1998
Linderoth, B; Gherardini, G; Lundeberg, T; Cui, J-G; Eriksson, S V; Trubek, S
SPINAL CORD STIMULATION COUNTERACTS ISCHEMIA IN EXPERIMENTAL SKIN FLAPS - Animal Studies Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 042, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_042,
title = {SPINAL CORD STIMULATION COUNTERACTS ISCHEMIA IN EXPERIMENTAL SKIN FLAPS - Animal Studies},
author = {B Linderoth and G Gherardini and T Lundeberg and J-G Cui and S V Eriksson and S Trubek},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_042_Linderoth.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {042},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Purpose: Spinal cord stimulation (SCS) is favourable in limb ischemia and ischemic pain. The best results are observed in vasospastic cases, e.g. Raynaud's syndrome. It has earlier been demonstrated that SCS may attenuate experimentally induced vasospasm in ischemic neurovascular skin flaps in the rat. In these studies it was observed the application of SCS before ischemia induction was more effective than if used only when ischemia was apparent. The present study was designed to investigate whether pre-emptive SCS can increase long-term flap survival after severe ischemia and to elucidate the neurohumoral mediation of the effect. Methods: Rats were implanted with chronic monopolar SCS systems. Three days later a groin flap based on the superficial epigastric vessels was harvested and the single feeding artery occluded by a detachable microvascular clip. After 12 hours the clip was removed. Flap survival was evaluated after seven days. Immediately before flap surgery three groups of animals received 30 min. SCS with clinical current parameters and with stimulation amplitudes of 70 or 90% of that evoking muscular contractions in the abdomen. The outcomes in these groups were compared to those in two control groups. In one group a calcitonin gene-related peptide (CGRP)- receptor antagonist was injected i.v. prior to SCS. Results: In the control groups without stimulation virtually all flaps had necrotized after one week. In SCS treated groups flap survival rate was 60% at the lower intensity and almost 90% at the higher. The administration of a CGRPantagonist before SCS reduced treatment efficacy to below 40% survival. The differences between the untreated and treated groups were significant. The decrease in survival after CGRP receptor blockage was significant in one out of two statistical tests. Conclusions: Pre-emptive spinal cord stimulation significantly enhances survival of skin flaps with critical ischemia. This effects seem to be dependent on the stimulation intensity and it may be mediated by the release of CGRP in the periphery. These findings may have practical implications in surgery of skin flaps with critical ischemia in humans.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Purpose: Spinal cord stimulation (SCS) is favourable in limb ischemia and ischemic pain. The best results are observed in vasospastic cases, e.g. Raynaud's syndrome. It has earlier been demonstrated that SCS may attenuate experimentally induced vasospasm in ischemic neurovascular skin flaps in the rat. In these studies it was observed the application of SCS before ischemia induction was more effective than if used only when ischemia was apparent. The present study was designed to investigate whether pre-emptive SCS can increase long-term flap survival after severe ischemia and to elucidate the neurohumoral mediation of the effect. Methods: Rats were implanted with chronic monopolar SCS systems. Three days later a groin flap based on the superficial epigastric vessels was harvested and the single feeding artery occluded by a detachable microvascular clip. After 12 hours the clip was removed. Flap survival was evaluated after seven days. Immediately before flap surgery three groups of animals received 30 min. SCS with clinical current parameters and with stimulation amplitudes of 70 or 90% of that evoking muscular contractions in the abdomen. The outcomes in these groups were compared to those in two control groups. In one group a calcitonin gene-related peptide (CGRP)- receptor antagonist was injected i.v. prior to SCS. Results: In the control groups without stimulation virtually all flaps had necrotized after one week. In SCS treated groups flap survival rate was 60% at the lower intensity and almost 90% at the higher. The administration of a CGRPantagonist before SCS reduced treatment efficacy to below 40% survival. The differences between the untreated and treated groups were significant. The decrease in survival after CGRP receptor blockage was significant in one out of two statistical tests. Conclusions: Pre-emptive spinal cord stimulation significantly enhances survival of skin flaps with critical ischemia. This effects seem to be dependent on the stimulation intensity and it may be mediated by the release of CGRP in the periphery. These findings may have practical implications in surgery of skin flaps with critical ischemia in humans.
North, R B; Kidd, D H; Olin, J; Sieracki, J M
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 167, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_167,
title = {SPINAL CORD STIMULATION ELECTRODE DESIGN, A PROSPECTIVEand RANDOMIZED COMPARISON OR PERCUTANEOUS AND INAULATOD PADDLE ELECTRODE},
author = {R B North and D H Kidd and J Olin and J M Sieracki},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_167_North.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {167},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Spinal cord stimulation for chronic, intractable has been increasingly successful in clinical practice because of recent technical improvements, in particular the development of electrode arrays with multiple contacts, supported by programmable implated pulse generators. The electrodes in current use may in some cases be placed percutaneously, and in other cases require laminectomy. Wo have performed a prospective, randomized comparison between different electrode designs, using a computerized system which allows direct patient interaction and quantitative measures, A series of 24 patients with chronic lumbosacral pain syndromes, in whom percutaneous four-contact electrodes were tested first, then underwent implantation at the same spinal level of two different electrode configurations. Either a new percutaneous four-contact electrode of the same design, or an insulated paddle electrode. By comparison with the percutaneous temporary electrode, at subjectivity identical stimulation intensities, the permanent insulated paddle electrode required significantly lower amplitude. Overlap of Pain by paresthesias, calculated from patients' drawings on a graphic input device, was significantly better for the permanent electrode, whether percutaneous or paddle design. Patient ratings of overlap were significantly better for the permanent electrodes, as well; each design was superior by one of two measures. Same of the technical advantages we have observed may be associated with improved clinical outcome; extended followup is planned to address this.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Spinal cord stimulation for chronic, intractable has been increasingly successful in clinical practice because of recent technical improvements, in particular the development of electrode arrays with multiple contacts, supported by programmable implated pulse generators. The electrodes in current use may in some cases be placed percutaneously, and in other cases require laminectomy. Wo have performed a prospective, randomized comparison between different electrode designs, using a computerized system which allows direct patient interaction and quantitative measures, A series of 24 patients with chronic lumbosacral pain syndromes, in whom percutaneous four-contact electrodes were tested first, then underwent implantation at the same spinal level of two different electrode configurations. Either a new percutaneous four-contact electrode of the same design, or an insulated paddle electrode. By comparison with the percutaneous temporary electrode, at subjectivity identical stimulation intensities, the permanent insulated paddle electrode required significantly lower amplitude. Overlap of Pain by paresthesias, calculated from patients' drawings on a graphic input device, was significantly better for the permanent electrode, whether percutaneous or paddle design. Patient ratings of overlap were significantly better for the permanent electrodes, as well; each design was superior by one of two measures. Same of the technical advantages we have observed may be associated with improved clinical outcome; extended followup is planned to address this.
