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1.
Neuromodulation ; 23(2): 260-261, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32103591
2.
PLoS One ; 15(2): e0228306, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32074111

RESUMO

BACKGROUND: Chronic pain has been associated with alterations in brain structure and function that appear dependent on pain phenotype. Functional connectivity (FC) data on chronic back pain (CBP) is limited and based on heterogeneous pain populations. We hypothesize that failed back surgery syndrome (FBSS) patients being considered for spinal cord stimulation (SCS) therapy have altered resting state (RS) FC cross-network patterns that 1) specifically involve emotion and reward/aversion functions and 2) are related to pain scores. METHODS: RS functional MRI (fMRI) scans were obtained for 10 FBSS patients who are being considered for but who have not yet undergone implantation of a permanent SCS device and 12 healthy age-matched controls. Seven RS networks were analyzed including the striatum (STM). The Wilcoxon signed-rank test evaluated differences in cross-network FC strength (FCS). Differences in periaqueductal grey (PAG) FC were assessed with seed-based analysis. RESULTS: Cross-network FCS was decreased (p<0.05) between the STM and all other networks in these FBSS patients. There was a negative linear relationship (R2 = 0.76, p<0.0022) between STMFCS index and pain scores. The PAG showed decreased FC with network elements and amygdala but increased FC with the sensorimotor cortex and cingulate gyrus. CONCLUSIONS: Decreased FC between STM and other RS networks in FBSS has not been previously reported. This STMFCS index may represent a more objective measure of chronic pain specific to FBSS which may help guide patient selection for SCS and subsequent management.


Assuntos
Síndrome Pós-Laminectomia/terapia , Estimulação da Medula Espinal , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Estudos de Casos e Controles , Dor Crônica/complicações , Dor Crônica/patologia , Síndrome Pós-Laminectomia/complicações , Feminino , Giro do Cíngulo/fisiologia , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Vias Neurais , Substância Cinzenta Periaquedutal , Córtex Sensório-Motor/fisiologia
3.
Medicine (Baltimore) ; 99(3): e18633, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011443

RESUMO

Pain has a major impact on anxiety and depression levels. The aim of this study is to demonstrate how these symptoms (depression and anxiety) could positively influence the perception of pain after neurostimulation system implantation.We enrolled 100 patients and divided in 2 different groups, by using tests screening such as Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Nursing Rating Scale (NRS): the group with spinal cord stimulation (SCS) and the group with pulsed spinal cord radiofrequency (RFP).We highlighted a significant decrease of scores (BDI, HAM-A, NRS) in each group between T0 (baseline) and T1. Moreover, the intra-group analysis showed a positive significant correlation between NRS and depressive and anxiety symptoms.We assert that the use of alternative methods (SCS and RFP) to the traditional pharmaceutical-surgical treatments, provide the reduction of the algic and anxiety-depressant symptoms, restoring also the perception of psychological well-being.


Assuntos
Ansiedade/psicologia , Dor Crônica/psicologia , Dor Crônica/terapia , Depressão/psicologia , Tratamento por Radiofrequência Pulsada/psicologia , Estimulação da Medula Espinal/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Escalas de Graduação Psiquiátrica , Tratamento por Radiofrequência Pulsada/métodos , Estimulação da Medula Espinal/métodos
4.
Neuromodulation ; 23(1): 140-141, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31965668
5.
World Neurosurg ; 136: 44-48, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31917309

RESUMO

BACKGROUND: Spinal myoclonus (SM) is a rare hyperkinetic movement disorder that is either idiopathic or secondary to spinal cord lesions. The treatment is either symptomatic only or addresses the underlying etiology. We describe 2 patients with SM with compression myelopathy who were treated with spinal cord stimulation (SCS). CASE DESCRIPTION: The first patient was a 39-year-old man with cervicobrachial pain owing to compression myelopathy at level C5-6 underwent fusion. A year later, he developed neurologic deficits including left-limb dominant tetraparesis and involuntary movements of the right leg. Despite ventral fusion at C5-7 due to progressive myelopathy, the involuntary movements extended to both left extremities. A paddle electrode was placed at level C5-6. SM disappeared immediately under stimulation, and the effect continued even after 24 months. The second patient, a 57-year-old man, underwent fusion at level C5-6 in 1998. Since then, he experienced a persistent tremor in his left hand. After 20 years, he developed cervicobrachial pain of the right upper limb with paresis. Compression myelopathy at segment C6-7 was treated with fusion plating. Six months later, pain returned in both upper limbs, and the tremor extended discretely to his right side. A paddle electrode for SCS was placed at level C7-Th1. SM disappeared immediately under stimulation, and the effect persisted after 10 months. Both patients reported sustained pain reduction. CONCLUSIONS: SCS might offer a more selective medicament-free therapy option for SM. The activation of intraspinal networks and replacement of supraspinal descending influences are mechanisms of SCS in this disorder.


