Percutaneous epidural stimulation of the low thoracic spinal cord was carried out in 41 patients with pain from peripheral arterial disease of the lower limbs. Results are reported relating to pain, claudication distance, peripheral blood flow, and trophic lesion changes. Following a trial period of stimulation, 37 patients had stimulators permanently implanted. After a mean poststimulation follow-up period of 25 months, substantial pain relief (75% to 100%) was obtained in 29 cases; claudication distance significantly increased in 15 cases; Doppler ultrasound recordings of lower-limb distal arteries showed a tendency toward normalization of pulse-wave morphology, with increase of amplitude in 12 of the 23 patients studied; a rise in skin temperature was also detected by thermography. Distal arterial blood pressure remained unchanged with stimulation. Ischemic cutaneous trophic lesions of less than 3 sq cm healed, but gangrenous conditions were not benefited. A placebo effect or the natural history of the disease can be excluded as the reason for these improvements. It is concluded that spinal cord stimulation is a valid alternative treatment for moderate peripheral arterial disorders when direct arterial surgery is not possible or has been unsuccessful.

Spinal cord stimulation (SCS) was used in 49 cases to control resistant deafferentation pain resulting from causalgia, phantom limb, plexus and nerve root avulsion, postherpetic neuralgia, reflex sympathetic dystrophy and amputation. In all cases, one or two Standard percutaneous leads were introduced into the epidural space and manipulated until the spinal segment at which external stimulation provoked paresthesic sensation in the painful area. Two weeks of external stimulation trial was used to determine the efficiency of the system. Pulse width of 0.1–0.2 ms, a rate of 80–120 cps and amplitude to low paresthesia theshold were programed as electric parameters. In 36 out of the 49 tested cases showing a positive response to percutaneous SCS, the device was permanently implanted. After a mean follow-up of 5.5 years, 57% of patients had satisfactory pain relief (over 75 %). Side effects were limited to dislodgement of the electrode in 1 case and wire extrusion in another, both requiring replacement of the stimulator.

Today it is accepted that chronic infusion of baclofen produces significant relaxation and drastic reduction of spasms, amelioration of cramping pain and improvement of sphincter functions in spasticity of spinal cord origin. Based on these results our group had the opportunity of treating 11 cases with refractory spasticity and dystonic symptoms due to central damage caused by head injury in 8 cases and to cerebral palsy in 3 using cervical intrathecal infusion of baclofen. During the trial period with percutaneous intrathecal infusion of a daily bolus of 12.5–75 µg of baclofen through a reservoir, improvement of mentation and speech conditions, marked improvement of dystonic and abnormal movements of the upper limbs and trunk and a notable reduction of hypertonia were observed in all cases, which led to a better performance of motor activities in skilled acts and transfer. With these preliminary results in mind, in all cases the previous cervical subarachnoid catheter was attached to a programmable pump that infused a daily total dose varying from 100 to 190 µg of baclofen in a continuous or multistep complex mode. After a mean follow-up of 21 months previous results were long-lasting. Neither overdose side effects nor malfunction of the system were observed.

Sixty laminectomies were performed in dogs to investigate the prevention of the laminectomy membrane and its side effects. These operations were distributed in six groups of 10, one was a control group, and in the others the bone defect was protected with different materials (Oxicel, Silastic, Dacron, methyl methacrylate, and Kiel bone graft). After a survival of 2 months, suboccipital myelography was performed, immediately after which the animals were sacrificed and the operated spinal slice obtained. The different radiographic densities of the tissues of each slice were calculated and the diverse histological nature identified by hematoxylin and eosin, periodic acid Schiff, Masson's trichrome, and Gomori's reticulin strains. Only the acrylic plastic and the Kiel bone graft prevented expansion of the scar tissue inside the spinal canal and adhesions between the dura and the cicatrical overlying muscles. Therefore, the authors suggest that a solid barrier is necessary to effectively prevent the so-called "laminectomy membrane."

On the basis of previous experimental and clinical studies, 14 patients with severe spasticity due to central or spinal cord damage, resistant to all conservative treatments, were selected after a percutaneous trial period for chronic intrathecal baclofen infusion by programmable pumps. The agent was delivered at C₄ in quadriplegic patients or in cases with central spasticity and in the neighbouring areas on the affected segments in paraplegic patients. The daily baclofen dose varied from 25 to 260 µg and was infused in a bolus, continuously infused or both combined according to the results during the trial period. After a mean follow-up period of 11 months, constant decrease of rigidity, absence of spasms, improvement of bladder function, cramping pain remission, and moderate improvement in walking capacity and transfer activities were usually observed. Neither complications nor side effects were noted.