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Spinal cord stimulators in the operating room

Steven M Falowski, Ashwini Sharan, James McInerney, Darren Jacobs, Lalit Venkatesan, Filippo Agnesi
BACKGROUND: Spinal cord stimulation (SCS) is a common intervention for managing intractable pain. Generally, leads are implanted in a minimally invasive procedure with verbal feedback regarding the location and nature of generated paresthesias by active stimulation; in this way their optimal location can be confirmed. However, lead placement under general anesthesia can have additional benefits. OBJECTIVE: To investigate the outcomes of awake vs asleep lead placement procedures...
March 14, 2018: Neurosurgery
Aaron Lawson McLean, Susanne Frank, Daniel Staribacher, Rolf Kalff, Rupert Reichart
INTRODUCTION: The correct positioning of spinal cord stimulator leads is assessed radiographically during their percutaneous implantation for trial stimulation. Usually the C-arm is repositioned several times to allow imaging in different planes, which may extend the total duration of surgery. The study aimed to evaluate whether the concurrent intraoperative use of 2 C-arms could safely reduce the duration of surgery. MATERIALS: This retrospective study included cases of percutaneous implantation of a spinal cord stimulation (SCS) lead for trial neurostimulation between 2006 and 2011...
September 2017: World Neurosurgery
Michael E Harned, Brandon Gish, Allison Zuelzer, Jay S Grider
BACKGROUND: Patients with implanted spinal cord stimulators (SCS) present to the anesthesia care team for management at many different points along the care continuum. Currently, the literature is sparse on the perioperative management. What is available is confusing; monopolar electrocautery is contraindicated but often used, full body magnetic resonance imaging (MRI) is safe with particular systems but with other manufactures only head and specific extremities exams are safe. Moreover, there are anesthetizing locations outside of the operating room where implanted SCS can interact with surrounding medical equipment and pose significant risk to patient and device...
May 2017: Pain Physician
N André-Obadia, F Mauguière
Evoked potentials (EPs) are useful to evaluate the functional impairment of motor and somatosensory pathways in spinal cord tumors. Conduction through pyramidal tracts is evaluated by motor EPs (MEPs) elicited by transcranial stimulation, magnetic for awake patients or electric in the operating room. Somatosensory EPs (SEPs) and laser EPs (LEPs) are complementary procedures to explore conduction in dorsal columns and spinothalamic tracts, respectively. MEPs as well as SEPs show conduction abnormalities in about 60% of cases with a sensitivity that increases up to 70% when both procedures are carried out...
November 2017: Neuro-Chirurgie
Erlangga Yusuf, Sven Bamps, Bénédicte Thüer, Jan Mattheussen, Jean-Paul Ursi, Elke Del Biondo, Kris de Smedt, Raf Van Paesschen, Dirk Berghmans, Kaat Hofkens, Jef Van Schaeren, Tony van Havenbergh, Bruno Van Herendael
OBJECTIVE: To investigate the effect of a quality improvement project that resulted in an infection control bundle to reduce the number of spinal cord stimulator (SCS) infections. MATERIALS AND METHODS: The study was performed in a single center for neuromodulation from January 1, 2014, through May 31, 2016. In response to a high number of surgical site infections (SSIs) after SCS surgery, a multidisciplinary team analyzed the surgical process and developed an infection prevention bundle consisting of five items: 1) showering and decolonization for five days prior to surgery and showering in the hospital on the morning of surgery; 2) performing the SCS implantation as the first in the daily operating room (OR) program; 3) maintaining a minimal number of people in the OR; 4) providing home care nurses with a folder with SCS wound care instructions including pictures; 5) giving oral specific wound care instructions to patients...
January 24, 2017: Neuromodulation: Journal of the International Neuromodulation Society
Michel Wager, Philippe Rigoard, Benoit Bataille, Claude Guenot, Aurélie Supiot, Jean-Luc Blanc, Veronique Stal, Claudette Pluchon, Coline Bouyer, Roger Gil, Foucaud Du Boisgueheneuc
OBJECTIVE: Many neurosurgical procedures are now performed with the patient aware in order to allow interactions between the patient and healthcare professionals. These procedures include awake brain surgery and spinal cord stimulation (SCS), lead placement for treatment of refractory chronic back and leg pain. Neurosurgical procedures under local anaesthesia require optimal intraoperative cooperation of the patient and all personnel involved in surgery. In addition to accommodating this extra source of intraoperative information all other necessary sources of data relevant to the procedure must be presented...
