No abstract available.
Pain Management* ; Spinal Cord Stimulation* ; Spinal Cord*

No abstract available.
Humans ; Neuralgia* ; Spinal Cord Stimulation* ; Spinal Cord* ; Syringomyelia*

After a traumatic brachial plexus injury, 80% of patients develop severe pain in the deafferentated arm. This type of pain is considered very resistant to many forms of therapy. When we plan treatments for the patient who suffer from a pain from traumatic brachial plexus injury, clarifying the location of injured nerve is very important. EMG (electromyography), NCV (nerve conduction study), MRI (magnetic resonance imaging) and CT (computed tomography) myelography are recommended diagnostic method for this purpose. Here, we presented a patient who was suspected to have both preganglionic and postganglionic brachial plexus lesion by EMG and NCV study, he showed favorable response after spinal cord stimulation.
Arm ; Brachial Plexus ; Humans ; Myelography ; Spinal Cord ; Spinal Cord Stimulation

We present a patient with intractable neuropathic pain because of idiopathic transverse myelitis unresponsive to medical treatment. After a successful trial of spinal cord stimulation, a permanent stimulator was implanted. Improvement was noted in visual analogue scale, medication usage and daily function. Spinal cord stimulation may offer a therapeutic option for patients with neuropathic pain resulting from transverse myelitis and should be considered when other treatments are failed.
Humans ; Myelitis, Transverse ; Neuralgia ; Spinal Cord ; Spinal Cord Stimulation

Sacral nerve stimulation through the retrograde approach has been used for peroneal or irritable bowel syndrome through the retrograde approach. However, several reasons, lead could not be advanced down ward. In this case, anterograde sacral nerve stimulation through the sacral hiatus could be used. The aim of this report is to present of technique of sacral nerve root stimulation through the sacral hiatus approach.
Irritable Bowel Syndrome ; Spinal Cord Stimulation

Spinal cord stimulation (SCS) for pain is usually implanted as an open loop system using unchanged parameters. To avoid the under and over stimulation caused by lead migration, evoked compound action potentials (ECAP) is used as feedback signal to change the stimulating parameters. This study established a simulation model of ECAP recording to investigate the relationship between ECAP component and dorsal column (DC) fiber recruitment. Finite element model of SCS and multi-compartment model of sensory fiber were coupled to calculate the single fiber action potential (SFAP) caused by single fiber in different spinal cord regions. The synthetized ECAP, superimposition of SFAP, could be considered as an index of DC fiber excitation degree, because the position of crests and amplitude of ECAP corresponds to different fiber diameters. When 10% or less DC fibers were excited, the crests corresponded to fibers with large diameters. When 20% or more DC fibers were excited, ECAP showed a slow conduction crest, which corresponded to fibers with small diameters. The amplitude of this slow conduction crest increased as the stimulating intensity increased while the amplitude of the fast conduction crest almost remained unchanged. Therefore, the simulated ECAP signal in this paper could be used to evaluate the degree of excitation of DC fibers. This SCS-ECAP model may provide theoretical basis for future clinical application of close loop SCS base on ECAP.
Action Potentials ; Computer Simulation ; Electric Stimulation ; Evoked Potentials ; Spinal Cord ; Spinal Cord Stimulation

BACKGROUND: Spinal cord stimulation(SCS) evolved as a direct clinical application of the famous gate-control theory, the idea of activating the central collaterals of large afferent fibers contained in the dorsal column. It is well known that the cord dorsum potential(CDP) evoked by stimulation of dorsal roots or peripheral nerves can be recorded from the cord surface in spinal animals. However, there have been no data about the changes in CDP after SCS. METHODS: Using ball-type electrode, CDP was recorded at the dorsal root entry zone of lumbosacral enlargement in anesthetized cats. The dorsal root was stimulated electrically to activate Adelta-fiber(single pulse of 0.2 ms duration and 1 mA intensity) and C-fiber(single pulse of 0.2 ms duration and 10 mA intensity). Potentials were averaged 10 times and measured before(control) and immediately after, and 10, 20, 30, 40, 50, 60 min after SCS for 20 min. RESULTS: CDP elicited by dorsal root stimulation consisted of the characteristic waves of Adelta-fiber and C-fiber with different time latency. CDP showed significant decrease in the amplitude of C-fiber wave immediately after SCS(75.0+/-8.8%), and 20 min(69.0+/-7.9%), 30 min(75.1+/-4.4%), 40 min(75.4+/-4.4%), 50 min(78.3+/-5.9%), but not 10 min and 60 min, after SCS. However there were no statistically significant decrease in the amplitude of Adelta-fiber wave after SCS. CONCLUSIONS: The above results indicates that SCS suppresses the transmission of nociceptive electrical stimuli via C-fiber, while SCS has little influence on the transmission of electrical nociceptive stimuli via Adelta-fiber.
Animals ; Cats ; Cytidine Diphosphate ; Electrodes ; Peripheral Nerves ; Spinal Cord Stimulation* ; Spinal Cord* ; Spinal Nerve Roots

