Treatment of Contact Dermatitis Associated With Spinal Cord Stimulator Pulse Generator-Technical Note

2012 ◽  
Vol 16 (6) ◽  
pp. 600-602 ◽  
Author(s):  
Nisha Gadgil ◽  
Allen W. Burton ◽  
Ashwin Viswanathan
Keyword(s):  
Spinal Cord ◽  
Contact Dermatitis ◽  
Pulse Generator ◽  
Technical Note ◽  
Spinal Cord Stimulator

scholarly journals A Fully Implantable Miniaturized Liquid Crystal Polymer (LCP)-Based Spinal Cord Stimulator for Pain Control

Sensors ◽  
2022 ◽  
Vol 22 (2) ◽  
pp. 501
Author(s):  
Seunghyeon Yun ◽  
Chin Su Koh ◽  
Jungmin Seo ◽  
Shinyong Shim ◽  
Minkyung Park ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Electrical Stimulation ◽  
Liquid Crystal ◽  
Mechanical Stimulation ◽  
Spinal Cord Stimulation ◽  
Pulse Generator ◽  
Spinal Cord Stimulator ◽  
Stimulation Threshold ◽  
Crystal Polymer ◽  
Stimulation Of

Spinal cord stimulation is a therapy to treat the severe neuropathic pain by suppressing the pain signal via electrical stimulation of the spinal cord. The conventional metal packaged and battery-operated implantable pulse generator (IPG) produces electrical pulses to stimulate the spinal cord. Despite its stable operation after implantation, the implantation site is limited due to its bulky size and heavy weight. Wireless communications including wireless power charging is also restricted, which is mainly attributed to the electromagnetic shielding of the metal package. To overcome these limitations, here, we developed a fully implantable miniaturized spinal cord stimulator based on a biocompatible liquid crystal polymer (LCP). The fabrication of electrode arrays in the LCP substrate and monolithically encapsulating the circuitries using LCP packaging reduces the weight (0.4 g) and the size (the width, length, and thickness are 25.3, 9.3, and 1.9 mm, respectively). An inductive link was utilized to wirelessly transfer the power and the data to implanted circuitries to generate the stimulus pulse. Prior to implantation of the device, operation of the pulse generator was evaluated, and characteristics of stimulation electrode such as an electrochemical impedance spectroscopy (EIS) were measured. The LCP-based spinal cord stimulator was implanted into the spared nerve injury rat model. The degree of pain suppression upon spinal cord stimulation was assessed via the Von Frey test where the mechanical stimulation threshold was evaluated by monitoring the paw withdrawal responses. With no spinal cord stimulation, the mechanical stimulation threshold was observed as 1.47 ± 0.623 g, whereas the stimulation threshold was increased to 12.7 ± 4.00 g after spinal cord stimulation, confirming the efficacy of pain suppression via electrical stimulation of the spinal cord. This LCP-based spinal cord stimulator opens new avenues for the development of a miniaturized but still effective spinal cord stimulator.

Management of incidental lumboiliac hernia during spinal cord stimulator implant: a case report

2019 ◽  
Vol 44 (11) ◽  
pp. 1033-1034
Author(s):  
David Hao ◽  
Charles Odonkor ◽  
Shane Volney ◽  
Mihir Kamdar ◽  
Shihab Ahmed
Keyword(s):  
Spinal Cord ◽  
Pulse Generator ◽  
Incidental Finding ◽  
Correct Diagnosis ◽  
Synthetic Mesh ◽  
Lumbar Hernia ◽  
Spinal Cord Stimulator ◽  
Operative Repair ◽  
Lumbar Triangle

Lumboiliac or lumbar hernia is a rare defect in the posterolateral abdominal wall that may be inadvertently misidentified and interfere with the implantable pulse generator (IPG) portion of spinal cord stimulator (SCS) implants. We report the case of a 54-year-old Caucasian man with an incidental finding of a lumboiliac hernia in the inferior lumbar triangle of Petit with placement of an IPG in a SCS implant. With the assistance of surgical colleagues, the correct diagnosis was made intraoperatively. We describe the operative repair of the lumboiliac hernia with a synthetic mesh. A new IPG pocket was created above the mesh prior to proceeding with IPG placement. No recurrence of the hernia defect was observed on 2-month follow-up. It is important that pain physicians and neurosurgeons who perform SCS implants are aware of lumboiliac hernias to avoid potential diagnostic or management errors. Lumboiliac hernias should be included on the differential diagnosis of lumbar or flank masses. Confirmation with imaging may be necessary and definitive surgical treatment should be pursued.

