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Lequin MB, Verbaan D, Schuurman PR, Tasche S, Peul WC, Vandertop WP, Bouma GJ. The long-term outcome of revision microdiscectomy for recurrent sciatica. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08199-5. [PMID: 38512504 DOI: 10.1007/s00586-024-08199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/29/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To study the long-term outcome of revision microdiscectomy after classic microdiscectomy for lumbosacral radicular syndrome (LSRS). METHODS Eighty-eight of 216 patients (41%) who underwent a revision microdiscectomy between 2007 and 2010 for MRI disc-related LSRS participated in this study. Questionnaires included visual analogue scores (VAS) for leg pain, RDQ, OLBD, RAND-36, and seven-point Likert scores for recovery, leg pain, and back pain. Any further lumbar re-revision operation(s) were recorded. RESULTS Mean (SD) age was 59.8 (12.8), and median [IQR] time of follow-up was 10.0 years [9.0-11.0]. A favourable general perceived recovery was reported by 35 patients (40%). A favourable outcome with respect to perceived leg pain was present in 39 patients (45%), and 35 patients (41%) reported a favourable outcome concerning back pain. The median VAS for leg and back pain was worse in the unfavourable group (48.0/100 mm (IQR 16.0-71.0) vs. 3.0/100 mm (IQR 2.0-5.0) and 56.0/100 mm (IQR 27.0-74.0) vs. 4.0/100 mm (IQR 2.0-17.0), respectively; both p < 0.001). Re-revision operation occurred in 31 (35%) patients (24% same level same side); there was no significant difference in the rate of favourable outcome between patients with or without a re-revision operation. CONCLUSION The long-term results after revision microdiscectomy for LSRS show an unfavourable outcome in the majority of patients and a high risk of re-revision microdiscectomy, with similar results. Based on also the disappointing results of alternative treatments, revision microdiscectomy for recurrent LSRS seems to still be a valid treatment. The results of our study may be useful to counsel patients in making appropriate treatment choices.
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Affiliation(s)
- M B Lequin
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - D Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Saskia Tasche
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - W C Peul
- Department of Neurosurgery, University Neurosurgical Center Holland, UMC | HMC | HAGA, Leiden, The Hague, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - G J Bouma
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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Krishnan J, Joseph R, Vayalappil MC, Krishnan S, Kishore A. A Review on Implantable Neuroelectrodes. Crit Rev Biomed Eng 2024; 52:21-39. [PMID: 37938182 DOI: 10.1615/critrevbiomedeng.2023049282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The efficacy of every neuromodulation modality depends upon the characteristics of the electrodes used to stimulate the chosen target. The geometrical, chemical, mechanical and physical configuration of electrodes used in neurostimulation affects several performance attributes like stimulation efficiency, selectivity, tissue response, etc. The efficiency of stimulation in relation to electrode impedance is influenced by the electrode material and/or its geometry. The nature of the electrode material determines the charge transfer across the electrode-tissue interface, which also relates to neuronal tissue damage. Electrode morphology or configuration pattern can facilitate the modulation of extracellular electric field (field shaping). This enables selective activation of neurons and minimizes side effects. Biocompatibility and biostability of the electrode materials or electrode coating have a role in glial formation and tissue damage. Mechanical and electrochemical stability (corrosion resistance) determines the long-term efficacy of any neuromodulation technique. Here, a review of electrodes typically used for implantable neuromodulation is discussed. Factors affecting the performance of electrodes like stimulation efficiency, selectivity and tissue responses to the electrode-tissue interface are discussed. Technological advancements to improve electrode characteristics are also included.
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Affiliation(s)
- Jithin Krishnan
- Department of Medical Devices Engineering, BMT Wing, SCTIMST, Kerala, India
| | - Roy Joseph
- Department of Medical Devices Engineering, BMT Wing, SCTIMST, Kerala, India
| | | | | | - Asha Kishore
- Aster Parkinson & Movement Disorder Centre, Senior Consultant Neurologist and Movement Disorder Specialist
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3
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Kirketeig T, Söreskog E, Jacobson T, Karlsten R, Zethraeus N, Borgström F. Real-world outcomes in spinal cord stimulation: predictors of reported effect and explantation using a comprehensive registry-based approach. Pain Rep 2023; 8:e1107. [PMID: 38027468 PMCID: PMC10653578 DOI: 10.1097/pr9.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/04/2023] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Despite advancements in implanted hardware and development of novel stimulation paradigms in Spinal Cord Stimulation (SCS), real world evidence suggests a large variation in patient reported outcomes and a proportion of patients are later explanted due to loss of analgesia. Possible predictors for outcome have been explored in smaller short-term evaluations, but few clinically applicable robust measures for long term outcome have emerged. Methods We performed a comprehensive retrospective study based on an assembled patient-level aggregated database from multiple local and national registries in Sweden. Variables associated with risk of explantation (due to insufficient analgesia) and analgesic effect was analyzed using a Cox regression analysis and an ordered logit regression model, respectively. Results We found the accumulated risk of explantation due to loss of analgesia to be 10% and 21% at two and ten years follow up, respectively. The use of 10 kHz spinal cord stimulation (compared with Tonic waveform; p = 0.003), and being 60 years or older (reference 18-40 years; p = 0.003) were associated with an increased risk of explantation.At a mean follow up at 1 year, 48% of patients reported a pain intensity reduction from baseline of at least 30%. Secondary (p = 0.030) and post-secondary (p = 0.001) education (compared with primary education) was associated with an increased probability of successful patient reported outcomes. Conclusion This study suggests that a higher educational level and being employed are associated with successful treatment outcome in patients with chronic pain treated with SCS in Sweden.
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Affiliation(s)
- Terje Kirketeig
- Akademiska Sjukhuset, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Emma Söreskog
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | - Rolf Karlsten
- Akademiska Sjukhuset, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Puylaert M, Nijs L, Buyse K, Vissers K, Vanelderen P, Nagels M, Daenekindt T, Weyns F, Mesotten D, Van Zundert J, Van Boxem K. Long-Term Outcome in Patients With Spinal Cord Stimulation for Failed Back Surgery Syndrome: A 20-Year Audit of a Single Center. Neuromodulation 2023; 26:1433-1440. [PMID: 35577695 DOI: 10.1016/j.neurom.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN This is a retrospective, observational study. INTRODUCTION Spinal cord stimulation (SCS) has found its application in chronic pain treatment, with failed back surgery syndrome (FBSS) as one of the most important indications. However, to date, little is known about the long-term effectiveness of the treatment. The aim of this study is to analyze retrospectively the long-term outcomes of SCS treatment in a single multidisciplinary pain center on predominant radicular pain, using devices of a single manufacturer. MATERIALS AND METHODS Patient data on overall patient satisfaction, pain intensity, and adverse events were retrospectively collected in our clinical practice between January 1998 and January 2018, for 191 patients who received a permanent SCS implant. Secondary health measures included the influence of opioid and nicotine use on pain reduction after therapy. RESULTS The trial-to-implant ratio was 93.6%. At a mean follow-up of 10.6 years, 78.5% of the patients were satisfied with the treatment outcome, with a significant pain reduction of an average three points on a Numeric Rating Scale. Opioid and nicotine usage did not have a significant link with the pain reduction one year after the treatment. Furthermore, devices had an average battery lifespan of 8.4 years. A total of 248 revisions were recorded. A total of 24 patients (11.7%) acquired an infection; 7 of 204 patients had an infection during the trial period, 2 of 191 patients had an infection in the first postoperative year, and 15 of 191 patients had an infection after the first year. The average time to infection, if not in the first year, was 10.1 years. CONCLUSIONS A successful long-term outcome regarding pain relief in patients with predominant radicular pain due to FBSS is established with SCS therapy.
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Affiliation(s)
- Martine Puylaert
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - Lynn Nijs
- KU Leuven, Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, Leuven, Belgium
| | - Klaas Buyse
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pascal Vanelderen
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University and Limburg Clinical Research Center, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Margot Nagels
- Department of Medicine, Hasselt University, Hasselt, Belgium
| | | | - Frank Weyns
- Hasselt University and Limburg Clinical Research Center, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dieter Mesotten
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University and Limburg Clinical Research Center, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands.
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Shirvalkar P, Poree L. How SAFE Is Real-world Use of Spinal Cord Stimulation Therapy for Chronic Pain? JAMA Neurol 2023; 80:10-11. [PMID: 36441541 DOI: 10.1001/jamaneurol.2022.3471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Prasad Shirvalkar
- Division of Pain Medicine, Department of Anesthesiology, University of California, San Francisco.,Department of Neurological Surgery, University of California, San Francisco.,Department of Neurology, University of California, San Francisco.,Weill Institute of Neurosciences, University of California, San Francisco
| | - Lawrence Poree
- Division of Pain Medicine, Department of Anesthesiology, University of California, San Francisco
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Gill JS, Kohan LR, Hasoon J, Urits I, Viswanath O, Cai VL, Yazdi C, Aner MM, Kaye AD, Simopoulos TT. A Survey on the Choice of Spinal Cord Stimulation Parameters and Implantable Pulse Generators and on Reasons for Explantation. Orthop Rev (Pavia) 2022; 14:39648. [PMID: 36381501 PMCID: PMC9662606 DOI: 10.52965/001c.39648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE Spinal Cord Stimulation (SCS) is a vital treatment for chronic intractable pain. In the last few years, the field has undergone dramatic changes in new waveform and frequency introduction as well as device miniaturization. It is important to understand contemporary practice patterns regarding these parameters. METHODS We surveyed the active membership of Spine Intervention Society (SIS), and American Society of Regional Anesthesia (ASRA) on their practices regarding various aspects of Spinal Cord Stimulation therapy. Here we report on SCS waveform usage, battery types, and causes of explant in this cohort of providers. RESULTS There was similar degree of usage of tonic, burst, and 10 kHz usage at 71.5%, 74.1% and 61.7% respectively. Dorsal root ganglion stimulation was used by 32.6% and other modes of stimulation by 13.5%. Rechargeable systems were often or always used by 67.2% whereas 10% never used a rechargeable system. Most common cause of explant was loss of effectiveness, reported by 53.7%. CONCLUSION There has been significant adoption of new waveforms in daily practice of spinal cord stimulation therapy and there is robust mixed usage of new waveforms and frequencies. Rechargeable systems are the most commonly used but primary cell is also used in significant numbers. Loss of efficacy remains the most common cause of explant for the majority of practitioners. This survey establishes practice patterns of SCS usage regarding these important variables against which future changes can be gauged.
