Name: treating low back pain in failed back surgery patients with multicolumn-lead spinal cord stimulation
Uploaded: 2018-06-26T12:30:00
Description: Watch this Scientific Journal Video about Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation at JoVE.com

Forfatterne vil gerne takke Gabrielle Leyden for at revidere det endelige forslag til dette papir.

1. patienten udvælgelse
<ol><li>Stille en diagnose af FBSS20.</li>
	<li>
Sørg for at FBSS patienten opfylder alle inklusionskriterierne før at blive accepteret for en SCS retssag:
	<ol>
<li>Kroniske lændesmerter og/eller radikulære ben smerte der er refraktære over for optimal medicinsk behandling i mindst 6 måneder.</li>
		<li>Vedvarende smerter trods 3 typer af farmakologiske behandlinger (paracetamol, non-steroide anti-inflammatoriske lægemidler, opioider, antidepress...

<ol>
	<li>Schofferman, J., Reynolds, J., Herzog, R., Covington, E., Dreyfuss, P., O'Neill, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery:+Etiology+and+diagnostic+evaluation.">Failed back surgery: Etiology and diagnostic evaluation.</a> Spine Journal. 3 (5), 400-403 (2003).</li><li>Hazard, R. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery+syndrome:+surgical+and+nonsurgical+approaches.">Failed back surgery syndrome: surgical and nonsurgical approaches.</a> Clinical Orthopaedics and Related Research. 443 (443), 228-232 (2006).</li><li>Rigoard, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+Algorithmic+Programming+Approach+for+Back+Pain+Symptoms+in+Failed+Back+Surgery+Syndrome+Using+Spinal+Cord+Stimulation+with+a+Multicolumn+Surgically+Implanted+Epidural+Lead:+A+Multicenter+International+Prospective+Study.">An Algorithmic Programming Approach for Back Pain Symptoms in Failed Back Surgery Syndrome Using Spinal Cord Stimulation with a Multicolumn Surgically Implanted Epidural Lead: A Multicenter International Prospective Study.</a> Pain Practice. 15 (3), 195-207 (2015).</li><li>Thomson, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery+syndrome+-+definition,+epidemiology+and+demographics.">Failed back surgery syndrome - definition, epidemiology and demographics.</a> British Journal of Pain. 7 (1), 56-59 (2013).</li><li>Balagu&#233;, F., Mannion, A. F., Pellis&#233;, F., Cedraschi, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-specific+low+back+pain.">Non-specific low back pain.</a> Lancet. 379 (9814), 482-491 (2012).</li><li>Melzack, R., Wall, P. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pain+Mechanisms:+A+New+Theory.">Pain Mechanisms: A New Theory.</a> Science. 150 (3699), 971-979 (1965).</li><li>Gonz&#225;lez, J. C. A., Melzack, R., Wall, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+gate+theory:+Beyond+the+scientific+concept+two+worlds+scientists+dedicated+to+the+understanding+of+pain.">The gate theory: Beyond the scientific concept two worlds scientists dedicated to the understanding of pain.</a> Revista de la Sociedad Espanola del Dolor. 20 (4), 191-202 (2013).</li><li>Loeser, D., John, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concepts+of+pain.">Concepts of pain.</a> The Lancet. 353 (May 8), 1607-1609 (1992).</li><li>Cui, J. G., Linderoth, B., Meyerson, B. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+spinal+cord+stimulation+on+touch-evoked+allodynia+involve+GABAergic+mechanisms.+An+experimental+study+in+the+mononeuropathic+rat.">Effects of spinal cord stimulation on touch-evoked allodynia involve GABAergic mechanisms. An experimental study in the mononeuropathic rat.</a> Pain. 66 (2-3), 287-295 (1996).</li><li>Song, Z., Meyerson, B. A., Linderoth, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Muscarinic+receptor+activation+potentiates+the+effect+of+spinal+cord+stimulation+on+pain-related+behavior+in+rats+with+mononeuropathy.">Muscarinic receptor activation potentiates the effect of spinal cord stimulation on pain-related behavior in rats with mononeuropathy.</a> Neuroscience Letters. 436 (1), 7-12 (2008).</li><li>Song, Z., Meyerson, B. A., Linderoth, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+5-HT+receptors+that+contribute+to+the+pain-relieving+effects+of+spinal+cord+stimulation+in+a+rat+model+of+neuropathy.">Spinal 5-HT receptors that contribute to the pain-relieving effects of spinal cord stimulation in a rat model of neuropathy.</a> Pain. 152 (7), 1666-1673 (2011).</li><li>Waszak, P. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+Cord+Stimulation+in+Failed+Back+Surgery+Syndrome:+Review+of+Clinical+Use,+Quality+of+Life+and+Cost-effectiveness.">Spinal Cord Stimulation in Failed Back Surgery Syndrome: Review of Clinical Use, Quality of Life and Cost-effectiveness.