Neurochirurgische Klinik des Kantonsspitals Aarau.
[The current significance of spinal cord stimulation in the framework of functional neurosurgery].
[Review] [18 refs] [German]
Schweizerische Rundschau fur Medizin Praxis. 79(36):1025-30, 1990 Sep 4.
Abstract:
Spinal cord stimulation (DCS) has proved effective in different types of Deafferentation Pain. Long-term results are good in 60-85% of cases. DCS improves microcirculation and ischemia in cases of inoperable peripheral vascular diseases. Advantages of this method are: Absence of severe complications and estimation of the effect during the test phase. - Nevertheless, other neurosurgical possibilities (destructive pain surgery, spinal/cerebral application of medicaments) continue to preserve their indications.
[References: 18]
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Spinal cord stimulation for chronic, intractable pain: experience over two decades. [Review] [86 refs]
Neurosurgery. 32(3):384-94; discussion 394-5, 1993 Mar.
Abstract:
Over the past two decades, spinal cord stimulation devices and techniques have evolved from single-channel systems, with electrodes requiring laminectomy, into programmable "multichannel" systems with electrodes that may be placed percutaneously. We have reviewed our experience in 320 consecutive patients treated with these devices at our institution between 1972 and 1990. Technical details of treatment as well as patient characteristics have been assessed as predictors of clinical outcome and of hardware reliability by univariate and multivariate statistical methods. Current follow-up has been obtained at intervals from 2 to 20 years (mean, 7.1 yr) postoperatively on 205 patients. All clinical outcome measures have been based on sinterested third-party interview data--standard analog pain ratings, employment status, activities of daily living, and use of analgesics. At 7-year mean follow-up, 52% of the 171 patients who received permanent implants reported at least 50% continued pain relief. A majority had maintained improvements in activities of daily living and analgesic use. Analysis of hardware reliability for 298 permanent implants revealed significantly fewer clinical failures (P < 0.001) and technical failures (in particular, electrode migration and malposition, P= 0.025) as single-channel implants have evolved into programmable, multichannel devices. Our analysis of technical and clinical prognostic factors may be useful to the clinician in selecting patients for this procedure.
[References: 86]