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Affiliation(s)
- Jatinder S Gill
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Lynn R Kohan
- University of Virginia Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Charlottesville, VA
| | - Jamal Hasoon
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
- UTHealth McGovern Medical School, Department of Anesthesia and Pain Medicine, Houston, TX
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Omar Viswanath
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA
- Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, AZ
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
- University of Arizona College of Medicine Phoenix, Department of Anesthesiology, Phoenix, AZ
| | - Viet L Cai
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Musa M Aner
- Dartmouth-Hitchcock Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Dartmouth Medical School, Lebanon, NH
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Thomas T Simopoulos
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
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Novel Therapies for the Treatment of Neuropathic Pain: Potential and Pitfalls. J Clin Med 2022; 11:jcm11113002. [PMID: 35683390 PMCID: PMC9181614 DOI: 10.3390/jcm11113002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022] Open
Abstract
Neuropathic pain affects more than one million people across the globe. The quality of life of people suffering from neuropathic pain has been considerably declining due to the unavailability of appropriate therapeutics. Currently, available treatment options can only treat patients symptomatically, but they are associated with severe adverse side effects and the development of tolerance over prolonged use. In the past decade, researchers were able to gain a better understanding of the mechanisms involved in neuropathic pain; thus, continuous efforts are evident, aiming to develop novel interventions with better efficacy instead of symptomatic treatment. The current review discusses the latest interventional strategies used in the treatment and management of neuropathic pain. This review also provides insights into the present scenario of pain research, particularly various interventional techniques such as spinal cord stimulation, steroid injection, neural blockade, transcranial/epidural stimulation, deep brain stimulation, percutaneous electrical nerve stimulation, neuroablative procedures, opto/chemogenetics, gene therapy, etc. In a nutshell, most of the above techniques are at preclinical stage and facing difficulty in translation to clinical studies due to the non-availability of appropriate methodologies. Therefore, continuing research on these interventional strategies may help in the development of promising novel therapies that can improve the quality of life of patients suffering from neuropathic pain.
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Dorsal Column Stimulation and Cannabinoids in the Treatment of Chronic Nociceptive and Neuropathic Pain: a Review of the Clinical and Pre-clinical Data. Curr Pain Headache Rep 2022; 26:103-118. [PMID: 35119602 DOI: 10.1007/s11916-022-01008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The main objective of this review is to appraise the literature on the role of spinal cord stimulation (SCS), cannabinoid therapy, as well as SCS and cannabinoid combination therapy for the management of chronic neuropathic and nociceptive pain. Current research suggests that SCS reduces pain and increases functional status in carefully selected patients with minimal side effects. RECENT FINDINGS As cannabinoid-based medications become a topic of increasing interest in pain management, data remains limited regarding the clinical efficacy of cannabinoids for pain relief. Furthermore, from a mechanistic perspective, although various pain treatment modalities utilize overlapping pain-signaling pathways, clarifying whether cannabinoids work synergistically with SCS via shared mechanisms remains to be determined. In considering secondary outcomes, the current literature suggests cannabinoids improve quality of life, specifically sleep quality, and that SCS decreases opioid consumption, increases functional capacity, and decreases long-term healthcare costs. These findings, along with the high safety profiles of SCS and cannabinoids overall, incentivize further exploration of cannabinoids as an adjunctive therapy to SCS in the treatment of neuropathic and nociceptive pain.
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9
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Shlobin NA, Rosenow JM. Ethical Considerations in the Implantation of Neuromodulatory Devices. Neuromodulation 2022; 25:222-231. [PMID: 35125141 DOI: 10.1111/ner.13357] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Neuromodulatory devices are increasingly used by neurosurgeons to manage a variety of chronic conditions. Given their potential benefits, it is imperative to create clear ethical guidelines for the use of these devices. We present a tiered ethical framework for neurosurgeon recommendations for the use of neuromodulatory devices. MATERIALS AND METHODS We conducted a literature review to identify factors neurosurgeons should consider when choosing to offer a neuromodulatory device to a patient. RESULTS Neurosurgeons must weigh reductions in debilitating symptoms, improved functionality, and preserved quality of life against risks for intraoperative complications and adverse events due to stimulation or the device itself. Neurosurgeons must also evaluate whether patients and families will maintain responsibility for the management of neuromodulatory devices. Consideration of these factors should occur on an axis of resource allocation, ranging from provision of neuromodulatory devices to those with greatest potential benefit in resource-limited settings to provision of neuromodulatory devices to all patients with indications in contexts without resource limitations. Neurosurgeons must also take action to promote device effectiveness throughout the duration of care. CONCLUSIONS Weighing risks and benefits of providing neuromodulatory devices and assessing ability to remain responsible for the devices on the level of the individual patient indicate which patients are most likely to achieve benefit from these devices. Consideration of these factors on an axis of resource allocation will allow for optimal provision of neuromodulatory devices to patients in settings of varied resources. Neurosurgeons play a primary role in promoting the effectiveness of these devices.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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10
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Henson JV, Varhabhatla NC, Bebic Z, Kaye AD, Yong RJ, Urman RD, Merkow JS. Spinal Cord Stimulation for Painful Diabetic Peripheral Neuropathy: A Systematic Review. Pain Ther 2021; 10:895-908. [PMID: 34244979 PMCID: PMC8586096 DOI: 10.1007/s40122-021-00282-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/15/2021] [Indexed: 01/22/2023] Open
Abstract
Painful diabetic neuropathy is a common disease that results in significant pain and disability. Treatment options have traditionally consisted of conservative measures including topical and oral medication management as well as transcutaneous electrical stimulation units. These treatments demonstrate various degrees of efficacy, and many times initial treatments are discontinued, indicating low levels of satisfaction or poor tolerability. Spinal cord stimulation has been proposed as an alternative therapy for treatment of painful diabetic neuropathy of the lower extremities. We performed a systematic literature review to evaluate the safety and effectiveness of this procedure. A literature search identified 14 prospective studies. Based on our analysis of the available evidence, there is moderate-quality evidence for the safety and efficacy of spinal cord stimulation for painful diabetic neuropathy. However, further high-quality research, including a large-scale randomized controlled trial is warranted.
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Affiliation(s)
- Josianna V. Henson
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Narayana C. Varhabhatla
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Zvonimir Bebic
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana Statement University, New Orleans, LA USA
| | - R. Jason Yong
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Richard D. Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Justin S. Merkow
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045 USA
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11
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Spinal cord stimulation in chronic neuropathic pain: mechanisms of action, new locations, new paradigms. Pain 2021; 161 Suppl 1:S104-S113. [PMID: 33090743 PMCID: PMC7434213 DOI: 10.1097/j.pain.0000000000001854] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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McClure JJ, Desai BD, Ampie L, You W, Smith JS, Buchholz AL. A Systematic Review of the Cost-Utility of Spinal Cord Stimulation for Persistent Low Back Pain in Patients With Failed Back Surgery Syndrome. Global Spine J 2021; 11:66S-72S. [PMID: 33890806 PMCID: PMC8076810 DOI: 10.1177/2192568220970163] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To review the literature surrounding the cost-effectiveness of implanting spinal cord stimulators for failed back surgery syndrome. METHODS A systematic review was conducted inclusive of all publications in the Medline database and Cochrane CENTRAL trials register within the last 10 years (English language only) assessing the cost-effectiveness of Spinal Cord Stimulator device implantation (SCSdi) in patients with previous lumbar fusion surgery. RESULTS The majority of reviewed publications that analyzed cost-effectiveness of SCSdi compared to conventional medical management (CMM) or re-operation in patients with failed back surgery syndrome (FBSS) showed an overall increase in direct medical costs; these increased costs were found in nearly all cases to be offset by significant improvements in patient quality of life. The cost required to achieve these increases in quality adjusted life years (QALY) falls well below $25 000/QALY, a conservative estimate of willingness to pay. CONCLUSIONS The data suggest that SCSdi provides both superior outcomes and a lower incremental cost: effectiveness ratio (ICER) compared to CMM and/or re-operation in patients with FBSS. These findings are in spite of the fact that the majority of studies reviewed were agnostic to the type of device or innervation utilized in SCSdi. Newer devices utilizing burst or higher frequency stimulation have demonstrated their superiority over traditional SCSdi via randomized clinical trials and may provide lower ICERs.
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Affiliation(s)
- Jesse J. McClure
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA
| | - Bhargav D. Desai
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA
| | - Leonel Ampie
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA,Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Wen You
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA
| | - Justin S. Smith
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA
| | - Avery L. Buchholz
- Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA,Avery L. Buchholz, Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA.
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13
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The dimensions of "failed back surgery syndrome": what is behind a label? Acta Neurochir (Wien) 2021; 163:245-250. [PMID: 32875358 DOI: 10.1007/s00701-020-04548-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The term failed back surgery syndrome (FBSS) has been criticized for being too unspecific and several studies have shown that a variety of conditions may underlie this label. The aims of the present study were to describe the specific symptoms and to investigate the primary and secondary underlying causes of FBSS in a contemporary series of patients who had lumbar spinal surgery before. METHODS We used a multilevel approach along three different axes defining symptomatic, morphological, and functional pathology dimensions. RESULTS Within the study period of 3 years, a total of 145 patients (74 f, 71 m, mean age 51a, range 32-82a) with the external diagnosis of FBSS were included. Disk surgery up to 4 times and surgery for spinal stenosis up to 3 times were the commonest index operations. Most often, the patients complained of low back pain (n = 126), pseudoradicular pain (n = 54), and neuropathic pain (n = 44). Imaging revealed osteochondrosis (n = 61), spondylarthrosis (n = 48), and spinal misalignment (n = 32) as the most frequent morphological changes. The majority of patients were assigned at least to two different symptomatic subcategories and morphological subcategories, respectively. According to these findings, one or more functional pathologies were assigned in 131/145 patients that subsequently enabled a specific treatment strategy. CONCLUSIONS FBSS has become rather a vague and imprecisely used generic term. We suggest that it should be avoided in the future both with regard to its partially stigmatizing connotation and its inherent hindering to provide individualized medicine.
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Hamm-Faber TE, Engels Y, Vissers KCP, Henssen DJHA. Views of patients suffering from Failed Back Surgery Syndrome on their health and their ability to adapt to daily life and self-management: A qualitative exploration. PLoS One 2020; 15:e0243329. [PMID: 33284851 PMCID: PMC7721158 DOI: 10.1371/journal.pone.0243329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023] Open
Abstract
Background The clinical outcomes of Spinal Cord Stimulation (SCS) therapy in patients with a Failed Back Surgery Syndrome (FBSS) is mostly done by standardized pain and quality of life measurements instruments and hardly account for personal feelings and needs as a basis for a patient-centred approach and shared decision making. Objectives The objective of this study is to explore perspectives on personal health and quality of life (QoL) in FBSS patients concerning their physical-, psychological and spiritual well-being prior to receiving an SCS system. Methods We performed face-to-face, semi-structured, in-depth interviews to obtain descriptive and detailed data on personal health, guided by the Web diagram of Positive Health (Huber et al.) and a topic list. The following main topics were assessed qualitatively: 1) Bodily functioning, 2) Mental function and perception 3) Spiritual dimension, 4) Quality of life, 5) Social and societal participation and 6) Daily functioning. Results Seventeen FBSS patients (eight male, nine female) were included from April–November 2019 at the department of pain medicine in the Albert Schweitzer Hospital in the Netherlands. Median age 49 years; range 28 to 67 years, and patients underwent between one and five lumbar surgical operations. The duration of their chronic pain was between four and 22 years. After analyzing the interviews, three themes emerged: 1) dealing with chronic pain, 2) the current situation regarding aspects of positive health, and 3) future perspectives on health and quality of life. These themes arose from eleven categories and a hundred ninety codes. Conclusion This qualitative study explored FBSS patients ‘views on their health and the ability to adapt to daily life having complex chronic pain, and showed that patients experienced shortcomings in daily life within the six dimensions of the Web diagram of Positive Health before the SCS implant.
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Affiliation(s)
- Tanja E. Hamm-Faber
- Department of Pain Medicine, Albert Schweitzer Hospital, Zwijndrecht, The Netherlands
- * E-mail:
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kris C. P. Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dylan J. H. A. Henssen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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Rigoard P, Billot M, Ingrand P, Durand-Zaleski I, Roulaud M, Peruzzi P, Dam Hieu P, Voirin J, Raoul S, Page P, Djian MC, Fontaine D, Lantéri-Minet M, Blond S, Buisset N, Cuny E, Cadenne M, Caire F, Ranoux D, Mertens P, Naous H, Simon E, Emery E, Béraud G, Debiais F, Durand G, Serrie A, Diallo B, Bulsei J, Ounajim A, Nivole K, Duranton S, Naiditch N, Monlezun O, Bataille B. How Should we Use Multicolumn Spinal Cord Stimulation to Optimize Back Pain Spatial Neural Targeting? A Prospective, Multicenter, Randomized, Double-Blind, Controlled Trial (ESTIMET Study). Neuromodulation 2020; 24:86-101. [PMID: 32865344 DOI: 10.1111/ner.13251] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent studies have highlighted multicolumn spinal cord stimulation (SCS) efficacy, hypothesizing that optimized spatial neural targeting provided by new-generation SCS lead design or its multicolumn programming abilities could represent an opportunity to better address chronic back pain (BP). OBJECTIVE To compare multicolumn vs. monocolumn programming on clinical outcomes of refractory postoperative chronic BP patients implanted with SCS using multicolumn surgical lead. MATERIALS AND METHODS Twelve centers included 115 patients in a multicenter, randomized, double-blind, controlled trial. After randomization, leads were programmed using only one or several columns. The primary outcome was change in BP visual analogic scale (VAS) at six months. All patients were then programmed using the full potential of the lead up until 12-months follow-up. RESULTS At six months, there was no significant difference in clinical outcomes whether the SCS was programmed using a mono or a multicolumn program. At 12 months, in all patients having been receiving multicolumn SCS for at least six months (n = 97), VAS decreases were significant for global pain (45.1%), leg pain (55.8%), and BP (41.5%) compared with baseline (p < 0.0001). CONCLUSION The ESTIMET study confirms the significant benefit experienced on chronic BP by patients implanted with multicolumn SCS, independently from multicolumn lead programming. These good clinical outcomes might result from the specific architecture of the multicolumn lead, giving the opportunity to select initially the best column on a multicolumn grid and to optimize neural targeting with low-energy requirements. However, involving more columns than one does not appear necessary, once initial spatial targeting of the "sweet spot" has been achieved. Our findings suggest that this spatial concept could also be transposed to cylindrical leads, which have drastically improved their capability to shape the electrical field, and might be combined with temporal resolution using SCS new modalities.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France.,Department of Neurosurgery, Spine & Neurostimulation Unit, Poitiers University Hospital, Poitiers, France.,UPR 3346, CNRS, P' Institute, Futuroscope, Faculty of Sciences, Poitiers, France
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Pierre Ingrand
- Faculty of Medicine and Pharmacy, Poitiers University Hospital, Poitiers, France
| | | | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Philippe Peruzzi
- Department of Neurosurgery, Reims University Hospital, Reims, France
| | - Phong Dam Hieu
- Department of Neurosurgery, Brest University Hospital, Brest, France
| | - Jimmy Voirin
- Department of Neurosurgery, Colmar Hospital, Colmar, France
| | - Sylvie Raoul
- Department of Neurosurgery, Nantes University Hospital, Nantes, France
| | - Philippe Page
- Department of Neurosurgery, Spine & Neurostimulation Unit, Poitiers University Hospital, Poitiers, France
| | | | - Denys Fontaine
- Centre Hospitalier Universitaire de Nice, Department of Neurosurgery, Université Côte d'Azur, Nice, France.,FHU InovPain, Côte Azur University, Nice, France
| | - Michel Lantéri-Minet
- FHU InovPain, Côte Azur University, Nice, France.,Pain Evaluation and Treatment Centre, Nice University Hospital, Nice, France.,INSERM U1107, Neuro-Dol, Trigeminal Pain and Migraine, Auvergne University, Clermont-Ferrand, France
| | - Serge Blond
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Nadia Buisset
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Emmanuel Cuny
- Department of Neurosurgery, Bordeaux University Hospital, Bordeaux, France
| | - Myriam Cadenne
- Pain Evaluation and Treatment Centre, Bordeaux University Hospital, Bordeaux, France
| | - François Caire
- Department of Neurosurgery, Limoges University Hospital, Limoges, France
| | - Danièle Ranoux
- Pain Evaluation and Treatment Centre, Limoges University Hospital, Limoges, France
| | - Patrick Mertens
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | - Hussein Naous
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | - Emile Simon
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Guillaume Béraud
- Internal Medicine/Infectious and Tropical Diseases Department, Poitiers University Hospital, Poitiers, France
| | - Françoise Debiais
- Department of Rheumatology, Poitiers University Hospital, Poitiers, France
| | - Géraldine Durand
- Department of Rheumatology, Poitiers University Hospital, Poitiers, France
| | - Alain Serrie
- Pain Evaluation and Treatment Centre, Lariboisière Hospital, Paris, France
| | - Bakari Diallo
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, Poitiers, France
| | - Julie Bulsei
- Clinical Research Unit in Economics, Hôtel Dieu, Paris, France
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Kevin Nivole
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Sophie Duranton
- Vigilance Department, Clinical Research Direction, Poitiers University Hospital, Poitiers, France
| | - Nicolas Naiditch
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Olivier Monlezun
- PRISMATICS Lab (Predictive Research In Spine/neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Benoit Bataille
- Department of Neurosurgery, Spine & Neurostimulation Unit, Poitiers University Hospital, Poitiers, France
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Remacle T, Mauviel S, Renwart HJ, Ghassempour K, Belle F, Lückers O, Bex V, Remacle JM, Bonhomme V. Long-Term Multicolumn-Lead Spinal Cord Stimulation Efficacy in Patients with Failed Back Surgery Syndrome: A Six-Year Prospective Follow-up Study. World Neurosurg 2020; 142:e245-e252. [PMID: 32599205 DOI: 10.1016/j.wneu.2020.06.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The use of multicolumn-lead spinal cord stimulation (SCS) to control back pain (BP) and leg pain (LP) in patients with failed back surgery syndrome (FBSS) in the short term and mid-term has been well documented. Our study investigated whether SCS remained efficient after 72 months. METHODS In an observational, single-center study, we assessed SCS efficacy in 62 patients with FBSS patients. BP, LP, and magnitude of daily activity limitation (DAL) were graded using a 0-10 visual analog scale (VAS) preoperatively and at 2, 6, 12, 24, 36, and 72 months after SCS implantation. Sleep quality, use of medications, and complications were also recorded. RESULTS Of the 62 patients, 15 with complete follow-up data available were still using their SCS device at 72 months (SCS+). For these patients, the VAS scores for BP, LP, and DAL had changed from a median of 9 (interquartile range [IQR], 8.5-10), 7 (IQR, 6-8), and 8 (IQR, 8-9) preoperatively to a median of 4 (IQR, 3-4.5), 3 (IQR, 1.5-3.5), and 3 (IQR, 2-4) at 72 months. Their quality of sleep and analgesic medication consumption had also improved. In a subset of patients no longer using the SCS device after 72 months (SCS-), the VAS scores for BP, LP, and DAL, quality of sleep, and medication consumption were comparable to those for the SCS+ group. The SCS- group was less satisfied with the technique and were less professionally active than were the SCS+ group. CONCLUSIONS The SCS device provides sustained beneficial effects on BP, LP, DAL, sleep, and medication consumption in patients with FBSS still using it at 72 months postoperatively. Further studies are needed to identify the factors of adherence to the technique and the chances of success compared with the natural evolution of FBSS.
