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Manfield J, Vajramani G. Burst Dorsal Root Ganglion Stimulation With Paddle Leads: Report of Two Cases. Neuromodulation 2024:S1094-7159(24)00633-0. [PMID: 39140935 DOI: 10.1016/j.neurom.2024.06.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/26/2024] [Accepted: 06/13/2024] [Indexed: 08/15/2024]
Affiliation(s)
- James Manfield
- Centre for Functional Neurosurgery, University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - Girish Vajramani
- Centre for Functional Neurosurgery, University Hospital Southampton National Health Service Foundation Trust, Southampton, UK.
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Tekmyster G, Jonely H, Lee DW, Myerson J, Avery M, Moradian M, Desai MJ. Physical Therapy Considerations and Recommendations for Patients Following Spinal Cord Stimulator Implant Surgery. Neuromodulation 2023; 26:260-269. [PMID: 33819381 DOI: 10.1111/ner.13391] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Spinal cord stimulation (SCS) is an established therapy option in interventional pain medicine. Recent advances in technology have allowed for greater compliance with treatment and improved efficacy in pain control. This article was proposed to fill the gap in the literature addressing this specific patient population and to facilitate further research. Even though there is a lack of consensus among societies and experts on exact parameters of physical therapy (PT) considerations and postoperative limitations in patients with SCS, we propose rehabilitative care for this population should be standardized. As the number of patients with SCS implants grow, it is vital to understand how to appropriately approach patients with implantable devices when additional treatments such as PT are prescribed. MATERIALS AND METHODS A literature search was performed on the use of PT following SCS implantation. Presently, there is no literature to date which addresses the use of PT in this patient population. The lack of data is the largest hurdle in the creation of formal SCS therapy guidelines. The authors therefore proposed recommendations for rehabilitation based upon a detailed understanding of SCS hardware alongside well-studied physiotherapy concepts. RESULTS Considerations when initiating PT in the SCS patient population should include: 1) biomechanics and quality of SCS output; 2) therapeutic exercise and spinal manipulation in association with risk for lead migration and fracture; 3) the application of therapeutic modalities and risk for injury to the patient and/or damage to the SCS componentry; and 4) integration of a biopsychosocial, person-centered approach. CONCLUSIONS PT treatment protocol in patients with a recently implanted SCS device should be person-centered addressing individual needs, values, and goals. Further research is needed to fully appreciate the impact of an interprofessional approach to management of SCS patients, particularly following stimulator implantation.
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Affiliation(s)
- Gene Tekmyster
- Keck Medicine of USC, Orthopaedic Surgery, Los Angeles, CA, USA
| | - Holly Jonely
- International Spine Pain & Performance Center, Washington, DC, USA
| | - David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA.
| | - Jason Myerson
- Performance Physical Therapy & Wellness, Westport, CT, USA
| | - Melinda Avery
- International Spine Pain & Performance Center, Washington, DC, USA
| | | | - Mehul J Desai
- International Spine Pain & Performance Center, Washington, DC, USA
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Song J, Humphrey T, Zhang A, Chao S, Czerwein J. Superior Cluneal Nerve Stimulator Lead Displacement to the Thigh: A Case Report and Management Recommendations. JBJS Case Connect 2022; 12:01709767-202206000-00058. [PMID: 37440694 DOI: 10.2106/jbjs.cc.21.00637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
CASE An 82-year-old man with a history of lumbar spinal stenosis and prior laminectomy presented with chronic lower back pain and was treated with placement of bilateral superior cluneal nerve stimulators. At the 2-week follow-up, the patient reported loss of efficacy and new-onset paresthesia of the left lower extremity. Fluoroscopic evaluation revealed lead breakage and distal migration of the left-sided stimulator lead to the left anteromedial thigh. CONCLUSION Lead breakage and migration remains a challenge in peripheral nerve stimulation. This report illustrates the case of a nerve stimulator lead breakage and migration resulting in treatment failure and new-onset sensory disturbance.
