Effect of a Novel Fixation Method for Spinal Cord Stimulators (original) (raw)
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Safety and efficacy of a new percutaneously implantable interspinous process device
Acta Neurochirurgica, 2010
Background Lumbar spinal stenosis is a degenerative disease of the elderly population. Although microsurgical decompression has shown good long-term results, percutaneous techniques could provide an alternative in the presence of significant comorbidities. Method Eighty-seven interspinous process decompression devices (In-space; Synthes, Umkirch, Germany) were implanted percutaneously in up to three segments of 50 patients. Outcome was assessed directly after surgery, at 6-8 weeks, and at average follow-up of 1 year (11.8± 6 months). Assessment included complications, pain and spinal claudication, neurodeficit, time to recurrence of symptoms, and time to second surgery. Subgroups with additional low back pain at presentation and mild spondylolisthesis were analyzed separately. Findings Intraoperative complications were rare (one misplacement and two cases of failed implantation); average operation time was 16.4±12.2 min per segment. Initial response was very good with 72% good or excellent relief of symptoms. After a 1-year follow-up, 42% reported of lasting relief from spinal claudication. Thirteen percent of these complained about lasting or new-onset low back pain. A second surgery had been performed in 22%. Subgroup analysis was performed for patients presenting with additional low back pain and spondylolisthesis patients. No significant differences could be noted between subgroups.
Spinal Cord Stimulation Surgical Technique for the Nonsurgically Trained
Neuromodulation: Technology at the Neural Interface, 2009
The objective of this paper is to educate physicians who implant spinal cord stimulators in current surgical techniques. Many implanters have not gone through formal surgical residencies and learn their surgical techniques during a one year Fellowship or from proctoring experience. This paper utilizes current concepts from the literature to reinforce appropriate surgical practices, which are applicable to surgeons as well as interventional pain physicians. This should be a valuable resource for all Fellows whether they are in surgical programs or pain fellowship programs. In addition, a more detailed presentation is made at the end of this paper on a proposed simple one-incision surgical technique for implantation of small internal pulse generators. This is the first publication in the literature describing such a technique and may be useful for less-experienced implanters, as well as conferring potential advantages in surgical technique.
Alternative Approach To Needle Placement In Spinal Cord Stimulator Trial/Implantation
Pain Physician, 2011
Neuromodulation with spinal cord stimulation is a proven, cost effective treatment for the management of chronic radicular low back pain from failed low back surgery syndrome and other neuropathic pain conditions. The traditionally instructed method for percutaneous spinal cord stimulator lead placement promotes the use of a “loss of resistance” technique under anteroposterior fluoroscopic guidance to assure midline lead placement and proper entry into the epidural space. Loss of resistance is a reliable method to locate the epidural space in most clinical situations. However, in certain circumstances such as a congenital underdeveloped ligamentum flavum or defects of the ligamentum flavum, sometimes occurring after lumbar spine surgery, it might become difficult to use a loss of resistance technique to locate the epidural space. In this case, the level of resistance might not be clear. Further, a false loss of resistance might occur between changes in fascial planes that might lead...