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Affiliation(s)
- Thibault Remacle
- Department of Neurosurgery, Regional Hospital Center Citadelle, Liege, Belgium; Department of Neurosurgery, University Hospital Center Liege, Liege, Belgium.
| | - Stephane Mauviel
- Department of Algology, Regional Hospital Center Citadelle, Liege, Belgium
| | - Henri-Jean Renwart
- Department of Neurosurgery, Regional Hospital Center Citadelle, Liege, Belgium
| | - Keyvan Ghassempour
- Department of Neurosurgery, Regional Hospital Center Citadelle, Liege, Belgium
| | - Frederic Belle
- Department of Neurosurgery, Regional Hospital Center Citadelle, Liege, Belgium
| | - Olivier Lückers
- Department of Neurosurgery, Regional Hospital Center Citadelle, Liege, Belgium
| | - Vincent Bex
- Department of Neurosurgery, Regional Hospital Center Citadelle, Liege, Belgium
| | - Jean-Michel Remacle
- Department of Neurosurgery, Regional Hospital Center Citadelle, Liege, Belgium
| | - Vincent Bonhomme
- Department of Algology, Regional Hospital Center Citadelle, Liege, Belgium; University Department of Anesthesia and Intensive Care Medicine, Regional Hospital Center Citadelle, Liege, Belgium; Department of Anesthesia and Intensive Care Medicine, University Hospital Center Liege, Liege, Belgium; Anesthesia and Intensive Care Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
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17
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Mehta SH, Hoelscher CM, Sharan AD, Thalheimer S, Wu C. Implantable Pulse Generator Site May Be Associated With Spinal Cord Stimulation Revision Surgeries. Neuromodulation 2019; 24:1336-1340. [PMID: 31215711 DOI: 10.1111/ner.12976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/06/2019] [Accepted: 05/01/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The use of implantable pulse generators (IPG) for spinal cord stimulation (SCS) in patients with chronic pain has been well established. Although IPG-related complications have been reported on, the association between IPG site and SCS complications has not been well studied. OBJECTIVE To investigate whether IPG placement site in buttock or flank is associated with SCS complications and, hence, revision surgeries. METHOD A retrospective cohort study was performed that included 330 patients (52% female) treated at a single institution who underwent permanent implantation of an SCS system between 2014 and 2018. Patients ranged between 20 and 94 years of age (mean: 57.54 ± 13.25). Statistical analyses were conducted using IBM SPSS Statistics. Tests included independent samples t test, chi-square test, Mann-Whitney U test, Spearman's rank correlation coefficient, and logistic regression. RESULTS There was a total of 93 revision surgeries (rate of 28%), where 71 out of 330 patients (rate of 21.5%) had had at least one revision surgery. Univariate tests demonstrated a significant association between IPG site and revision surgeries (p = 0.028 [chi-square test] and p = 0.031 [Mann-Whitney U test]); however, multivariate logistic regression demonstrated that neither IPG site was more likely than the other to require revision surgeries (p = 0.286). CONCLUSION Although this study found a significant association between IPG site and revision surgeries, the effect of IPG site was not found to be predictive. The IPG site likely influences whether a patient will require revision surgery, but further investigation is required to establish this association.
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Affiliation(s)
- Shyle H Mehta
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christian M Hoelscher
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sara Thalheimer
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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18
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Flight L, Arshad F, Barnsley R, Patel K, Julious S, Brennan A, Todd S. A Review of Clinical Trials With an Adaptive Design and Health Economic Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:391-398. [PMID: 30975389 DOI: 10.1016/j.jval.2018.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/28/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE An adaptive design uses data collected as a clinical trial progresses to inform modifications to the trial. Hence, adaptive designs and health economics aim to facilitate efficient and accurate decision making. Nevertheless, it is unclear whether the methods are considered together in the design, analysis, and reporting of trials. This review aims to establish how health economic outcomes are used in the design, analysis, and reporting of adaptive designs. METHODS Registered and published trials up to August 2016 with an adaptive design and health economic analysis were identified. The use of health economics in the design, analysis, and reporting was assessed. Summary statistics are presented and recommendations formed based on the research team's experiences and a practical interpretation of the results. RESULTS Thirty-seven trials with an adaptive design and health economic analysis were identified. It was not clear whether the health economic analysis accounted for the adaptive design in 17/37 trials where this was thought necessary, nor whether health economic outcomes were used at the interim analysis for 18/19 of trials with results. The reporting of health economic results was suboptimal for the (17/19) trials with published results. CONCLUSIONS Appropriate consideration is rarely given to the health economic analysis of adaptive designs. Opportunities to use health economic outcomes in the design and analysis of adaptive trials are being missed. Further work is needed to establish whether adaptive designs and health economic analyses can be used together to increase the efficiency of health technology assessments without compromising accuracy.
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Affiliation(s)
- Laura Flight
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Fahid Arshad
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Rachel Barnsley
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Kian Patel
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Steven Julious
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Alan Brennan
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Susan Todd
- Department of Mathematics and Statistics, University of Reading, Reading, England, UK
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19
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Designing and conducting proof-of-concept chronic pain analgesic clinical trials. Pain Rep 2019; 4:e697. [PMID: 31583338 PMCID: PMC6749910 DOI: 10.1097/pr9.0000000000000697] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction: The evolution of pain treatment is dependent on successful development and testing of interventions. Proof-of-concept (POC) studies bridge the gap between identification of a novel target and evaluation of the candidate intervention's efficacy within a pain model or the intended clinical pain population. Methods: This narrative review describes and evaluates clinical trial phases, specific POC pain trials, and approaches to patient profiling. Results: We describe common POC trial designs and their value and challenges, a mechanism-based approach, and statistical issues for consideration. Conclusion: Proof-of-concept trials provide initial evidence for target use in a specific population, the most appropriate dosing strategy, and duration of treatment. A significant goal in designing an informative and efficient POC study is to ensure that the study is safe and sufficiently sensitive to detect a preliminary efficacy signal (ie, a potentially valuable therapy). Proof-of-concept studies help avoid resources wasted on targets/molecules that are not likely to succeed. As such, the design of a successful POC trial requires careful consideration of the research objective, patient population, the particular intervention, and outcome(s) of interest. These trials provide the basis for future, larger-scale studies confirming efficacy, tolerability, side effects, and other associated risks.
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Bose R, Banerjee AD. Spinal cord stimulation for complex regional pain syndrome type I with spinal myoclonus – a case report and review of literature. Br J Neurosurg 2019:1-3. [DOI: 10.1080/02688697.2018.1552755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ratnadip Bose
- Consultant Neurosurgeon, Institute of Neurosciences, Medanta The Medicity, Gurgaon, Haryana, India
| | - Anirban Deep Banerjee
- Senior Consultant Neurosurgeon, Institute of Neurosciences, Medanta The Medicity, Gurgaon, Haryana, India
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Jain S, Fishman MA, Wu C. Significant cephalad lead migration with use of externally powered spinal cord stimulator. BMJ Case Rep 2018; 2018:bcr-2018-225813. [PMID: 30244224 DOI: 10.1136/bcr-2018-225813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neuromodulation devices. Externally powered neuromodulation devices, that do not require an internal pulse generator (IPG) implantation, have recently been approved for treatment of chronic pain and the data on potential pitfalls and unforeseen complications with these devices is minimal. Here, we report a case of a 60-year-old woman with chronic back pain who underwent the implantation of one of such devices and developed complication that required neurosurgical intervention. The epidural stimulator leads in the patient migrated cranially to the T2 level that required extensive neurosurgical exploration. We believe this is the first reported case of such significant cranial epidural lead migration with the use of neurostimulation devices and demands more research into the safety of externally powered neurostimulation devices.
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Affiliation(s)
- Sameer Jain
- Pain Management, Pain Treatment Centers of America, Little rock, Arkansas, USA
| | - Michael A Fishman
- Pain Management, Center for Interventional Pain and Spine, Wilmington, Delaware, USA
| | - Chengyuan Wu
- Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Unique aspects of clinical trials of invasive therapies for chronic pain. Pain Rep 2018; 4:e687. [PMID: 31583336 PMCID: PMC6749926 DOI: 10.1097/pr9.0000000000000687] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022] Open
Abstract
Nearly all who review the literature conclude that the role of invasive procedures to treat chronic pain is poorly characterized because of the lack of “definitive” studies. The overt nature of invasive treatments, along with the risks, technical skills, and costs involved create challenges to study them. However, these challenges do not completely preclude evaluating invasive procedure effectiveness and safety using well-designed methods. This article reviews the challenges of studying outcomes of invasive therapies to treat pain and discuss possible solutions. Although the following discussion can apply to most invasive therapies to treat chronic pain, it is beyond the scope of the article to individually cover every invasive therapy used. Therefore, most of the examples focus on injection therapies to treat spine pain, spinal cord stimulation, and intrathecal drug therapies.
