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What is Spinal Cord Stimulator?
Spinal electric cord stimulator consists of two devices Epidural Electrode and Neurostimulator ( Generator ) . extradural electrode is implanted in extradural space and Neurostimulator ( author ) is range under the pelt over abdomen or posterior . Spinal electric cord electrode is connected internally to generator by a especially design connecting conducting wire . Spinal Cord Stimulator ( Generator ) is program by an external remote .
How Does Spinal Cord Stimulator Relieve Pain?
Neurostimulator sends signal to extradural electrode to have spinal corduroy and immobilize pain impulses going to the pain nitty-gritty in brain.1 , 2Spinal cord stimulator is electric healing used for the neuromodulation.1 , 2
How Does Spinal Cord Stimulator Block Pain Impulse at Spinal Cord?
The hurting impulses decease through a gate ( Gate Control Theory ) at spinal cord.1 , 2Opening and culmination of gate is controlled by neurotransmitter ( neurochemicals ) . Spinal corduroy stimulator closes the logic gate by modulating the neurochemicals known as neuromodulation.1 , 2
What is Neuromodulation?
Spinal electric cord stimulator modulates neurotransmitter in spinal cord and also pain controlling logic gate . The pitch contour or alteration of forward passageway of pain in the ass impulse to brain is visit neuromodulation .
When was the First Spinal Cord Stimulator Placed in USA?
Dr. Shealy stick in first spinal cord stimulator in human subject in 19671 and Dr. Shimogi write the first scientific paper regarding intromission of spinal cord stimulator in the extradural space.3
Is the Spinal Cord Stimulator Better Now Than in 1967?
Yes , over the last 45 years several Institutions have done research on machine and its sanative effect on patients . operative technique and spinal cord stimulator machine has been improve over the last several eld .
Is Spinal Cord Stimulator Approved By FDA (Food And Drug Administration)?
Yes , FDA has approved spinal corduroy stimulator since 1989 .
Is Spinal Cord Stimulator Effective in Treating Back Pain in All Segment of the Spinal Cord?
Yes , spinal cord stimulator has been effective in treating several disease have upper , center and lower back pain or backache.4
Which Diseases Causing Upper Back Pain Are Treated With Spinal Cord Stimulator?
Which Diseases Causing Middle Back Pain Are Treated With Spinal Cord Stimulator?
Which Diseases Causing Lower Back Pain Are Treated With Spinal Cord Stimulator?
Am I A Candidate for Spinal Cord Stimulator for My Back Pain, I Have Had Multiple Back Surgery (Failed Back Surgery)?
Yes , you should confabulate an Interventional Pain Specialist for spinal corduroy stimulator for your back painfulness or backache . You will be schedule for irregular emplacement of electrode for trial . Trial period will last for 2 to 3 weeks . The electrode is also known as epidural electrode . One or two epidural electrodes are come out in epidural place calculate on pain statistical distribution . Unilateral pain is treated with individual spinal cord electrode and bilateral nuisance is treated with two spinal cord electrode ( right and leave electrode ) .
What Does Trial Lead Placement Involve?
Trial electrode is a irregular extradural electrode , which is placed in epidural space for 2 to 3 week . The function involves transdermic emplacement of extradural electrode through epidural needle . Epidural electrode are placed on right or left side at later or back of spinal cord for unilateral ( one side ) pain . Bilateral pain is process with two epidural electrode placed on the right way and leave side in the epidural outer space .
Why is Trial Lead Placed in Epidural Space?
Spinal cord is vasiform in shape and surrounded by a cerebrospinal fluid ( CSF ) . A thick membrane of sinewy tissue paper called dura encloses CSF and spinal cord . Space outside dura is an extradural distance . Epidural space is relatively easy to regain without penetrating through dura . Placement of epidural electrode at appropriate spirit level within epidural space is necessary to get optimum pain rest .
Is it Safe to Place Spinal Cord Electrode Close to Spinal Cord?
Yes , it is secure and several thousand surgery have already been performed with least side effects . slurred dura prevents transmission of transmission to CSF and spinal corduroy . Dura and CSF also act as a cushion absorber against metallic electrode . CSF also dampens transition of stimulation from stimulator to spinal electric cord .
How Would I Be Qualified For Permanent Placement of Spinal Cord Stimulator?
You will be considered for placement of lasting extradural electrode and neurostimulator only after a test of 2 to 3 weeks . Back pain relief of over 50 % is expected during the trial point to be dependant for permanent placement of electrode and author .
What is Dermatomal Distribution of Pain?
Pain distribute along the spinal cheek to neck , arms , dresser , stomach and legs . deterrent example of dermatomal distribution of sciatica pain in the neck is as pursue . Sciatica pain is feel in fundament and lower leg and nuisance is carried by a L4 , L5 and S1 spinal nerve . The dermatomal statistical distribution of this bother is feet , ankle and lower ramification and lesions causing annoyance of nerve are L4 , L5 and S1 spinal cheek . Dermatomal statistical distribution of pain determines the level of spinal cord where pain in the neck is generated .
How Would Pain Specialist or Neurosurgeon or Orthopedic Surgeon Determine the Appropriate Level of Spinal Cord to Place Epidural Electrode to Achieve Optimum Pain Relief?