North, R A; Kidd, D H; Olin, J; Sieracki, J M; Cutchis, P N
SPINAL CORD STIMULATION FOR AXIAL LOW BACK PAIN: $#$V E.004FE SINGLE PERCUTANEOUS ELECTRODES Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 168, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_168,
title = {SPINAL CORD STIMULATION FOR AXIAL LOW BACK PAIN: $#$V E.004FE SINGLE PERCUTANEOUS ELECTRODES},
author = {R A North and D H Kidd and J Olin and J M Sieracki and P N Cutchis},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_168_North.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {168},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Spinal cord stimulation for chronic, intractable pain has been increasingly successful in clinical practice because of recent technical improvements, in paticular the development of electrode arraya with multiple contacts, supported by programmable implanted pulse generators. "Dual electrode" percutaneous arrays, created by inserting electrode in parallel, recently have been reported to have advantages in the treatment of axial low back pain, which is a common clinical problem. We have undertaken a prospective, controlled study to compare the performance of single and dual electrodes in the treatment of axial low back pain. The standard clinical practice of screening patients with temporary electrodes before implanting a permanent system has allowed each of 20 patients to serve as hie or her own control. cgingle percutaneous electrodes with 4 contacts (1x4) and 9mm intercontact spacing have been compared with dual electrodes with 4 contacts (2x4) and 7-10 mm intercontact distances at the same spinal levels in the same patients. The two designs have been compared in a quantitative fashion, using a computerized system which allows direct patient interaction, adjusting stimulation parameters to specific psychophysical thresholds. Significant performance advantages have been observed for the single over the dual electrode systems; Patient ratings of overlap of pain by stimulation paresthesias, calculated overlap (from graphic inputs by patients), and scaled amplitude necessary to cover the low back, were all significantly better for the single electrode than the dual 7 mm electrodes, and slightly (but not significantly) better for the single electrode the= for the du&!. 10 mm electrode. Amplitude requirements were significantly lower for the single electrode than for either dual electrode configuration. While we have not observed advantages for the more elaborate dual electrode systems in treating axial low back pain, we have observed that technically successful treatment can be achieved with single or dual electrodes in the great majority of patients. Extended clinical followup will be required to demonstrate that this can be maintained chronically, und that it is clinically useful.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Spinal cord stimulation for chronic, intractable pain has been increasingly successful in clinical practice because of recent technical improvements, in paticular the development of electrode arraya with multiple contacts, supported by programmable implanted pulse generators. "Dual electrode" percutaneous arrays, created by inserting electrode in parallel, recently have been reported to have advantages in the treatment of axial low back pain, which is a common clinical problem. We have undertaken a prospective, controlled study to compare the performance of single and dual electrodes in the treatment of axial low back pain. The standard clinical practice of screening patients with temporary electrodes before implanting a permanent system has allowed each of 20 patients to serve as hie or her own control. cgingle percutaneous electrodes with 4 contacts (1x4) and 9mm intercontact spacing have been compared with dual electrodes with 4 contacts (2x4) and 7-10 mm intercontact distances at the same spinal levels in the same patients. The two designs have been compared in a quantitative fashion, using a computerized system which allows direct patient interaction, adjusting stimulation parameters to specific psychophysical thresholds. Significant performance advantages have been observed for the single over the dual electrode systems; Patient ratings of overlap of pain by stimulation paresthesias, calculated overlap (from graphic inputs by patients), and scaled amplitude necessary to cover the low back, were all significantly better for the single electrode than the dual 7 mm electrodes, and slightly (but not significantly) better for the single electrode the= for the du&!. 10 mm electrode. Amplitude requirements were significantly lower for the single electrode than for either dual electrode configuration. While we have not observed advantages for the more elaborate dual electrode systems in treating axial low back pain, we have observed that technically successful treatment can be achieved with single or dual electrodes in the great majority of patients. Extended clinical followup will be required to demonstrate that this can be maintained chronically, und that it is clinically useful.
Nuttin, B; De, SutterP.; Holsheimer, J; Wesselink, W; Gybels, J
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 069, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_069,
title = {SPINAL CORD STIMULATION IN PATIENTS WITH PAIN IN BACK OR LOWER LIMBS USING A NEW TRANSVERSE TRIPOLAR LEAD (TTL) AND TEMPORARY DUAL PULSE GENERATOR. THE LEUVEN EXPERIENCE},
author = {B Nuttin and SutterP. De and J Holsheimer and W Wesselink and J Gybels},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_069_Nuttin.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {069},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Purpose: To evaluate the efficacy of a transverse tripolar lead (TTL) and to test computer predictions on steering of paraesthesia. This lead has three electrodes oriented transversely to the spinal cord axis, and a fourth electrode on the midline close to the center electrode. By computer modeling, it has been predicted to bias recruitment in favor of dorsal column fibers, and with a new dual pulse stimulator may steer paraesthesia in a finely controlled manner. Methods: In patients with chronic intractable pain in one or more limbs from non-malignant origin a TTL was implanted and trial stimulation was performed using a new dual pulse stimulator All patients had had multiple stimulation devices before with good results if the paraesthesia could be delivered to the site of pain. They were – so to speak – the worst possible "stimulation cases" drawn from a large practice with patients having had electrical stimulation of the spinal cord. The study was performed after approval by an ethical committee and with respect for European Standard of Clinical Investigation on Medical Devices for Human Subjects (EN 540). Results: In a first study a TTL prototype (Model A, 12 mm wide) was implanted in four patients. Using the dual pulse stimulator, steering of paraesthesia could be demonstrated in all but one patient whose central contact was too close to the cord. Three out of four patients were satisfied after implant of the TTL. However, after 12 months only one patient remained with good effect from the stimulation, mainly due to technical problems with lead shifting and lead wire breakage. In a second study two patients received another type of TTL (Model B, 10 mm wide). These also did not last long due to unsolved technical drawbacks. The inclusion of patients was stopped and the leadwas totally redesigned. 12 months later, in a third study nine patients received a new TTL (Model 3991A, 10 mm wide). No technical defects of the lead were encountered. Steering could be demonstrated and 6 patients have received valuable benefit 1 year after implant, which was considered to be a good result in these selected worst possible patient population. Conclusions: Steering of paraesthesia is possible when the lead is near physiological midline and not too tilted. One concern is a more than doubling of the current needed over 12 weeks, sometimes to the limit of the stimulation device. The TTL Model 3991A can now be called reliable. A five center trial is underway with patients having the lead implanted as their first implantable stimulating device.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Purpose: To evaluate the efficacy of a transverse tripolar lead (TTL) and to test computer predictions on steering of paraesthesia. This lead has three electrodes oriented transversely to the spinal cord axis, and a fourth electrode on the midline close to the center electrode. By computer modeling, it has been predicted to bias recruitment in favor of dorsal column fibers, and with a new dual pulse stimulator may steer paraesthesia in a finely controlled manner. Methods: In patients with chronic intractable pain in one or more limbs from non-malignant origin a TTL was implanted and trial stimulation was performed using a new dual pulse stimulator All patients had had multiple stimulation devices before with good results if the paraesthesia could be delivered to the site of pain. They were – so to speak – the worst possible "stimulation cases" drawn from a large practice with patients having had electrical stimulation of the spinal cord. The study was performed after approval by an ethical committee and with respect for European Standard of Clinical Investigation on Medical Devices for Human Subjects (EN 540). Results: In a first study a TTL prototype (Model A, 12 mm wide) was implanted in four patients. Using the dual pulse stimulator, steering of paraesthesia could be demonstrated in all but one patient whose central contact was too close to the cord. Three out of four patients were satisfied after implant of the TTL. However, after 12 months only one patient remained with good effect from the stimulation, mainly due to technical problems with lead shifting and lead wire breakage. In a second study two patients received another type of TTL (Model B, 10 mm wide). These also did not last long due to unsolved technical drawbacks. The inclusion of patients was stopped and the leadwas totally redesigned. 12 months later, in a third study nine patients received a new TTL (Model 3991A, 10 mm wide). No technical defects of the lead were encountered. Steering could be demonstrated and 6 patients have received valuable benefit 1 year after implant, which was considered to be a good result in these selected worst possible patient population. Conclusions: Steering of paraesthesia is possible when the lead is near physiological midline and not too tilted. One concern is a more than doubling of the current needed over 12 weeks, sometimes to the limit of the stimulation device. The TTL Model 3991A can now be called reliable. A five center trial is underway with patients having the lead implanted as their first implantable stimulating device.