</a> Asian Spine Journal. 10 (6), 1195-1204 (2016).</li><li>Kishima, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modulation+of+neuronal+activity+after+spinal+cord+stimulation+for+neuropathic+pain;+H(2)15O+PET+study.">Modulation of neuronal activity after spinal cord stimulation for neuropathic pain; H(2)15O PET study.</a> Neuroimage. 49 (2), 2564-2569 (2010).</li><li>Stanc&#225;k, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+magnetic+resonance+imaging+of+cerebral+activation+during+spinal+cord+stimulation+in+failed+back+surgery+syndrome+patients.">Functional magnetic resonance imaging of cerebral activation during spinal cord stimulation in failed back surgery syndrome patients.</a> European Journal of Pain (London, England). 12 (2), 137-148 (2008).</li><li>Yang, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bipolar+spinal+cord+stimulation+attenuates+mechanical+hypersensitivity+at+an+intensity+that+activates+a+small+portion+of+A-fiber+afferents+in+spinal+nerve-injured+rats.">Bipolar spinal cord stimulation attenuates mechanical hypersensitivity at an intensity that activates a small portion of A-fiber afferents in spinal nerve-injured rats.</a> Neuroscience. 199, 470-480 (2011).</li><li>North, R. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+cord+stimulation+versus+re-operation+in+patients+with+failed+back+surgery+syndrome:+an+international+multicenter+randomized+controlled+trial+(EVIDENCE+study).">Spinal cord stimulation versus re-operation in patients with failed back surgery syndrome: an international multicenter randomized controlled trial (EVIDENCE study).</a> Neuromodulation: Journal of the International Neuromodulation Society. 14, 330-335 (2011).</li><li>Kapural, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+10-kHz+High-Frequency+and+Traditional+Low-Frequency+Spinal+Cord+Stimulation+for+the+Treatment+of+Chronic+Back+and+Leg+Pain:+24-Month+Results+From+a+Multicenter,+Randomized,+Controlled+Pivotal+Trial.">Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-Month Results From a Multicenter, Randomized, Controlled Pivotal Trial.</a> Neurosurgery. 79 (5), 667-677 (2016).</li><li>Remacle, T. Y., Bonhomme, V. L., Renwart, H. J. P., Remacle, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Multicolumn+Lead+Spinal+Cord+Stimulation+on+Low+Back+Pain+in+Failed+Back+Surgery+Patients:+A+Three-Year+Follow-Up.">Effect of Multicolumn Lead Spinal Cord Stimulation on Low Back Pain in Failed Back Surgery Patients: A Three-Year Follow-Up.</a> Neuromodulation: Technology at the Neural Interface. 20 (7), 668-674 (2017).</li><li>Veizi, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+Cord+Stimulation+(SCS)+with+Anatomically+Guided+(3D)+Neural+Targeting+Shows+Superior+Chronic+Axial+Low+Back+Pain+Relief+Compared+to+Traditional+SCS-LUMINA+Study.">Spinal Cord Stimulation (SCS) with Anatomically Guided (3D) Neural Targeting Shows Superior Chronic Axial Low Back Pain Relief Compared to Traditional SCS-LUMINA Study.</a> Pain Medicine (Malden, Mass). 18 (8), 1534-1548 (2017).</li><li>Chan, C., Peng, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Failed+back+surgery+syndrome.">Failed back surgery syndrome.</a> Pain Medicine. 12 (4), 577-606 (2011).</li><li>Hawker, G., Mian, S., Kendzerska, T., French, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measures+of+adult+pain.">Measures of adult pain.</a> Arthritis Care and Research. 63 (11), 240-252 (2011).</li><li>Deer, T. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Neurostimulation+Appropriateness+Consensus+Committee+(NACC)+Safety+Guidelines+for+the+Reduction+of+Severe+Neurological+Injury.">The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury.</a> Neuromodulation. 20 (1), 15-30 (2017).</li><li>Gupta, P., Kumar, A., Kumar, A., Goel, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Congenital+Spinal+Cord+Anomalies:+A+Pictorial+Review.">Congenital Spinal Cord Anomalies: A Pictorial Review.</a> Current Problems in Diagnostic Radiology. 42 (2), 57-66 (2013).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Medtronic N'VISION&#174; Programmer Quick Guide. , (2009).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Medtronic MyStim&#174; Programmer Quick Guide. , (2014).</li><li>Frey, M. E., Manchikanti, L., Benyamin, R. M., Schultz, D. M., Smith, H. S., Cohen, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+cord+stimulation+for+patients+with+failed+back+surgery+syndrome:+a+systematic+review.">Spinal cord stimulation for patients with failed back surgery syndrome: a systematic review.</a> Pain Physician. 12 (2), 379-397 (2009).</li></ol>

