatory cells, the presence of neuronal degeneration, neuron counts, and myelin degeneration. Conclusion: No clinical or histopathological evidence for the neurotoxic effect of the ABS was observed in the present study. Our findings might precipitate the use of ABS on human subjects regarding medulla spinalis surgery.

In Vivo Testing of a Prototype Intradural Spinal Cord Stimulator in a Porcine Model.

BACKGROUND: Chronic midline low back pain is the number one reason for disability in the United States despite the prolific use of medical and surgical interventions. Notwithstanding the widespread use of epidural spinal cord stimulators (SCSs), there remains a large portion of the population with inadequate pain control thought to be because of the limited volume of stimulated neural tissue. Intradural SCSs represent an underexplored alternative strategy with the potential to improve selectivity, power efficiency, and efficacy. We studied and carried out development of an intradural form of an SCS. Herein we present the findings of in vivo testing of a prototype intradural SCS in a porcine model. METHODS: Six female juvenile pigs underwent surgical investigation. One control animal underwent a laminectomy only, whereas the 5 other animals had implantation of an intradural SCS prototype. One of the prototypes was fully wired to enable acute stimulation and concurrent electromyographic recordings. All animals underwent terminal surgery 3 months postimplantation, with harvesting of the spinal column. Imaging (microcomputed tomography scan) and histopathologic examinations were subsequently performed. RESULTS: All animals survived implantation without evidence of neurologic deficits or infection. Postmortem imaging and histopathologic examination of the spinal column revealed no evidence of spinal cord damage, cerebrospinal fluid fistula formation, abnormal bony overgrowth, or dural defect. Viable dura was present between the intra- and extradural plates of the device. Electromyographic recordings revealed evoked motor units from the stimulator. CONCLUSIONS: Chronically implanted intradural device in the porcine model demonstrated safety and feasibility for translation into humans.

Pseudomeningocele and percutaneous intrathecal lead placement complication for spinal cord stimulator.

The incidence of symptomatic percutaneous intrathecal subarachnoid lead placement for spinal cord stimulator is almost an unheard of complication in the literature. We present the first case of a spinal cord stimulator implant with a complication of symptomatic intrathecal subarachnoid lead placement with a pseudomeningocele. This complication was found with myelogram and addressed by replacement with a new spinal cord stimulator implant with paddle leads instead of percutaneous leads and obliterating the pseudomeningocele tract. Technique for epidural lead placement is discussed. This case illustrates a spinal cord stimulator implant complication of intrathecal percutaneous lead placement with pseudomeningocele and its recognition and treatment involving replacement of the system while minimizing risk of postoperative cerebrospinal fluid leakage. Intraoperative neuromonitoring and interrogation of the spinal cord stimulator system during implantation are effective tools for accurate epidural lead placement.

[Application of three artemisinin derivatives in neuropathic pain: evaluating co-curation of nociceptive and emotional syndromes in spinal cord ligation mice].

In this study, on aspects of the nociceptive, anxiety and depressive syndromes in neuropathic pain (NP), the effects of dihydroartemisinine (DHA), artesunate (ART) and artemether (ARTN) (40 mg·kg⁻¹) were analyzed in the spinal cord ligation (SNL) mice. Clinical equivalent dose of the first-line drug for NP, pregabalin (PGB, 25 mg·kg⁻¹) and amitriptyline (ARP, 20 mg·kg⁻¹), were used as positive controls. General, from day 7 to 14, significant remissions of the nociceptive, anxiety and depressive behaviors were achieved by DHA, ART and ARTN separately. Moreover, on day 14, on aspects of the nociceptive behaviors, analyzed 1.5 h after the gavage administration, no significant difference between the shamed mice and mice administrated with DHA, ART and ARTN was detected; analyzed 3 h after the gavage, significant decreases of pain thresholds in ARTN, but not in DHA nor ART group, were detected as compared with thresholds measured 1.5 h; analyzed 24 h after gavage, pain thresholds in DHA, ART and ARTN were still higher than PGB, in spite of the significant decreases as compared to Sham group. On aspects of the anxiety and depressive behaviors, no significant difference was detected between the shamed mice and mice administrated with DHA nor ART. However, differences still remained between the shamed ones and ones administrated with ARTN. Preliminarily, the effects of DHA, ART and ARTN were consolidated in SNL mice. On aspects of the duration of analgesic effects and the control of negative emotion, ART and ARTN were proven more favorable than ARTN.

Neuroprotective Potential of Gentongping in Rat Model of Cervical Spondylotic Radiculopathy Targeting PPAR-γ Pathway.

Cervical spondylotic radiculopathy (CSR) is the most general form of spinal degenerative disease and is characterized by pain and numbness of the neck and arm. Gentongping (GTP) granule, as a classical Chinese patent medicine, has been widely used in curing CSR, whereas the underlying mechanism remains unclear. Therefore, the aim of this study is to explore the pharmacological mechanisms of GTP on CSR. The rat model of CSR was induced by spinal cord injury (SCI). Our results showed that GTP could significantly alleviate spontaneous pain as well as ameliorate gait. The HE staining and Western blot results showed that GTP could increase the quantity of motoneuron and enhance the activation of peroxisome proliferator-activated receptor gamma (PPAR-γ) in the spinal cord tissues. Meanwhile, immunofluorescence staining analysis indicated that GTP could reduce the expression of TNF-α in the spinal cord tissues. Furthermore, the protein level of Bax was decreased whereas the protein levels of Bcl-2 and NF200 were increased after the GTP treatment. These findings demonstrated that GTP might modulate the PPAR-γ pathway by inhibiting the inflammatory response and apoptosis as well as by protecting the cytoskeletal integrity of the spinal cord, ultimately play a neuroprotective role in CSR.

Developing new methods of spinal cord injury treatment using magnetic nanoparticles in combination with electromagnetic field / Desenvolvimento de novos métodos de tratamento de lesões medulares que usam nanopartículas magnéticas em combinação com campos eletromagnéticos / Desarrollo de nuevos métodos de tratamiento de lesiones medulares que usan nanopartículas magnéticas en combinación con campos electromagnéticos

ABSTRACT Objective: To determine the amount of loss of function after spinal cord transection of varying extents, and whether magnetic iron oxide nanoparticles, in combination with an external magnetic field, improve the rate of subsequent functional recovery in rats. Methods: The animals were divided into groups with 50%, 80% and complete spinal cord transection. The animals of all three study groups were administered magnetic iron oxide nanoparticle suspension to the area of injury. The three control groups were not administered magnetic nanoparticles, but had corresponding transection levels. All animals were exposed to a magnetic field for 4 weeks. Loss of postoperative function and subsequent recovery were assessed using the BBB motor function scale and somatosensory evoked potential monitoring on the first day after surgery, and then weekly. Terminal histological analysis was also conducted in all the groups. Results: The animals in the control or complete transection groups did not demonstrate statistically significant improvement in either the BBB scores or evoked potential amplitude over the four-week period. In the group with 50% transection, however, a statistically significant increase in evoked potential amplitude and BBB scores was observed four weeks after surgery, with the highest increase during the second week of the study. In the group with 80% transection, only improvement in evoked potential amplitude was statistically significant, although less pronounced than in the 50% transection group. Conclusion: The use of magnetic iron oxide nanoparticles in combination with a magnetic field leads to higher rates of functional recovery after spinal cord injury in laboratory animals. The mechanism of this functional improvement needs further investigation.

