Recent Development Of Five Column Paddle Spinal Cord Electrode Used For Intractable Pain After Traumatic Lumbar Spine Injury.

摘要

Treatment of chronic low back pain (LBP) after lumbar spine trauma is challenging. Despite fixation of the fractured spine, chronic pain afflicts most of these patients. Spinal cord stimulation (SCS) is a treatment option with an unsatisfactory success rate for low back pain [1], which is attributed to inadequate coverage of painful area [2]. The configuration of the transverse tri-polar lead might have resulted with deeper penetration of the dorsal columns stimulation, resulting in improvement of low back paresthesia coverage [3]. Struijk [4] illustrated that transverse system might be effective in a theoretical model, which results of clinical study have confirmed [5]. However, the innovation of five column electrode, that has the broadest lateral electrode span of stimulation, may provide better pain reduction control.In this paper, the authors present the first report on five-column, paddle electrode (St. Jude Medical Neuromodulation Division, Plano, TX) implanted via thoracic foraminotomy, to achieve paresthesia of the lower back region, in a patient after lumbar spine injury. Introduction Treatment of chronic low back pain (LBP) after lumbar spine trauma is challenging. Despite fixation of the fractured spine, chronic pain afflicts most of these patients. Spinal cord stimulation (SCS) is a treatment option with an unsatisfactory success rate for low back pain [1], which is attributed to inadequate coverage of painful area [2]. The configuration of the transverse tri-polar lead might have resulted with deeper penetration of the dorsal columns stimulation, resulting in improvement of low back paresthesia coverage [3]. Struijk [4] illustrated that transverse system might be effective in a theoretical model, which results of clinical study have confirmed [5]. However, the innovation of five column electrode, that has the broadest lateral electrode span of stimulation, may provide better pain reduction control.In this paper, the authors present the first report on five-column, paddle electrode (St. Jude Medical Neuromodulation Division, Plano, TX) implanted via thoracic foraminotomy, to achieve paresthesia of the lower back region, in a patient after lumbar spine injury. Case report A 23-year-old woman was referred to our Neurosurgery Outpatient Department due to LBP and neuropathic radical pain in both legs. In 2007 year the patient sustained a car accident injury of lumbar spine region, resulting in “burst fracture” of L4 vertebral body. (Figure 1)