scholarly journals Neuromodulation of the Cervical Spinal Cord in the Treatment of Chronic Intractable Neck and Upper Extremity Pain: A Case Series and Review of the Literature

2007 ◽  
Vol 2;10 (3;2) ◽  
pp. 305-311
Author(s):  
Ricardo Vallejo
Keyword(s):  
Spinal Cord ◽  
Upper Extremity ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Case Series ◽  
Low Back ◽  
Limb Pain ◽  
Fusion Surgery ◽  
Upper Limb Pain ◽  
Pain Patients

Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upper extremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70–90%) reductions in pain, including axial neck pain and upper extremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upper extremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upper extremity pain. Key words: spinal cord stimulator, cervical, neck pain, radicular pain, axial pain, headache, leg pain

scholarly journals Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110040
Author(s):  
Kuen Su Lee ◽  
Yoo Kyung Jang ◽  
Gene Hyun Park ◽  
In Jae Jun ◽  
Jae Chul Koh
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Therapeutic Potential ◽  
Case Series ◽  
Limb Amputation ◽  
Intractable Pain ◽  
Limb Pain ◽  
Cord Injury ◽  
Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

scholarly journals Long-Term Improvements in Chronic Axial Low Back Pain Patients Without Previous Spinal Surgery: A Cohort Analysis of 10-kHz High-Frequency Spinal Cord Stimulation over 36 Months

Pain Medicine ◽  
2017 ◽  
Vol 19 (6) ◽  
pp. 1219-1226 ◽  
Author(s):  
Adnan Al-Kaisy ◽  
Stefano Palmisani ◽  
Thomas E Smith ◽  
Roy Carganillo ◽  
Russell Houghton ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Spinal Surgery ◽  
Cohort Analysis ◽  
Low Back ◽  
Pain Patients

Multicentre, clinical trial of burst spinal cord stimulation for neck and upper limb pain NU-BURST: a trial protocol

2021 ◽  
Author(s):  
Adnan Al-Kaisy ◽  
Girish Vajramani ◽  
Sarah Love-Jones ◽  
Nikunj K. Patel ◽  
Jonathan Royds ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Trial Protocol ◽  
Limb Pain ◽  
Multicentre Clinical Trial ◽  
Upper Limb Pain

scholarly journals Cervical Spinal Cord Stimulation: An Analysis of 23 Patients with Long-term Follow-up

2012 ◽  
Vol 3;15 (3;5) ◽  
pp. 203-212 ◽  
Author(s):  
Tilman Wolter
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Lower Limb ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Head Movements ◽  
Limb Pain ◽  
Pain Scores ◽  
Stimulation Parameters

Background: For more than 3 decades, spinal cord stimulation has successfully been employed to treat neuropathic pain. Cervical spinal cord stimulation, despite now being standard in many hospitals, has only rarely been subjected to a critical review within the literature. Objectives: The aim of this study was to determine the efficacy of cervical spinal cord stimulation (SCS) in a representative clinical sample. We also wanted to evaluate how factors such as stimulation parameters, unwanted paresthesia of the trunk and legs, and changes in paresthesia status due to head movement and how they affect SCS effectiveness. Study design: Retrospective study. Setting: Academic university interdisciplinary pain center. Methods: We reviewed the records of patients who had been treated at our institution with cervical neurostimulators from November 1, 2001 through October 31, 2011. Information regarding age, gender, diagnosis, age at time of implantation, duration of disease, lead position, hardware in use, revision operations, and stimulation parameters were recorded. In addition, a short telephone interview was conducted, which contained the following items: pain scores on the numeric analog scale (NAS) with and without stimulation, time intervals of stimulation, paresthesia coverage, changes in paresthesia coverage by head movements, unwanted paresthesia of the trunk and legs, treatment satisfaction, and medication intake. Results: Twenty-three patients were treated. Eighteen patients proceeded to an implantable pulse generator (IPG) implant. In one patient, the system was removed after 4 years despite optimal function, because the patient was no longer experiencing pain. Average NAS pain scores were 6.8 (range 5.5 - 10.0, standard deviation [SD] 1.7) without, and 2.8 (range 0 - 7.5, SD 2.2) with neurostimulation. Fourteen revisions (5 due to lead dislocation, 5 due to lead breakage and 4 IPG revisions) were necessary in 9 of the 18 patients during a mean follow-up of 6.2 years. Most patients reported complete paresthesia coverage. Four patients reported unwanted paresthesia of the trunk or lower limb and 11 patients reported changes in paresthesia with head movements. In both instances, pain reduction was not affected. Limitations: Retrospective study. Conclusions: Cervical spinal cord stimulation appears to be effective in the treatment of neuropathic upper limb pain. Complications are not significantly more frequent than in SCS for lower limb pain. Changes in paresthesia with head movements and unwanted paresthesia did not affect the outcome. Key words: Spinal cord stimulation, cervical, neuropathic pain, clinical efficacy, paresthesia, paresthesia coverage, changes in paresthesia, brachial plexus lesion, nerve root avulsion, stimulation parameters

scholarly journals High cervical spinal cord stimulation for occipital neuralgia: a case series and literature review