RESUMO Objetivo: Determinar a quantidade de perda de função depois de transecção de medula espinal de várias extensões, e se as nanopartículas magnéticas de óxido de ferro combinadas a um campo magnético externo melhoram a taxa de recuperação funcional em ratos. Métodos: Os animais foram divididos em grupos com transecção de medula espinal de 50%, 80% e completa. Os animais dos três grupos do estudo receberam suspensão de nanopartículas magnéticas de óxido de ferro na região da lesão. Os três grupos controle não receberam as nanopartículas magnéticas, mas tinhas níveis de transecção correspondentes. Todos os animais foram expostos a um campo magnético durante 4 semanas. A perda de função pós-operatória e a recuperação subsequente foram avaliadas pela escala de BBB quanto à função motora e por monitoração do potencial somatossensorial evocado no primeiro dia depois da cirurgia e, a seguir, uma vez por semana. A análise histológica terminal também foi realizada em todos os grupos. Resultados: Os animais do grupo controle ou nos grupos transecção completa não demonstraram melhora estatisticamente significante tanto nos escores BBB quanto na amplitude do potencial evocado durante o período de quatro semanas. No grupo com transecção de 50%, porém, constatou-se um aumento estatisticamente significante da amplitude do potencial evocado e dos escores BBB quatro semanas depois da cirurgia, sendo o maior aumento durante a segunda semana do estudo. No grupo com transecção de 80%, só a melhora da amplitude do potencial evocado teve significância estatística, embora inferior à verificada no grupo com transeção de 50%. Conclusões: O uso de nanopartículas magnéticas de óxido de ferro combinadas com um campo magnético, leva a taxas mais altas de recuperação funcional depois de lesão da medula espinal em animais de laboratório. O mecanismo dessa melhora precisa ser mais investigado.

RESUMEN Objetivo: Determinar la cantidad de pérdida de función después de transección de médula espinal de varias extensiones, y si las nanopartículas magnéticas de óxido de hierro combinadas a un campo magnético externo mejoran la tasa de recuperación funcional en ratas. Métodos: Los animales fueron divididos en grupos con transección de médula espinal de 50%, 80% y completa. Los animales de los tres grupos del estudio recibieron suspensión de nanopartículas magnéticas de óxido de hierro en la región de la lesión. Los tres grupos control no recibieron las nanopartículas magnéticas, pero tenían niveles de transección correspondientes. Todos los animales fueron expuestos a un campo magnético durante 4 semanas. La pérdida de función postoperatoria y la recuperación subsiguiente fueron evaluadas por la escala de BBB cuanto a la función motriz u por monitorización del potencial somatosensorial evocado en el primer día después de la cirugía y, a continuación, una vez por semana. El análisis histológico terminal también fue realizado en todos los grupos. Resultados: Los animales del grupo control o en los grupos transección completa no demostraron mejora estadísticamente significativa tanto en los escores BBB como en la amplitud del potencial evocado durante el período de cuatro semanas. En el grupo con transección de 50%, sin embargo, se constató un aumento estadísticamente significativo de la amplitud del potencial evocado y de los escores BBB cuatro semanas después de la cirugía, siendo el mayor aumento durante la segunda semana del estudio. En el grupo con transección de 80%, sólo la mejora de la amplitud del potencial evocado tuvo significancia estadística, aunque inferior a la verificada en el grupo con transección de 50%. Conclusiones: El uso de nanopartículas magnéticas de óxido de hierro combinadas con un campo magnético, lleva a tasas más altas de recuperación funcional después de lesión de la médula espinal en animales de laboratorio. El mecanismo de esa mejora precisa ser más investigado.

Stimulation of the Spinal Cord and Dorsal Nerve Roots for Chronic Groin, Pelvic, and Abdominal Pain.

BACKGROUND: Chronic neuropathic groin pain is a common problem. It can arise following surgery or trauma, or spontaneously as part of various pelvic pain syndromes. A number of different stimulation techniques have been reported in the literature to treat this area, but due to the complex anatomy of the region, it can be difficult to target effectively with paresthesias. OBJECTIVES: In this study we report our results treating patients with chronic neuropathic groin, pelvic, and abdominal pain, using spinal cord stimulation and dorsal nerve root stimulation. STUDY DESIGN: Open label, prospective study that includes all patients treated with a new trial stimulator system at a single center between July 1, 2011, and October 31, 2013. SETTING: Academic university neurosurgical pain center, Canada. METHODS: Thirty-two patients had trials of spinal cord stimulation and/or dorsal nerve root stimulation in the thoracic or lumbar spine. Patients were evaluated on visual analog scale pain scores, SF-36, and morphine equivalent daily dose. Data were recorded at the pre-implant visit, and 3, 6, and 12 months following permanent implant. RESULTS: The 15 patients who went on to permanent implants had, on average, significant pain reduction and improvements in quality of life at the 12 month follow-up. The majority of patients who were taking opioids at the initial assessment were able to reduce their dose with treatment. Three patients with successful trials were long-term non-responders, of whom 2 had the permanent device removed. LIMITATIONS: This study would benefit from a larger sample size that would have adequate power for comparisons between patient subgroups and stimulation techniques. CONCLUSION: Dorsal nerve root stimulation is an effective long-term treatment for neuropathic groin pain.

