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Jaime Broseta, José Barberá, J. A. de Vera, Juan Luis Barcia-Salorio, Guillermo Garcia-March, José González-Darder, Francisco Rovaina, and Vicente Joanes

P atients with pain problems treated with spinal cord stimulation (SCS) commonly describe a warm sensation in the affected area during stimulation. Based on this empiric observation and prior studies showing the effect of posterior root 7 and spinal cord stimulation 8 on peripheral blood flow, SCS was used to treat ischemic pain resulting from arterial insufficiency. Early clinical reports have confirmed pain relief from SCS and mentioned an increase in skin temperature and plethysmographic and rheographic amplitudes with healing of ischemic ulcers in

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Joshua M. Rosenow, Michael Stanton-Hicks, Ali R. Rezai, and Jaimie M. Henderson

complications. We conducted a retrospective study of SCS systems, both those initially placed and those revised, at a single institution during a 5-year period. Clinical Material and Methods We reviewed electronic charts detailing data obtained in all patients who underwent SCS implantation at the Cleveland Clinic Foundation between January 1998 and December 2002. Charts were selected by searching the institutional database for selected current procedural terminology codes corresponding to implantation of spinal cord stimulating electrodes. Once charts were selected, we

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Beatrice Cioni, Mario Meglio, Luigi Pentimalli, and Massimiliano Visocchi

diffuse, persistent, burning or tingling sensation located in an area below the level of the lesion. The underlying mechanisms responsible for this type of pain are not yet clear. Muscle spasms and cauda equina lesions may also produce pain. 6, 19 Furthermore, patients may complain of more than one type of pain. Paraplegic pain is thus regarded as one of the most difficult to evaluate and treat. 1, 2, 8, 12, 22, 23 Spinal cord stimulation is a nondestructive tool and its use is widely accepted in benign chronic pain therapy. Its effectiveness in pain related to

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Giancarlo Barolat-Romana, Joel B. Myklebust, David C. Hemmy, Barbara Myklebust, and William Wenninger

-tendon reflexes were hyperactive. Figure 2 shows the EMG recording of a knee jerk with the patient in the sitting position. An after-discharge contraction of the quadriceps femoris and of the hamstrings followed the knee jerk. Stimulation applied for a few seconds caused the after-discharge to disappear in the quadriceps and to decrease in the hamstrings. Fig. 2. Electromyographic recordings of the patellar reflex in Case 2, with the patient in the sitting position (hips and knees flexed 90°). Q = quadriceps; H = hamstrings. Left: Spinal cord stimulation off. Notice

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Elon Eisenberg and Hanan Waisbrod

risk associated with implantation of cervical SCS devices: a permanent CNS injury that, possibly, could reach a life-threatening level. Both clinicians and patients should be aware of this rare yet hazardous injury. References 1. Broseta J , Barberá J , de Vera J , et al : Spinal cord stimulation in peripheral arterial disease. A cooperative study. J Neurosurg 64 : 71 – 80 , 1986 Broseta J, Barberá J, de Vera J, et al: Spinal cord stimulation in peripheral arterial disease. A cooperative study. J Neurosurg 64

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Smruti K. Patel, Yair M. Gozal, Mohamed S. Saleh, Justin L. Gibson, Michael Karsy, and George T. Mandybur

E pidural spinal cord stimulation is a well-established treatment modality developed to assist in the management of various medically and surgically refractory neuropathic pain syndromes. 22 It has been shown to improve pain relief, reduce narcotic analgesic use, and promote independence in patients with refractory pain syndromes. 8 Given its fairly consistent results in this extremely complex patient population, the application of spinal cord stimulation has rapidly expanded since its first use in 1967. 23 The treatment is used most often to address

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Alfred G. Kaschner, Wilhelm Sandmann, and Heinz Larkamp

. An alternative to tibial nerve stimulation is spinal cord stimulation with a percutaneous flexible bipolar neuroelectrode inserted into the epidural space. We describe our experience with cortical SEP's in monkeys and dogs. Materials and Methods Experiments were performed on adult German Bernhardiner dogs (each weighing 50 to 55 kg) and healthy Macaca fascicularis monkeys (each weighing about 5 kg). Anesthesia was induced with thiamylal (Surital, 16 mg/kg) and phencyclidine (Ketanest, 10 mg/kg). Endotracheal anesthesia was maintained with enflurane (0.5% to 1

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Mario Meglio, Beatrice Cioni, and Gian Franco Rossi

T wenty years after the first report of spinal cord stimulation (SCS) for pain relief in man 35 there is still skepticism regarding this technique. This might be due in part to the difficulties of managing patients with chronic pain, to technical problems related to the devices used, and to the lack of objectivity in assessing the results of stimulation. It might also be ascribed to the natural attitude of the surgeon toward handling these problems in more aggressive and definitive ways. Nine years of personal experience with this technique have convinced

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Richard B. North, Karen Streelman, Lance Rowland, and P. Jay Foreman

evoked potential collision testing. Clinical article . J Neurosurg 114 : 200 – 205 , 2011 2 Carpenter MB , Sutin J : Human Neuroanatomy ed 8 Baltimore , Williams & Wilkins , 1983 . 265 – 314 3 Chang P , Levy RM : High lateral cervical spinal cord stimulation (SCS) for neuropathic facial pain: Report of 10 cases . Neurosurgery 67 : 550 , 2010 . (Abstract) 4 de Andrade DC , Bendib B , Hattou M , Keravel Y , Nguyen JP , Lefaucheur JP : Neurophysiological assessment of spinal cord stimulation in failed back surgery syndrome

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Bernardino Clavo, Francisco Robaina, Jesús Morera, Eugenio Ruiz-Egea, Juan L. Pérez, David Macías, Miguel Á. Caramés, Luis Catalá, M. Antonia Hernández, and Martina Günderoth

= systolic arterial pressure; DAP = diastolic arterial pressure. Clinical Material and Methods Spinal Cord Stimulation Neurostimulation was performed using a Medtronic system (Medtronic Neurological, Minneapolis, MN). A few days before the scheduled surgery a tetrapolar electrode (Pisces-Quad; Medtronic Neurological) was percutaneously inserted after the patient received a local anesthetic. The electrode was placed on the posterior surface of the spinal cord at C2–4, in the epidural space. An external impulse generator provided an adjustable range of