A Single Center Prospective Observational Study of Outcomes With Tonic Cervical Spinal Cord Stimulation

Haider, Sameah; Owusu-Sarpong, Stephane; Celda, María Peris; Wilock, Meghan; Prusik, Julia; Youn, Youngwon; Pilitsis, Julie G.

doi:10.1111/ner.12483

Cited by 24 publications

(17 citation statements)

References 19 publications

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“…15,16,[21][22][23] Evidence for use of SCS in UEP is available from prospective studies testing traditional SCS and dorsal nerve root stimulation (DNRS) for upper limb and/or neck pain. [26][27][28] Pain relief, responder rate, and remitter rates observed in the current study are substantial, sustained, and comparable to 10 kHz SCS studies for treating chronic back and/or leg pain, such as randomized controlled trials, long-term retrospective evaluations, real-world data 10,[26][27][28][29][31][32][33] and an investigational 10 kHz SCS study for treating upper limb and neck pain. 15 Interestingly, outcomes improved over time and responses at 12 months were better than three months.…”

supporting

confidence: 67%

“…[21][22][23] Lead migration is among the most concerning complications reported in prospective studies of cervical lead placement for management of pain. 7,[24][25][26][27] A systematic literature review of outcomes in patients with cervical SCS documented the rates for hardware malfunction (17.8%), lead migration (13.9%), lead fracture (6.7%), pain over implant site (4.4%) and infection (2.2%). 28 The AE rates reported in this study and in the previous studies evaluating 10 kHz SCS for upper limb and neck pain treatment compare favorably with the published literature…”

Section: Discussionmentioning

confidence: 99%

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<p>Ten kilohertz SCS for Treatment of Chronic Upper Extremity Pain (UEP): Results from Prospective Observational Study</p>

Burgher

Kosek²,

Surrett³

et al. 2020

JPR

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Background Chronic upper extremity pain (UEP) has complex etiologies and is often disabling. It has been shown that 10 kHz SCS can provide paresthesia-free and durable pain relief in multiple pain types and improve the quality of life of patients. Objective To gain additional evidence on the safety and effectiveness of 10 kHz SCS for the treatment of chronic UEP. Study Design It was a prospective, multicenter, and observational study. The study was registered on ClinicalTrials.gov prospectively (clinical trial identifier: NCT02703818). Setting Multicenter. Patients, Intervention and Main Outcomes A total of 43 subjects with chronic UEP of ≥5 cm (on a 0–10 cm visual analog scale; VAS) underwent a trial of 10 kHz SCS, and subjects with ≥40% pain relief received a permanent implant. All subjects had upper limb pain at baseline, while some had concomitant shoulder or neck pain. Subject outcomes were assessed for 12 months, and the primary outcome was the responder rate (percentage of subjects experiencing ≥50% pain relief from baseline) at three months. Results Thirty-eight subjects successfully completed the trial (88.3% success rate), 33 received permanent implants (five withdrew consent), and 32 had device activation (per protocol population). There were no paresthesias or uncomfortable changes in stimulation related to changes in posture during the study and there were no neurological deficits. Responder rates at 12 months for upper limb, shoulder, and neck pain in per protocol population (N=32) were 78.1%, 85.2%, and 75.0%, respectively. At 12 months, 84.4% of subjects were satisfied or very satisfied with 10 kHz SCS, and 38.7% either reduced or eliminated opioid usage. Conclusion This study further supports the effectiveness of 10 kHz SCS for chronic UEP treatment and documents the safety profile of the therapy. Clinical Trial Identifier NCT02703818.

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supporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

<p>Ten kilohertz SCS for Treatment of Chronic Upper Extremity Pain (UEP): Results from Prospective Observational Study</p>

Burgher

Kosek²,

Surrett³

et al. 2020

JPR

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“…Cervical spinal cord stimulation stops the transmission of the abnormal electrical impulses coming from the deafferented posterior spinal cord horn neurons [123], controlling the pain with preservation of the remaining upper limb function [112,124,125]. Its success rate in the treatment of neuropathic pain associated with brachial plexus injuries is 50% [51,[111][112][113][124][125][126][127][128][129]. It is particularly useful in CRPS [112] but it also helpful in nerve root avulsions [129].…”