2019 ◽  
Vol Volume 12 ◽  
pp. 2547-2553
Author(s):  
Pavlos Texakalidis ◽  
Muhibullah S Tora ◽  
Purva Nagarajan ◽  
Orion P Keifer Jr ◽  
Nicholas Boulis
Keyword(s):  
Spinal Cord ◽  
Literature Review ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Case Series ◽  
Occipital Neuralgia ◽  
High Cervical

scholarly journals The use of high-dose cervical spinal cord stimulation in the treatment of chronic upper extremity and neck pain

2019 ◽  
Vol 10 ◽  
pp. 109
Author(s):  
Trey A. Baird ◽  
Chris S. Karas
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Upper Extremity ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Dorsal Column ◽  
High Dose ◽  
Before And After ◽  
Stage Process ◽  
Dorsal Column Stimulation

Background: Dorsal column spinal cord stimulation is used for the treatment of chronic neuropathic pain of the axial spine and extremities. Recently, high-dose (HD) thoracic dorsal column stimulation for paresthesias has been successful. This study evaluates the utility of HD stimulation in the cervical spine for managing upper neck and upper extremity pain and paresthesias. Methods: Three patients suffering from cervical and upper extremity chronic pain were assessed. Each underwent a two-stage process that included a trial period, followed by permanent stimulator implantation. Therapy included the latest HD stimulation settings including a pulse width of 90 μs, a frequency setting of 1000 Hz, and an amplitude range of 1.5 amps–2.0 amps. Pain relief was measured utilizing relative percent pain improvement as self-reported by each patient before and after surgery. Results: After permanent implantation, (range 15–21 months), all three patients continued to experience persistent pain and paresthesia relief (70%–90%). Conclusions: In three patients, HD cervical spinal cord stimulation successfully controlled upper extremity chronic pain/paresthesias.

scholarly journals High-Frequency Spinal Cord Stimulation at 10 kHz for the Treatment of Combined Neck and Arm Pain: Results From a Prospective Multicenter Study

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 176-185 ◽  
Author(s):  
Kasra Amirdelfan ◽  
Ricardo Vallejo ◽  
Ramsin Benyamin ◽  
Cong Yu ◽  
Thomas Yang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Neck Pain ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Limb Pain ◽  
Arm Pain ◽  
System A ◽  
Institutional Review ◽  
Upper Limb Pain

Abstract BACKGROUND Intractable neck and upper limb pain has historically been challenging to treat with conventional spinal cord stimulation (SCS) being limited by obtaining effective paresthesia coverage. OBJECTIVE To assess the safety and effectiveness of the 10-kHz SCS system, a paresthesia-independent therapy, in the treatment of neck and upper limb pain. METHODS Subjects with chronic, intractable neck and/or upper limb pain of ≥5 cm (on a 0-10 cm visual analog scale [VAS]) were enrolled in 6 US centers following an investigational device exemption from the Food and Drug Administration (FDA) and institutional review board approval. Each subject was implanted with 2 epidural leads spanning C2-C6 vertebral bodies. Subjects with successful trial stimulation were implanted with a Senza® system (Nevro Corp) and included in the evaluation of the primary safety and effectiveness endpoints. RESULTS In the per protocol population, the primary endpoint (≥50% pain relief at 3 mo) was achieved in 86.7% (n = 39/45) subjects. Compared to baseline, subjects reported a significant reduction (P < .001) in their mean (± standard error of the mean) VAS scores at 12-mo assessment for neck pain (7.6 ± 0.2 cm, n = 42 vs 1.5 ± 0.3 cm, n = 37) and upper limb pain (7.1 ± 0.3 cm, n = 24 vs 1.0 ± 0.2 cm, n = 20). At 12-mo assessment, 89.2% of subjects with neck pain and 95.0% with upper limb pain had ≥50% pain relief from baseline, 95.0% reported to be “satisfied/very satisfied” and 30.0% either eliminated or reduced their opioid intake. CONCLUSION In conclusion, 10-kHz SCS can treat intractable neck and upper limb pain with stable long-term outcomes.

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