Spinal Cord Stimulation in the Management of Pain from Brachial Plexus Avulsion

Piva, Bruno; Shaladi, A; Saltari, Rita; Gilli, Giuseppe

doi:10.1046/j.1525-1403.2003.03004.x

Cited by 21 publications

(24 citation statements)

References 15 publications

(16 reference statements)

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“…It was first described by Wall and Sweet in 1967 [30]; they used an electrode to stimulate a peripheral nerve in post-traumatic neuralgic pain. A variety of techniques have since been developed [20]. In the 1970s, PNS was seldom performed because the high morbidity and poor long-term outcomes related to poor patient selection and technical limitations for inadequate devices.…”

Section: Discussionmentioning

confidence: 99%

“…This clinical picture is usually at high risk for non-responsiveness with other neuro-modulation techniques such as spinal cord stimulation (SCS) or motor cortex stimulation (MCS) [1, 3, 20]. In particular, SCS is reported to be more effective in painful syndrome with spinal hyperactivity in the dorsal part of spinal cord but compared with PNS is less selective in covering the painful skin area of peripheral nerve injuries and has higher risk of dislocation [13, 26].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the clinical evaluation was completed with upper arm examination in order to rule out any intrinsic joint disease and acromioclavicular pathology, and in patients with lower brachial plexus involvement the elevated arm stress test [20, 23] was performed in order to relieve thoracic outlet syndrome [24]. …”

Section: Methodsmentioning

confidence: 99%

“…One of the possible mechanisms is based on the assumption that direct application of low-intensity, high-frequency electrical current onto a peripheral nerve can elicit the A-beta myelinated fibres and produce analgesia according to the “gate-control” mechanism [16]. Another mechanism proposed was the ortho- and antidromic collision in Aβ fibres [10, 20]. Both mechanisms as a key part of PNS are closely related to the brain function and brain plasticity in particular [22, 26].…”

Section: Introductionmentioning

confidence: 99%

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Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation

et al. 2014

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The aim of the study was to evaluate the effect on pain relief in patients with peripheral neuropathic pain after brachial plexus injuries using an implanted peripheral nerve stimulator applied directly to the nerve branch involved into the axillary cavity. Seven patients with post-traumatic brachial plexus lesions or distal peripheral nerve complaining of severe intractable chronic pain were enrolled in a single-centre, open-label trial. Conventional drugs and traditional surgical treatment were not effective. Patients underwent careful neurological evaluation, pain questionnaires and quantitative sensory testing (QST). Surgical treatment consists of a new surgical technique: a quadripolar electrode lead was placed directly on the sensory peripheral branch of the main nerve involved, proximally to the site of lesion, into the axillary cavity. To assess the effect, we performed a complete neuroalgological evaluation and QST battery after 1 week and again after 1, 6 and 12 weeks. All patients at baseline experienced severe pain with severe positive phenomena in the median (5) and/or radial (2) territory. After turning on the neuro-stimulator system, all patients experienced pain relief within a few minutes (>75 % and >95 % in most), with long-lasting pain relief with a reduction in mean Numerical Rating Scale (NRS) of 76.2 % after 6 months and of 71.5 % after 12 months. No significant adverse events occurred. We recommend and encourage this surgical technique for safety reasons; complications such as dislocation of electrocatheters are avoided. The peripheral nerve stimulation is effective and in severe neuropathic pain after post-traumatic nerve injuries of the upper limbs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation

et al. 2014

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“…Spinal cord and deep brain stimulation have been shown to provide reduction in pain after BPA, as measured by the visual analog scale (VAS), with a statistically significant but slight reduction in pain scores. 21,22 Ablative procedures such as medial thalamotomy, spinothalamic tractotomy, and anterolateral cordotomy have not demonstrated longterm benefits and have disabling side effects.…”

mentioning

confidence: 99%

Correlation of preoperative MRI with the long-term outcomes of dorsal root entry zone lesioning for brachial plexus avulsion pain

Ozpinar

Raskin

Magill

et al. 2016

JNS

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aBBreViatiONS BPA = brachial plexus avulsion; DREZ = dorsal root entry zone; DZEZotomy = dorsal root entry zone lesioning; VAS = visual analog scale. OBJectiVe Lesioning of the dorsal root entry zone (DREZotomy) is an effective treatment for brachial plexus avulsion (BPA) pain. The role of preoperative assessment with MRI has been shown to be unreliable for determining affected levels; however, it may have a role in predicting pain outcomes. Here, DREZotomy outcomes are reviewed and preoperative MRI is examined as a possible prognostic factor. methOdS A retrospective review was performed of an institutional database of patients who had undergone brachial plexus DREZ procedures since 1995. Preoperative MRI was examined to assess damage to the DREZ or dorsal horn, as evidenced by avulsion of the DREZ or T2 hyperintensity within the spinal cord. Phone interviews were conducted to assess the long-term pain outcomes. reSultS Between 1995 and 2012, 27 patients were found to have undergone cervical DREZ procedures for BPA. Of these, 15 had preoperative MR images of the cervical spine available for review. The outcomes were graded from 1 to 4 as poor (no significant relief), good (more than 50% pain relief), excellent (more than 75% pain relief), or pain free, respectively. Overall, DREZotomy was found to be a safe, efficacious, and durable procedure for relief of pain due to BPA. The initial success rate was 73%, which declined to 66% at a median follow-up time of 62.5 months. Damage to the DREZ or dorsal horn was significantly correlated with poorer outcomes (p = 0.02). The average outcomes in patients without MRI evidence of DREZ or dorsal horn damage was significantly higher than in patients with such damage (3.67 vs 1.75, t-test; p = 0.001). A longer duration of pain prior to operation was also a significant predictor of treatment success (p = 0.004). cONcluSiONS Overall, the DREZotomy procedure has a 66% chance of achieving meaningful pain relief on longterm follow-up. Successful pain relief is associated with the lack of damage to the DREZ and dorsal horn on preoperative MRI.http://thejns.org/doi/abs/10.3171/2015.2.JNS142572KeY wOrdS brachial plexus avulsion; neuropathic pain; DREZotomy; dorsal root entry zone

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Surgical Leads for the Cervical Spine

Strachan

Eldabe

2019

Deer's Treatment of Pain

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Spinal Cord Stimulation in the Management of Pain from Brachial Plexus Avulsion

Cited by 21 publications

References 15 publications

Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation

Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation

Correlation of preoperative MRI with the long-term outcomes of dorsal root entry zone lesioning for brachial plexus avulsion pain

Surgical Leads for the Cervical Spine

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