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Gupta M, Rajak BL, Bhatia D, Mukherjee A. Neuromodulatory effect of repetitive transcranial magnetic stimulation pulses on functional motor performances of spastic cerebral palsy children. J Med Eng Technol 2018; 42:352-358. [PMID: 30175934 DOI: 10.1080/03091902.2018.1510555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Neuromodulation is emerging as a new therapeutic field towards treatment of neurological disorders through advances in medical devices. Repetitive Transcranial Magnetic Stimulation (rTMS) is one such neuromodulatory device that has received increasing interest as a tool for modulating cortical excitability that influence motor activity in both normal and diseased population. However, the therapeutic effect of rTMS varies depending on stimulation frequency, intensity, pulse trains, duration, etc. Our previous studies had already demonstrated that higher frequency of 10 Hz was effective in improving the motor activity of spastic CP patients. OBJECTIVE This study was aimed to evaluate the effect of different rTMS pulses on gross motor performance of spastic CP patients. METHOD Thirty spastic CP patients were divided equally into three groups P1500, P2000 and P2500 with mean age (in years) 7.7 ± SD4.4, 6.8 ± SD5.3 and 7.2 ± SD5.1 respectively. Gross Motor Function Measure (GMFM) was employed as an outcome measure to assess the motor performance. Constant rTMS frequency of 10 Hz was delivered to each participant but the number of stimulation pulse varied according to the groups; which were 1500, 2000 and 2500 pulses for P1500, P2000 and P2500 group respectively. rTMS therapy of 15 minutes duration was followed by physical therapy of 30 minutes daily for 20 days. RESULT Statistical analysis of pre versus post GMFM scores of different groups revealed significant result (p < .001) and the improvement in functional motor activity was 2.33% in P1500, 3.58% in P2000 and 5.17% in P2500 group. INTERPRETATION The result demonstrated modulatory effect of rTMS pulse by improving motor function of spastic CP patients.
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Affiliation(s)
- Meena Gupta
- a Department of Biomedical Engineering , North Eastern Hill University , Shillong , India
| | - Bablu Lal Rajak
- a Department of Biomedical Engineering , North Eastern Hill University , Shillong , India
| | - Dinesh Bhatia
- a Department of Biomedical Engineering , North Eastern Hill University , Shillong , India
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Kashcheev AA, Gushcha AO, Tjurnikov VM, Arestov SO, Vershinin AV, Dreval’ MD, Poltorako EN, Petrosyan DV. SPINAL CORD STIMULATION FOR FAIL BACK SURGERY SYNDROME: LITERATURE REVIEW AND CLINICAL STUDY. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181703193251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: Fail back surgery syndrome (FBSS) is a common cause of pain following spine surgery, and is associated with persistent or recurrent pain despite anatomically correct intervention. Spinal cord stimulation (SCS) is regarded as one of the most effective methods of treatment for fail back surgery syndrome. Methods: We studied 34 patients who underwent test stimulation and chronic SCS for FBSS. Results: Six months postoperatively, mean improvement by the visual analog scale (VAS) of average and maximum daily pain, and the painDETECT score, were 54.4%, 50.7% and 57.3%, respectively. This meets the criteria for effectiveness of the method, according to the literature. Most of patients reported significant improvements in life quality and less need for analgesics. Complications were seen in nine patients (26.4%) and included: intraoperative dura injury (one patient, 2.9%), wound infection (one patient, 2.9%), and electrode displacement (seven patients, 20.5%). No cases of postoperative neurological deterioration were seen. Conclusions: SCS is safe and effective for the treatment of neuropathic pain caused by FBSS. Level of Evidence IV; Case series.
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Remacle T, Gilis N, Mauviel S, Remacle JM. Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation. J Vis Exp 2018. [PMID: 30010647 DOI: 10.3791/56804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Failed back surgery syndrome (FBSS) refers to persistent, chronic pain following spinal surgery. Spinal cord stimulation with dorsal epidural leads can be used to treat back and leg pain in FBSS patients. This paper presents a detailed protocol for using spinal cord stimulation with surgical leads in FBSS patients. In our department, with the patient under general anesthesia, we place the lead in the epidural space by means of a small laminectomy at the 10th thoracic level. Placement of the lead is followed by a 1 month trial period with an externalized lead. If pain relief is greater than 50% at the end of this 1 month stimulation trial (required by Belgian reimbursement criteria), an internal pulse generator is then placed under the skin and connected to the lead in a second surgical procedure. We have demonstrated that using this technique in rigorously selected FBSS patients can significantly improve back pain, leg pain, patient activity, and quality of life for a sustained period of time.
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Abstract
Objectives A significant number of chronic pain patients rely on spinal cord stimulation (SCS) for treatment of their intractable pain. A screening trial using percutaneous electrodes is an integral step for predicting a successful treatment course with a permanent SCS system. Most of these trials are performed in an outpatient ambulatory surgical center and some in the office setting. However, there are select patients who are considered poor candidates for percutaneous trials. We present the initial report of patients who have received surgical implantation of permanent paddle-leads for SCS trials at our institution and show that this was a safe and effective alternative for our patients who could not undergo percutaneous trials. Methods We retrospectively reviewed the hospital charts of 12 patients who underwent permanent surgically-implanted paddle-lead trials from 2014 to 2017. Success was considered positive with a 50% reduction in pain rating. If positive, patients were brought back to the operating room to have the implanted leads connected to an internalized pulse generator. Results All 12 patients met the criteria for a successful trial. Only one patient had his SCS system surgically removed after nine months. None of our patients reported or returned with paddle-lead migrations or infections. Conclusions We report that surgically-implanted paddle-lead trials were a safe and effective alternative to percutaneous trials in our patients who were deemed poor candidates for percutaneous trials. No complications occurred and all of our patients received a second surgery for internalization of the SCS system. Patients who have previously failed percutaneous trials may be false-negatives to SCS.
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Affiliation(s)
- Jonathan J Lee
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, USA
| | - Richard K Simpson
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, USA
| | - Brian Dalm
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, USA
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Hunter CW, Carlson J, Yang A, Deer T. Spinal Cord Stimulation for the Treatment of Failed Neck Surgery Syndrome: Outcome of a Prospective Case Series. Neuromodulation 2018; 21:495-503. [DOI: 10.1111/ner.12769] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Ajax Yang
- Department of Physical Medicine & Rehabilitation, Ichan School of Medicine; Mount Sinai Hospital; New York NY USA
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Abstract
Neuropathic pain after spinal surgery, the so-called failed back surgery syndrome (FBSS), is a frequently observed troublesome disease entity. Although medications may be effective to some degree, many patients continue experiencing intolerable pain and functional disability. Only gabapentin has been proven effective in patients with FBSS. No relevant studies regarding manipulation or physiotherapy for FBSS have been published. Spinal cord stimulation (SCS) has been widely investigated as a treatment option for chronic neuropathic pain, including FBSS. SCS was generally accepted to improve chronic back and leg pain, physical function, and sleep quality. Although the cost effectiveness of SCS has been proved in many studies, its routine application is limited considering that it is invasive and is associated with safety issues. Percutaneous epidural adhesiolysis has also shown good clinical outcomes; however, its effects persisted for only a short period. Because none of the current methods provide absolute superiority in terms of clinical outcomes, a multidisciplinary approach is required to manage this complex disease. Further studies concerning the etiology, diagnosis, treatment, and cost effectiveness of FBSS are warranted to deepen our understanding of this condition.
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Pope JE, Deer TR, Falowski S, Provenzano D, Hanes M, Hayek SM, Amrani J, Carlson J, Skaribas I, Parchuri K, McRoberts WP, Bolash R, Haider N, Hamza M, Amirdelfan K, Graham S, Hunter C, Lee E, Li S, Yang M, Campos L, Costandi S, Levy R, Mekhail N. Multicenter Retrospective Study of Neurostimulation With Exit of Therapy by Explant. Neuromodulation 2017; 20:543-552. [DOI: 10.1111/ner.12634] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/23/2017] [Accepted: 05/20/2017] [Indexed: 12/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maged Hamza
- Midatlantic Spine Specialists; Richmond, VA USA
| | | | - Sean Graham
- Spine Diagnostic and Treatment; Baton Rouge, LA USA
| | - Corey Hunter
- Ainsworth Institute of Pain Management; New York, NY USA
| | - Eric Lee
- Summit Pain Alliance; Santa Rosa CA USA
| | - Sean Li
- Premier Pain Centers, East Brunswick; NJ USA
| | | | | | | | - Robert Levy
- Boca Raton Regional Hospital; Boca Raton FL USA
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Remacle TY, Bonhomme VL, Renwart HJP, Remacle JM. Effect of Multicolumn Lead Spinal Cord Stimulation on Low Back Pain in Failed Back Surgery Patients: A Three-Year Follow-Up. Neuromodulation 2017; 20:668-674. [DOI: 10.1111/ner.12603] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Vincent Luce Bonhomme
- Department of Anesthesia and Intensive Care Medicine; CHR Citadelle and CHU University, Hospital of Liège; Liège Belgium
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Collison C, Prusik J, Paniccioli S, Briotte M, Grey R, Feustel P, Pilitsis JG. Prospective Study of the Use of Intraoperative Neuromonitoring in Determining Post-Operative Energy Requirements and Physiologic Midline in Spinal Cord Stimulation. Neuromodulation 2017; 20:575-581. [PMID: 28370852 DOI: 10.1111/ner.12590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/12/2016] [Accepted: 01/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intraoperative neuromonitoring (IONM) through electromyography (EMG) studies has been shown to be a safe, effective way to determine the laterality of the spinal cord and guide electrode placement during spinal cord stimulation (SCS). However, the use of IONM to predict post-operative energy requirements and midline has not been examined and offers a new avenue to streamline programming and device selection. Further, the impact of cerebrospinal fluid (CSF) thickness on intraoperative and post-operative amplitudes is understood but has not been explicitly characterized. METHODS A total of 24 patients undergoing SCS implantation for chronic pain had intraoperative EMG studies performed to determine physiologic midline. The intraoperative midline was compared to the midline determined on post-operative day 1 based on paresthesia patterns during programming. For patients who had thoracic leads placed, the amplitudes needed to induce abdominal and extremity lateralization during SCS placement were compared with the intensities needed to induce therapy at post-operative day 1. Additionally, we examined whether CSF thickness, body mass index, diabetes, drug use, and smoking correlated with intraoperative and post-operative amplitudes. RESULTS Intraoperative EMG was able to predict post-operative paresthesia-based midline in 70.83% of patients. There was a statistically significant relationship between the intraoperative intensity needed to induce extremity lateralization with the post-operative intensity to induce therapy (p = 0.009) as well as the intraoperative intensity needed to stimulate abdominals with the post-operative intensity (p = 0.033). There was also a relationship seen between CSF thickness and the post-operative energy requirements in patients (p = 0.039). DISCUSSION EMG accurately predicts post-operative energy requirements and midline in SCS patients. While 29.17% of patients did not have a match between their intraoperative and post-operative midlines, EMG testing was still valuable in guiding electrode placement and providing information to predict post-operative intensities. Additionally, CSF thickness correlated with amplitude settings on the first post-operative day.