2015: British Journal of Neurosurgery
Sung-Min Kim, Seung Hyun Kim, Dae-Won Seo, Kwang-Woo Lee
The recent developments of new devices and advances in anesthesiology have greatly improved the utility and accuracy of intraoperative neurophysiological monitoring (IOM). Herein, we review the basic principles of the electrophysiological methods employed under IOM in the operating room. These include motor evoked potentials, somatosensory evoked potentials, electroencephalography, electromyography, brainstem auditory evoked potentials, and visual evoked potentials. Most of these techniques have certain limitations and their utility is still being debated...
September 2013: Journal of Korean Medical Science
Mitchell P Engle, Baominh P Vinh, Nusrat Harun, Dhanalakshmi Koyyalagunta
BACKGROUND: Intrathecal drug delivery (IDD) and spinal cord stimulator (SCS) systems are implantable devices for the management of both chronic and cancer pain. Although these therapies have favorable long-term outcomes, they are associated with occasional complications including infection. The incidence of infectious complications varies from 2 - 8% and frequently requires prolonged antibiotics and device revision or removal. Cancer patients are particularly susceptible to infectious complications because they are immunocompromised, malnourished, and receiving cytotoxic cancer-related therapies...
May 2013: Pain Physician
Florian Roser, Gerd Pfister, Marcos Tatagiba, Florian H Ebner
BACKGROUND: Training courses in neurosurgery are essential educational elements of residency. Teaching methods vary due to cultural differences, monetary restrictions and infrastructure conditions. Anatomical dissection courses combined with annotated live surgeries performed by senior surgeons have proved to be best accepted by students. OBJECTIVE: In this technical note, we provide detailed information about the necessary requirements, resources and optimal performance of live surgeries in neurosurgical training courses...
March 2013: Acta Neurochirurgica
William Porter McRoberts, Paul Wu, Ishmael Bentley
INTRODUCTION: Spinal cord stimulation is a well-established treatment for recalcitrant pain syndromes such as failed back surgery syndrome. Techniques minimizing surgical time and incision size and increasing lead stability are of great value to both the patient and implanting physician. We present a consecutive case series review of ten permanent percutaneous spinal cord implants utilizing a novel lead fixation device. The purpose of this case series review is to present initial findings of the minimized incision size and thoughts surrounding the new device and technique...
September 2013: Neuromodulation: Journal of the International Neuromodulation Society
Jordan Graybill, Till Conermann, Abraham J Kabazie, Sunil Chandy
Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area of the thoracotomy incision for at least 2 months following the initial procedure.  The true incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5% to 90%.  Thoracotomy is associated with a high risk of severe chronic postoperative pain.  Presenting symptoms include both neuropathic pain in the area of the incision, as well as myofascial pain commonly in the ipsilateral scapula and shoulder...
September 2011: Pain Physician
Silvia Malaguti
Surgical or interventional neurophysiology is a term commonly used to refer to a large number of neurosurgical procedures involving the brain, cranial nerves, spinal cord and peripheral nervous system which, to be efficient and safe, demand specific neurophysiological know-how. As a result of the development of these procedures and their increasing use in the operating room, the role of clinical neurophysiology, traditionally diagnostic, has been extended. With the advent of 'neurostimulation' and 'neuromodulation', some neurophysiological techniques have, in themselves, progressively become more therapeutic, the therapeutic alteration of nervous system activity being achieved not only by surgical ablation or medication but also through electrophysiological means via implanted or non-implanted devices, whose development was made possible by extensive studies in the field of neurophysiology...
October 2009: Functional Neurology
Eugenio Pompeo, Tommaso C Mineo
The authors' initial experience with awake videothoracoscopic lung resection suggests that these procedures can be easily and safely performed under sole thoracic epidural anesthesia with no mortality and negligible morbidity. One major concern was that operating on a ventilating lung would render surgical maneuvers more difficult because of the lung movements and lack of a sufficient operating space. Instead, the open pneumothorax created after trocar insertion produces a satisfactory lung collapse that does not hamper surgical maneuvers...
August 2008: Thoracic Surgery Clinics
K F Kothbauer
During resection of intramedullary spinal-cord tumors intraoperative neurophysiological monitoring has become a true surgical technology. Motor evoked potentials are the most important modality for this purpose. Its use requires neurophysiological expertise from the surgeon, and a monitoring team in place able to handle the necessary equipment. Motor potentials are evoked by transcranial electrical motor cortex stimulation. A "single stimulus technique" evokes D-waves recorded from the spinal cord. The "multipulse (or train) stimulation technique" evokes electromyographic responses in peripheral muscles...
December 2007: Neurophysiologie Clinique, Clinical Neurophysiology
Enno Freye
An evoked potential differs from the EEG mainly in two ways: 1. The EEG is a random, continuous signal, which arises from the ongoing activity of the outer layers of the cortex. An evoked potential is the brain's response to a repetitive stimulus along a specific nerve pathway. 2.EEG signals range from 10-200 milliVolt (mV). Evoked potentials are smaller in amplitude (1-5-20 microVolt requiring precise electrode positioning and special techniques (signal averaging) to extract the specific response from the underlying EEG "noise"...
April 2005: Journal of Clinical Monitoring and Computing
Cheng-fu Dai, Chuan-guo Xiao
OBJECTIVE: To identify and separate the ventral root from dorsal root, which is the key for success of the artificial somatic-autonomic reflex pathway procedure for neurogenic bladder after spinal cord injury (SCI). Here we report the results of intra-operating room monitoring with 10 paralyzed patients. METHODS: Ten male volunteers with complete suprasacral SCI underwent the artificial somatic-autonomic procedure under general anesthesia. Vastus medialis, tibialis anticus and gastrocnemius medialis of the left lower limb were monitored for electromyogram (EMG) activities resulted from L4, L5, and S1 stimulation respectively to differentiate the ventral root from dorsal root...
April 2005: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
D G Vossler, T Stonecipher, M D Millen
STUDY DESIGN: A case report of unilateral leg ischemia caused by femoral artery compression detected using posterior tibial nerve somatosensory-evoked potentials during spinal scoliosis instrumentation surgery. OBJECTIVES: To report a rare cause of intraoperative unilateral loss of all posterior tibial nerve somatosensory-evoked potential waveforms. SUMMARY OF BACKGROUND DATA: Failure to obtain adequate popliteal fossa, spinal, subcortical, and cortical potentials during posterior tibial nerve somatosensory-evoked potential spinal cord monitoring usually results from technical factors or chronic conditions affecting the peripheral nerve...
June 1, 2000: Spine
G J Fanciullo, R J Rose, P G Lunt, P K Whalen, E Ross
UNLABELLED: The purpose of this questionnaire survey was to provide an overview of anesthesiology pain fellowship programs in the United States with regard to implantation of spinal cord stimulators (SCS) and opioid infusion devices. Of the 95 programs solicited, 80% responded to questions pertaining to the prevalence of use and technical considerations of implantation. Of the responding programs, 87% report implanting SCS, and 84% report implanting neuraxial infusion pumps. All programs perform a stimulation or infusion trial before implantation, although the duration varied from a trial in the operating room at the time of implantation to 25 days...
June 1999: Anesthesia and Analgesia
J A Bouchard, H H Bohlman, C Biro
STUDY DESIGN: Retrospective review of all patients who underwent surgical treatment of cervical spondylitic myelopathy and were monitored by somatosensory evoked potentials. OBJECTIVES: To identify the patients who had recognizable improvements in somatosensory evoked potential signals intraoperatively and to correlate the changes in somatosensory evoked potential signals to the post-operative clinical status of the patients and compare this group of patients with those that had stable intraoperative somatosensory evoked potential recordings...
March 1, 1996: Spine
S Tani, H Shimizu, B Ishijima, R Hanakago
Percutaneously inserted spinal cord electrical stimulation (PISCES) was carried out in eleven intractable pain cases and in one spastic paraplegic case. The causes of intractable pain constitute subacute myelo-optic neuropathy (SMON) 6 cases, cerebrovascular disease 2 cases, multiple sclerosis (MS) 1 case, Charcot-Marie-Tooth (CMT) 1 case and transverse myelitis (TM) 1 case. The cause of spastic paraplegia was due to the ossification of posterior longitudinal ligament (OPLL). A trial stimulation was performed about two weeks before planning a permanent implantation of PISCES system...
April 1984: Nō to Shinkei, Brain and Nerve
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