Spinal Cord Stimulation for Intractable Pain Evaluated by a Collision Study Using Somatosensory Evoked Potentials: A Preliminary Report

2014 ◽  
Vol 17 (8) ◽  
pp. 746-752 ◽  
Author(s):  
Eiichirou Urasaki ◽  
Mami Tsuda ◽  
Shunya Nakane ◽  
Keisuke Toyoda ◽  
Tetsuya Umeno ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Spinal Cord Stimulation ◽  
Preliminary Report ◽  
Intractable Pain

Percutaneous flexible bipolar epidural neuroelectrode for spinal cord stimulation

1984 ◽  
Vol 60 (6) ◽  
pp. 1317-1319 ◽  
Author(s):  
Alfred G. Kaschner ◽  
Wilhelm Sandmann ◽  
Heinz Larkamp
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Epidural Space ◽  
Somatosensory Evoked Potentials ◽  
Spinal Cord Stimulation ◽  
Spinal Cord Ischemia ◽  
Aortic Occlusion ◽  
Content Type ◽  
Fine Print

✓ This article describes a new flexible bipolar neuroelectrode which is inserted percutaneously into the epidural space for segmental spinal cord stimulation. This electrode was used in experiments with dogs and monkeys for recording cortical somatosensory evoked potentials in order to identify intraoperative spinal cord ischemia during periods of aortic occlusion.

scholarly journals Radiation Exposure in Percutaneous Spinal Cord Stimulation Mapping: A Preliminary Report

2010 ◽  
Vol 1;13 (1;1) ◽  
pp. 7-18
Author(s):  
Kevin L. Wininger
Keyword(s):  
Spinal Cord ◽  
Radiation Exposure ◽  
Spinal Cord Stimulation ◽  
Preliminary Report ◽  
Management Practice ◽  
The United States ◽  
Fluoroscopy Time ◽  
Intractable Pain ◽  
Data Set ◽  
Air Kerma

Background: The utilization of spinal cord stimulation (SCS) to treat intractable pain has increased substantially in recent years. Integral to this therapy, the fluoroscope assists with requisite mapping protocols during trialing procedures to identify topographical dermatomal representations of spinal segments, and its use demands measurements of radiation exposure. However, such data is not found in the literature. Purpose: The aim of this study was to report on radiation exposure during percutaneous SCS trialing procedures. Design: An observational study. Setting: A non-university out-patient Interventional Pain Management practice in the United States. Methods: Fluoroscopy time from 110 SCS trialing procedures performed in a non-university, outpatient setting was studied retrospectively. Summary statistics were reported for all procedures collectively, as well as for lead arrangement and location. The interventional spine team carried out all procedural cases with the same mobile C-arm fluoroscopy system. Incident air kerma was evaluated by simplistic modeling. Results: Mean total fluoroscopy time was 133.4 s with a standard deviation of 84.8 s, and the mean percentage of time allocated to pulsed fluoroscopy was 31.9%. Fluoroscopy time for the most common lead arrangement/location, neural canal dual leads/low-thoracic (n=87), ranged from 28.5 s to 387.4 s. Incident air kerma was 1.8–43.7 mGy. Limitations: A preliminary report with a sample size of 110. Conclusion: Various lead placement options are available to the spinal interventionalist to treat pain with SCS. Our data set provides first steps to obtain benchmark reference estimates on fluoroscopy times and radiation exposure during SCS trialing procedures/spinal segment mapping. Fluoroscopy times for such interventions may be considerable when compared to more commonly performed pain medicine procedures; however, skin injury is improbable. Key words: Neuromodulation, radiation safety, fluoroscopy, dosimetry, dose reduction, health physics

scholarly journals Spinal Cord Stimulation Inhibits Cortical Somatosensory Evoked Potentials Significantly Stronger than Transcutaneous Electrical Nerve Stimulation

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. 405-414
Author(s):  
Tilman Wolter
Keyword(s):  
Spinal Cord ◽  
Nervous System ◽  
Pain Relief ◽  
Evoked Potentials ◽  
Nerve Stimulation ◽  
Somatosensory Evoked Potentials ◽  
Spinal Cord Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Dose Dependency ◽  
Electrical Nerve Stimulation