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Affiliation(s)
- Claire Collison
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Julia Prusik
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neurology, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | | | | | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
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Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers 2017; 3:17002. [PMID: 28205574 PMCID: PMC5371025 DOI: 10.1038/nrdp.2017.2] [Citation(s) in RCA: 1149] [Impact Index Per Article: 164.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7-10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain.
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Affiliation(s)
- Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing and Department of Anesthesiology School of Medicine, University of Maryland, 655 West Lombard Street, 21201 Baltimore, Maryland, USA
| | - Taylor Ludman
- Department of Pain and Translational Symptom Science, School of Nursing and Department of Anesthesiology School of Medicine, University of Maryland, 655 West Lombard Street, 21201 Baltimore, Maryland, USA
| | - Didier Bouhassira
- INSERM, Unit 987, Ambroise Paré Hospital, UVSQ, Boulogne Billancourt, France
| | - Ralf Baron
- Department of Neurology, Division of Neurological Pain Research and Therapy, Klinik fur Neurologie Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - David Yarnitsky
- Department of Neurology, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Nadine Attal
- Pain Evaluation and Treatment Centre of Hôpital Ambroise Paré, Paris, France
| | - Nanna B Finnerup
- Department of Clinical Medicine - The Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eija Kalso
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Robert H Dworkin
- Department of Anesthesiology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lind AL, Emami Khoonsari P, Sjödin M, Katila L, Wetterhall M, Gordh T, Kultima K. Spinal Cord Stimulation Alters Protein Levels in the Cerebrospinal Fluid of Neuropathic Pain Patients: A Proteomic Mass Spectrometric Analysis. Neuromodulation 2017; 19:549-62. [PMID: 27513633 DOI: 10.1111/ner.12473] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Electrical neuromodulation by spinal cord stimulation (SCS) is a well-established method for treatment of neuropathic pain. However, the mechanism behind the pain relieving effect in patients remains largely unknown. In this study, we target the human cerebrospinal fluid (CSF) proteome, a little investigated aspect of SCS mechanism of action. METHODS Two different proteomic mass spectrometry protocols were used to analyze the CSF of 14 SCS responsive neuropathic pain patients. Each patient acted as his or her own control and protein content was compared when the stimulator was turned off for 48 hours, and after the stimulator had been used as normal for three weeks. RESULTS Eighty-six proteins were statistically significantly altered in the CSF of neuropathic pain patients using SCS, when comparing the stimulator off condition to the stimulator on condition. The top 12 of the altered proteins are involved in neuroprotection (clusterin, gelsolin, mimecan, angiotensinogen, secretogranin-1, amyloid beta A4 protein), synaptic plasticity/learning/memory (gelsolin, apolipoprotein C1, apolipoprotein E, contactin-1, neural cell adhesion molecule L1-like protein), nociceptive signaling (neurosecretory protein VGF), and immune regulation (dickkopf-related protein 3). CONCLUSION Previously unknown effects of SCS on levels of proteins involved in neuroprotection, nociceptive signaling, immune regulation, and synaptic plasticity are demonstrated. These findings, in the CSF of neuropathic pain patients, expand the picture of SCS effects on the neurochemical environment of the human spinal cord. An improved understanding of SCS mechanism may lead to new tracks of investigation and improved treatment strategies for neuropathic pain.
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Affiliation(s)
- Anne-Li Lind
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Payam Emami Khoonsari
- Department of Medical Sciences, Cancer Pharmacology and Computational Medicine, Uppsala University, Uppsala, Sweden
| | - Marcus Sjödin
- Department of Chemistry-BMC, Analytical Chemistry, Uppsala University, Uppsala//GE Healthcare, Sweden
| | - Lenka Katila
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Magnus Wetterhall
- Department of Chemistry-BMC, Analytical Chemistry, Uppsala University, Uppsala//GE Healthcare, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Kim Kultima
- Department of Medical Sciences, Cancer Pharmacology and Computational Medicine, Uppsala University, Uppsala, Sweden
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Choi JG, Ha SW, Son BC. Comparison of Clinical Efficacy and Computed Tomographic Analysis of Lead Position Between Three-Column and Five-Column Paddle Leads Spinal Cord Stimulation for Failed Back Surgery Syndrome. World Neurosurg 2017; 97:292-303. [DOI: 10.1016/j.wneu.2016.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 11/26/2022]
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Tan D, Tyler D, Sweet J, Miller J. Intensity Modulation: A Novel Approach to Percept Control in Spinal Cord Stimulation. Neuromodulation 2015; 19:254-9. [PMID: 26479774 DOI: 10.1111/ner.12358] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/11/2015] [Accepted: 09/01/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) can be effective for neuropathic pain, but clinical benefit is sometimes inadequate or is offset by stimulation-induced side-effects, and response can be inconsistent among patients. Intensity-modulated stimulation (IMS) is an alternative to tonic stimulation (TS) that involves continuous variation of stimulation intensity in a sinusoidal pattern between two different values, sequentially activating distinct axonal populations to produce an effect that resembles natural physiological signals. The purpose of this study is to evaluate the effect of IMS on the clinical effect of SCS. METHODS Seven patients undergoing a percutaneous SCS trial for postlaminectomy syndrome were enrolled. Thresholds for perception, pain relief, and discomfort were measured and used to create patient-specific models of axonal activation and charge delivery for both TS and IMS. All participants underwent three two-min periods of blinded stimulation using TS, IMS, and placebo, and were asked to describe the effect on quality of the sensory percept and pain relief. RESULTS All participants perceived IMS differently from placebo, and five noted significant differences from TS that resulted in a more comfortable sensation. TS was described as electric and tingling, whereas IMS was described as producing a focal area of deep pressure with a sense of motion away from that focus. The anatomic location of coverage was similar between the two forms of stimulation, although one participant reported better lower back coverage with IMS. Computer modeling revealed that, compared with TS, IMS involved 36.4% less charge delivery and produced 78.7% less suprathreshold axonal activation. CONCLUSIONS IMS for SCS is feasible, produces a more comfortable percept than conventional TS, and appears to provide a similar degree of pain relief with significantly lower energy requirements. Further studies are necessary to determine whether this represents an effective alternative to tonic SCS for treatment of neuropathic pain.
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Affiliation(s)
- Daniel Tan
- The Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Dustin Tyler
- The Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Jennifer Sweet
- The Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Jonathan Miller
- The Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
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Walsh KM, Machado AG, Krishnaney AA. Spinal cord stimulation: a review of the safety literature and proposal for perioperative evaluation and management. Spine J 2015; 15:1864-9. [PMID: 25957536 DOI: 10.1016/j.spinee.2015.04.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/03/2015] [Accepted: 04/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There is currently no consensus on appropriate perioperative management of patients with spinal cord stimulator implants. Magnetic resonance imaging (MRI) is considered safe under strict labeling conditions. Electrocautery is generally not recommended in these patients but sometimes used despite known risks. PURPOSE The aim was to discuss the perioperative evaluation and management of patients with spinal cord stimulator implants. STUDY DESIGN A literature review, summary of device labeling, and editorial were performed, regarding the safety of spinal cord stimulator devices in the perioperative setting. METHODS A literature review was performed, and the labeling of each Food and Drug Administration (FDA)-approved spinal cord stimulation system was reviewed. The literature review was performed using PubMed and the FDA website (www.fda.gov). RESULTS Magnetic resonance imaging safety recommendations vary between the models. Certain systems allow for MRI of the brain to be performed, and only one system allows for MRI of the body to be performed, both under strict labeling conditions. Before an MRI is performed, it is imperative to ascertain that the system is intact, without any lead breaks or low impedances, as these can result in heating of the spinal cord stimulation (SCS) and injury to the patient. Monopolar electrocautery is generally not recommended for patients with SCS; however, in some circumstances, it is used when deemed required by the surgeon. When cautery is necessary, bipolar electrocautery is recommended. Modern electrocautery units are to be used with caution as there remains a risk of thermal injury to the tissue in contact with the SCS. As with MRI, electrocautery usage in patients with SCS systems with suspected breaks or abnormal impedances is unsafe and may cause injury to the patient. CONCLUSIONS Spinal cord stimulation is increasingly used in patients with pain of spinal origin, particularly to manage postlaminectomy syndrome. Knowledge of the safety concerns of SCS and appropriate perioperative evaluation and management of the SCS system can reduce risks and improve surgical planning.