Nylige undersøgelser har vist at SCS kan pålideligt forbedre de forskellige smerter komponenter af FBSS patienter, forbedre deres livskvalitet (f.eks. kvaliteten af søvn og fysisk aktivitet), og disse fordele er påført under en langsigtet opfølgning 3 , 17 , 18 , 19.
Afhængigt af lokaliseringen af smerten bruger vi en anden tilgang. Når patienten har...

Fejlslagen rygkirurgi syndrom (FBSS) refererer til vedvarende, kroniske smerter efter rygkirurgi. Før FBSS kan være etableret, andre betingelser, såsom vedvarende nerve rod kompression, permanent nerveskade rod som følge af oprindelige kompression eller kirurgi, arachnoiditis, forkert oprindelige diagnoser og dokumenterede mekaniske årsager til lændesmerter (som spinal ustabilitet, posterior fælles slidgigt, spondylolysthesis og discogenic smerter), bør være udelukket1,2,3. FBSS patienter kan have alvorlig eller invaliderende neuropatiske smerter og syndromet er bekymrende, da det er kronisk og resistente over for konventionel behandling. Dens incidens og prævalens er svarende til leddegigt4. Det er således en stor byrde for industrialiserede samfund5.
Rygmarv stimulation (SCS) med dorsal epidural fører kan bruges til at behandle rygsmerter (BP) og ben smerte (LP) hos FBSS patienter, selv om SCS pain relief mekanisme ikke er blevet fuldt undersøgt. Ifølge gate control teorien blev først foreslået af Ronald Melzack og Patrick Wall i 1965, hjernen overvåger aktiviteten af et lille neurale netværk fordelt langs den dorsale horn af rygmarven, der er reguleret af nociceptive men også ikke-nociceptive afferenter6. Disse komplekse kredsløb i den overfladiske dorsale horn af rygmarven er ansvarlig for at lindre smerte i et bestemt sted i kroppen, når en intens taktile stimulus anvendes på den samme plads7,8. Flere undersøgelser har dog vist, at SCS ikke er kun afhængige af denne teori. Flere neurotransmittere (acetylcholin, gamma - aminosmørsyre og serotonin) er blevet rapporteret at have en rolle i SCS mekanisme9,10,11,12, samt talrige områder i hjernen 13 , 14 og forskellige spinal fibre15.
En SCS enhed omfatter en epidural bly, interne pulsgenerator (IPG) og en forlængerledning til slut ledningen til IPG. Indstillingerne for stimulation er justeret med en ekstern fjernbetjening. To typer af elektrode kan bruges, nemlig perkutan og kirurgisk fører.
Effekten af SCS i forbedring af komponenten radikulære LP af FBSS allerede er blevet demonstreret i tidligere offentliggjorte undersøgelser, herunder de beviser undersøgelse16, og to nye teknologier har for nylig vist sig at være effektiv til behandling af BP komponent, som er kendt for at være genstridige at SCS. Den første er høj frekvens stimulation17. Den anden er brugen af kirurgiske multicolumn bly3,18. De største ulemper ved den tidligere teknik er at deres batterier mere brug for hyppig opladning og at programmering optimering er udfordret af længere "wash-in" gange19. Den sidstnævnte teknik er mere indgribende end perkutan højfrekvente stimulation teknik, fordi det kræver en lille laminektomi, gør peroperative paræstesi kortlægning under lokalbedøvelse udfordrende, selv om muligt3. Faktisk kan denne procedure udføres under lokalbedøvelse, suppleret med bevidst sedation eller spinal anæstesi3. I vores institution, når målretning rygsmerter hos FBSS patienter, lægge vi sådanne kirurgiske fører gennem en lille laminektomi på 10th thorax niveau med patienten under fuld narkose. Varig effektiviteten af denne metode med sådanne multicolumn fører til behandling af LP og BP i FBSS patienter er blevet påvist ved 3 års opfølgning18. En detaljeret protokol af vores metode er givet nedenfor.

