Laminectomy versus Percutaneous Electrode Placement for Spinal Cord Stimulation

Villavicencio, Alan T.; Lévêque, Jean; Rubin, Linda; Bulsara, Ketan R.; Gorecki, John P.

doi:10.1097/00006123-200002000-00025

Cited by 141 publications

(101 citation statements)

References 19 publications

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“…These leads are passed through a 14-gauge needle, inserted into the epidural space (usually) 4-6 levels caudal to the desired level and then threaded up under fluoroscopic guidance Paddle leads require a more invasive procedure for placement (1-or 2-level laminotomy) and higher initial cost, but are much less likely to require revision or repositioning due to spontaneous lead migration. 10 The procedure is performed in either an operating room or fluoroscopy suite, using sterile technique.…”

Section: Vasodilationmentioning

confidence: 99%

Managing Chronic Pain With Spinal Cord Stimulation

Epstein

Palmieri

2012

Mount Sinai J Medicine

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Since its introduction as a procedure of last resort in a terminally ill patient with intractable cancer‐related pain, spinal cord stimulation has been used to effectively treat chronic pain of varied origins. Spinal cord stimulation is commonly used for control of pain secondary to failed back surgery syndrome and complex regional pain syndrome, as well as pain from angina pectoris, peripheral vascular disease, and other causes. By stimulating one or more electrodes implanted in the posterior epidural space, the patient feels paresthesias in their areas of pain, which reduces the level of pain. Pain is reduced without the side effects associated with analgesic medications. Patients have improved quality of life and improved function, with many returning to work. Spinal cord stimulation has been shown to be cost effective as compared with conservative management alone. There is strong evidence for efficacy and cost effectiveness of spinal cord stimulation in the treatment of pain associated with intractable angina, failed back surgery syndrome, and complex regional pain syndrome. In this article, we review the history and pathophysiology of spinal cord stimulation, and the evidence (or lack thereof) for efficacy in common clinical practice. Mt Sinai J Med 79:123–132, 2012. © 2012 Mount Sinai School of Medicine

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Section: Vasodilationmentioning

confidence: 99%

Managing Chronic Pain With Spinal Cord Stimulation

Epstein

Palmieri

2012

Mount Sinai J Medicine

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“…21, 33 The goal of this narrative review is to examine the evidence supporting safety of the SCS technique among patients being managed for PPNP after lumbar spinal surgery for degenerative disease.…”

mentioning

confidence: 99%

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

Shamji

Westwick

Heary

2015

FOC

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OBJECT Structural spinal surgery yields improvement in pain and disability for selected patients with spinal stenosis, spondylolisthesis, or a herniated intervertebral disc. A significant fraction of patients exhibit persistent postoperative neuropathic pain (PPNP) despite technically appropriate intervention, and such patients can benefit from spinal cord stimulation (SCS) to alleviate suffering. The complication profile of this therapy has not been systematically assessed and, thus, was the goal of this review. METHODS A comprehensive literature search was performed to identify prospective cohorts of patients who had PPNP following structurally corrective lumbar spinal surgery and who underwent SCS device implantation. Data about study design, technique of SCS lead introduction, and complications encountered were collected and analyzed. Comparisons of complication incidence were performed between percutaneously and surgically implanted systems, with the level of significance set at 0.05. RESULTS Review of 11 studies involving 542 patients formed the basis of this work: 2 randomized controlled trials and 9 prospective cohorts. Percutaneous implants were used in 4 studies and surgical implants were used in 4 studies; in the remainder, the types were undefined. Lead migration occurred in 12% of cases, pain at the site of the implantable pulse generator occurred in 9% of cases, and wound-related complications occurred in 5% of cases; the latter 2 occurred more frequently among surgically implanted devices. CONCLUSIONS Spinal cord stimulation can provide for improved pain and suffering and for decreased narcotic medication use among patients with PPNP after lumbar spinal surgery. This study reviewed the prospective studies forming the evidence base for this therapy, to summarize the complications encountered and, thus, best inform patients and clinicians considering its use. There is a significant rate of minor complications, many of which require further surgical intervention to manage, including lead migration or implant infection, although such complications do not directly threaten patient life or function.

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“…In addition, percutaneous procedures at the cervical level were not familiar for neurosurgeons. As electrode placed via laminectomy can have significant longterm effectiveness for epidural stimulation 22) . Moreover, complications such as lead migration and positional stimulation occurred more frequently with percutaneous lead insertion than with surgical type lead insertion 22) .…”

Section: Discussionmentioning

confidence: 99%

“…As electrode placed via laminectomy can have significant longterm effectiveness for epidural stimulation 22) . Moreover, complications such as lead migration and positional stimulation occurred more frequently with percutaneous lead insertion than with surgical type lead insertion 22) . Few reports on the effect of spinal cord stimulation for treatment of chronic pain after spinal cord injury have appeared.…”

Section: Discussionmentioning

confidence: 99%

High-Level Cervical Spinal Cord Stimulation Used to Treat Intractable Pain Arising from Transverse Myelitis Caused by Schistosomiasis

Kim

Hong

Lee

2010

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 47 : [151][152][153][154] 2010 The efficacy of spinal cord stimulation (SCS) for treatment of various chronic painful conditions is well established. Very few reports have documented the use of SCS for treatment of chronic pain after spinal cord injury. We present a case showing a good outcome after such treatment, and suggest that high cervical stimulation may be efficacious. A 53-year-old male underwent SCS on the C1-3 level for treatment of intractable neuropathic pain below the T3 level, and in the upper extremities, arising from spinal cord injury resulting from transverse myelitis caused by schistosomiasis. High cervical SCS significantly improved the pain in the upper extremities and at the T3-T10 dermatome level. The patient continues to report excellent pain relief 9 months later. The present case suggests that high cervical stimulation may improve chronic pain in the upper extremities and the T3-T10 dermatome level arising from spinal cord injury.

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Laminectomy versus Percutaneous Electrode Placement for Spinal Cord Stimulation

Cited by 141 publications

References 19 publications

Managing Chronic Pain With Spinal Cord Stimulation

Managing Chronic Pain With Spinal Cord Stimulation

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

High-Level Cervical Spinal Cord Stimulation Used to Treat Intractable Pain Arising from Transverse Myelitis Caused by Schistosomiasis

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