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Affiliation(s)
- Kevin M Walsh
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA.
| | - Andre G Machado
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 500 Euclid Ave., Cleveland, OH 44195, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, 500 Euclid Ave., Cleveland, OH 44195, USA
| | - Ajit A Krishnaney
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Center for Spine Health, Neurological Institute, Cleveland Clinic, 500 Euclid Ave., Cleveland, OH 44195, USA
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Deer TR, Mekhail N, Provenzano D, Pope J, Krames E, Leong M, Levy RM, Abejon D, Buchser E, Burton A, Buvanendran A, Candido K, Caraway D, Cousins M, DeJongste M, Diwan S, Eldabe S, Gatzinsky K, Foreman RD, Hayek S, Kim P, Kinfe T, Kloth D, Kumar K, Rizvi S, Lad SP, Liem L, Linderoth B, Mackey S, McDowell G, McRoberts P, Poree L, Prager J, Raso L, Rauck R, Russo M, Simpson B, Slavin K, Staats P, Stanton-Hicks M, Verrills P, Wellington J, Williams K, North R. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee. Neuromodulation 2015; 17:515-50; discussion 550. [PMID: 25112889 DOI: 10.1111/ner.12208] [Citation(s) in RCA: 304] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/07/2014] [Accepted: 02/28/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications. METHODS The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar. RESULTS Neurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medication-related side effects and has enduring effect. Device-related complications are not uncommon; however, the incidence is becoming less frequent as technology progresses and surgical skills improve. Randomized controlled studies support the efficacy of spinal cord stimulation in treating failed back surgery syndrome and complex regional pain syndrome. Similar studies of neurostimulation for peripheral neuropathic pain, postamputation pain, postherpetic neuralgia, and other causes of nerve injury are needed. International guidelines recommend spinal cord stimulation to treat refractory angina; other indications, such as congestive heart failure, are being investigated. CONCLUSIONS Appropriate neurostimulation is safe and effective in some chronic pain conditions. Technological refinements and clinical evidence will continue to expand its use. The NACC seeks to facilitate the efficacy and safety of neurostimulation.
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Epidural spinal cord stimulation for neuropathic pain: a neurosurgical multicentric Italian data collection and analysis. Acta Neurochir (Wien) 2015; 157:711-20. [PMID: 25646850 DOI: 10.1007/s00701-015-2352-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spinal cord stimulation (SCS) is a technique used worldwide to treat several types of chronic neuropathic pain refractory to any conservative treatment. The aim of this data collection is to enforce evidence of SCS effectiveness on neuropathic chronic pain reported in the literature and to speculate on the usefulness of the trial period in determining the long-term efficacy. Moreover, the very low percentage of undesired side effects and complications reported in our case series suggests that all implants should be performed by similarly well-trained and experienced professionals. METHOD A multicentric data collection on a common database from 11 Italian neurosurgical departments started 3 years ago. Two different types of electrodes (paddle or percutaneous leads) were used. Of 122 patients, 73 % (N = 89) were submitted to a trial period, while the remaining patients underwent the immediate permanent implant (N = 33). Statistical comparisons of continuous variables between groups were performed. RESULTS Most of the patients (80 %) had predominant pain to their lower limbs, while only 17 % of patients had prevalent axial pain. Significant reduction in pain, as measured by variation in visual analogue scale (VAS) score, was observed at least 1 year after implantation in 63.8 % of the cases, 59.5 % of patients who underwent a test trial and 71.4 % of patients who underwent permanent implant at once. No statistical differences were found between the lower-limb pain group and the axial pain group. CONCLUSIONS No relevant differences in long-term outcomes were observed in previously tested patients compared with patients implanted at once. Through this analysis we hope to recruit new centres, to give more scientific value to our results.
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The “neuro-mapping locator” software. A real-time intraoperative objective paraesthesia mapping tool to evaluate paraesthesia coverage of the painful zone in patients undergoing spinal cord stimulation lead implantation. Neurochirurgie 2015; 61 Suppl 1:S90-8. [DOI: 10.1016/j.neuchi.2014.10.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 08/06/2014] [Accepted: 10/08/2014] [Indexed: 11/19/2022]
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Delmotte A, Jacques L, Kumar K, Poon K, Monlezun O, Roulaud M, Prevost A, Munson R, Guetarni F, Bataille B, Rigoard P. The Franco-Canadian multicolumn spinal cord stimulation prospective study: A subgroup analysis focusing on the decisive role of lead positioning. Neurochirurgie 2015; 61 Suppl 1:S83-9. [DOI: 10.1016/j.neuchi.2014.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 06/23/2014] [Accepted: 06/29/2014] [Indexed: 11/26/2022]
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Failed back surgery syndrome: Who has failed? Neurochirurgie 2015; 61 Suppl 1:S6-S14. [DOI: 10.1016/j.neuchi.2014.10.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 07/24/2014] [Accepted: 10/18/2014] [Indexed: 11/24/2022]
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Soin A, Syed Shah N, Fang ZP. High-Frequency Electrical Nerve Block for Postamputation Pain: A Pilot Study. Neuromodulation 2015; 18:197-205; discussion 205-6. [DOI: 10.1111/ner.12266] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/07/2014] [Accepted: 12/04/2014] [Indexed: 11/30/2022]
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Cervical and cervicomedullary spinal cord stimulation for chronic pain: Efficacy and outcomes. Clin Neurol Neurosurg 2014; 127:33-41. [DOI: 10.1016/j.clineuro.2014.09.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/12/2014] [Accepted: 09/28/2014] [Indexed: 11/22/2022]
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Roulaud M, Durand-Zaleski I, Ingrand P, Serrie A, Diallo B, Peruzzi P, Hieu PD, Voirin J, Raoul S, Page P, Fontaine D, Lantéri-Minet M, Blond S, Buisset N, Cuny E, Cadenne M, Caire F, Ranoux D, Mertens P, Naous H, Simon E, Emery E, Gadan B, Regis J, Sol JC, Béraud G, Debiais F, Durand G, Guetarni Ging F, Prévost A, Brandet C, Monlezun O, Delmotte A, d'Houtaud S, Bataille B, Rigoard P. Multicolumn spinal cord stimulation for significant low back pain in failed back surgery syndrome: design of a national, multicentre, randomized, controlled health economics trial (ESTIMET Study). Neurochirurgie 2014; 61 Suppl 1:S109-16. [PMID: 25456442 DOI: 10.1016/j.neuchi.2014.10.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 09/24/2014] [Accepted: 10/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Many studies have demonstrated the efficacy of spinal cord stimulation (SCS) for chronic neuropathic radicular pain over recent decades, but despite global favourable outcomes in failed back surgery syndrome (FBSS) with leg pain, the back pain component remains poorly controlled by neurostimulation. Technological and scientific progress has led to the development of new SCS leads, comprising a multicolumn design and a greater number of contacts. The efficacy of multicolumn SCS lead configurations for the treatment of the back pain component of FBSS has recently been suggested by pilot studies. However, a randomized controlled trial must be conducted to confirm the efficacy of new generation multicolumn SCS. Évaluation médico-économique de la STImulation MEdullaire mulTi-colonnes (ESTIMET) is a multicentre, randomized study designed to compare the clinical efficacy and health economics aspects of mono- vs. multicolumn SCS lead programming in FBSS patients with radicular pain and significant back pain. MATERIALS AND METHODS FBSS patients with a radicular pain VAS score≥50mm, associated with a significant back pain component were recruited in 14 centres in France and implanted with multicolumn SCS. Before the lead implantation procedure, they were 1:1 randomized to monocolumn SCS (group 1) or multicolumn SCS (group 2). Programming was performed using only one column for group 1 and full use of the 3 columns for group 2. Outcome assessment was performed at baseline (pre-implantation), and 1, 3, 6 and 12months post-implantation. The primary outcome measure was a reduction of the severity of low back pain (bVAS reduction≥50%) at the 6-month visit. Additional outcome measures were changes in global pain, leg pain, paraesthesia coverage mapping, functional capacities, quality of life, neuropsychological aspects, patient satisfaction and healthcare resource consumption. TRIAL STATUS Trial recruitment started in May 2012. As of September 2013, all 14 study centres have been initiated and 112/115 patients have been enrolled. Preliminary results are expected to be published in 2015. TRIAL REGISTRATION Clinical trial registration information-URL: www.clinicaltrials.gov. Unique identifier NCT01628237.
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Affiliation(s)
- M Roulaud
- N(3)lab (Neuromodulation and Neural Networks), Inserm CIC 802, Poitiers University Hospital, 86000 Poitiers, France.