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Affiliation(s)
- Junho Song
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Tyler Humphrey
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew Zhang
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Simon Chao
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John Czerwein
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Schultheis BC, Wille C, Ross-Steinhagen NE, De Ridder D, Vancamp T, Weidle PA. Alternative Dorsal Root Ganglion Neuromodulation Electrode Implantation: A Report of 2 Cases with 3 Different Techniques. J Neurol Surg A Cent Eur Neurosurg 2021. [PMID: 34897626 DOI: 10.1055/s-0041-1739219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND STUDY AIMS The traditional percutaneous placement of dorsal root ganglion (DRG) electrodes may not be eligible for every patient. In this tertiary spine surgery and interventional pain therapy center, alternative neurostimulation implantation techniques were developed and applied where standard percutaneous approaches failed or were contraindicated. CASE PRESENTATION Three alternative implantation techniques can be used: (1) open surgical placement of DRG leads, (2) two-lead insertion via a lateral to medial transforaminal approach (level L3), and (3) percutaneous approach with two leads close to the spinal nerves L4 (peripheral nerve stimulation). RESULTS The placement of the leads occurred without complications and resulted in similar expected outcomes as with the common percutaneous technique with long-term stable pain suppression at 7 months and 1 year. CONCLUSIONS In patients in whom the DRG cannot be approached by the standard percutaneous approach, at least three alternatives may be used in experienced hands resulting in stable pain suppression of similar magnitude.
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Affiliation(s)
- Björn Carsten Schultheis
- Krankenhaus Neuwerk "Maria von den Aposteln," Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
| | - Christian Wille
- Department of Neurosurgery, NCN Neurochirurgische Praxis Neuss, Neuss, Neuss, Germany
| | - Nikolas Eugenio Ross-Steinhagen
- Krankenhaus Neuwerk "Maria von den Aposteln," Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Patrick A Weidle
- Krankenhaus Neuwerk "Maria von den Aposteln," Muskulo-Skeletales Zentrum, interventionelle Schmerztherapie, Mönchengladbach, Germany
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Chapman KB, Mogilner AY, Yang AH, Yadav A, Patel KV, Lubenow T, van Helmond N, Deer T, Kallewaard JW. Lead migration and fracture rate in dorsal root ganglion stimulation using anchoring and non-anchoring techniques: A multicenter pooled data analysis. Pain Pract 2021; 21:859-870. [PMID: 34145740 DOI: 10.1111/papr.13052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Dorsal root ganglion stimulation (DRG-S) is a neuromodulation technique introduced in the last decade with evolving implant methods. Initial prospective research found low incidences of lead migration and lead fracture with DRG-S. However, several recent studies have highlighted high lead migration and lead fracture rates with DRG-S. We investigated the influence of lead anchoring on migrations and fractures. METHODS We performed a retrospective review between 2016 and 2020 of individuals implanted with DRG-S leads by 4 experienced implanters. The implanters independently changed their standard practice regarding lead anchoring over time, with opposing trends (no anchoring > anchoring, anchoring > no anchoring). We compared lead migration and lead fracture rates between anchored and unanchored DRG-S leads in the entire study cohort. Cox regression was performed on lead migration and fracture distributions. RESULTS We included 756 leads (n = 565 anchored and n = 191 unanchored) from 249 patients. In unanchored leads, migration occurred in 16 leads (8.4%) from 13 patients (21.0%). In anchored leads, migration occurred in 8 leads (1.4%) from 5 patients (2.7%). Fracture in unanchored leads occurred in 6 leads (3.1%) from 6 patients (9.7%). Fractures in anchored leads occurred in 11 leads (1.9%) from 9 patients (4.8%). The migration survival distributions for the anchored and unanchored leads were statistically significantly different (p < 0.01) with decreased survival for unanchored leads (hazard ratio = 5.8, 95% confidence interval [CI] = 2.2-15.5). DISCUSSION We found that anchoring DRG-S leads significantly reduces lead migration when compared to leads placed without an anchor. There was no significant difference in fracture rate between anchored and unanchored leads.
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Affiliation(s)
- Kenneth B Chapman
- The Spine & Pain Institute of New York, New York, New York, USA.,Department of Anesthesiology, NYU Langone Medical Center, New York, New York, USA.,Department of Anesthesiology, Zucker School of Medicine at Hofstra Northwell, Manhasset, New York, USA
| | - Alon Y Mogilner
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Ajax H Yang
- The Spine & Pain Institute of New York, New York, New York, USA
| | - Abhishek Yadav
- Department of Anesthesiology and Perioperative Medicine, Brown University, Providence, Rhode Island, USA
| | - Kiran V Patel
- The Spine & Pain Institute of New York, New York, New York, USA.,Department of Anesthesiology, Zucker School of Medicine at Hofstra Northwell, Manhasset, New York, USA
| | - Timothy Lubenow
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA
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Graziano F, Scalia G, Cammarata G, Lo Bue E, Brunasso L, Maugeri R, Umana GE, Gerardi RM, Iacopino DG, Nicoletti GF. Letter to the Editor Regarding "First Report of Extraspinal Lead Migration Along a Thoracic Spinal Nerve After Spinal Cord Stimulation". World Neurosurg 2021; 145:536-537. [PMID: 33348507 DOI: 10.1016/j.wneu.2020.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Francesca Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy; Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy.
| | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Giacomo Cammarata
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - Enrico Lo Bue
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - Lara Brunasso
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Rosa Maria Gerardi
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
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Ridwan S, Ostertun B, Stubbe H, Hans FJ. In Reply to the Letter to the Editor Regarding "First Report of Extraspinal Lead Migration Along a Thoracic Spinal Nerve After Spinal Cord Stimulation". World Neurosurg 2021; 145:538-539. [PMID: 33348508 DOI: 10.1016/j.wneu.2020.09.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Sami Ridwan
- Departments of Neurosurgery, Intensive Care and Pain Management, Paracelsus-Klinik Osnabrueck, Osnabrueck, Germany.
| | - Burkhard Ostertun
- Departments of Radiology, Intensive Care and Pain Management, Paracelsus-Klinik Osnabrueck, Osnabrueck, Germany
| | - Henning Stubbe
- Departments of Anesthesiology, Intensive Care and Pain Management, Paracelsus-Klinik Osnabrueck, Osnabrueck, Germany
| | - Franz-Josef Hans
- Departments of Neurosurgery, Intensive Care and Pain Management, Paracelsus-Klinik Osnabrueck, Osnabrueck, Germany
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Karri J, Palmer JS, Charnay A, Garcia C, Orhurhu V, Shah S, Abd-Elsayed A. Utility of Electrical Neuromodulation for Treating Chronic Pain Syndromes in the Pediatric Setting: A Systematic Review. Neuromodulation 2021; 25:671-679. [PMID: 33556220 DOI: 10.1111/ner.13365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/08/2020] [Accepted: 01/05/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Chronic pain syndromes in children can carry significant threats to psychological well-being, opioid overuse, functional impairments, and severe disability. While several high-level studies, almost exclusively in adults, have demonstrated the utility of implantable electrical neuromodulation systems for treating various chronic pain syndromes, there exists a paucity of pediatric-specific evidence. Unfortunately, evidence and practice patterns established from adults may not be fully translatable to children given differences in disease manifestations and anatomical variances. MATERIALS AND METHODS We performed a systematic review using conventional PRISMA methodology to identify studies reporting use of implantable electrical neuromodulation systems in children. The primary outcome parameters collected were analgesic relief and functional benefits. Additionally, previous interventions attempted, neuromodulation parameters, and limitations were collected as reported. RESULTS A total of 11 studies was identified, which described 19 patients who were refractory to multidisciplinary pain management strategies. The cohort was mostly adolescent (18/19), suffered from CRPS (14/19), and received SCS (17/19). Nearly all patients, both those with CRPS (13/14) and non-CRPS conditions (4/4), reported significant pain relief and functional recovery following neuromodulation. There were no severe complications reported; limitations included suboptimal benefit or loss of analgesia (3/19), lead or device revision (3/19), and subcutaneous infection (1/19), all of which were congruent with adult outcomes. CONCLUSION There exist children with chronic pain refractory to standard of care approaches who could be considered for neuromodulation interventions. The existing data, which was limited and from a low tier of evidence, suggest that these interventions are relatively safe and provide meaningful pain reduction and functional improvements. While not previously reported, we recommend careful consideration of the pubertal growth spurt prior to device lead placement-if reasonable and appropriate-given the possibility of inferior lead migration with physiologic growth in patients with SCS devices or foraminal extrusion in patients with dorsal root ganglion stimulation devices.
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Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Jeremé Sharíf Palmer
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Aaron Charnay
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Carol Garcia
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vwaire Orhurhu
- Department of Anesthesia, Division of Pain Medicine, University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
| | - Shalini Shah
- Department of Anesthesiology & Perioperative Care, Division of Pain Medicine, University of California Irvine, Orange, CA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Ridwan S, Ostertun B, Stubbe H, Hans FJ. First Report of Extraspinal Lead Migration Along a Thoracic Spinal Nerve After Spinal Cord Stimulation. World Neurosurg 2020; 141:247-250. [DOI: 10.1016/j.wneu.2020.06.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 11/24/2022]
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