Assuntos
Vértebras Cervicais/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Mioclonia/terapia , Compressão da Medula Espinal/cirurgia , Estimulação da Medula Espinal/métodos , Adulto , Descompressão Cirúrgica , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mioclonia/etiologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Fusão Vertebral
6.
World Neurosurg ; 133: e658-e665, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574335

RESUMO

BACKGROUND: Recurrent and chronic low back pain, caused by degenerative lumbar spondylosis, commonly affects elderly patients, even those with no previous low back surgery. These patients, like those affected by failed back surgery syndrome (FBSS), may become unresponsive to medical conservative treatment and their quality of life could be easily compromised. Moreover, general comorbidities, obesity, and other typical conditions of the elderly may make surgery under general anesthesia riskier than the natural history of the disease. These patients could be considered affected by surgical back risk syndrome (SBRS). METHODS: In this article, we report our preliminary observational prospective study on the role of spinal cord stimulation (SCS) in 3 groups of patients: the FBSS group, the SBRS group, and the "other" group. Selection criteria, treatment modality, and outcomes for each patient group are described and discussed. Moreover, a potentially useful diagnostic and therapeutic flowchart on the management options for lumbar back diseases is discussed. RESULTS: The FBSS group included 25 patients, the SBRS group included 10 patients, and the other group included 3 patients. In 22/25 patients with FBSS (88% of the total), the implantation of a definitive neurostimulator was successful. In almost all patients in both the SBRS and the other groups, the implantation of a definitive neurostimulator was successful. CONCLUSIONS: In our opinion, SCS could be considered as a valid alternative treatment not only in selected patients affected by FBSS but also in selected patients affected by SBRS, in whom back surgery under general anesthesia may be challenging and overcome the potential benefit of the surgery itself. SBRS could be considered a new disease entity to be managed through SCS.


Assuntos
Dor Lombar/terapia , Estimulação da Medula Espinal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome Pós-Laminectomia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos
7.
AJR Am J Roentgenol ; 214(2): 406-412, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31846373

RESUMO

OBJECTIVE. MRI is an imaging modality frequently ordered for patients with neuromodulation systems implanted for spinal cord stimulation. The purpose of this investigation was to evaluate MRI safety issues (magnetic field interactions, MRI-related heating, functional disturbances, and artifacts) for a new wirelessly powered lead with receiver used for SCS. MATERIALS AND METHODS. Lead samples underwent in vitro evaluation for MRI safety issues using standardized techniques. Magnetic field interactions (i.e., translational attraction and torque) and artifacts were tested at 3 T. MRI-related heating was performed at 1.5 T/64 MHz and 3 T/128 MHz using two different methods: numerical simulations with analytical modeling and physical testing. Possible functional disturbances were evaluated under exposures to 1.5-T/64-MHz and 3-T/128-MHz MRI conditions. RESULTS. The lead exhibited minor magnetic field interactions (22° deflection angle, no torque) at 3 T. The highest temperature change recorded at 1.5 T/64 MHz and 3 T/128 MHz was 3.8°C and 11.3°C, respectively. Exposures to MRI conditions did not damage or alter the functional aspects of the leads. The maximum artifact size seen on a gradient-echo pulse sequence extended approximately 10 mm relative to the size of the lead. CONCLUSION. The MRI tests performed on patients with the new lead with receiver revealed no substantial concerns with respect to the conditions that we provide in the safety guidelines that were based on the results of this investigation. Therefore, MRI examinations will result in acceptable heating when conducted at appropriate whole-body-averaged specific absorption rate levels (i.e., 2.0 W/kg at 1.5 T/64 MHz and 0.3 W/kg at 3 T/128 MHz, corresponding to adjusted temperature rises of 3.6°C and 1.2°C, respectively). Therefore, patients with this wirelessly powered lead and receiver implanted can safely undergo MRI examinations under specific conditions.