Percutaneous Spinal Cord Stimulation Lead Placement Under Deep Sedation and General Anesthesia
Pain and Therapy, 2021
Introduction: Spinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of neuropathic pain conditions. The Neurostimulation Appropriateness Consensus Committee (NACC) has recommended that the placement of percutaneous SCS leads be performed in an awake patient capable of providing feedback. It is not currently known how commonly this recommendation is adhered to by physicians in clinical practice. This article presents the findings of a survey designed to answer this important question. Methods: We conducted a survey of the active membership of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Spine Intervention Society (SIS) regarding practice patterns with SCS therapy. We analyzed the percent of respondents who indicated that they use deep sedation and general anesthesia during SCS placement as well as any reported complications. Results: Many practitioners frequently utilize deep sedation as well as general anesthesia when performing SCS implants. Our findings demonstrate that 77% of physicians reported that they utilize deep sedation for permanent SCS implants at times, and 45% of physicians
Neuromodulation: Technology at the Neural Interface, 2007
Spinal cord stimulation (SCS) is an effective technique for the relief of neuropathic pain. Biologic complications are more prevalent within the first 3 months after implantation, are generally minor and reversible, and do not affect patients' acceptance of the treatment. Technically, hardware-related complications are uncommon and occur more frequently in the first 2 years following implantation of the device than after. Nevertheless, the incidence of technological complications can be relatively high if the technique is not performed correctly. Based on a review of the literature and on the experience and consensus of an expert panel, this manuscript attempts to provide practical guidelines, which may help implanters avoid some of the technological complications of SCS implantation. Areas covered by this article include patient positioning, the appropriate use of imaging, insertion of percutaneous and surgical leads, intraoperative stimulation, lead choice and suturing, considerations pre- and postimplantation, stimulation settings and regimens, implantable pulse generator positioning, and control of infections. It is hoped that these guidelines may help physicians to improve their SCS implantation technique and thereby improve the outcomes of the therapy. These guidelines should be of special value for newer centers starting SCS therapy for their patients.
The utility of electrocautery for suture passage through bone: A biomechanical study
Journal of Orthopaedic Research, 2019
Electrosurgical devices are routinely employed during surgery. The use of a Bovie Electrosurgical Unit (ESU) to facilitate the passage of a suture needle through bone has not been studied in the literature. This study aimed to identify force reduction with the application of Bovie ESU to the suture needle through the bone. Peak and the average axial force required for a suture needle to penetrate cadaveric proximal humeri were measured using a custom setup. Twenty-four trials were conducted without electricity, and 72 trials were conducted with a Bovie ESU applying current. Needle size and Bovie ESU power settings were varied. T-tests and ANOVA were used with p ≤0.05 denoting statistical significance. The application of electricity reduced the peak and average axial force needed for a needle to pierce bone, regardless of the Bovie ESU power setting (p <0.001). The average peak force with the Bovie ESU was 65.7 N, compared to 126.0 N without (p<0.001), a 47.9% reduction. The average axial force with the Bovie ESU was 38.2 N compared to 81.8 N without (p<0.001), a 53.3% reduction. There was no significant difference in peak or average axial forces between power settings. At 30W and 90W of power, larger needle size was associated with significantly lower peak This article is protected by copyright. All rights reserved. Accepted Article (p=0.001 and p<0.001, respectively) and axial (p=0.002 and p=0.004, respectively) force. The Bovie ESU reduces the axial force required to pass a suture needle through bone. The use of this technique may allow for the avoidance of drilling for soft tissue repair. * S.D. = Standard Deviation Measurements are expressed in Newtons (N) unless otherwise specified.
Turkish Neurosurgery, 2011
AIm: The aim of implantation of interspinous device is to unload the facet joints, restore foraminal height and provide stability in order to improve the clinical outcome of surgery. mAterIAl and methOds: After microsurgical decompression, Coflex™ device was applied. Patients were evaluated at a month after surgery and last follow-up using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). Foraminal height and lumbar lordosis angle were recorded. results: The mean preoperative VAS was 7.85 and fell to 1.7 a month after surgery (p<0.0001). At the last follow-up the mean VAS score was 1.65 (p<0.0001). The mean foraminal heights were measured 19.95 mm preoperatively and 25.05 mm a month after surgery (p<0.0001). The mean foraminal height was 21.60 mm at the last follow-up (p=0.002). The mean lumbar lordosis were measured 32.05 and 34.3 degrees at preoperative and a month after surgery respectively (p=0.155). The mean lumbar lordosis was 32 (±5.99) degrees at the last follow-up (p=0.974). COnClusIOn: Using the Coflex device is a minimal invasive, effective and safe procedure. Restoration of the foraminal height may not be a responsible factor for clinical improvement. We think microsurgical decompression looks responsible of the good clinical outcome and using interspinous device is unnecessary. Comparative clinical studies can be informative.