Neurologic foundations of spinal cord fusion (GEMINI).

Cephalosomatic anastomosis has been carried out in both monkeys and mice with preservation of brain function. Nonetheless the spinal cord was not reconstructed, leaving the animals unable to move voluntarily. Here we review the details of the GEMINI spinal cord fusion protocol, which aims at restoring electrophysiologic conduction across an acutely transected spinal cord. The existence of the cortico-truncoreticulo-propriospinal pathway, a little-known anatomic entity, is described, and its importance concerning spinal cord fusion emphasized. The use of fusogens and electrical stimulation as adjuvants for nerve fusion is addressed. The possibility of achieving cephalosomatic anastomosis in humans has become reality in principle.

Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score-matched analysis using a nationwide administrative database.

OBJECTIVE Although minimally invasive spinal surgery has recently gained popularity, few nationwide studies have compared the adverse events that occur during endoscopic versus open spinal surgery. The purpose of this study was to compare perioperative complications associated with microendoscopic discectomy (MED) and open discectomy for patients with lumbar disc herniation. METHODS The authors retrospectively extracted from the Diagnosis Procedure Combination database, a national inpatient database in Japan, data for patients admitted between July 2010 and March 2013. Patients who underwent lumbar discectomy without fusion surgery were included in the analysis, and those with an urgent admission were excluded. The authors examined patient age, sex, Charlson Comorbidity Index, body mass index, smoking status, blood transfusion, duration of anesthesia, type of hospital, and hospital volume (number of patients undergoing discectomy at each hospital). One-to-one propensity score matching between the MED and open discectomy groups was performed to compare the proportions of in-hospital deaths, surgical site infections (SSIs), and major complications, including stroke, acute coronary events, pulmonary embolism, respiratory complications, urinary tract infection, and sepsis. The authors also compared the hospital length of stay between the 2 groups. RESULTS A total of 26,612 patients were identified in the database. The mean age was 49.6 years (SD 17.7 years). Among all patients, 17,406 (65.4%) were male and 6422 (24.1%) underwent MED. A propensity score-matched analysis with 6040 pairs of patients showed significant decreases in the occurrence of major complications (0.8% vs 1.3%, p = 0.01) and SSI (0.1% vs 0.2%, p = 0.02) in patients treated with MED compared with those who underwent open discectomy. Overall, MED was associated with significantly lower risks of major complications (OR 0.62, 95% CI 0.43-0.89, p = 0.01) and SSI (OR 0.29, 95% CI 0.09-0.87, p = 0.03) than open discectomy. There was a significant difference in length of hospital stay (11 vs 15 days, p < 0.001) between the groups. There was no significant difference in in-hospital mortality between MED and open discectomy. CONCLUSIONS The microendoscopic technique was associated with lower risks for SSI and major complications following discectomy in patients with lumbar disc herniation.

Stimulation of the Dorsal Root Ganglion.

Dorsal root ganglion (DRG) stimulation has recently emerged as a new neuromodulation modality that stays on the intersection of the peripheral and central nervous system. With DRG location within the spinal column and with electrodes for DRG stimulation placed through the intraspinal epidural space, it may make more sense to group DRG stimulation together with more commonly used spinal cord stimulation (SCS) rather than peripheral nerve stimulation (PNS), particularly if one agrees that the stimulation delivered to DRG partly works downstream at the spinal cord level. Based on current experience, it appears that DRG stimulation of the spinal cord is as effective as SCS in relieving various neuropathic pain syndromes including pain due to failed back surgery syndrome, complex regional pain syndromes, and chronic postsurgical pain. In addition to its efficacy, DRG stimulation of the spinal cord is associated with a lower rate of migrations and lack of positional side effects that may be seen with SCS and PNS. Here we summarize the knowledge base and clinical evidence for DRG stimulation of the spinal cord, and present hypotheses of its mechanism of action.