Assuntos
Segurança de Equipamentos , Imagem por Ressonância Magnética , Segurança do Paciente , Estimulação da Medula Espinal/instrumentação , Tecnologia sem Fio/instrumentação , Artefatos , Instalação Elétrica , Temperatura Alta , Humanos , Campos Magnéticos , Imagens de Fantasmas
8.
Ann Vasc Surg ; 62: 356-364, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30802587

RESUMO

BACKGROUND: The aim of this study was to evaluate the long-term outcomes of spinal cord stimulation in patients with critical limb ischemia and to test the hypothesis that the dynamics of clinical changes one year after therapy depend both on the clinical determinants associated with the underlying disease and on factors related to systemic atherosclerosis. METHODS: This prospective cohort study included 56 patients with critical limb ischemia. All patients before and after spinal cord stimulation were examined in terms of the dynamics of their clinical changes using the Rutherford scale and transcutaneous oxygen tension (TcPO2, mm Hg) in the affected foot. The active orthostatic test was used to assess the functional state of peripheral perfusion. RESULTS: One year after spinal cord stimulation, 74% of patients showed positive clinical outcomes. No changes were observed in 9.3% of patients, whereas adverse clinical outcomes were revealed in 16.7% of cases. The TcPO2 values were significantly reduced before spinal cord stimulation: 10.5 (6.4-16.0) mm Hg. The functional status of the peripheral microvasculature was also disturbed. One year after therapy, TcPO2 significantly increased and the adaptive mechanisms of the microvasculature were improved in more than 70% of patients. Logistic regression analysis showed that the initially low TcPO2 values (<10 mm Hg) with a lack of gain in TcPO2 during the orthostatic test are associated with the negative clinical outcomes after spinal cord stimulation. The gain in TcPO2 during the orthostatic test to >10 mm Hg is associated with the positive clinical outcomes after spinal cord stimulation. The age-adjusted Charlson Comorbidity Index >5 and duration of critical ischemic symptoms also had a negative effect on the clinical outcomes after spinal cord stimulation. CONCLUSIONS: The positive clinical outcomes were revealed in most patients with critical limb ischemia one year after spinal cord stimulation. The low values of peripheral tissue metabolism with the disturbed functional status of the microvasculature are associated with the negative clinical outcome. The patients with baseline TcPO2 <10 mm Hg can recover if they still have a sufficient microcirculatory reserve capacity. Duration of critical ischemic symptoms and high comorbidity burden with allowance for age are negative factors affecting the clinical outcome.


Assuntos
Isquemia/terapia , Doença Arterial Periférica/terapia , Estimulação da Medula Espinal , Idoso , Biomarcadores/sangue , Monitorização Transcutânea dos Gases Sanguíneos , Estado Terminal , Feminino , Humanos , Isquemia/sangue , Isquemia/diagnóstico , Isquemia/fisiopatologia , Masculino , Microcirculação , Pessoa de Meia-Idade , Oxigênio/sangue , Doença Arterial Periférica/sangue , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Fluxo Sanguíneo Regional , Fatores de Tempo , Resultado do Tratamento
11.
PLoS One ; 14(12): e0227057, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31877192