Section: Neuromodulation Proceduresmentioning

confidence: 99%

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Saiz-Sapena¹,

Vanaclocha‐Vanaclocha²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

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Brachial plexus injuries are commonly followed by chronic pain, mostly with neuropathic characteristics. This is due to peripheral nerve lesions, particularly nerve root avulsions, as well as upper limb amputations, and complex regional pain syndrome (CRPS). The differential diagnosis between CRPS and neuropathic pain is essential as the treatment is different for each of them. Medical treatments are the first step, but for refractory cases there are two main types of surgical alternatives: ablative techniques and neuromodulation. The first group involves destruction of the posterior horn deafferented neurons and usually provides a better pain control but has a 10% complication rate. The second group provides pain control with function preservation but with limited effectiveness. Each case has to be thoroughly evaluated to apply the treatment modality best suited for it. due to iatrogenia [8][9][10][11][12][13][14][15][16], particularly during lymph node biopsy [17, 18] or treatment of some malignancies [19]. The pain is chronic [20], persistent [7], constant [21], burning [22] and throbbing [17], with paroxysmal discharges [3, 6, 23], particularly upon gentle rubbing the affected area [4].The pain is distributed in the distal areas of the upper limb, covering several dermatomes, mostly the caudal ones [24] and particularly the hand [5, 17, 23, 25]. The paroxysmal pain is felt in the arm [26]. Allodynia, hypersensitivity and electric-like discharges are present at the border between the normal and affected dermatomes [17,[26][27][28][29], particularly between T 1 and T 2 at the posterior aspect of the elbow [26].The pain severity correlates with the magnitude of the brachial plexus injury [2,3] and to the number of avulsed nerve roots [2-4, 21, 26, 30-33], particularly when the lower roots are affected [24,34,35]. Nevertheless, Bertelli et al. [21] found that in isolated C 8 and T 1 nerve root avulsions, there was no pain at all.The pain does not appear immediately after the injury but a few days later [24] and no longer than 3 months after it [5, 6, 24, 26,35,36].The neuropathic pain can be associated with phantom [37] or stump pain [38] in case of upper limb amputation, or to complex regional pain syndrome (CRPS) [6], inducing a complex pain condition rather difficult to control [19,30,31].Self-mutilation has been described in 5-29% of obstetric brachial plexus injury cases [39,40].The quality of life is seriously impaired with sleep disorders, family troubles, unemployment, chronic depression and social withdrawal [2, 5, 6, 17, 21,[41][42][43][44]. Additionally, the chronic pain is a further hindrance to comply with a good rehabilitation programme, impairing a possible functional recovery [6,45,46]. Among all the disabilities induced by the brachial plexus injury, the pain has been found to be the symptom that most negatively affects the quality of life [47].Treatment of this chronic pain can be troublesome, as the response to the different treatment modalities is poor and not all of them allow preservatio...

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“…In controlled conditions, cervical SCS significantly improved CRPS pain located in the hand, compared to physiotherapy only . However, only few and small studies reported specifically the outcome of cervical SCS , with mean improvement of the pain severity varying across series from two to four on a ten point‐numeric rating scale (NRS). Although efficient, cervical SCS exposes the patients to several inconveniences or complications: lead dislocation or breakage (0–43%), lead migration (0–12.5%), unwanted paresthesias in the trunk or the lower limb(s) (17%), paresthesias changes during head movements (48%) .…”

Section: Discussionmentioning

confidence: 99%

Peripheral Nerve Stimulation of Brachial Plexus Nerve Roots and Supra-Scapular Nerve for Chronic Refractory Neuropathic Pain of the Upper Limb

Bouche¹,

Manfiotto

Rigoard

et al. 2017

Neuromodulation: Technology at the Neural Interface

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A Single Center Prospective Observational Study of Outcomes With Tonic Cervical Spinal Cord Stimulation

Cited by 24 publications

References 19 publications

<p>Ten kilohertz SCS for Treatment of Chronic Upper Extremity Pain (UEP): Results from Prospective Observational Study</p>

<p>Ten kilohertz SCS for Treatment of Chronic Upper Extremity Pain (UEP): Results from Prospective Observational Study</p>

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Peripheral Nerve Stimulation of Brachial Plexus Nerve Roots and Supra-Scapular Nerve for Chronic Refractory Neuropathic Pain of the Upper Limb

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