Dorsal column stimulation for control of pain

Preliminary report on 30 patients

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✓ Thirty patients with chronic intractable pain have had dorsal column implants and a trial of subsequent electrical self-stimulation to relieve the pain. Burning pain originating from damage to the CNS was most often relieved, while chronic bone, joint, and disc pain responded less well. Patients with severe psychiatric factors should be excluded, but preoperative selection is still difficult because of the lack of objective clinical tests. The long-term effect of the implant on the tissues of the dorsal column is still unknown and requires further evaluation. Although relief of pain has been reported for as long as 3 years, much longer follow-ups are necessary to evaluate the efficiency of this system in patients with chronic pain. Direct stimulation of the spinal cord raises a number of interesting questions in regard to perception and sensory phenomena in man but, as yet, there are no answers as to how dorsal column stimulation effects its relief of pain.

Article Information

Address reprint requests to: Blaine S. Nashold, Jr., M.D., Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina 27706.

© AANS, except where prohibited by US copyright law.

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Figures

  • View in gallery

    DCS equipment with four platinum electrodes used for bilateral dorsal column stimulation.

  • View in gallery

    Roentgenogram of patient with bilateral thoracic DCS. Subcutaneous rf receiver and external antenna seen on left. Arrow indicates contacts on DCS implant.

  • View in gallery

    Left: Drawing of cross section of spinal cord showing the DCS plate resting on the dorsal column separated by a thin layer of arachnoid. Right: Drawing of dorsal view of spinal cord with DCS plate positioned over the dorsal columns with anchoring sutures.

References

1.

Adams J. Unpublished data.Adams J. Unpublished data.

2.

Hillman PWall PD: Inhibitory and excitory factors influencing the receptive fields of lamina 5 spinal cord cells. Exp Brain Res 9:2843061969Hillman P Wall PD: Inhibitory and excitory factors influencing the receptive fields of lamina 5 spinal cord cells. Exp Brain Res 9:284–306 1969

3.

Melzack RWall PD: Pain mechanisms: a new theory. Science N Y 150:9719791965Melzack R Wall PD: Pain mechanisms: a new theory. Science N Y 150:971–979 1965

4.

Nathan PWSmith MC: The centripetal pathway from the bladder and urethra within the spinal cord. J Neurol Neurosurg Psychiat 14:2622801951Nathan PW Smith MC: The centripetal pathway from the bladder and urethra within the spinal cord. J Neurol Neurosurg Psychiat 14:262–280 1951

5.

Norton AC: The dorsal column system of the spinal cord. UCLA Brain Information Network. U S Dept of Health Education1969Norton AC: The dorsal column system of the spinal cord. UCLA Brain Information Network. U S Dept of Health Education 1969

6.

Shealy CNMortimer JTHagfors NR: Dorsal column electroanalgesia. J Neurosurg 32:5605641970Shealy CN Mortimer JT Hagfors NR: Dorsal column electroanalgesia. J Neurosurg 32:560–564 1970

7.

Sweet WHWepsic JG: Treatment of chronic pain by stimulation of fibers of primary afferent neurone. Trans Amer Neurol Ass 93:1031071968Sweet WH Wepsic JG: Treatment of chronic pain by stimulation of fibers of primary afferent neurone. Trans Amer Neurol Ass 93:103–107 1968

8.

Wall PDSweet WH: Temporary abolition of pain in man. Science 155:1081091967Wall PD Sweet WH: Temporary abolition of pain in man. Science 155:108–109 1967

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