No abstract

This retrospective study includes 53 patients who underwent reoperation after failure of lumbar disc surgery to relieve pain. All patients had leg pain before reoperation, which was successful in 28% of cases. Most clinical features, such as persistence or mode of recurrence of pain, radicular quality of pain, positive straight-leg raising, and myelographic root sleeve defects, were not helpful in predicting successful and unsuccessful reoperations. However, a significantly larger percentage of women than men had successful reoperations. Patients who had past or pending compensation claims, who had sensory loss involving more than one dermatome, or who failed to have myelographic dural sac indentations resembling those caused by a herniated disc did poorly with reoperation. A very convincing myelographic defect appears to be needed to justify reoperation at a previously unoperated location. Excision of scar alone or dorsal rhizotomy was of no avail in these cases.

No abstract

A prospective study of a large number of spinal stimulating electrodes permitted a statistical comparison of stimulus parameters, including phase, polarity and orientation of bipolar electrodes. For the treatment of pain, the technical grade of a stimulator is proportional to the range of stimulation, which was found to be significantly greater under the conditions listed in the title.

Twenty-two patients with chronic pain, chiefly from posttraumatic neuropathy, were treated by implanted peripheral nerve stimulators located proximal to the pain. Thirteen of these (62%) have experienced pain control for an average of 25 months. The experience of the surgeon is thought to be a major factor contributing to the successful results. There are theoretical and practical advantages to electrical stimulation and proximal portions of the peripheral nervous system. The surgical technique for implantation is described and the necessity for reoperation in some patients is explained.