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			<td>16-20 GA needle</td>
			<td>BD Insyte- W</td>
			<td></td>
			<td></td>
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			<td>NaCl 0.9% 1 L</td>
			<td>Baxter</td>
			<td>AKE1324</td>
			<td></td>
		</tr>
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			<td>Iso-betadine Dermic (500mL)</td>
			<td>MEDA</td>
			<td>09461.16</td>
			<td></td>
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		<tr>
			<td>Iso-betadine Soap (500mL)</td>
			<td>MEDA</td>
			<td>09462.10</td>
			<td></td>
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			<td>Iso-betadine hydroalcoolic (125 mL)</td>
			<td>MEDA</td>
			<td>41534.1</td>
			<td></td>
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		<tr>
			<td>Ziehm Vision R FD</td>
			<td>Ziehm Imaging Inc.</td>
			<td>CB05183</td>
			<td></td>
		</tr>
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			<td>Marcain 0.5% + adrenaline 1/200.000 20 mL</td>
			<td>Astrazenca</td>
			<td>PA 970/46/2</td>
			<td>0.5% Bupivacaine/1:200,000 adrenaline solution&#160;</td>
		</tr>
		<tr>
			<td>external Neurostimulator (eNs)&#160;</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>37022</td>
			<td></td>
		</tr>
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			<td>Trousse de colonne lombaire CHR Citadelle (Procedure pack)&#160;</td>
			<td>M&#246;lnlycke</td>
			<td>97061425-01</td>
			<td></td>
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			<td>OR Table</td>
			<td>Maquet</td>
			<td>1150.30D0</td>
			<td></td>
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			<td>OR Lights</td>
			<td>Trumpf</td>
			<td>1929278</td>
			<td></td>
		</tr>
		<tr>
			<td>Specify SureScan MRI</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>977C165</td>
			<td>Multicolumn lead</td>
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		<tr>
			<td>Primeadvanced surescan mri neurostimulator&#160;</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>97702</td>
			<td>Internal Pulse Generator</td>
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			<td>Monocryl 3/0</td>
			<td>Ethicon</td>
			<td>Y423</td>
			<td></td>
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			<td>Polysorb 2/0</td>
			<td>Covidien</td>
			<td>GL123</td>
			<td></td>
		</tr>
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			<td>Polysorb 1</td>
			<td>Covidien</td>
			<td>CL535</td>
			<td></td>
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			<td>Polysorb 2</td>
			<td>Covidien</td>
			<td>CL055</td>
			<td></td>
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		<tr>
			<td>Cutiplast Steril 20x10 cm</td>
			<td>Smith&#38;Nephew</td>
			<td>66001475</td>
			<td>Bandage</td>
		</tr>
		<tr>
			<td>MyStim Programmer</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>97740</td>
			<td></td>
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			<td>FixoCath</td>
			<td>Pajunk</td>
			<td>001151-37Z</td>
			<td></td>
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			<td>N&#39;Vision Programmer&#160;</td>
			<td>&#160;Medtronic Inc., MN, USA</td>
			<td>8840</td>
			<td></td>
		</tr>
		<tr>
			<td>3M Tegaderm Film 10x12cm</td>
			<td>3M Deutschland GmbH</td>
			<td>1626W</td>
			<td></td>
		</tr>
		<tr>
			<td>Extension Kit</td>
			<td>Medtronic Inc., MN, USA</td>
			<td>37081-40</td>
			<td></td>
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		<tr>
			<td>Paracetamol</td>
			<td>Fresenius Kabi</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Tradonal&#160;</td>
			<td>Meda Pharma</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sufentanil</td>
			<td>Janssen- Cilag</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Propolipid 1%</td>
			<td>Fresenius Kabi</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ketalar (Ketamine Hydrochloride)</td>
			<td>Pfizer</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Rocuronium Bromide</td>
			<td>Bbraun</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Cefazolin</td>
			<td>Milan</td>
			<td></td>
			<td></td>
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treating low back pain in failed back surgery patients with multicolumn-lead spinal cord stimulation

Fejlslagen rygkirurgi syndrom (FBSS) refererer til vedvarende, kroniske smerter efter rygkirurgi. Rygmarv stimulation med dorsal epidural fører kan bruges til behandling af ryg og ben i FBSS patienter. Dette paper præsenterer en detaljeret protokol for ved hjælp af rygmarven stimulation med kirurgisk fører i FBSS patienter. I vores afdeling, med patienten under fuld narkose, placerer vi i spidsen i epiduralrummet ved hjælp af en lille laminektomi på 10th thorax niveau. Placering af bly er efterfulgt af en 1 måneds prøveperiode med en externalized bly. Hvis smertelindring er større end 50% ved udgangen af dette 1 måned stimulation retssag (kræves af belgiske refusion kriterier), er en indre pulsgenerator derefter placeret under huden og forbundet med bly i en anden kirurgisk procedure. Vi har demonstreret, at bruge denne teknik i nøje udvalgte FBSS patienter kan forbedre rygsmerter, smerter i benene, patient aktivitet og livskvalitet for en længere periode.