BACKGROUND: The pain-inhibitory effects of spinal cord stimulation (SCS) may be exerted at two alternative or complementary levels, segmentally or supraspinally. However the actual pathways, site of action, and synaptic relays are poorly understood. No data is available which concerns the changes in cord dorsum potential (CDP) associated with a single neuronal level, after SCS. METHODS: SCS was performed in normal and spinalized cats. At the lumbosacral enlargement, CDP and extracellular single cell activity in response to electrical stimulation of Asigma- or C-fiber of the dorsal root or sciatic nerve were recorded. RESULTS: The resulting CDP consisted of characteristic waves of Asigma- and C-fiber with a different time latency. CDP sno significant differences in the amplitude of Asigma- and C-fiber wave between the normal and spinalized cats. In both groups, CDP showed decrease in the amplitude of C-fiber wave. Single cell responses were either increased or decreased after SCS. The C- response changed more marKedly than the A-response in both the normal and spinalized cats. In the bicuculline administered cats, single cell responses increased after SCS, but no change was found in the amplitude of CDP. CONCLUSIONS: The above results might indicate that SCS suppresses C-fiber transmission of nociceptive electrical stimuli via a segmental inhibitory mechanism, and that SCS is more effective in blocKing the transmission of nociceptive electrical stimuli via the C-fiber than Asigma-fiber.
Animals ; Bicuculline ; Cats* ; Cytidine Diphosphate ; Electric Stimulation ; Neurons ; Sciatic Nerve ; Spinal Cord Stimulation* ; Spinal Cord* ; Spinal Nerve Roots

Complex regional pain syndrome (CRPS) along with post-operative syndrome in the lumbar spine shows confusing and duplicated symptoms, and this makes it difficult to make a clear differential diagnosis. Therefore, the patient with post-operative syndrome in the lumbar spine suffers losses of time and money, and the surgeon who diagnoses and treats post-operative syndrome in the lumbar spine also agonize from the patient's losses. It is necessary to provide these patients with a multidisciplinary approach to their disease and symptoms. We diagnosed herniation of an intervertebral disc of the lumbar spine (L4/5) and we performed discetomy twice in different hospitals. However, the symptoms did not improve, so we re-operated and performed discetomy along with monosegmental fixation using pedicular screws and interbody cages. There was improvement of pre-operation symptoms, but neurogenic symptoms occurred and then progressed after the surgery. Therefore, we report here on the case of CRPS that was diagnosed with the exclusion of the causes of post-operative syndrome in the lumbar spine, and the patient was finally effectively treated with spinal cord stimulation. Although differentiating post-operative syndrome in the lumbar spine from CRPS is difficult, we recommend suspecting CRPS as the cause of post-operative syndrome in the lumbar spine and taking CRPS as the main interest in order to diagnose and treat CRPS more effectively and accurately.
Diagnosis, Differential ; Felodipine ; Humans ; Intervertebral Disc ; Spinal Cord Stimulation ; Spine

Spinal cord stimulation (SCS) in trials involving external stimulation are easily conducted under local anesthesia. However, implantation of a permanent SCS system is painful, and can be intolerable in some patients. Epidural anesthesia can be used to perform the SCS implantation without discomfort if the patient can localize the area of paresthesia. However, little is known about epidural anesthesia for SCS. This paper reports 23 cases of permanent SCS with a cylindrical type lead implanted under the epidural anesthesia. Epidural anesthesia was sufficient in 22 patients without discomfort and significant complications. The remaining patient experienced incomplete epidural anesthesia and required additional analgesics to blunt the pain. All the leads were placed consistent with the patient's report of paresthesia area under epidural anesthesia. Thus, epidural anesthesia is an effective and safe method for the optimal placement of SCS to minimize the discomfort for patients without impairing patients' response to the intraoperative stimulation test.
Analgesics ; Anesthesia, Epidural* ; Anesthesia, Local ; Humans ; Paresthesia ; Spinal Cord Stimulation*