Functional_targets and technique and limitations Flashcards
Var kan SCS placeras?
- alltid epiduralt
*från C1-C5 o nedåt.
Effect av SCS C1-2 placering?
neck, schoulder or arm.
What parts can be difficult to reach w SCS?
Midline truncal stimulation between neck and low back pain.
SCS: Var ska elektroder placeras för posterior column stimulation och hur upplevs det?
De läggs alltid i dorsal epidural space and give a tingling paresthesia overlaying the area of pain.
what type of guidance is usually used for SCS midline placement?
Flouroscopy
SCS: What can be done if the pain is lateralised?
The elecrodes may be placed eccentrically from midline towards the affected side.
What are the two ways to introduce electrodes in SCS?
- Tuohy needles, inserted via puncture
- Paddles, inserted via laminotomy.
SCS: How to reach effect level T8-9?
- Tuohy needle inserted some level below conus. Then threaded rostrally until desired coverage. Allow wide coverage.
- Paddle leads placed via laminotomy level T9-10 and passed rostrally to T8-9 vertebral body level.
How is the effect/success of an SCS determined?
ALWAYS several day trial period with an external generator before the patient fill out a VAS.
Success= more than 50% pain reduction.
SCS: What does IPG mean?
implanted pulse generator.
SCS: Where is the IPG placed?
in a subcutaneous pocket.
Flank, buttock, lower abdominal quadrant.
SCS: How is an SCS device controlled?
The IPG can be externally reprogrammed to fine tune stimulation.
DBS: for deafferentation pain syndromes
- sensory thalamus: VPM or VPL
For chronic neuropathic pain, 40-50% reduction in 20-60% of patients.
DBS: for nociceptive pain syndromes
PVG (perivenricular grey matter)
PAG (periaqueductal grey matter)
Response rate about 20%
DBS: cluster headaches
hypothalamic stimulation, but not evaluated enough.