Kurt, E; Spincemaille, G H J J; Blaauw, G; Slooff, A C J
Spinal Cord Stimulation In The Management Of Pain From Brachial Plexus Avulsion Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 196, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Full Paper
@inproceedings{IFESS1998_196,
title = {Spinal Cord Stimulation In The Management Of Pain From Brachial Plexus Avulsion},
author = {E Kurt and G H J J Spincemaille and G Blaauw and A C J Slooff},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_196_Kurt.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {196},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Objectives: The effectiveness of spinal cord stimulation (SCS) in 11 patients suffering pain from brachial plexus avulsion (BPA) is presented. Background: After a traumatic plexus brachialis lesion about 80 % of the patients develop pain in the deafferentated arm, which reduces to 20 % after 3 years. This pain is considered as resistent to many forms of therapy. In the early 1970s, SCS was introduced in the treatment of BPA pain, with disappointing results1,2. Dorsal root entry zone (DREZ) thermocoagulation turned out to be specially suitable to treat this type of pain3,5 , but is however a destructive procedure. Material, Methods: In the period 1990- 1998 11 patients (9 males, 2 females) with severe pain were selected for a trial of SCS. The mean age at the time of the trauma was 25, mean age at presentation for SCS was 36, pointing out that most patients already had a long history of pain and several previous treatments which had failed thusfar. Patients underwent cervical myelography and CT scanning, and were analyzed by pain and quality of life scores before they underwent a trial of stimulation. If the pain relief was more than 50 % a definitive system was implanted. Results: The results of the SCS were divided in 3 groups: Group A, consisting of 4 patients with a good result, defined as more than 50 % pain relief. Group B, consisting of 3 patients with a poor result, defined as less than 25 % pain relief. Finally group C, consisting of 4 patients, in which it was not possible to obtain stimulation in the area of the pain. At a later stage, DREZ lesions were performed in 4 patients, 2 belonging to group A, and 2 to group C. The 2 patients of group A preferred DREZ lesions because they expected a better pain relief than they reached after SCS. Three of the 4 patients with a DREZ lesion showed a good result. No complications were observed. Discussion: Although the results of DREZ lesions seem to be better when compared with SCS, DREZ thermocoagulation is a major irreversible operation including risks for neurological deficit. Complications of SCS are very rare. Besides, the success percentage of DREZ lesions is described to be 70 %5 , implying still a relative large group of 30% remains with pain. In our serie, the success percentage of SCS is 40% after 2 years follow up. Another point of interest is the experience that some patients with extensive root avulsions still felt stimulation in the area of the pain. The patients of group A suffered a remarkable minor loss of sensory when compared with the patients belonging to group B and C. Obviously, the findings on myelography not always correlate with the findings on electromyogram. This emphasizes that a trial of SCS should be offered to any patient, even when the findings on myelography and electromyogram suggest a severe BPA. Conclusion: SCS is expected to be more effective in patients with partial root avulsion or intact roots, nevertheless the success rate is unpredictable. Therefore SCS remains the first choice of treatment, especially due to its relative non-invasive technique when compared with DREZ lesions. After failure of SCS, DREZ thermocoagulation is a good option.},
keywords = {Full Paper},
pubstate = {published},
tppubtype = {inproceedings}
}
Objectives: The effectiveness of spinal cord stimulation (SCS) in 11 patients suffering pain from brachial plexus avulsion (BPA) is presented. Background: After a traumatic plexus brachialis lesion about 80 % of the patients develop pain in the deafferentated arm, which reduces to 20 % after 3 years. This pain is considered as resistent to many forms of therapy. In the early 1970s, SCS was introduced in the treatment of BPA pain, with disappointing results1,2. Dorsal root entry zone (DREZ) thermocoagulation turned out to be specially suitable to treat this type of pain3,5 , but is however a destructive procedure. Material, Methods: In the period 1990- 1998 11 patients (9 males, 2 females) with severe pain were selected for a trial of SCS. The mean age at the time of the trauma was 25, mean age at presentation for SCS was 36, pointing out that most patients already had a long history of pain and several previous treatments which had failed thusfar. Patients underwent cervical myelography and CT scanning, and were analyzed by pain and quality of life scores before they underwent a trial of stimulation. If the pain relief was more than 50 % a definitive system was implanted. Results: The results of the SCS were divided in 3 groups: Group A, consisting of 4 patients with a good result, defined as more than 50 % pain relief. Group B, consisting of 3 patients with a poor result, defined as less than 25 % pain relief. Finally group C, consisting of 4 patients, in which it was not possible to obtain stimulation in the area of the pain. At a later stage, DREZ lesions were performed in 4 patients, 2 belonging to group A, and 2 to group C. The 2 patients of group A preferred DREZ lesions because they expected a better pain relief than they reached after SCS. Three of the 4 patients with a DREZ lesion showed a good result. No complications were observed. Discussion: Although the results of DREZ lesions seem to be better when compared with SCS, DREZ thermocoagulation is a major irreversible operation including risks for neurological deficit. Complications of SCS are very rare. Besides, the success percentage of DREZ lesions is described to be 70 %5 , implying still a relative large group of 30% remains with pain. In our serie, the success percentage of SCS is 40% after 2 years follow up. Another point of interest is the experience that some patients with extensive root avulsions still felt stimulation in the area of the pain. The patients of group A suffered a remarkable minor loss of sensory when compared with the patients belonging to group B and C. Obviously, the findings on myelography not always correlate with the findings on electromyogram. This emphasizes that a trial of SCS should be offered to any patient, even when the findings on myelography and electromyogram suggest a severe BPA. Conclusion: SCS is expected to be more effective in patients with partial root avulsion or intact roots, nevertheless the success rate is unpredictable. Therefore SCS remains the first choice of treatment, especially due to its relative non-invasive technique when compared with DREZ lesions. After failure of SCS, DREZ thermocoagulation is a good option.