scholarly journals Laminoplasty for Cervical Spinal Cord Stimulator Implantation in Patients With Cervical Spondylosis and Fusion: A Technical Note

2019 ◽  
Vol 19 (1) ◽  
pp. 38-42
Author(s):  
Daniel J. Denis ◽  
Tianyi Niu ◽  
Pierre-Olivier Champagne ◽  
Daniel C. Lu
Keyword(s):  
Spinal Cord ◽  
Cervical Spondylosis ◽  
Cervical Spinal Cord ◽  
Technical Note ◽  
Spinal Cord Stimulator

scholarly journals Spinal Cord Stimulation for Chronic Refractory Neuropathic Pain: A Technical Note Initial Experience of Two cases

2021 ◽  
Author(s):  
Sanjeev Srivastava ◽  
Pawan Goyal ◽  
Anurag Sharma ◽  
Sanjay K. Rajan ◽  
Aditya Gupta
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Pulse Generator ◽  
Technical Note ◽  
Current Evidence ◽  
Chronic Neuropathic Pain ◽  
Thoracic Spinal Cord ◽  
Dorsal Aspect

AbstractSpinal cord stimulation is an established procedure for relieving chronic neuropathic pain conditions. Although it has been over five decades since the first spinal cord stimulation (SCS) was developed, it has only been used in a few cases in India. It is primarily based on the “Gate Theory” of pain. The mechanism of its action is not exactly clear, but reports have suggested that it plays the main role in selectively stimulating the large diameter pain fibers in the dorsal aspect of spinal cord. SCS procedure involves a very careful case selection, and current evidence suggests that only a few conditions of chronic refractory neuropathic pain are its established indications. In these patients too, the efficacy rate remains around 50 to 75%. The overall pain relief observed is around 50% decrease in visual analog scale (VAS) scores. It is a technically simple procedure involving placement of electrodes over the dorsal aspect of spinal cord in the epidural space. The procedure is a staged one in which trial lead electrodes are first implanted and stimulated with an external pulse generator (EPG). If the trial is successful and patient has acceptable pain relief over 1 week of stimulation at various settings, the patient undergoes the permanent implantation of electrodes at the same position. The permanent electrodes are then stimulated by an implantable pulse generator (IPG) in the subcutaneous pocket (abdominal or gluteal). Complications are rare and are more related to hardware like lead migration and breakage. Since it is does not damage the cord per se, its acceptance as a procedure for pain is known quite well in the Western world. Its availability and cost of implants is the major hurdle in its use in a developing nation like India. Here, we present a technical note and our experience of two cases of thoracic spinal cord stimulation for chronic neuropathic pain at our institution.

scholarly journals Late Extrusion of an Implantable Pulse Generator of a Spinal Cord Stimulator

2015 ◽  
Vol 4;19 (4;5) ◽  
pp. E671-E674
Author(s):  
Joseph Rabi
Keyword(s):  
Spinal Cord ◽  
Pulse Generator ◽  
Rare Complication ◽  
Late Complication ◽  
Gluteal Region ◽  
Spinal Cord Stimulator ◽  
Key Words Spinal Cord ◽  
Implantable Pulse Generator ◽  
Failed Back Syndrome ◽  
History Of

The objective of this manuscript was to report a case of a patient with extruded pulse generator 3 years after implantation of a spinal cord stimulator system. With the increasing incidence of chronic pain, spinal cord stimulation (SCS) is becoming more commonly utilized by pain physicians. SCS is a generally safe intervention with minimal adverse effects; however, there are risks of complications which practitioners should be aware of prior to and after placement of the SCS. We present a case of a patient with a late complication of extrusion of an implantable pulse generator (IPG) of a SCS that was promptly identified and successfully removed without any complications. A 60-year-old male truck driver with history of failed back syndrome and diabetes underwent a SCS system implanted with excellent relief of his pain. The SCS was implanted with 2 leads with the IPG being sutured 3 cm in depth in the superior gluteal region. Three years after the implantation, he developed pain over the site of the generator and presented to our clinic with extrusion of the non-rechargeable pulse generator from his gluteal region. The pulse generator was successfully removed with the battery not being infected. This late complication may have been related to his ongoing profession of daily driving with pressure necrosis from prolonged sitting and constant vibration during long rides associated. Structural size and design of the pulse generator may have had an important contribution as well. To our knowledge this complication has not been reported in the literature. Physicians that place or manage patients with SCSs should be aware of this rare complication and maintain vigilance even after remote implantation of the SCS systems. Key words: Spinal cord stimulator, complication, extrusion, implantable pulse generator, neuromodulation, failed back syndrome, battery complication

scholarly journals Evaluation of Interaction between a Spinal Cord Stimulator and Implanted CardioverterDefibrillator in a Swine Model

