![]() It provides crucial information to the neurosurgeon to prevent postoperative neurological deficits. Our revised technique is safe and reliable, and it can be easily incorporated into routine intramedullary spinal cord tumor resection. None of the patients had postoperative worsening of the DC function. ![]() In 3 cases, negative mapping with the use of this method enabled the surgeon to reliably identify additional inert tissue for incision. DCs were identified in all patients, regardless of whether they could be visually identified. The MR location was neurophysiologically confirmed in all patients in whom this structure was first visually identified as well as in those in whom it was not, with 1 exception. Phase reversal and amplitude changes of somatosensory evoked potentials were used to neurophysiologically identify the laterality of DCs, the inert MR, as well as other safe incision sites. The right and left DCs were stimulated by using a bipolar electric stimulator and the triggered somatosensory evoked potentials recorded from the scalp. To describe a new, safe, and reliable technique for intraoperative DC mapping. We present our experience with and improvements made to our previously described technique of DC mapping, successfully applied in a series of 12 cases. Identification of neurophysiologically viable dorsal columns (DCs) and of neurophysiologically inert tissue, eg, median raphe (MR), as a safe incision site is crucial for avoiding postoperative neurological deficits. Conventional SCS directly stimulates the large diameter nonnociceptive A-fibers in the dorsal column, and then it antidromically inhibits those nociceptive signals which enter the spinal dorsal horn. Undoubtedly, this proper selection and a better knowledge of its underlying mechanisms of action, will allow this cutting edge technique to be more acceptable among pain physicians.įailed back surgery syndrome indications neuromodulation review spinal cord stimulation.Safe resection of intramedullary spinal cord tumors can be challenging, because they often alter the cord anatomy. Current investigations are trying to balance between the advantages and disadvantages of the SCS technique. Adverse events associated with 10-kHz dorsal column spinal cord stimulation: a 5-year analysis of the manufacturer and user facility device experience (MAUDE) database. Spinal cord stimulation is a useful tool for neuromodulation, if an accurate patient selection is carried out prior, which should include a trial period. Further indications may be phantom limb pain, chronic intractable pain located in the head, face, neck, or upper extremities, spinal lumbar stenosis in patients who are not surgical candidates, and others. Also, this technique is useful in patients with refractory angina and critical limb ischemia, in whom surgical or endovascular treatment cannot be performed. Failed back surgery syndrome (FBSS) is the most common indication for SCS, whereas, the complex regional pain syndrome (CRPS) is the second one. At present, the indications of SCS are being revised constantly, while new applications are being proposed and researched worldwide. The mechanism of action of SCS would be based on the antidromic activation of the dorsal column fibers, which activate the inhibitory interneurons within the dorsal horn. In spite of the existence of several studies that try to prove the mechanism of action of SCS, it still remains unknown. This article is a non-systematic review of the mechanism of action, indications, results, programming parameters, complications, and cost-effectiveness of SCS. Following that, technological progress, among other advances, helped SCS become an effective tool to reduce pain. Dorsal Column Stimulation is a pain-relief technique that delivers a low-voltage electrical current continuously to the spinal cord to block the sensation of pain. Spinal cord stimulation (SCS) has been used to treat neuropathic pain since 1967.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |