Neuromodulation implants are currently one of the most successful techniques in the treatment of chronic pain, a condition that affects more and more patients each year, leading to reduced quality of life as well as economic losses.
Neuromodulation implants for pain are a relatively new technique and are being increasingly used around the globe. However, technical training is not available for every implanter as there are relatively few centers in the world. Further, refresher courses for low-rate implanters are not available. This book fills that gap by offering an update on the best techniques currently used, providing a step-by-step guide on how to perform these procedures correctly.
Based on the experiences of leading physicians in the field, it also discusses how to manage both major and minor complications. Lastly, it covers the neuromodulatory intervention techniques used to treat chronic pain in various clinical areas. As such it is a valuable resource for pain physicians as well as neurosurgeons, orthopedists and anesthetists.
Author(s): Tiago da Silva Freitas, Bernardo Assumpcao de Monaco, Stanley Golovac
Publisher: Springer
Year: 2021
Language: English
Pages: 334
City: Cham
Preface
Contents
Contributors
Introduction and History of Neuromodulation for Pain
Introduction
Part I: From Electrical Fishes to Faradic Currents
Part II: Neuromodulation as a Long-Term Treatment
Deep Brain Stimulation
Spinal Cord Stimulation and Peripheral Nerve Stimulation
Motor Cortex Stimulation
Intrathecal Infusion Pumps
Part III: State-of-the-Art of Neuromodulation for Pain
State of the Art in Spinal Cord Stimulation for Pain
State of the Art in Deep Brain Stimulation (DBS) for Pain
References
Spinal Cord Stimulation: Percutaneous Technique
Introduction to the Technique
Indications [5]
Contraindications [5]
Strategies for Prevention of Spinal Cord Stimulator Infection
Preoperative [6, 7]
Intraoperative [6, 7]
Postoperative [6, 7]
Before the Procedure
Technical Details of Procedure (Trial)
Trial Period
Permanent Implant
Implantable Pulse Generator Placement
Complications
Dorsal Root Ganglion Stimulation
References
Suggested Reading
Spinal Cord Stimulation: Surgical (Paddle) Technique
Introduction
History
Rationale
Indications and Results
Percutaneous Leads Versus Paddle Leads
Technical Aspects
Trial Procedure
Implant of Pulse Generator
Spinal Cord Stimulation in Upper Thoracic and Cervical Regions
Complications
The Future of Spinal Cord Stimulation
Conclusions
References
The Penta Implant as I Do it
Status of SCS
Why Penta
Indicated Patients
Preoperative Evaluation
Operative Method
Summary Comments
References
Deep Brain Stimulation for Pain: Indications and Technique
Introduction
Indications and Surgical Aspects
Postoperative Aspects and Results
Conclusions
References
Introduction to Dorsal Root Ganglion Stimulation an Overview of the Field
Introduction
Real-World Evidence
Clinical Efficacy
Safety of Dorsal Root Ganglion Stimulation
MRI Safety
Regulatory Requirement
Conclusion
References
Percutaneous/Paddle Techniques: Values and Pearls
Introduction
Materials
Technique and Methods
Final Considerations
References
Peripheral Nerve Field Stimulation (PNfS)
Introduction
Proposed Mechanism
Modality Advantages
Candidate Selection
Neuropsychological Testing
PNfS Trial
PNfS Permanent Implant
Risk Mitigation
Conclusion
Supplemental Images
References
Ultrasound Indications, Historical Aspects, and Devices in Peripheral Nerve Stimulation
Indications, Historical Aspects, and Devices in Peripheral Nerve Stimulation
Introduction: Peripheral Nerve Stimulation History
General Indications
Devices in Peripheral Nerve Stimulation
New Specific Systems
Bibliography
Brachial Plexus Stimulation Using Ultrasound: New Technique Description
Introduction
Surgical Technique
Basic Anatomy
Surgical Technique
Bibliography
Occipital Nerve Stimulation Using an Ultrasound Surgical Technique
History and General Indications
Surgical Technique
Stimulation Trial
Surgical Technique
First Step: Stimulation Trial Procedure
Permanent Implant
Complications and how to Avoid Them