| | - I Durand-Zaleski
- Clinical Research Unit in Economics, Hôtel Dieu, 75004 Paris, France
| | - P Ingrand
- Faculty of medicine and pharmacy, Poitiers University Hospital, 86000 Poitiers, France
| | - A Serrie
- Pain Evaluation and Treatment Centre, Lariboisière Hospital, 75010 Paris, France
| | - B Diallo
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86000 Poitiers, France
| | - P Peruzzi
- Department of Neurosurgery, Reims University Hospital, 51092 Reims, France
| | - P D Hieu
- Pain Evaluation and Treatment Centre, Brest University Hospital, 29200 Brest, France
| | - J Voirin
- Department of Neurosurgery, Colmar Hospital, 68024 Colmar, France
| | - S Raoul
- Department of Neurosurgery, Nantes University Hospital, 44093 Nantes, France
| | - P Page
- Department of Neurosurgery, Sainte-Anne Hospital, AP-HP, 75014 Paris, France
| | - D Fontaine
- Department of Neurosurgery, Nice University Hospital, 06003 Nice, France
| | - M Lantéri-Minet
- Department of Neurosurgery, Nice University Hospital, 06003 Nice, France
| | - S Blond
- Department of Neurosurgery, Lille University Hospital, 59037 Lille, France
| | - N Buisset
- Department of Neurosurgery, Lille University Hospital, 59037 Lille, France
| | - E Cuny
- Department of Neurosurgery, Bordeaux University Hospital, 33076 Bordeaux, France
| | - M Cadenne
- Department of Neurosurgery, Bordeaux University Hospital, 33076 Bordeaux, France
| | - F Caire
- Department of Neurosurgery, Limoges University Hospital, 87042 Limoges, France
| | - D Ranoux
- Department of Neurosurgery, Limoges University Hospital, 87042 Limoges, France
| | - P Mertens
- Department of Neurosurgery, Lyon University Hospital, 69677 Lyon, France
| | - H Naous
- Department of Neurosurgery, Lyon University Hospital, 69677 Lyon, France
| | - E Simon
- Department of Neurosurgery, Lyon University Hospital, 69677 Lyon, France
| | - E Emery
- Department of Neurosurgery, Caen University Hospital, 14000 Caen, France
| | - B Gadan
- Department of Neurosurgery, Caen University Hospital, 14000 Caen, France
| | - J Regis
- Department of Neurosurgery, AP-HM, Timone Hospital, 13385 Marseille, France
| | - J-C Sol
- Department of Neurosurgery, Toulouse University Hospital, 31000 Toulouse, France
| | - G Béraud
- Internal Medicine/Infectious and Tropical Diseases Department, Poitiers University Hospital, 86000 Poitiers, France
| | - F Debiais
- Department of Rheumatology, Poitiers University Hospital, 86000 Poitiers, France
| | - G Durand
- Department of Rheumatology, Poitiers University Hospital, 86000 Poitiers, France
| | - F Guetarni Ging
- N(3)lab (Neuromodulation and Neural Networks), Inserm CIC 802, Poitiers University Hospital, 86000 Poitiers, France
| | - A Prévost
- N(3)lab (Neuromodulation and Neural Networks), Inserm CIC 802, Poitiers University Hospital, 86000 Poitiers, France
| | - C Brandet
- N(3)lab (Neuromodulation and Neural Networks), Inserm CIC 802, Poitiers University Hospital, 86000 Poitiers, France
| | - O Monlezun
- N(3)lab (Neuromodulation and Neural Networks), Inserm CIC 802, Poitiers University Hospital, 86000 Poitiers, France
| | - A Delmotte
- Department of Neurosurgery, Spine-Neurostimulation Unit, Poitiers University Hospital, 86000 Poitiers, France
| | - S d'Houtaud
- Department of Neurosurgery, Spine-Neurostimulation Unit, Poitiers University Hospital, 86000 Poitiers, France
| | - B Bataille
- Department of Neurosurgery, Spine-Neurostimulation Unit, Poitiers University Hospital, 86000 Poitiers, France
| | - P Rigoard
- N(3)lab (Neuromodulation and Neural Networks), Inserm CIC 802, Poitiers University Hospital, 86000 Poitiers, France; Department of Neurosurgery, Spine-Neurostimulation Unit, Poitiers University Hospital, 86000 Poitiers, France
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Deer T, Pope J, Hayek S, Narouze S, Patil P, Foreman R, Sharan A, Levy R. Neurostimulation for the Treatment of Axial Back Pain: A Review of Mechanisms, Techniques, Outcomes, and Future Advances. Neuromodulation 2014; 17 Suppl 2:52-68. [DOI: 10.1111/j.1525-1403.2012.00530.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Salim Hayek
- University Hospitals Case Medical Center-Anesthesiology; Cleveland OH USA
| | - Samer Narouze
- Center for Pain Medicine-Summa Western Reserve Hospital; Cuyahoga Falls OH USA
| | - Parag Patil
- Taubman Health Care Center; Ann Arbor MI USA
| | - Robert Foreman
- University of Oklahoma Health Sciences Center-Physiology; Oklahoma City OK USA
| | - Ashwini Sharan
- Thomas Jefferson University-Neurosurgery; Philadelphia PA USA
| | - Robert Levy
- Shands Jacksonville Neuroscience Institute; University of Florida College of Medicine; Jacksonville FL USA
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Moeschler SM, Sanders RA, Hooten WM, Hoelzer BC. Spinal Cord Stimulator Explantation for Magnetic Resonance Imaging: A Case Series. Neuromodulation 2014; 18:285-8; discussion 288. [DOI: 10.1111/ner.12254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 08/29/2014] [Accepted: 09/10/2014] [Indexed: 11/29/2022]
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Neurostimulation options for failed back surgery syndrome: The need for rational and objective measurements. Proposal of an international clinical network using an integrated database and health economic analysis: the PROBACK network. Neurochirurgie 2014; 61 Suppl 1:S131-6. [PMID: 25245927 DOI: 10.1016/j.neuchi.2014.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 04/18/2014] [Accepted: 07/24/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In the context of failed back surgery syndrome (FBSS) treatment, the current practice in neurostimulation varies from center-to-center and most clinical decisions are based on an individual diagnosis. Neurostimulation evaluation tools and pain relief assessment are of major concern, as they now constitute one of the main biases of clinical trials. Moreover, the proliferation of technological devices, in a fertile and unsatisfied market, fosters and only furthers the confusion. There are three options available to apply scientific debates to our daily neurostimulation practice: intentional ignorance, standardized evidence-based practice or alternative data mining approach. OBJECTIVE In view of the impossibility of conducting multiple randomized clinical trials comparing various devices, one by one, the proposed concept would be to redefine the indications and the respective roles of the various spinal cord and peripheral nerve stimulation devices with large-scale computational modeling/data mining approach, by conducting a multicenter prospective database registry, supported by a clinician's global network called "PROBACK". METHODS We chose to specifically analyze 6 parameters: device coverage performance/coverage selectivity/persistence of the long-term electrical response (technical criteria) and comparative mapping of patient pain relief/persistence of the long-term clinical response/safety and complications occurrence (clinical criteria). Two types of analysis will be performed: immediate analysis (including cost analysis) and computational analysis, i.e. demonstration of the robustness of certain correlations of variables, in order to extract response predictors. DISCUSSION/CONCLUSION By creating an international prospective database, the purpose of the PROBACK project was to set up a process of extraction and comparative analysis of data derived from the selection, implantation and follow-up of FBSS patients candidates for implanted neurostimulation. This evaluation strategy should help to change the opinions of each implanter and each health system towards a more rational decision-making approach subtended by mathematical reality.
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Monlezun O, Voirin J, Roulaud M, Ingrand P, Veyrieras C, Brandet C, Bataille B, Guetarni F, Prévost A, Rigoard P. "MAST" prospective study: value of minimal access spine technologies technique for multicolumn spinal cord stimulation surgical lead implantation in the context of a French multicentre randomized controlled trial (ESTIMET study). Neurochirurgie 2014; 61 Suppl 1:S125-30. [PMID: 25224961 DOI: 10.1016/j.neuchi.2014.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 04/30/2014] [Accepted: 06/06/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Spinal cord stimulation (SCS) has been demonstrated to be an effective treatment for postoperative persistent leg pain after spine surgery, but treatment of the back pain component remains much more difficult, as it comprises mixed neuropathic and mechanical pain mechanisms. Moreover, these patients could present damaged tissues at the site of SCS lead implantation as a result of previous spine surgery. It can therefore be logically assumed that minimizing the surgical invasiveness of SCS implantation would be beneficial for these patients. Several studies have demonstrated the value of Minimal Access Spine Technologies (MAST) in spine surgery, but only a few case reports have been published concerning the use of MAST techniques for SCS. Therefore, we were prompted to conduct a second ESTIMET ancillary study to prospectively analyse the potential impact and benefits of MAST technique during SCS lead implantation versus an open surgical approach. METHODS This is a multicentre, comparative, ancillary study conducted in 61 patients among the 115 enrolled patients ESTIMET study. One arm comprises patients undergoing multicolumn lead implantation via a Conventional Open Approach (COA) and the other arm comprises patients implanted by a MAST approach. Patients will be followed for 12 months after lead implantation. The following data will be collected: elevation of muscle enzymes (serum CPK), scar size, blood loss, infection rate, operating time and global, leg, back and scar NPRS. TRIAL STATUS The first patient of this ancillary study was enrolled on 21 May 2012 and recruitment has now been achieved. Primary endpoint findings are expected to be available in 2015. CONCLUSION Minimally invasive techniques have now been used for spine surgery for the past 12 years, and could also be useful in the context of SCS lead implantation, especially in patients with chronic back pain prior to implantation.
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Affiliation(s)
- O Monlezun
- N(3)Lab (Neuromodulation & Neural Networks), Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
| | - J Voirin
- Department of Neurosurgery, Colmar Hospital, 68000 Colmar, France
| | - M Roulaud
- N(3)Lab (Neuromodulation & Neural Networks), Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - P Ingrand
- Faculty of Medicine and Pharmacy, Poitiers University Hospital, 86000 Poitiers, France
| | - C Veyrieras
- N(3)Lab (Neuromodulation & Neural Networks), Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - C Brandet
- N(3)Lab (Neuromodulation & Neural Networks), Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - B Bataille
- Department of Neurosurgery, Spine-Neurostimulation Unit, Poitiers University Hospital, 86000 Poitiers, France
| | - F Guetarni
- N(3)Lab (Neuromodulation & Neural Networks), Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - A Prévost
- N(3)Lab (Neuromodulation & Neural Networks), Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - P Rigoard
- N(3)Lab (Neuromodulation & Neural Networks), Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Department of Neurosurgery, Spine-Neurostimulation Unit, Poitiers University Hospital, 86000 Poitiers, France
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[Neuromodulation for neuropathic pain]. Schmerz 2014; 28:417-30; quiz 431-2. [PMID: 25070725 DOI: 10.1007/s00482-014-1437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In pain therapy neurostimulation procedures have replaced the previously used lesional methods with only very few exceptions. This is especially true for neuropathic pain, i.e. pain which occurs as a direct consequence of a lesion or disease of the somatosensory system. Nowadays, various stimulation procedures are included in the neurosurgical and anesthesiological armamentarium for pain therapy, depending on the site of damage. This article gives an overview of the currently used invasive stimulation procedures and the indications.
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Levy RM. Krishna Kumar, MD, Neuromodulation and Immortality. Neuromodulation 2014; 17:401-3. [DOI: 10.1111/ner.12219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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