Cervical spinal cord stimulation with 5-column paddle lead in Raynaud's disease.
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OBJECTIVE: To report a case of Raynaud disease and its successful treatment with spinal cord stimulation utilizing the newly designed five-column Penta lead paddle. Specific electrode design, programming characteristics, and surgical technique are also discussed in this case. DESIGN: Case Report. SETTING: University pain management center. BACKGROUND: A 65-year-old man with Raynaud disease presented with neck and upper extremity pain. The patient also had herniation and spondylosis of the lumbar spine and intervertebral disc disease of the cervical spine. An examination revealed venous changes, chronic ulceration, and digit discoloration in upper and lower extremities. METHOD: Conservative management and pharmacological treatment were ineffective. Sympathetic block produced significant but limited improvement. Treatment with spinal cord stimulation was tried after a successful 7-day trial. RESULTS: Initial stimulation of the cervical spine with two octapolar leads at the C2 level produced greater than 75% pain improvement. However, the patient lost coverage shortly after discharge due to lead migration which could not be regained with reprogramming. A revision with Penta lead paddles produced sustainable and significant paresthesia coverage. LIMITATIONS: A case report. CONCLUSION: We report the successful application of spinal cord stimulation utilizing a five-column paddle lead in an individual with severe refractory Raynaud disease. (+info)
Spinal cord stimulation for the treatment of abnormal posture and gait disorder in patients with Parkinson's disease.
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Patients with advanced Parkinson's disease (PD) often present with axial symptoms, including abnormal posture, postural instability, and gait disorder. Although spinal cord stimulation (SCS) is effective for pain, little is known about the effect of SCS on motor function in PD patients. The present study investigated the effect of SCS on posture and gait in 15 PD patients, 5 men and 10 women aged 63-79 years (mean 71.1 years), with low back pain and leg pain who received SCS. A visual analog scale (VAS) was used for pain evaluation pre- and postoperatively. The Unified Parkinson's Disease Rating Scale, Timed Up and Go tests, and Timed 10-Meter Walk tests were used to evaluate motor function and activities of daily living of patients. Preoperative mean VAS score was 8.9 (range 7.8-10), which showed significant postoperative improvement at 3 months to mean VAS score of 2.0 (range 0-3.3). The improvements in VAS scores persisted at 12 months after surgery with mean VAS score of 2.3 (range 0-4). Posture and postural stability motor subscores were improved at 3 months after SCS, and gait had significantly improved at 3 months and 1 year after surgery. Timed 10-Meter Walk tests also demonstrated that patient gait was significantly improved at 3 months and 12 months after surgery. Most advanced stage PD patients suffer considerable pain that causes abnormal posture and gait disturbance. SCS is expected to lead to both amelioration of pain and improvement of motor function in such patients. (+info)
Spinal cord stimulation for treatment of patients in the minimally conscious state.
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Minimally conscious state (MCS) is characterized by inconsistent but clearly discernible behavioral evidence of consciousness, and can be distinguished from coma and the vegetative state (VS). Ten MCS patients were evaluated neurologically and electrophysiologically over 3 months after the onset of brain injury, and were treated by spinal cord stimulation (SCS). A flexible four-contact, cylinder electrode was inserted into the epidural space of the cervical vertebrae, and placed at the C2-C4 levels. Stimulation was applied for 5 minutes every 30 minutes during the daytime at an intensity that produced motor twitches of the upper extremities. We used 5 Hz for SCS, considering that the induced muscle twitches can be a useful functional neurorehabilitation for MCS patients. Eight of the 10 MCS patients satisfied the electrophysiological inclusion criteria, which we proposed on the basis of the results of deep brain stimulation for the treatment of patients in the VS. Seven patients recovered from MCS following SCS therapy, and were able to carry out functional interactive communication and/or demonstrate the functional use of two different objects. Cervical SCS increased cerebral blood flow (CBF) diffusely in the brain, and CBF increased by 22.2% during the stimulation period compared with CBF before stimulation in MCS patients (p < 0.0001, paired t-test). Five-Hz cervical SCS could increase CBF and induce muscle twitches of the upper extremities. This SCS therapy method may be suitable for treating MCS. (+info)
Pain relief and quality-of-life improvement after spinal cord stimulation in painful diabetic polyneuropathy: a pilot study.
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Spinal cord stimulation for chronic pain originating from Lyme disease.
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BACKGROUND: Neuropathic pain is a relatively common outcome of Lyme disease. Pain management options for these patients have been limited to pharmaceutical treatments. OBJECTIVE: We present a case of chronic pain following Lyme disease treated successfully using spinal cord stimulation (SCS). STUDY DESIGN: Case report. SETTING: Pain management clinic. METHODS: A 62-year-old patient presented with a 5-year history of bilateral foot pain following Lyme disease that failed to respond to medication and physical therapy. The patient was treated by a trial of SCS at the clinic and then implanted with a spinal cord stimulator. The Visual Analog Scale (VAS) assessed pain before and after SCS. RESULTS: The patient reported significant pain relief and improved foot function. The 10 point VAS score was reduced from 8-10 to 1-3. LIMITATIONS: Single case report. CONCLUSION: Spinal cord stimulation may be an effective option for relieving chronic pain originating from Lyme disease. (+info)