The perfumed point to modulate the botheration is often at much higher stage than the grade of dermatomal painfulness . Dermatomal gap of pain in pegleg is because of irritation of L4 , L5 and S1 nerve . Sweet spot for pitch contour of L4 , L5 and S1 dermatomal pain is at thoracic spinal level of T8 to T11 . Trial electrode ( Trial booster cable ) is site in epidural space at level of T5 and T6 . Surgeon will energise the spinal cord to line up out the spread of stimulation . Lead will be pulled gently down by few mm until the paresthesia or pleasant tingling stimulation is felt over sore dermatome of branch . extradural electrode is then anchored to ligaments at the back of the spine once the acceptable pain ministration is accomplished .
What is a Sweet Spot?
The honeyed smirch is the level of spinal corduroy when stimulated by extradural electrode causes spread of pleasant prickling stimulation or paresthesia along the dermatome of terrible arena . Sweet spot is assess during trial while take appropriate placement of extradural spinal cord stimulator to attain optimum pain in the neck relief .
Why Percutaneous Spinal Cord Stimulator is Preferred Over Paddle Electrode?
Percutaneous electrode is regularly used for test and in most grammatical case also for lasting electrode placement . Electrode is place in extradural space through particular extradural needle . Surgery is less extensive and placement of electrode does not need laminectomy as in placement of paddle electrode .
What is The Advantage of Paddle Electrode?
boat paddle type of electrode is preferred if percutaneous electrode placement fails or patient had multiple back surgery . boat paddle electrode seldom changes post in extradural distance , unlike transdermal electrode . Paddle electrode is placed follow a partial laminectomy operative procedure.8
What is Laminectomy?
Lamina is posterior part of the ring of the vertebral bone , which surround epidural space . Partial laminectomy is a surgical procedure , which call for removal of small patch of lamina os . Paddle electrode is flat and spacious . Electrode can not be placed through needle . Paddle electrode ask wider surgical distance to set electrode in epidural outer space .
How is The Trial Spinal Cord Stimulator Programmed?
Trial spinal corduroy stimulator is programmed at convalescence room postdate surgery . Distal goal of the spinal corduroy stimulator will be connected to external generator or neurostimulator . Trial spinal cord stimulator is programmed using Remote Physician Programmer . There are two character of programmer , Physician Programmer and Patient Programmer .
Why Two Programmers Are Used in Spinal Cord Stimulator?
Physician or technician will apply the Physician Programmer for initial programming and for any changes if needed in future . computer programmer will prefer the combination of lede ( arrays ) place at proximal end of the spinal electric cord stimulator ( electrode ) placed at epidural quad . Multiple booster cable are activated to father modulating impulse to achieve optimum back pain in the neck relief . Patient is discharge home with Patient Remote Programmer .
What Can I Do With Patient Programmer or Patient Remote Programmer?
You will be able-bodied to switch the neurostimulator on and off . You will be able-bodied to increase or lessen the volume of spinal electric cord stimulation to accomplish optimal symptoms of tingling spread over painful dermatome ( anatomic arena ) .
Describe The Structure of Epidural Electrode?
Epidural Electrodes are of two types percutaneous and paddle type . Percutaneous epidural electrode is thin and vasiform used mostly for trial and also lasting use . Paddle epidural electrode is flat and wider , mostly used for lasting use . The electrode consists of arrays of lead on both side . Each leads are connected to each other . Each electrode may have 4 to 8 leads .
What Are The Configurations of Electrode?
Percutaneous and paddle eccentric epidural electrode host single or paired editorial of 4 to 8 lead ( arrays ) at the proximal end . The leads or array are connected to distal contact by petite wire . Distal metal contacts are located at distal ( forbidden ) end of spinal cord stimulator . Distal ( outer ) end of electrode is threaded in one of the slot of external or internal neurostimulator and lock in with peculiar screws . Electrode is now linked to computer computer programmer ( external or inner neurostimulator ) .
What is The Function of External or Internal Neurostimulator or Generator?
Neurostimulator is the brain of spinal corduroy stimulation . Electrical sign from Neurostimulator ( generator ) is transmitted to distal contact and through tiny wire to proximal leads ( arrays ) . The leads channelise radiofrequency sign passing through CSF to spinal corduroy . Neurostimulator controls all the Pb ( arrays ) locate within proximal end of spinal cord stimulator . Neurostimulator can choose number of leads on one or both side . Neurostimulator can transmit pulsing at various situated frequencies , voltage , waveform and duration to electrode . impulse are programme at ceaseless current , variable potential drop or perpetual electromotive force , and variable current setting . Stimulation can be correct on or off at want meter .
Can I Change The Combinations And Stimulation Patterns of Leads of Electrode With Patient Control Programming Remote?
No , you’re able to not exchange the combination of leads ( arrays ) that are selected for spinal electric cord stimulant . The impulses engender by the leads are selected to modulate particular level of spinal cord during programming by expert . Leads can be changes by using Physician Programmer only .
Why External Instead of Internal Neurotransmitter Is Used For Trial?
Trial live on for 2 to 6 week , in most cases 2 to 3 hebdomad . Trial epidural electrode is removed after 2 to 3 calendar week . inner author is expensive and battery inside the author last for over 2 years . Placement of generator is an extra OR and not recommended for 2 to 3 week trial . External generator is used only for trial run . External Generator can be used for dissimilar patients and works on AA or AAA batteries
What Are The Different Types of Neurostimulator or Generators?
External Neurotransmitter - used only during trial . Equipment is reused after cleaning and external sterilization .
Internal Neurotransmitter - Internal neurotransmitter are classified as follows-
Which Neurotransmitter is Better RF or IPG?
RF Receiver-
Intermittent Pulse Generator (IPG Neurotransmitter)
What Are The Complications of Spinal Cord Stimulator?
Spinal cord stimulator include epidural electrode and neurotransmitter .
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