Functional and metabolic changes in the brain in neuropathic pain syndrome against the background of chronic epidural electrostimulation of the spinal cord.

Changes in functional and metabolic activities of the brain were evaluated by EEG and positron-emission/computer tomography with 18F-fluorodeoxyglucose in patients with neuropathic pain syndrome previous to and 3 months after implantation of a system for chronic epidural spinal cord stimulation. In most cases, the use of a nerve stimulator was followed by alleviation of neuropathic pain and partial normalization of functional and metabolic activities of brain structures responsible for pain perception, emotiogenic, behavioral, and autonomic responses.

Importância da neuroestimulação medular no tratamento da síndrome do insucesso da cirurgia espinal / Importance of spinal cord stimulation for the treatment of failed back surgery syndrome

Eletrodos vêm sendo utilizados desde 1967 para estimulação da coluna espinal (em inglês, spinal cord stimulation ? SCS) no tratamento de dor crônica refratária em uma série de distúrbios dolorosos, entre eles a síndrome do insucesso da cirurgia espinal (em inglês, failed-back surgery syndrome ? FBSS), caracterizada por dor persistente após cirurgias de coluna, principalmente laminectomia. Neste artigo, apresenta-se uma revisão sistemática da literatura sobre o estudo da neuromodulação no tratamento da FBSS, utilizando-se as plataformas dos portais virtuais PubMed e MedLine, com o objetivo de levantar evidências que corroborem a eficácia e a segurança desse procedimento para dor crônica lombar decorrente de FBSS. A seleção dos estudos, publicados no período entre janeiro de 2003 e janeiro de 2013, envolveu critérios de análise de eficácia (melhora da dor, com redução de 50% ou mais, utilizando a Escala Visual Analógica ? VAS ? ou outras similares) e de segurança (quando complicações foram citadas). Foram inicialmente identificados 186 artigos, entre os quais nove foram selecionados por preencherem os critérios de inclusão/exclusão, totalizando 313 pacientes. Em todos os trabalhos selecionados, observou-se melhora considerável da dor após os procedimentos neuromodulatórios. Conclui-se que, quando bem indicada, a SCS é mais eficaz do que a reoperação ou qualquer outro tipo de terapia conservadora no tratamento de dor crônica lombossacral.

Electrodes have been used since 1967 for spinal cord stimulation (SCS) for the treatment of chronic pain in a series of painful conditions, such as failed-back surgery syndrome (FBSS), characterized by persistent pain after surgical procedures in the spinal column, mainly laminectomy. In this article, a systematic review of the literature is presented about the study of neuromodulation for the treatment of FBSS using data available at PubMed and MedLine, aiming to assess evidences that corroborate the efficacy and safety of this procedure for the treatment of low back chronic pain due to FBSS. The selection of the articles, published from January 2003 to January 2013, involved criteria of efficacy analysis (pain relief, with reduction by 50% or more, using the visual analogue scale ? VAS or other similar ones) and safety (when complications were mentioned). Initially, 186 articles were identified, among which, nine were selected because they fulfilled the inclusion/exclusion criteria, in a total of 313 patients. In all the articles selected, considerable pain relief was observed after neuromodulation procedures. We conclude that, when correctly indicated, SCS is more efficient than a new surgery or any other type of conservative therapy for the treatment of low back chronic pain.

Postsurgical pathologies associated with intradural electrical stimulation in the central nervous system: design implications for a new clinical device.

Spinal cord stimulation has been utilized for decades in the treatment of numerous conditions such as failed back surgery and phantom limb syndromes, arachnoiditis, cancer pain, and others. The placement of the stimulating electrode array was originally subdural but, to minimize surgical complexity and reduce the risk of certain postsurgical complications, it became exclusively epidural eventually. Here we review the relevant clinical and experimental pathologic findings, including spinal cord compression, infection, hematoma formation, cerebrospinal fluid leakage, chronic fibrosis, and stimulation-induced neurotoxicity, associated with the early approaches to subdural electrical stimulation of the central nervous system, and the spinal cord in particular. These findings may help optimize the safety and efficacy of a new approach to subdural spinal cord stimulation now under development.