RESUMO

Posterior root-muscle (PRM) reflexes are short-latency spinal reflexes evoked by epidural or transcutaneous spinal cord stimulation (SCS) in clinical and physiological studies. PRM reflexes share key physiological characteristics with the H reflex elicited by electrical stimulation of large-diameter muscle spindle afferents in the tibial nerve. Here, we compared the H reflex and the PRM reflex of soleus in response to transcutaneous stimulation by studying their recovery cycles in ten neurologically intact volunteers and ten individuals with traumatic, chronic spinal cord injury (SCI). The recovery cycles of the reflexes, i.e., the time course of their excitability changes, were assessed by paired pulses with conditioning-test intervals of 20-5000 ms. Between the subject groups, no statistical difference was found for the recovery cycles of the H reflexes, yet those of the PRM reflexes differed significantly, with a striking suppression in the intact group. When comparing the reflex types, they did not differ in the SCI group, while the PRM reflexes were more strongly depressed in the intact group for durations characteristic for presynaptic inhibition. These differences may arise from the concomitant stimulation of several posterior roots containing afferent fibers of various lower extremity nerves by transcutaneous SCS, producing multi-source heteronymous presynaptic inhibition, and the collective dysfunction of inhibitory mechanisms after SCI contributing to spasticity. PRM-reflex recovery cycles additionally obtained for bilateral rectus femoris, biceps femoris, tibialis anterior, and soleus all demonstrated a stronger suppression in the intact group. Within both subject groups, the thigh muscles showed a stronger recovery than the lower leg muscles, which may reflect a characteristic difference in motor control of diverse muscles. Based on the substantial difference between intact and SCI individuals, PRM-reflex depression tested with paired pulses could become a sensitive measure for spasticity and motor recovery.


Assuntos
Reflexo H , Músculo Esquelético/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia , Estimulação da Medula Espinal , Adulto , Feminino , Humanos , Masculino , Músculo Esquelético/fisiologia , Reflexo , Medula Espinal/fisiologia , Medula Espinal/fisiopatologia , Estimulação da Medula Espinal/métodos , Adulto Jovem
12.
Artigo em Russo | MEDLINE | ID: mdl-31626155

RESUMO

BACKGROUND: Spinal cord injury causes significant impairments of both motor and pelvic organ functions. Latest studies have shown impressive potentials for using transcutaneous spinal cord electrical stimulation (TcSCES) in the late period of injury to restore motor functions. All results were obtained in a limited number of patients in the specific conditions of a physiological experiment. It remains unclear how effective a TcSCES cycle is in restoring motor activity in patients after spinal cord injury in real clinical conditions. AIM: The main objective of this investigation was to study the effectiveness of TcSCES in combination with the standard rehabilitation of patients after a spinal cord injury. An additional objective was to evaluate the effect of TcSCES to excretory functions in patients with spinal cord injury. SUBJECTS AND METHODS: The studies were conducted at Saint Petersburg City Hospital Forty, which included 15 patients with thoracic spinal injury at 2.4±2.06 years after injury; the severity of the latter was American Spinal Injury Association (ASIA) Grades B and C. All the patients underwent a 2-week standard cycle of rehabilitation treatment; of them 7 patients (a study group) received additionally TcSCES. Standard scales were used to assess neurological status and muscle strength and sensitivity. The patients filled out a urinary diary; residual urine volume was monitored using bladder catheterization or ultrasound. RESULTS: An increase in muscle strength was recorded in 6 patients of the study group and in 1 patient of the control one. The end of the treatment cycle was marked by a 1-score spasticity increase in 1 patient of the study group and in 2 patients in the control one. In the study group, the level of anesthesia decreased per segment in 1 patient; an improvement in deep and proprioceptive sensitivity was recorded in 2 patients; no change in sensitivity was observed in the control group. In the study group, 2 patients showed a reduction in the severity of injury from ASIA Grade B to ASIA Grade C. In three patients of the study group, the residual urine volume decreased and control and a sensation of urgency to urinate appeared; in the control group, these parameters remained unchanged after the treatment cycle. DISCUSSION: The main result of the study is evidence for the efficiency of using TcSCES in the complex therapy of motor neurorehabilitation. The performed cycle of TcSCES in patients was noted to result in better motor and excretory functions. CONCLUSION: The use of a short-term TcSCES cycle in the motor rehabilitation program for patients with spinal cord injury contributes to recovery of severe motor disorders and is accompanied by an improvement in urinary functions.


