Spinal Cord Stimulation Electrode Design: A Prospective, Randomized, Controlled Trial Comparing Percutaneous with Laminectomy Electrodes: Part II–Clinical Outcomes

North, Richard B.; Kidd, David H.; Olin, John; Sieracki, Jeffrey M.

doi:10.1227/01.neu.0000180030.00167.b9

Cited by 162 publications

(125 citation statements)

References 39 publications

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“…46 During programming, the stimulation is initiated at 1 mA, with the pulse width fixed at 300 μsec, and increased until an improvement is noted by the patient. Once the patient experiences a difference in the tinnitus percept, the amplitude, pulse width, and frequency are adjusted by increasing and decreasing the individual parameters to what yields best suppression of the phantom percept.…”

Section: Discussionmentioning

confidence: 99%

Theta-gamma dysrhythmia and auditory phantom perception

Ridder¹,

Loo²,

Vanneste³

et al. 2011

JNS

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Tinnitus is considered an auditory phantom percept analogous to phantom pain. Thalamocortical dysrhythmia has been proposed as a possible pathophysiological mechanism for both tinnitus and pain. Thalamocortical dysrhythmia refers to a persistent pathological resting state theta-gamma coupling that is spatially localized at an area where normally alpha oscillations predominate. Auditory cortex stimulation via implanted electrodes has been developed to treat tinnitus, targeting an area of activation on functional MR imaging elicited by tinnitus-matched sound presentation. The authors describe a case in which clinical improvement was correlated with changes in intracranial recordings. Maximal tinnitus suppression was obtained by current delivery exactly at the blood oxygen level-dependent activation hotspot, which colocalizes with increased gamma and theta activity, in contrast to the other electrode poles, which demonstrated a normal alpha peak. These spectral changes normalized when stimulation induced tinnitus suppression, both on electrode and source-localized electroencephalography recordings. These data suggest that thetagamma coupling as proposed by the thalamocortical dysrhythmia model might be causally related to a conscious auditory phantom percept.

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Section: Discussionmentioning

confidence: 99%

Theta-gamma dysrhythmia and auditory phantom perception

Ridder¹,

Loo²,

Vanneste³

et al. 2011

JNS

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“…It should be mentioned that placement of wire leads has been in clinical use for several decades for control of spasticity and pain, including failed back surgery syndrome and radicular pain syndrome. [30][31][32][33][34][35][36] A clinical trial of this technology will be necessary, however, to establish the safety and efficacy of this method in persons with SCI.…”

Section: Discussionmentioning

confidence: 99%

Comparison of wire and disc leads to activate the expiratory muscles in dogs

Kowalski

DiMarco

2011

The Journal of Spinal Cord Medicine

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Objective: Respiratory complications account for a major cause of morbidity and mortality in subjects with spinal cord injury (SCI) due to paralysis of the expiratory muscles and the consequent inability to generate effective cough. We demonstrated previously that effective cough can be restored in SCI via spinal cord stimulation (SCS) with disc leads positioned on the lower thoracic and upper lumbar spinal cord via laminotomy incisions. In this study, the effectiveness of wire leads, which can be placed using minimally invasive techniques, to activate the expiratory muscles was evaluated. Design: Animal study. Setting: Research laboratory. Animals: Dogs (n = 8).Interventions: In separate trials, disc and wire leads were inserted onto the dorsal epidural space at the T9, T11, and L1 spinal cord levels. Effects of electrical stimulation with disc, single wire, and two wire leads placed in parallel were compared. Outcome measures: Airway pressure generation following stimulation with disc and various configurations of wire leads were compared. Results: Several different configurations of wire leads resulted in airway pressures that were similar to those generated with monopolar stimulation with disc leads (MSDLs). For example, combined monopolar stimulation with parallel wire leads at the T9 + T11 and T9 + L1 levels resulted in airway pressures that were 103.5 ± 6.4 and 101.9 ± 7.0%, respectively, of those achieved with MSDL. Bipolar stimulation with parallel wire leads at T9-T11 and T9-L1 resulted in airway pressures that were 94.2 ± 3.4 and 96.8 ± 5.0%, respectively, of the pressures achieved with MSDL. Other wire configurations were also evaluated, but were generally less effective. Conclusion: These results suggest that specific configurations of wire leads, which can be placed via minimally invasive techniques, result in comparable activation of the expiratory muscles compared to disc leads and may be a useful technique to restore cough in persons with SCI.

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“…31 No superiority of SCS over control (2B−) was noted when comparing laminectomy to percutaneous electrodes, 26 SCS to repeat lumbosacral surgery, or burst stimulation to 500-Hz or sham stimulation ( 28 found that position-adaptive stimulation provided a 69% patient-perceived improvement in activity, a 57.8% improvement perceived in the control group, and a 47.9% patient-rated improvement in sleep, when compared with manually adjusted stimulation ( Table 3).…”

Section: Functional Capacitymentioning

confidence: 99%

“…24,[26][27][28][29][30][31] Outcomes-specific data are reported in Table 3. The earliest study, by North et al, 24 in 2005, compared SCS with repeated lumbosacral spine surgery for FBSS patients, which yielded a difference of 35.8% (P < 0.01) in the primary outcome (≥50% pain relief ) favoring the SCS group at 3 years' follow-up, albeit with a small sample size in a single center.…”

Section: Perceived Pain Relief or Change In Pain Scorementioning

confidence: 99%

Spinal Cord Stimulation 50 Years Later

Mekhail

Visnjevac

Azer

et al. 2018

Regional Anesthesia and Pain Medicine

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To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization. Interventions were SCS, without limitation to the type of controls or the type of SCS in the active arms. For each study analyzed, a quality assessment was performed using a validated scale that assesses reporting, external validity, bias, confounding, and power. Each outcome was assessed specific to its indication, and the primary measure of each abovementioned outcome was a summary of the level of evidence. Twenty-one randomized controlled trials were analyzed (7 for trunk and limb pain, inclusive of failed back surgery syndrome; 8 for refractory angina pectoris; 1 for cardiac X syndrome; 3 for critical limb ischemia; 2 for complex regional pain syndrome; and 2 for painful diabetic neuropathy). Evidence assessments for each outcome for each indication were depicted in tabular format. Outcome-specific evidence scores were established for each of the abovementioned indications, providing both physicians and patients with a summary of evidence to assist in choosing the optimal evidence-based intervention. The evidence presented herein has broad applicability as it encompasses a breadth of patient populations, variations of SCS therapy, and comparable controls that, together, reflect comprehensive clinical decision making.

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Spinal Cord Stimulation Electrode Design: A Prospective, Randomized, Controlled Trial Comparing Percutaneous with Laminectomy Electrodes: Part II–Clinical Outcomes

Cited by 162 publications

References 39 publications

Theta-gamma dysrhythmia and auditory phantom perception

Theta-gamma dysrhythmia and auditory phantom perception

Comparison of wire and disc leads to activate the expiratory muscles in dogs

Spinal Cord Stimulation 50 Years Later

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