Spinal cord malformations.

Malformations of the spinal cord are one of the most frequent malformations. They should be clearly divided into two completely different families of malformations: open dysraphisms and occult dysraphisms. Open dysraphism mostly consists in myelomeningocele (MMC). Its incidence is 1/1000 live births with a wide variation. Folic acid supplementation has been shown to reduce its risk. In most cases, the diagnosis is done prenatally by serum screening and ultrasound and may lead to termination of pregnancy. In case of decision to continue pregnancy, surgical treatment must be achieved during the first days of life, and in 50 to 90% of cases, a ventricular shunt must be installed. The follow-up of these children must be continued throughout life looking for late complications (Chiari II and syringomyelia, vertebral problems, neuropathic bladder, tethered cord). Occult dysraphisms are a heterogeneous group of malformations. Lipomas (filum and conus) are the most frequent and their treatment remains controversial. Diastematomyelia, neurenteric cysts, dermal sinus, and more complex forms (Currarino syndrome) belong to this group. Most of them can and must be diagnosed prenatally or at birth by careful examination of the lower back for the cutaneous stigmata of the disease to decrease the risk of neurological, urological, or orthopedic permanent handicap.

Spinal anesthesia and minimal invasive laminotomy for paddle electrode placement in spinal cord stimulation: technical report and clinical results at long-term followup.

OBJECT: We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. METHODS: 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values. RESULTS: No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. CONCLUSIONS: Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement.

Cervical spinal cord stimulation: an analysis of 23 patients with long-term follow-up.

BACKGROUND: For more than 3 decades, spinal cord stimulation has successfully been employed to treat neuropathic pain. Cervical spinal cord stimulation, despite now being standard in many hospitals, has only rarely been subjected to a critical review within the literature. OBJECTIVES: The aim of this study was to determine the efficacy of cervical spinal cord stimulation (SCS) in a representative clinical sample. We also wanted to evaluate how factors such as stimulation parameters, unwanted paresthesia of the trunk and legs, and changes in paresthesia status due to head movement and how they affect SCS effectiveness. STUDY DESIGN: Retrospective study. SETTING: Academic university interdisciplinary pain center. METHODS: We reviewed the records of patients who had been treated at our institution with cervical neurostimulators from November 1, 2001 through October 31, 2011. Information regarding age, gender, diagnosis, age at time of implantation, duration of disease, lead position, hardware in use, revision operations, and stimulation parameters were recorded. In addition, a short telephone interview was conducted, which contained the following items: pain scores on the numeric analog scale (NAS) with and without stimulation, time intervals of stimulation, paresthesia coverage, changes in paresthesia coverage by head movements, unwanted paresthesia of the trunk and legs, treatment satisfaction, and medication intake. RESULTS: Twenty-three patients were treated. Eighteen patients proceeded to an implantable pulse generator (IPG) implant. In one patient, the system was removed after 4 years despite optimal function, because the patient was no longer experiencing pain. Average NAS pain scores were 6.8 (range 5.5 - 10.0, standard deviation [SD] 1.7) without, and 2.8 (range 0 - 7.5, SD 2.2) with neurostimulation. Fourteen revisions (5 due to lead dislocation, 5 due to lead breakage and 4 IPG revisions) were necessary in 9 of the 18 patients during a mean follow-up of 6.2 years. Most patients reported complete paresthesia coverage. Four patients reported unwanted paresthesia of the trunk or lower limb and 11 patients reported changes in paresthesia with head movements. In both instances, pain reduction was not affected. LIMITATIONS: Retrospective study. CONCLUSIONS: Cervical spinal cord stimulation appears to be effective in the treatment of neuropathic upper limb pain. Complications are not significantly more frequent than in SCS for lower limb pain. Changes in paresthesia with head movements and unwanted paresthesia did not affect the outcome.