Assuntos
Traumatismos da Medula Espinal/reabilitação , Estimulação da Medula Espinal/métodos , Humanos , Espasticidade Muscular/fisiopatologia , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento
13.
Artigo em Russo | MEDLINE | ID: mdl-31626215

RESUMO

AIM: To study the clinical dynamics in the long-term period after spinal cord stimulation (SCS) in patients with chronic pain syndrome and critical lower limb ischemia (CLLI) and to identify factors affecting the prognosis of SCS. MATERIAL AND METHODS: The clinical dynamics was analyzed in 48 patients with pain syndrome and CLLI 1 year after SCS. Microcirculatory blood flow (MBF) was studied in the affected foot by laser-doppler flowmetry (LDF) (Perfusion Units (PU)) and transcutaneous oximetry (TcpO2, mmHg.) using an occlusive test before and after SCS. The factors associated with negative clinical dynamics 1 year after SCS were determined. RESULTS: In 74% of cases, SCS contributes to the improvement of clinical status (reduction of pain syndrome, increase in motor activity, healing of ulcers). After SCS, according to LDF and TcpO2, the authors observed an increase in MBF and tissue metabolism - from 1.3 (0.7-2.8) to 6.2 (3.8-8.7) PU and from 14.5 (7.5-22.1) to 41.1 (26.4-57.6) mmHg, respectively with normalization of the MBF reserve during the occlusion test. Negative clinical dynamics after SCS is associated with high comorbidity, TcO2 <10 mmHg and the duration of pain. CONCLUSION: SCS contributes to the improvement of the clinical status of patients with chronic pain syndrome and CLLI. The negative dynamics is associated with high comorbidity, TcrO2 <10 mmHg and the duration of pain.


Assuntos
Dor Crônica , Terapia por Estimulação Elétrica , Isquemia , Estimulação da Medula Espinal , Dor Crônica/terapia , Humanos , Isquemia/terapia , Microcirculação , Medula Espinal
15.
Neurosciences (Riyadh) ; 24(3): 221-224, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31380822

RESUMO

In the present article, we described a case of treating intractable pain from failed back surgery syndrome (FBSS) and multiple sclerosis (MS) after implantation of spinal cord stimulation (SCS) in a patient. We are reporting a case where SCS has been used for treating a patient with both FBSS and MS.


Assuntos
Síndrome Pós-Laminectomia/terapia , Esclerose Múltipla/terapia , Estimulação da Medula Espinal/métodos , Síndrome Pós-Laminectomia/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Esclerose Múltipla/complicações
16.
Exp Neurol ; 322: 113033, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31400304

RESUMO

Dysfunction of the lower urinary tract (LUT) is prevalent in neurological disorders, including multiple sclerosis, stroke, spinal cord injury and neurodegenerative conditions. Common symptoms include urgency, incontinence, and urinary retention. Recent advances in neuromodulation have resulted in improved treatments for overactive bladder symptoms of urgency, frequency, and nocturia. However, there are presently no treatments available for the induction of voiding to overcome urinary retention. We demonstrate that transcutaneous spinal cord stimulation (TSCS), a non-invasive intervention, applied over the thoracolumbar spine in neurologically intact rhesus macaques can activate the LUT, including activation of the bladder detrusor muscle, the urethral sphincter and pelvic floor muscles. Urodynamic studies show improved voiding efficiency and decreased post-voiding residual volumes in the bladder, while maintaining coordinated activity in the detrusor and sphincter with physiologic detrusor peak pressure, contraction duration, and urine flow rate remaining unchanged. We conclude that TSCS may represent a novel approach to activate the LUT and enable voiding in select neurological conditions.


Assuntos
Estimulação da Medula Espinal , Uretra/fisiologia , Bexiga Urinária/fisiologia , Micção/fisiologia , Urodinâmica/fisiologia , Animais , Feminino , Macaca mulatta
17.
World Neurosurg ; 131: 264-274.e3, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369885

RESUMO

In the United States, chronic low back pain affects up to 37% of adults and is a multibillion dollar health care expenditure. Spinal cord simulation (SCS) has been established as an effective treatment alternative for chronic neuropathic low back and leg pain, especially for patients with failed back surgery syndrome or chronic regional pain syndrome. The field of SCS has rapidly advanced such that analgesia can now be achieved through numerous different waveforms, each claiming to offer improved outcomes. These waveforms include traditional paresthesia-based SCS (<100 Hz), paresthesia-free high-frequency SCS (5-10 kHz), burst SCS, and subperception SCS (1-5 kHz). Level 1 evidence critically evaluating the efficacy of these different waveforms is lacking. We conducted a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify all randomized controlled trials of SCS in the treatment of chronic neuropathic low back and leg pain, failed back surgery syndrome, or chronic regional pain syndrome. Of 38 eligible studies reviewed, 13 randomized controlled trials were finally included in our systematic review. We reviewed evidence from randomized controlled trials in the field of SCS that have established paresthesia-based SCS, paresthesia-free high-frequency SCS, burst SCS, and subperception SCS as viable treatment options for chronic neuropathic low back and leg pain. We critically evaluated evidence that claims to support the use of one waveform over another and reviewed the literature on patient preference for different waveforms.