Kurt, E; Spincemaille, G H J J; Blaauw, G
SPINAL CORD STIMULATION IN THE MANAGEMENT OF PAIN FROM BRACHIAL PLEXUS AVULSION Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 129, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_129,
title = {SPINAL CORD STIMULATION IN THE MANAGEMENT OF PAIN FROM BRACHIAL PLEXUS AVULSION},
author = {E Kurt and G H J J Spincemaille and G Blaauw},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_129_Kurt.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {129},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Purpose: In the early 1970s, spinal cord stimulation (SCS) has been introduced in the treatment of brachial plexus avulsion (BPA) pain. Since dorsal root entry zone (DREZ) lesions turned out to be specially suitable to treat this type of pain, with a success percentage up to 70 % in literature, the indication for SCS became somewhat controversial. In this study we evaluate the effectiveness of SCS in 10 patients suffering pain from BPA. Methods: Ten patients with severe pain in the upper limb due to brachial plexus avulsion were selected for SCS. In these patients all other treatments had failed thusfar. Patients underwent cervical myelography and CT scanning, and were analyzed by pain and quality of life scores before they underwent a trial of stimulation. Results: In 4 patients it was not possible to achieve a stimulation in the area of the pain (group A), in 3 patients the pain relief was too low to justify the implantation of a definite system (group B), in 3 patients the effect was good (group C). At a later stage, we performed DREZ lesions in 4 patients, of whom 2 belonged to group A, and 2 belonged to group C. After treatment with DREZ lesions 3 patients showed a good result. Conclusion: Our disappointing results are according to the results mentioned in literature. Nevertheless SCS still remains the first choice of treatment due to its relative non-invasive technique when compared with DREZ lesions.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Purpose: In the early 1970s, spinal cord stimulation (SCS) has been introduced in the treatment of brachial plexus avulsion (BPA) pain. Since dorsal root entry zone (DREZ) lesions turned out to be specially suitable to treat this type of pain, with a success percentage up to 70 % in literature, the indication for SCS became somewhat controversial. In this study we evaluate the effectiveness of SCS in 10 patients suffering pain from BPA. Methods: Ten patients with severe pain in the upper limb due to brachial plexus avulsion were selected for SCS. In these patients all other treatments had failed thusfar. Patients underwent cervical myelography and CT scanning, and were analyzed by pain and quality of life scores before they underwent a trial of stimulation. Results: In 4 patients it was not possible to achieve a stimulation in the area of the pain (group A), in 3 patients the pain relief was too low to justify the implantation of a definite system (group B), in 3 patients the effect was good (group C). At a later stage, we performed DREZ lesions in 4 patients, of whom 2 belonged to group A, and 2 belonged to group C. After treatment with DREZ lesions 3 patients showed a good result. Conclusion: Our disappointing results are according to the results mentioned in literature. Nevertheless SCS still remains the first choice of treatment due to its relative non-invasive technique when compared with DREZ lesions.
Visocchi, M; Meglio, M; Cioni, B; Cabezas, C D; Romeo, F
SPINAL CORD STIMULATION (SCS) PREVENTS THE EFFECTS OF COMBINED EXPERIMENTAL ISCHEMIC AND TRAUMATIC BRAIN INJURY Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 026, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_026,
title = {SPINAL CORD STIMULATION (SCS) PREVENTS THE EFFECTS OF COMBINED EXPERIMENTAL ISCHEMIC AND TRAUMATIC BRAIN INJURY},
author = {M Visocchi and M Meglio and B Cioni and C D Cabezas and F Romeo},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_026_Visocchi.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {026},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Purpose: After demonstrating that SCS increases cerebral blood flow in animals (CBF) SCS has been shown to prevent experimental "early spasm" in the rabbit (Winner of the ICESS Award 1996). The aim of the present study is to demonstrate a similar SCS experimental "preventing effect" on combined ischemic and traumatic injury. Methods: After showing a non-fulfillment of the six-vessel occlusion ischemic model as well as a pure mechanical trauma model, 20 New Zealand rabbits (4-5 Kg) were anesthetized (Ketamine, Diazepam, N2O, Propofol). Homeostasis (pH, CO2, O2, arterial pressure)) was monitorized and kept constant. Control group : in 10 animals, after closure of both common carotid arteries, a monolateral hemispheric craniectomy was performed and the dura exposed. A 200 gr. cylinder (diameter 9 mm) was placed over the dura for three hours along with a Near Infrared Spectroscopy (NIRS) probe. After a lethal potassium injection, an MR study was performed. SCS group : in 10 animals, after occlusion of both common carotid arteries, an epidural electrode was placed over the cord at C2-C3 level on the right side and SCS was delivered at 210 microsec., 80 Hz, amplitude 2/3 of motor threshold, continuously up to the end of the experiment. Subsequently a right hemispheric craniectomy was performed and the 200 gr. cylinder was placed over the dura for three hours. Rabbits underwent MR and NIRS studies with the same modalities. Results: Control group: MR examination showed the evidence of T2 weighted hyperintense lesions (9-24mm in diameter) beneath the craniectomy and deep lesions close to the midline in all the cases. NIRS study showed a decrease of oxidized hemoglobin (O2Hb) along with an increase of hydrogenated hemoglobin (HHb) consistent with a decrease of cerebral blood flow (CBF). SCS group : MR imaging showed inconstant lesion beneath the craniectomy and none, but one, close to the midline. NIRS, in contrast with control group, showed an increase of O2Hb and a decrease of HHb consistent with an increase of CBF. Conclusions: The role of SCS in preventing deep lesions and the possible mechanisms underlying such an effect will be discussed.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Purpose: After demonstrating that SCS increases cerebral blood flow in animals (CBF) SCS has been shown to prevent experimental "early spasm" in the rabbit (Winner of the ICESS Award 1996). The aim of the present study is to demonstrate a similar SCS experimental "preventing effect" on combined ischemic and traumatic injury. Methods: After showing a non-fulfillment of the six-vessel occlusion ischemic model as well as a pure mechanical trauma model, 20 New Zealand rabbits (4-5 Kg) were anesthetized (Ketamine, Diazepam, N2O, Propofol). Homeostasis (pH, CO2, O2, arterial pressure)) was monitorized and kept constant. Control group : in 10 animals, after closure of both common carotid arteries, a monolateral hemispheric craniectomy was performed and the dura exposed. A 200 gr. cylinder (diameter 9 mm) was placed over the dura for three hours along with a Near Infrared Spectroscopy (NIRS) probe. After a lethal potassium injection, an MR study was performed. SCS group : in 10 animals, after occlusion of both common carotid arteries, an epidural electrode was placed over the cord at C2-C3 level on the right side and SCS was delivered at 210 microsec., 80 Hz, amplitude 2/3 of motor threshold, continuously up to the end of the experiment. Subsequently a right hemispheric craniectomy was performed and the 200 gr. cylinder was placed over the dura for three hours. Rabbits underwent MR and NIRS studies with the same modalities. Results: Control group: MR examination showed the evidence of T2 weighted hyperintense lesions (9-24mm in diameter) beneath the craniectomy and deep lesions close to the midline in all the cases. NIRS study showed a decrease of oxidized hemoglobin (O2Hb) along with an increase of hydrogenated hemoglobin (HHb) consistent with a decrease of cerebral blood flow (CBF). SCS group : MR imaging showed inconstant lesion beneath the craniectomy and none, but one, close to the midline. NIRS, in contrast with control group, showed an increase of O2Hb and a decrease of HHb consistent with an increase of CBF. Conclusions: The role of SCS in preventing deep lesions and the possible mechanisms underlying such an effect will be discussed.