En prospektiv, ikke-randomiseret, kontrolleret undersøgelse af 62 fortløbende FBSS patienter, der blev implanteret med en Flersøjle bly ved hjælp af denne metode i vores center, CHR Citadelle, i Liège, Belgien, blev for nylig offentliggjort i Neuromodulationsbehandling18 . Alle patienter havde tidligere rygkirurgi, var blevet screenet for mulige sekundære årsager til deres smerte og var ildfaste til optimal medicinsk behandling. Multicolumn kirurgisk fører ...

Watch this Scientific Journal Video about Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation at JoVE.com

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

Behandling af lændesmerter i fejlslagen rygkirurgi patienter med Flersøjle-bly rygmarven Stimulation

Dette paper præsenterer en metode, der bruger rygmarven stimulation med en Flersøjle bly til at behandle neuropatisk lændesmerter i fejlslagen rygkirurgi patienter.

Failed back surgery syndrome (FBSS) refers to persistent, chronic pain following spinal surgery. Spinal cord stimulation with dorsal epidural leads can be ...

Research

JoVE Journal

Behavior

Functional Magnetic Resonance Imaging (fMRI) with Auditory Stimulation in Songbirds

Functional Magnetic Resonance Imaging fMRI with Auditory Stimulation in Songbirds

Funktionel magnetisk resonans (fMRI) med Auditiv Stimulation i Songbirds

The neurobiology of birdsong, as a model for human speech, is a pronounced area of research in behavioral neuroscience. Whereas electrophysiology and ...

Use of the Operant Orofacial Pain Assessment Device (OPAD) to Measure Changes in Nociceptive Behavior

Use of the Operant Orofacial Pain Assessment Device OPAD to Measure Changes in Nociceptive Behavior

Anvendelse af operant Orofacial Pain Assessment Device (OPAD) at måle ændringer i Nociceptive Behavior

We present an operant  system for the detection of pain in awake, conscious rodents. The Orofacial  Pain Assessment Device (OPAD) assesses pain behaviors ...

Stimulating the Lip Motor Cortex with Transcranial Magnetic Stimulation

Stimulering af Lip Motor Cortex med Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception. ...

Treating Clinical Depression with Repetitive Deep Transcranial Magnetic Stimulation Using the Brainsway H1-coil

Behandling Klinisk depression med Gentagne Deep Transcranial magnetisk stimulation Brug af Brainsway H1-spole

Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-pharmacological approach to treating many brain-based disorders. rTMS uses ...

Eye-Tracking Control to Assess Cognitive Functions in Patients with Amyotrophic Lateral Sclerosis

Eye-Tracking Kontrol at vurdere kognitive funktioner hos patienter med amyotrofisk lateral sklerose

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to ...

Using Laser Doppler Imaging and Monitoring to Analyze Spinal Cord Microcirculation in Rat

Ved hjælp af Laser Doppler Imaging og overvågning til at analysere rygmarven mikrocirkulationen i Rat

Laser Doppler flowmetry (LDF) is a noninvasive method for blood flow (BF) measurement, which makes it preferable for measuring microcirculatory ...

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Paradigmer af nedre ekstremiteter elektrisk Stimulation uddannelse efter rygmarvsskade

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

Brain State-dependent Brain Stimulation with Real-time Electroencephalography-Triggered Transcranial Magnetic Stimulation

Brain State-afhængig hjerne stimulation med real-time elektroencefalografi-udløst Transcranial magnetisk stimulation

The effect of a stimulus to the brain depends not only on the parameters of the stimulus but also on the dynamics of brain activity at the time of the ...

Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

Hjemme baseret ordineret pulmonal motion hos patienter med stabil kronisk obstruktiv lungesygdom

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also ...

Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction

Brug af ensrettede rotationer for at forbedre den vestibulære system asymmetri hos patienter med vestibulær dysfunktion

The vestibular system provides information about head movement and mediates reflexes that contribute to balance control and gaze stabilization during ...