Assuntos
Síndromes da Dor Regional Complexa/terapia , Síndrome Pós-Laminectomia/terapia , Dor Lombar/terapia , Estimulação da Medula Espinal/métodos , Dor Crônica/terapia , Humanos , Perna (Membro) , Preferência do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
World Neurosurg ; 131: e521-e529, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31394362

RESUMO

BACKGROUND: Spinal cord stimulation (SCS), a common invasive neuromodulation technique, induces pain relief via electrical stimulation of the dorsal column of the spinal cord. To present an overview of research publications on SCS, a bibliometric analysis of scientific publications from 1998 to 2017 was performed. METHODS: The relevant data were obtained from the Web of Science and PubMed database. These articles were classified into several categories, such as total number, countries, institutions, authors, and citations reports. The analysis of co-occurrence key words was handled by VOSviewer software. RESULTS: We found that there existed an increasing trend in the number of publications on SCS between 1998 and 2017. Among these countries, the United States published the largest number of papers in the past 20 years. Case Western Reserve University in the United States contributed the most publications. Among all research categories, neuroscience neurology was the most common area. In addition, regarding article types, basic research comprised a great proportion of the total papers on SCS in the PubMed database. The author V. Reggie Edgerton from the United States was the most-frequent contributor among the authors. The results showed that "spinal cord," "stimulation," and "pain" were the most common key words in the past 20 years. CONCLUSIONS: This bibliometric analysis first provides a basic overview of research publications on SCS published during the last 2 decades. Considering the expanded indications of SCS, there are a lot of things to do, and various countries should increase support to complete high-quality SCS studies.


Assuntos
Pesquisa Biomédica/tendências , Manejo da Dor , Dor , Estimulação da Medula Espinal , Bibliometria , Humanos , Editoração/tendências , Estados Unidos
19.
Pain Res Manag ; 2019: 1236430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281554

RESUMO

Background: Spinal cord stimulation is an established treatment option for certain chronic pain conditions which have been previously unresponsive to conservative therapies or potentially for a subset of patients who have not improved following spine surgery. Prior to permanent lead implantation, stimulator lead trials are performed to ensure adequate patient benefit. During these trials, one of the most common complications and reasons for failure is the displacement and migration of the trial leads, resulting in lost therapeutic coverage. Other complications include infection and dislodged bulky dressings. There is a paucity of literature describing an adequate procedural method to prevent these common complications. Objective: This study utilizes a series of 19 patients to evaluate a new technique for securing percutaneous spinal cord simulator trial leads, which may minimize dislodgement and migration complications and improve the rate of trial success. Study Design: Retrospective case series. Setting: New Jersey Medical School, Department of Anesthesiology, Pain Management Division. Methods: A retrospective chart review was conducted on 19 consecutive patients undergoing placement of the percutaneous thoracic spinal cord stimulator trial leads for pain associated with lumbar spine pathology over a two-year period (2010-2012). Results: Of the 19 patients in our cohort, there was one trial lead displacement, no lead migrations, and no site infections. Thirteen patients went on to permanent lead implantation. This improved trial lead placement technique had a high success rate with a low number of complications. Limitations: Small sample size, retrospective case series, and no control group for comparison. Conclusion: This case series was able to demonstrate that our described novel spinal cord stimulator trial lead placement and dressing technique can decrease the incidence of lead displacement and migration, thus improving trial success.


Assuntos
Eletrodos Implantados/efeitos adversos , Migração de Corpo Estranho/prevenção & controle , Procedimentos Neurocirúrgicos/métodos , Estimulação da Medula Espinal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Retrospectivos
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