Grill, M W; Wang, B; Bhadra, N; Haxhiu, A M
SPINAL NEURONS REGULATING MICTURITION: IDENTIFICATION AND EFFECTS OF STIMULATION Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 113, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_113,
title = {SPINAL NEURONS REGULATING MICTURITION: IDENTIFICATION AND EFFECTS OF STIMULATION},
author = {M W Grill and B Wang and N Bhadra and A M Haxhiu},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_113_Grill.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {113},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Current motor prostheses use activation of last-order (motor) neurons to restore function. We are pursuing a new approach: control by activation of higher-order neurons. In the present experiments we used expression of the immediate early gene c-fos to identify the spinal neurons active during micturition and measured the bladder and urethral pressures evoked by intraspinal microstimulation of these neurons. Chloralose anesthetized male cats underwent a 1-2 h period of isometric micturition, were perfused, and immunochemistry used to detect expression of c- Fos. Neurons expressing c-Fos were found bilaterally in S1-S3 localized to the lateral portion of the superficial dorsal horn (laminae I and II), the intermediolateral region (lateral laminae V-VII), and around the central canal (lamina X and medial laminae V-VII). The pressures generated in the bladder and urethra in response to microstimulation of the sacral spinal cord were measured in chloralose anesthetized male cats. Increases in bladder pressure were generated by microstimulation in the intermediolateral region, in the lateral and ventrolateral ventral horn, and around the central canal. Simultaneous increases in intraurethral pressure were evoked by microstimulation in the ventrolateral ventral horn, but not at the other locations. Reductions in intraurethral pressure were evoked at locations in the intermediate laminae and around the central canal. Stimulation around the central canal produced bladder contractions with either no change or a reduction in urethral pressure and voiding of small amounts of fluid. These results support the hypothesis that activation of higher-orer neurons may simplify neural prosthetic control of complex functions.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Current motor prostheses use activation of last-order (motor) neurons to restore function. We are pursuing a new approach: control by activation of higher-order neurons. In the present experiments we used expression of the immediate early gene c-fos to identify the spinal neurons active during micturition and measured the bladder and urethral pressures evoked by intraspinal microstimulation of these neurons. Chloralose anesthetized male cats underwent a 1-2 h period of isometric micturition, were perfused, and immunochemistry used to detect expression of c- Fos. Neurons expressing c-Fos were found bilaterally in S1-S3 localized to the lateral portion of the superficial dorsal horn (laminae I and II), the intermediolateral region (lateral laminae V-VII), and around the central canal (lamina X and medial laminae V-VII). The pressures generated in the bladder and urethra in response to microstimulation of the sacral spinal cord were measured in chloralose anesthetized male cats. Increases in bladder pressure were generated by microstimulation in the intermediolateral region, in the lateral and ventrolateral ventral horn, and around the central canal. Simultaneous increases in intraurethral pressure were evoked by microstimulation in the ventrolateral ventral horn, but not at the other locations. Reductions in intraurethral pressure were evoked at locations in the intermediate laminae and around the central canal. Stimulation around the central canal produced bladder contractions with either no change or a reduction in urethral pressure and voiding of small amounts of fluid. These results support the hypothesis that activation of higher-orer neurons may simplify neural prosthetic control of complex functions.
Perkins, T A; Donaldson, N. de. N.; Harper, V J; Norton, J A; Rushton, D N; Tromans, A M; Wood, D E
STANDING, STEPPING AND CYCLING FOR A T9 PARAPLEGIC WITH A LUMBO-SACRAL ANTERIOR ROOT STIMULATOR IMPLANT (LARSI) Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 114, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_114,
title = {STANDING, STEPPING AND CYCLING FOR A T9 PARAPLEGIC WITH A LUMBO-SACRAL ANTERIOR ROOT STIMULATOR IMPLANT (LARSI)},
author = {T A Perkins and N.de.N. Donaldson and V J Harper and J A Norton and D N Rushton and A M Tromans and D E Wood},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_114_Perkins.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {114},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Purpose: To evaluate root stimulation responses and determine their suitability for restoring leg function in paraplegia. To obtain sufficient utility for the patient to maintain significant daily leg exercise. Method: In December 1994, a complete T9 paraplegic was implanted with electrodes for stimulating the anterior spinal roots from L2 to S2 bilaterally. For standing, lower lumbar root stimulation straightens the knees and sacral root stimulation stabilizes the hips. For stepping, upper lumbar root stimulation swings the leading leg forward. For semirecumbent tricycling, we stimulate, for each leg, alternate lumbar and sacral roots to push the corresponding pedal through half a turn. Result: The patient maintains training at about 40 minutes daily. At home she can stand at will for up to 3 minutes (limited by hip flexion), with sufficient stability to have one hand free for reaching. In the laboratory, she has taken 24 steps at a time, limited by hip adduction which can be eliminated temporarily by blocking the obturator nerves with Marcain. She has cycled up to 300 metres at a time, reaching a speed of 5.5kph. Conclusion: LARSI can provide sufficient standing, stepping and cycling capability to encourage a paraplegic to maintain daily leg exercise. Finding permanent solutions for excess hip flexion and adduction remain.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Purpose: To evaluate root stimulation responses and determine their suitability for restoring leg function in paraplegia. To obtain sufficient utility for the patient to maintain significant daily leg exercise. Method: In December 1994, a complete T9 paraplegic was implanted with electrodes for stimulating the anterior spinal roots from L2 to S2 bilaterally. For standing, lower lumbar root stimulation straightens the knees and sacral root stimulation stabilizes the hips. For stepping, upper lumbar root stimulation swings the leading leg forward. For semirecumbent tricycling, we stimulate, for each leg, alternate lumbar and sacral roots to push the corresponding pedal through half a turn. Result: The patient maintains training at about 40 minutes daily. At home she can stand at will for up to 3 minutes (limited by hip flexion), with sufficient stability to have one hand free for reaching. In the laboratory, she has taken 24 steps at a time, limited by hip adduction which can be eliminated temporarily by blocking the obturator nerves with Marcain. She has cycled up to 300 metres at a time, reaching a speed of 5.5kph. Conclusion: LARSI can provide sufficient standing, stepping and cycling capability to encourage a paraplegic to maintain daily leg exercise. Finding permanent solutions for excess hip flexion and adduction remain.