Surgical Technique (Figs. 1, 2, 3, and 4)
Bibliography
Peripheral Nerve Stimulation in Upper Limb Using Ultrasound Technique
General Instructions to Understand the USG Legends
USG Technique for Peripheral Nerve Stimulation in Upper Limb [2–14]
Axillary Nerve (Figs. 1, 2, 3, 4, 5, and 6)
Suprascapular Nerve (Figs. 7, 8, 9, 10, and 11)
Ulnar Nerve (Figs. 12, 13, 14, 15, 16, 17, 18, 19, 20, and 21)
Median Nerve (Nervus Medianus): Figs. 22, 23, 24, 25, and 26
Radial Nerve (Nervus Radialis): Figs. 27, 28, 29, 30, 31, 32, and 33
References
Peripheral Nerve Stimulation Technique Using Ultrasound in Lower Limbs
General Instructions to Understand the USG Legends
USG Technique for Peripheral Nerve Stimulation in Lower Limbs [2–18]
Saphenous Nerve (Figs. 1, 2, 3, and 4)
Tibial Nerve (Figs. 5, 6, 7, and 8)
Common Peroneal Nerve (Nervus Peroneus Communis): Figs. 9, 10, and 11
Superficial Peroneal Nerve (Nervus Peroneus Superficialis): Figs. 12, 13, 14, and 15
Lateral Femoral Cutaneous Nerve (Nervus Cutaneus Femoris Lateralis): Figs. 16, 17, 18, and 19
Femoral Nerve (Nervus Femoralis): Figs. 20, 21, 22, and 23
Sural Nerve (Nervus Suralis): Figs. 24, 25, 26, and 27
Sciatic Nerve (Nervus Ischiadicus): Figs. 28, 29, 30, and 31
References
Peripheral Nerve Stimulation (PNS) Using Ultrasound: Trunk and Pelvic Regions
General Instructions to Understand the USG Legends
USG Technique for Peripheral Nerve Stimulation in Trunk/Pelvis
Ilioinguinal and Iliohypogastric Nerves: Figs. 1, 2, 3, 4, 5, 6, and 7
Cluneal Nerve: Figs. 8, 9, 10, 11, and 12
Genitofemoral Nerve: Genital Rami (Figs. 13, 14, and 15)
Pudendal Nerve (Nervus Pudendus): Figs. 16, 17, 18, 19, and 20
References
Abdominal and Pancreatic Pain: Sites and Techniques in Neuromodulation
Introduction
Etiology
Pathophysiology
Pathophysiology of Pain in Chronic Pancreatitis (CP)
Clinical Features
Diagnosis
Treatment
Role of Neuromodulation in Visceral Pain
Clinical Evidence of SCS in CAP
Conclusion
References
IPG Site Creation, Considerations, and Risk Mitigation
Introduction and Background
Surgical Technique and Pocket Characteristics
Reducing Infectious Risk
Preoperative
Intraoperative
Postoperative
Management of Common Complications
IPG Site Reimplantation or Revision
References
Intrathecal Drug Delivery System: Surgical Technique
History and General Indications
Trialing Techniques
Surgical Technique
Preoperative Practices
Marking
Positioning
Skin Preparation and Draping
Preparation of Pump
Intrathecal Access and Catheter Placement
Lumbar Incision, Dissection, and Catheter Anchoring
Pump Pocket Creation and Anchoring Suture Placement
Tunneling
Pump Insertion and Skin Closure
Pump Refills
Types of Infusion Pumps
Mechanically Driven
Gas Propulsion
Programmable Infusion Pump
Complications
Medications
Morphine
Ziconotide
References
Intracerebroventricular Drug Infusion System Implant: Surgical Technique
Introduction
Patient Selection
Catheter Placement
Catheter Tunneling and Pump Implant
Infusion Management
Complications
References
Peripheral Nerve Stimulation: Fluoroscopic Implant Techniques
Introduction
Fluoroscopically Guided Procedures and Workflow
Occipital Nerve Stimulation
Trigeminal Branch Stimulation
Trigeminal Ganglion Stimulation
Peripheral Nerve Field Stimulation
Conclusion
References
The Value of Intraoperative Neuromonitoring for Neuromodulation
Introduction
Description of Neuromonitoring Protocol
Physician Interpretation of Data
Specific IONM for Dorsal Root Ganglion (DRG) Stimulation
Overview of Existing IONM Opportunities
References
Sacral Neuromodulation for Urinary and Fecal Incontinence: Surgical Technique
Introduction
Mechanisms of Action
Surgical Technique
Phase 1: Test Stimulation
Phase 2: Implantation of Internal Pulse Generator (IPG)
Illustration of Surgical Steps
Complications
References
Motor Cortex Stimulation: Neural Circuits and Practical Approach on Electrode Implantation Technique
Overview on Neural Circuits
Afferent Systems (See Fig. 1)
Efferent Systems (See Fig. 2)
Pathways Connecting Different Supraspinal Centers (See Fig. 2)
Techniques for Implantation of MCS Electrodes
References
Index