2013 ◽  
Vol 5;16 (5;9) ◽  
pp. 489-496
Author(s):  
Gassan M. Chaiban
Keyword(s):  
Spinal Cord ◽  
Right Ventricle ◽  
Epidural Space ◽  
Pulse Generator ◽  
Swine Model ◽  
Boston Scientific ◽  
Spinal Cord Stimulator ◽  
Electrode Lead ◽  
Chronic Pain Conditions ◽  
The Right

Background: Spinal cord stimulators (SCS) have been used for many years to treat a myriad of chronic pain conditions using electrical signals to diminish the perception of a painful stimulus. Because of the electrical nature of the devices, there is a concern about the potential for electromagnetic interaction between the device and lifesaving cardiac implantable cardiovertersdefibrillators (ICVD). Objective: The purpose of this study was to use a swine model to evaluate the potential for interaction between an implanted SCS and ICVD using the closest possible proximity, highest stimulation settings, and most sensitive ICVD settings. Methods: A pig was anesthetized and subsequently an ICVD and ICVD lead (Cogni 100-D and Endotak Reliance®, Boston Scientific, Natick, MA) were placed into the right prepectoral region and the right ventricle, respectively. An SCS (50 cm linear ST Precision Plu octad electrode lead [Boston Scientific, Valencia, CA] with 3 mm wide contacts spaced one mm apart) was implanted using fluoroscopic guidance into the posterior epidural space. Remote interrogation and programming of the ICVD were performed while the SCS lead was placed in as close proximity as possible, using fluoroscopy to guide the final position of the SCS electrode. After confirming that both systems were working, appropriately 9 stimulating configurations of varying current, pulse width, and frequency, including maximal settings, were delivered through the SCS. The effects on the ICVD were recorded at 2 sensitivity settings. Results: None of the tested SCS configurations caused interference with the proper functioning of the ICVD. Limitations: The anatomical proximity of the posterior epidural space and right ventricle of the swine is different from humans. While the entire pacer, including generator, was imbedded in a subcutaneous pocket, an implantable pulse generator for the SCS was not implanted, which did not allow us to study if any damage or a resetting of settings had occurred to the generator. Only one manufacturer was used in this study. Also, this study was performed in an anesthetized pig and the anatomical positions remained static. Realistically, changes in position of the devices would occur in patients who perform activities of daily living, and this can potentially shorten the distance between the 2 leads causing adverse interaction. Conclusion: This study clearly demonstrated the feasibility of the 2 devices coexisting and functioning appropriately in an animal model using an ICVD and SCS donated by Boston Scientific. Further studies are needed to elucidate restrictions, optimal settings and parameters in a human setting. Key words: Spinal cord stimulator, interaction, implantable cardioverter defibrillator, pacemaker, swine model, cross-talk.

scholarly journals Significant cephalad lead migration with use of externally powered spinal cord stimulator

2018 ◽  
pp. bcr-2018-225813
Author(s):  
Sameer Jain ◽  
Michael A Fishman ◽  
Chengyuan Wu
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Back Pain ◽  
Pulse Generator ◽  
Chronic Back Pain ◽  
Low Back ◽  
Spinal Cord Stimulator ◽  
Technological Advances ◽  
Internal Pulse Generator ◽  
Neurosurgical Intervention

Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neuromodulation devices. Externally powered neuromodulation devices, that do not require an internal pulse generator (IPG) implantation, have recently been approved for treatment of chronic pain and the data on potential pitfalls and unforeseen complications with these devices is minimal. Here, we report a case of a 60-year-old woman with chronic back pain who underwent the implantation of one of such devices and developed complication that required neurosurgical intervention. The epidural stimulator leads in the patient migrated cranially to the T2 level that required extensive neurosurgical exploration. We believe this is the first reported case of such significant cranial epidural lead migration with the use of neurostimulation devices and demands more research into the safety of externally powered neurostimulation devices.

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