Perkins, T A; Donaldson, N. de. N.; Harper, V J; Norton, J A; Rushton, D N; Tromans, A M; Wood, D E
STANDING, STEPPING AND CYCLING FOR A T9 PARAPLEGIC WITH A LUMBO-SACRAL ANTERIOR ROOT STIMULATOR IMPLANT (LARSI) Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 067, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_067,
title = {STANDING, STEPPING AND CYCLING FOR A T9 PARAPLEGIC WITH A LUMBO-SACRAL ANTERIOR ROOT STIMULATOR IMPLANT (LARSI)},
author = {T A Perkins and N.de.N. Donaldson and V J Harper and J A Norton and D N Rushton and A M Tromans and D E Wood},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_067_Perkins.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {067},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Purpose: To evaluate root stimulation responses and determine their suitability for restoring leg function in paraplegia. To obtain sufficient utility for the patient to maintain significant daily leg exercise. Method: In December 1994, a complete T9 paraplegic was implanted with electrodes for stimulating the anterior spinal roots from L2 to S2 bilaterally. For standing, lower lumbar root stimulation straightens the knees and sacral root stimulation stabilizes the hips. For stepping, upper lumbar root stimulation swings the leading leg forward. For semirecumbent tricycling, we stimulate, for each leg, alternate lumbar and sacral roots to push the corresponding pedal through half a turn. Result: The patient maintains training at about 40 minutes daily. At home she can stand at will for up to 3 minutes (limited by hip flexion), with sufficient stability to have one hand free for reaching. In the laboratory, she has taken 24 steps at a time, limited by hip adduction which can be eliminated temporarily by blocking the obturator nerves with Marcain. She has cycled up to 300 metres at a time, reaching a speed of 5.5kph. Conclusion: LARSI can provide sufficient standing, stepping and cycling capability to encourage a paraplegic to maintain daily leg exercise. Finding permanent solutions for excess hip flexion and adduction remain.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Purpose: To evaluate root stimulation responses and determine their suitability for restoring leg function in paraplegia. To obtain sufficient utility for the patient to maintain significant daily leg exercise. Method: In December 1994, a complete T9 paraplegic was implanted with electrodes for stimulating the anterior spinal roots from L2 to S2 bilaterally. For standing, lower lumbar root stimulation straightens the knees and sacral root stimulation stabilizes the hips. For stepping, upper lumbar root stimulation swings the leading leg forward. For semirecumbent tricycling, we stimulate, for each leg, alternate lumbar and sacral roots to push the corresponding pedal through half a turn. Result: The patient maintains training at about 40 minutes daily. At home she can stand at will for up to 3 minutes (limited by hip flexion), with sufficient stability to have one hand free for reaching. In the laboratory, she has taken 24 steps at a time, limited by hip adduction which can be eliminated temporarily by blocking the obturator nerves with Marcain. She has cycled up to 300 metres at a time, reaching a speed of 5.5kph. Conclusion: LARSI can provide sufficient standing, stepping and cycling capability to encourage a paraplegic to maintain daily leg exercise. Finding permanent solutions for excess hip flexion and adduction remain.
Perkins, Ta.; Donaldson, Nden; HarperVj.,; Norton, J; Tromans, Am.; Wood, De.; Rushton, Dn.
Standing, Stepping And Cycling For A T9 Paraplegic With A Lumbo-Sacral Anterior Root Stimulator Implant Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 203, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Full Paper
@inproceedings{IFESS1998_203,
title = {Standing, Stepping And Cycling For A T9 Paraplegic With A Lumbo-Sacral Anterior Root Stimulator Implant},
author = {Ta. Perkins and Nden Donaldson and HarperVj. and J Norton and Am. Tromans and De. Wood and Dn. Rushton},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_203_Perkins.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {203},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Root stimulation responses and effects of training were described for one female subject with a complete T9 spinal lesion. She has a 12 channel stimulator implant with electrodes on the anterior L2 to S2 spinal roots bilaterally. For standing, lower lumbar and sacral root stimulation extend knees and hips respectively. The primary clinical aim for the patient to stand under her own control with sufficient stability to have one hand free for reaching has been attained. The patient was authorised to use the implant controller for that purpose at home in January 1996. Standing is limited to a maximum of about 3 minutes at a time by hip flexion, the reasons for which are still under investigation. For stepping, the upper lumbar roots have been used to swing the leading leg forward, returning to lower lumbar and sacral root stimulation for the stance phase. Leg adduction during the swing phase has prevented use of this function outside the laboratory. This hip adduction can be adequately reduced temporarily by blocking the obturator nerves with Marcain. A permanent surgical solution is under consideration. She has taken 24 steps at a time using the stimulator. Leg powered cycling has been achieved using a recumbent tricycle. For each leg, alternate lumbar and sacral root stimulation was used to push the corresponding pedal through half a turn. She has cycled 1200 metres at a time at about 12kph.},
keywords = {Full Paper},
pubstate = {published},
tppubtype = {inproceedings}
}
Root stimulation responses and effects of training were described for one female subject with a complete T9 spinal lesion. She has a 12 channel stimulator implant with electrodes on the anterior L2 to S2 spinal roots bilaterally. For standing, lower lumbar and sacral root stimulation extend knees and hips respectively. The primary clinical aim for the patient to stand under her own control with sufficient stability to have one hand free for reaching has been attained. The patient was authorised to use the implant controller for that purpose at home in January 1996. Standing is limited to a maximum of about 3 minutes at a time by hip flexion, the reasons for which are still under investigation. For stepping, the upper lumbar roots have been used to swing the leading leg forward, returning to lower lumbar and sacral root stimulation for the stance phase. Leg adduction during the swing phase has prevented use of this function outside the laboratory. This hip adduction can be adequately reduced temporarily by blocking the obturator nerves with Marcain. A permanent surgical solution is under consideration. She has taken 24 steps at a time using the stimulator. Leg powered cycling has been achieved using a recumbent tricycle. For each leg, alternate lumbar and sacral root stimulation was used to push the corresponding pedal through half a turn. She has cycled 1200 metres at a time at about 12kph.
Sinkjaer, T; Struijk, J J; Bajd, T; Donaldson, N; Veltink, P; Veraart, C; Pedotti, A; Rabischong, P
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 020, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_020,
title = {STANDING WITH ELECTRICAL NEUROMUSCULAR STIMULATION APPLYING TACTILE AND PROPRIOCEPTIVE INFORMATION OBTAINED FROM NATURAL SENSORS (SENSATIONS)},
author = {T Sinkjaer and J J Struijk and T Bajd and N Donaldson and P Veltink and C Veraart and A Pedotti and P Rabischong},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_020_Sinkjaer.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {020},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {In this European Shared Cost RTD project, which includes seven research centres, we seek to improve control schemes for FES systems by selective muscle recruitment via nerve stimulation and the inclusion of feedback information from the body's own sensory system. Natural sensors are abundantly available in the body, and they are of paramount importance in the normal physiology of motor control. With the use of neural sensing and nerve stimulation, the largest part of the FES system is implantable, thus solving a part of the daily burden and acceptability for the patients. Within the three-year time frame of the BIOMED 2 Work Programme we focus on a system for paraplegic standing. Paraplegic persons are not able to stand without assisting devices and are thus unable to perform trivial tasks, although by far the largest part of their neuromuscular system involved in standing-up, standing, and sitting-down remains viable. We intend to design a system to bring about a safe and functional standing. The system consists of three parts: Sensing, Control and Stimulation. Signals are recorded with cuff electrodes placed around peripheral nerves innervating the natural sensors of the foot sole. The electrodes and multichannel telemeter will be fully implantable. The signal processing and control units will be external and receive inputs from the telemeter and outputs to the stimulator.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
In this European Shared Cost RTD project, which includes seven research centres, we seek to improve control schemes for FES systems by selective muscle recruitment via nerve stimulation and the inclusion of feedback information from the body's own sensory system. Natural sensors are abundantly available in the body, and they are of paramount importance in the normal physiology of motor control. With the use of neural sensing and nerve stimulation, the largest part of the FES system is implantable, thus solving a part of the daily burden and acceptability for the patients. Within the three-year time frame of the BIOMED 2 Work Programme we focus on a system for paraplegic standing. Paraplegic persons are not able to stand without assisting devices and are thus unable to perform trivial tasks, although by far the largest part of their neuromuscular system involved in standing-up, standing, and sitting-down remains viable. We intend to design a system to bring about a safe and functional standing. The system consists of three parts: Sensing, Control and Stimulation. Signals are recorded with cuff electrodes placed around peripheral nerves innervating the natural sensors of the foot sole. The electrodes and multichannel telemeter will be fully implantable. The signal processing and control units will be external and receive inputs from the telemeter and outputs to the stimulator.
