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 1-kHz high-frequency spinal cord stimulation alleviates chronic refractory pain after spinal cord injury: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Chiaki Yamada ◽  
Aiko Maeda ◽  
Katsuyuki Matsushita ◽  
Shoko Nakayama ◽  
Kazuhiro Shirozu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Cervical Vertebrae ◽  
Intractable Pain ◽  
Target Area ◽  
Positive Effects ◽  
Cord Injury

Abstract Background Patients with spinal cord injury (SCI) frequently complain of intractable pain that is resistant to conservative treatments. Here, we report the successful application of 1-kHz high-frequency spinal cord stimulation (SCS) in a patient with refractory neuropathic pain secondary to SCI. Case presentation A 69-year-old male diagnosed with SCI (C4 American Spinal Injury Association Impairment Scale A) presented with severe at-level bilateral upper extremity neuropathic pain. Temporary improvement in his symptoms with a nerve block implied peripheral component involvement. The patient received SCS, and though the tip of the leads could not reach the cervical vertebrae, a 1-kHz frequency stimulus relieved the intractable pain. Conclusions SCI-related symptoms may include peripheral components; SCS may have a considerable effect on intractable pain. Even when the SCS electrode lead cannot be positioned in the target area, 1-kHz high-frequency SCS may still produce positive effects.

scholarly journals Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110040
Author(s):  
Kuen Su Lee ◽  
Yoo Kyung Jang ◽  
Gene Hyun Park ◽  
In Jae Jun ◽  
Jae Chul Koh
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Therapeutic Potential ◽  
Case Series ◽  
Limb Amputation ◽  
Intractable Pain ◽  
Limb Pain ◽  
Cord Injury ◽  
Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

Spinal Cord Stimulation for Chronic Intractable Pain: Nursing Implications

1994 ◽  
Vol 26 (6) ◽  
pp. 347-351 ◽  
Author(s):  
Michele Gilbert ◽  
Colleen M. Counsell ◽  
Pam Martin ◽  
Christie Snively
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Intractable Pain

Spinal Cord Stimulation for Intractable Pain Following Limb Amputation

2012 ◽  
Vol 16 (6) ◽  
pp. 530-536 ◽  
Author(s):  
John McAuley ◽  
Richard van Gröningen ◽  
Christopher Green
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Limb Amputation ◽  
Intractable Pain

Spinal Cord Stimulation for Chronic, Intractable Pain

Neurosurgery ◽  
1993 ◽  
Vol 33 (5) ◽  
pp. 947
Author(s):  
Erik Van de Kelft ◽  
Christian De La Porte
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Intractable Pain

New Trends in Neuromodulation for the Management of Neuropathic Pain

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 690-704 ◽  
Author(s):  
Kenneth M. Aló ◽  
Jan Holsheimer
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Clinical Results ◽  
Intractable Pain ◽  
Long Term Effects ◽  
Long Term Outcomes ◽  
Dorsal Columns ◽  
Painful Area ◽  
Electronic Field

Abstract SINCE ITS FIRST application in 1967, the methodology and technology of spinal cord stimulation for the management of chronic, intractable pain have evolved continuously. Despite these developments and improved knowledge of the effects of spinal anatomy and epidural contact configuration on paresthesia coverage, the clinical results of spinal cord stimulation—particularly the long-term effects—are still unsatisfactory in many patients. This dissatisfaction has come primarily from the failure of single-electrode configurations to provide consistent paresthesia coverage of the entire painful area. Therefore, new approaches were developed during the late 1990s that attempted to selectively cover one or more dermatomes with paresthesia as well as to provide sequential stimulation of different anatomic sites. These approaches have been applied both intraspinally and extraspinally by stimulating either the spinal nerves or the dorsal columns. To target parts of the latter, different methods have been developed and tested using either two-dimensional contact configurations or electronic field steering. These developments hold promise for improving long-term outcomes as well as increasing the number of pain conditions that can be treated with neuromodulation therapy. In this review, the history, theoretical basis, and evolution of these methodologies, as well as the ways in which they represent new trends in neuromodulation, are discussed.

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