Background: Despite the good clinical results elicited by spinal cord stimulation (SCS), the physiological basis of action of SCS is widely unknown. Inhibition of somatosensory evoked potential (SEP) amplitudes by SCS has been described, but it is unclear whether this displays dose dependency. Moreover, it is unknown whether the pain-relieving effect elicited by SCS correlates with the inhibition of SEPs. Finally, this study aimed to answer the question whether there is a difference in the effect on SEPs between SCS and transcutaneous electrical nerve stimulation (TENS), thus between central nervous system stimulation and peripheral nervous system stimulation. Methods: Ten patients (4 men and 6 women, age range 40-77 years) with neuropathic lower limb pain were included in the study. All patients had implanted SCS systems with percutaneous type electrodes. Cortical SEPs under SCS and TENS were measured without stimulation, under stimulation at perception threshold (PT), and at maximal threshold (MT) in a crossover design. Results: Cortical SEP amplitudes were significantly inhibited by SCS. Stimulation at PT and at MT both led to a statistically significant inhibition of the SEP amplitude. The difference between amplitude reduction at PT and MT showed a tendency towards significance. The degree of SEP amplitude inhibition did not correlate with pain relief. Inhibition of SEP amplitudes by TENS was weaker than that elicited by SCS. The average percentage of amplitude reduction at MT was twice as high under SCS as it was under TENS. No effects on SEP latencies were seen. Conclusions: SCS exerts a significantly stronger inhibition of SEP amplitudes than TENS. The data hint at a dose dependency of SCS-induced SEP amplitude inhibition. No correlation between SEP amplitude inhibition and pain relief was found. Key words: spinal cord stimulation, SCS, transcutaneous electrical nerve stimulation, TENS, neuropathic pain, somatosensory evoked potentials, SEP

Predictive Value of Somatosensory Evoked Potentials for Long-lasting Pain Relief after Spinal Cord Stimulation: Practical Use for Patient Selection

Neurosurgery ◽  
2003 ◽  
Vol 52 (6) ◽  
pp. 1374-1384 ◽  
Author(s):  
Marc P. Sindou ◽  
Patrick Mertens ◽  
Uzi Bendavid ◽  
Luis García-Larrea ◽  
François Mauguière
Keyword(s):  
Patient Outcome ◽  
Spinal Cord ◽  
Pain Relief ◽  
Evoked Potentials ◽  
Success Rate ◽  
Patient Selection ◽  
Somatosensory Evoked Potentials ◽  
Spinal Cord Stimulation ◽  
Work Status ◽  
Conduction Time

Abstract OBJECTIVE Spinal cord stimulation (SCS) has been used for more than 30 years in patients with intractable neuropathic pain, and global success rates have varied from 40 to 70%, according to reported series. Patient selection is currently based on a preliminary percutaneous test, which is useful but invasive, increases the risk of infection, and has yielded false-positive and false-negative results. In this study, we evaluated an alternative method of predicting the effectiveness of SCS before deciding whether to implant laminotomy electrodes—specifically, assessment of neural conduction in the dorsal columns with the use of somatosensory evoked potentials (SSEPs). Thus, we examined the value of preoperative central conduction time (CCT) of SSEPs to stimulation at the level of the painful area as a possible predictor of patient outcome after SCS. METHODS Ninety-five patients were evaluated during a mean follow-up period of 18.8 months. Patients were classified into four categories according to the location of the lesion responsible for pain: 28 patients had lesions of the peripheral nerves, 27 had radicular lesions, 8 had root avulsions, and 32 had cord lesions. The SCS electrode was implanted through an interlaminar opening at the upper part of the painful territory without performing a percutaneous screening test. Clinical and social markers of pain relief (i.e., Visual Analog Scale scores, analgesic drug intake, work status) were evaluated prospectively 2 months after implantation and then annually. RESULTS The global success rate in our study group, with success defined as at least 50% long-term pain relief, was 54.7% (52 of 95 patients). Statistical analyses showed a clear influence of preoperative CCT on SCS outcome. Thus, the success rate was nil in patients with significantly abnormal CCT, whereas it was 75.4% in patients with normal preoperative SSEPs. Significant differences between the two groups of patients also were observed with regard to medication intake and work status. CONCLUSION Preoperative SSEPs provide an objective prediction of patient outcome after SCS. We suggest that if a patient's CCT is abolished or significantly altered, the patient should not undergo SCS.

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