Gorecki, I P; Villavincencio, A; Wellons, J; Rubin, L
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 056, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_056,
title = {STEREOTACTIC MANIPULATION: A COMPARISON OF RADIOFREQUENCYand CHEMICALand PHYSICALand AND ELECTRICAL STIMULATION METHODS OF PRODUCING "LESIONS"},
author = {I P Gorecki and A Villavincencio and J Wellons and L Rubin},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_056_Gorecki.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {056},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Stereotactic lesions are most commonly created using radiofreqency current to generate heat. Over the last decade there has been a dramatic increase in the availability of and use of radiation as method of lesioning. Historically various mechanical knives, wires, and temperature manipulation were used. Although chronic electrical stimulation has been available since the 1960's recent reports of success treating movement disorders with stimulation of the thalamus, globus pallidum, and subthalamus have created a dramatic new interest in deep brain stimulation. This interest has further been fueled by FDA approval of chronic thalamic stimulation for tremor in the USA. This now means that electrodes are more readily available for a wide variety of clinical investigations. There is at least a theoretical advantage to chronic stimulation over lesioning in the form of a lower risk of permanent morbidity. We present a review of the physiological effects of each of these modalities, including a comparison of the stability, consistency, reliability, and morbidity. The physiological effects of chronic stimulation are reviewed in detail, with a discussion of the effect of frequency on neural suppression. A review of the actual reported morbidity of chronic stimulation is presented. We briefly review our recent clinical trials: Prospective comparison of thalamic stimulation to nucleus caudalis DREZ for deafferentation pain in the face, pilot evaluation of midbrain spinothalamic tract and reticular stimulation for intractable benign pain.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Stereotactic lesions are most commonly created using radiofreqency current to generate heat. Over the last decade there has been a dramatic increase in the availability of and use of radiation as method of lesioning. Historically various mechanical knives, wires, and temperature manipulation were used. Although chronic electrical stimulation has been available since the 1960's recent reports of success treating movement disorders with stimulation of the thalamus, globus pallidum, and subthalamus have created a dramatic new interest in deep brain stimulation. This interest has further been fueled by FDA approval of chronic thalamic stimulation for tremor in the USA. This now means that electrodes are more readily available for a wide variety of clinical investigations. There is at least a theoretical advantage to chronic stimulation over lesioning in the form of a lower risk of permanent morbidity. We present a review of the physiological effects of each of these modalities, including a comparison of the stability, consistency, reliability, and morbidity. The physiological effects of chronic stimulation are reviewed in detail, with a discussion of the effect of frequency on neural suppression. A review of the actual reported morbidity of chronic stimulation is presented. We briefly review our recent clinical trials: Prospective comparison of thalamic stimulation to nucleus caudalis DREZ for deafferentation pain in the face, pilot evaluation of midbrain spinothalamic tract and reticular stimulation for intractable benign pain.
Mandybur, G; King, M
STEREOTACTIC POSTERIOVENTERAL PALLIDOTOMY IMPROVES BALANCE CONTROL AS ASSESSED BY COMPUTERIZED POSTUROGRAPHY Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 131, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_131,
title = {STEREOTACTIC POSTERIOVENTERAL PALLIDOTOMY IMPROVES BALANCE CONTROL AS ASSESSED BY COMPUTERIZED POSTUROGRAPHY},
author = {G Mandybur and M King},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_131_Mandybur.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {131},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Postural instability is arguably the most debilitating symptom of Parkinson's disease. Recently, posterioventral pallidotomy/pallidoansotomy (PVP) has been advocated to improve a multitude of symptoms associated with Parkinson's disease. Dyskinesias, rigidity and bradykinesia are the most talked about improved symptoms, but posture and gait are also affected after PVP. To analyze the effect of pallidoansotomy on postural control, 14 patients with Parkinson's disease were prospectively studied using a computerized dynamic posturography machine. 7 males and 7 females underwent a total of 18 procedures, 6 Lt PVP, 6 Rt PVP, 2 bilateral and 2 had VIM thalamotomies in addition to PVP. Data were collected pre and post-operatively after a 12 hour drug free interval (öff" period) and 1.5-2hrs after medications (ön" period). Postoperative analyses were performed between 1-3 months post-op. As a group, patients' balance, in the öff" period, improved after surgery. Prior to surgery, patients' sway exceeded their stability limits (patient fell) on 31% of the trials. After surgery, the fall rate decreased to 23%. Anterior-posterior sway and inter-aural sway decreased significantly across all tested balance conditions (p<0.05) post-operatively. In comparison of the effect of surgery in decreasing sway with the effect of medication pre-operatively showed that the improvement after surgery (öff" period) was better than pre-operative ön" period (p<0.05). Indeed, improvement could be seen for quiet standing with eyes closed, quiet standing on a sway-referenced platform, and quiet standing with eyes closed on a sway referenced platform. In conclusion, PVP improved standing balance performance better than that achieved by medications pre-operatively. The mechanism for balance improvement may be different between dopaminergic medication and posteriorventeral pallidotomy/pallidoansotomy.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Postural instability is arguably the most debilitating symptom of Parkinson's disease. Recently, posterioventral pallidotomy/pallidoansotomy (PVP) has been advocated to improve a multitude of symptoms associated with Parkinson's disease. Dyskinesias, rigidity and bradykinesia are the most talked about improved symptoms, but posture and gait are also affected after PVP. To analyze the effect of pallidoansotomy on postural control, 14 patients with Parkinson's disease were prospectively studied using a computerized dynamic posturography machine. 7 males and 7 females underwent a total of 18 procedures, 6 Lt PVP, 6 Rt PVP, 2 bilateral and 2 had VIM thalamotomies in addition to PVP. Data were collected pre and post-operatively after a 12 hour drug free interval (öff" period) and 1.5-2hrs after medications (ön" period). Postoperative analyses were performed between 1-3 months post-op. As a group, patients' balance, in the öff" period, improved after surgery. Prior to surgery, patients' sway exceeded their stability limits (patient fell) on 31% of the trials. After surgery, the fall rate decreased to 23%. Anterior-posterior sway and inter-aural sway decreased significantly across all tested balance conditions (p<0.05) post-operatively. In comparison of the effect of surgery in decreasing sway with the effect of medication pre-operatively showed that the improvement after surgery (öff" period) was better than pre-operative ön" period (p<0.05). Indeed, improvement could be seen for quiet standing with eyes closed, quiet standing on a sway-referenced platform, and quiet standing with eyes closed on a sway referenced platform. In conclusion, PVP improved standing balance performance better than that achieved by medications pre-operatively. The mechanism for balance improvement may be different between dopaminergic medication and posteriorventeral pallidotomy/pallidoansotomy.
Veltink, H P; Ladouceur, M; Sinkjaer, T
Stimulation Of The Deep Peroneal Nerve As A Method For Inhibition Of The Stretch Reflex In Spastic Ankle Extensor Muscles Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 217, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Full Paper
@inproceedings{IFESS1998_217,
title = {Stimulation Of The Deep Peroneal Nerve As A Method For Inhibition Of The Stretch Reflex In Spastic Ankle Extensor Muscles},
author = {H P Veltink and M Ladouceur and T Sinkjaer},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_217_Veltink.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {217},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Inhibition of the triceps surae stretch reflex by stimulation of the deep peroneal nerve was investigated in ten spastic persons. The stretch reflex was reduced significantly at stimulation levels between 2 and 4 times motor threshold of the tibialis anterior muscle when the triceps surae was relaxed. Regarding the stretch velocity dependency of the stretch reflex, stimulation significantly increased the velocity threshold and decreased the area under the velocity - reflex relation.},
keywords = {Full Paper},
pubstate = {published},
tppubtype = {inproceedings}
}
Inhibition of the triceps surae stretch reflex by stimulation of the deep peroneal nerve was investigated in ten spastic persons. The stretch reflex was reduced significantly at stimulation levels between 2 and 4 times motor threshold of the tibialis anterior muscle when the triceps surae was relaxed. Regarding the stretch velocity dependency of the stretch reflex, stimulation significantly increased the velocity threshold and decreased the area under the velocity - reflex relation.
Veltink, P H; Ladouceur, M; Sinkjaer, T
STIMULATION OF THE DEEP PERONEAL NERVE AS A METHOD FOR INHIBITION OF THE STRETCH REFLEX IN SPASTIC ANKLE EXTENSOR MUSCLES Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 071, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_071,
title = {STIMULATION OF THE DEEP PERONEAL NERVE AS A METHOD FOR INHIBITION OF THE STRETCH REFLEX IN SPASTIC ANKLE EXTENSOR MUSCLES},
author = {P H Veltink and M Ladouceur and T Sinkjaer},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_071_Veltink.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {071},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Increased stretch reflexes in the ankle extensors may affect mobility in spastic individuals. Inhibitory neural spinal pathways are known to exist between the motor neuron pools of antagonistic muscle groups. Stimulation of muscle afferents innervating the ankle dorsiflexors may therefore inhibit stretch reflexes in the ankle extensors. We investigated this inhibition in ten stroke patients while sitting. A servo-controlled motor imposed dorsiflexion movements to the ankle joint at varying velocities, stretching the ankle extensors, thus eliciting the soleus stretch reflex. Conditioning stimulation was applied to the deep peroneal nerve prior to imposing the movements. In all ten subjects, the stretch reflex soleus EMG reduced significantly (more than 50%) in relaxed ankle extensors. Stimulation levels of 2 to 4 times tibialis anterior motor threshold were required and the optimal conditioning-stretch delay was on average 150 ms. This conditioning stimulation also significantly reduced the reflex contribution to ankle joint moment. Furthermore, it had a marked effect on the relation between stretch velocity and soleus EMG reflex amplitude: the threshold increased and the slope decreased significantly. This is consistent with pre as well as post synaptic changes. The relatively long optimal conditioning-stretch interval indicated that disynaptic reciprocal inhibition is an unlikely cause for the inhibition effects found in our study.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Increased stretch reflexes in the ankle extensors may affect mobility in spastic individuals. Inhibitory neural spinal pathways are known to exist between the motor neuron pools of antagonistic muscle groups. Stimulation of muscle afferents innervating the ankle dorsiflexors may therefore inhibit stretch reflexes in the ankle extensors. We investigated this inhibition in ten stroke patients while sitting. A servo-controlled motor imposed dorsiflexion movements to the ankle joint at varying velocities, stretching the ankle extensors, thus eliciting the soleus stretch reflex. Conditioning stimulation was applied to the deep peroneal nerve prior to imposing the movements. In all ten subjects, the stretch reflex soleus EMG reduced significantly (more than 50%) in relaxed ankle extensors. Stimulation levels of 2 to 4 times tibialis anterior motor threshold were required and the optimal conditioning-stretch delay was on average 150 ms. This conditioning stimulation also significantly reduced the reflex contribution to ankle joint moment. Furthermore, it had a marked effect on the relation between stretch velocity and soleus EMG reflex amplitude: the threshold increased and the slope decreased significantly. This is consistent with pre as well as post synaptic changes. The relatively long optimal conditioning-stretch interval indicated that disynaptic reciprocal inhibition is an unlikely cause for the inhibition effects found in our study.
Saltuari, L
STROKE INDUCED SPASTIC HEMIPLEGIA - BENEFIT OF INTRATHECAL BACLOFEN? Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 049, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_049,
title = {STROKE INDUCED SPASTIC HEMIPLEGIA - BENEFIT OF INTRATHECAL BACLOFEN?},
author = {L Saltuari},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_049_Saltuari.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {049},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {About 30% of patients who survive a stroke experience severe impairment due to spastic hemiplegia. The goal of the therapeutic regimen during neurorehabilitation is to reduce the spasticity to a degree, not interferring with motor performance. Oral antispastic treatment is not effective in these cases and when administered an higher dosages affected with intolerable side-effects. Botulinumtoxin may be one treatment of joice, but beside the insignificant number of non-responders a high total dosage is needed. Intrathecally administered baclofen proved to be effective in reducing supraspinal spasticity. In this preliminary study we investigated the efficiency of intrathecal baclofen on severe spastic hemiplegia associated with stroke. Five patients (1 female/4 male; mean age 52,3 1) were included and received during the screening phase between 50 and 175 mg baclofen as bolus via lumbar puncture (n = 3) or continuously over 24 hours via an intrathecal catheter (n = 2). The reflexes were reduced in all patients on both sides (2 degrees on a 4 degree scale). Muscle tonus (Ashworth scale) deminished to an extent deteriorating gate performance (n = 4). Only one patient responded well with improved motor performance. As a consequence intrathecal baclofen is effective in reducing spasticity secondary to stroke but improves motor performance only in those cases where remaining underlying motor ability is covered by spastic pattern.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
About 30% of patients who survive a stroke experience severe impairment due to spastic hemiplegia. The goal of the therapeutic regimen during neurorehabilitation is to reduce the spasticity to a degree, not interferring with motor performance. Oral antispastic treatment is not effective in these cases and when administered an higher dosages affected with intolerable side-effects. Botulinumtoxin may be one treatment of joice, but beside the insignificant number of non-responders a high total dosage is needed. Intrathecally administered baclofen proved to be effective in reducing supraspinal spasticity. In this preliminary study we investigated the efficiency of intrathecal baclofen on severe spastic hemiplegia associated with stroke. Five patients (1 female/4 male; mean age 52,3 1) were included and received during the screening phase between 50 and 175 mg baclofen as bolus via lumbar puncture (n = 3) or continuously over 24 hours via an intrathecal catheter (n = 2). The reflexes were reduced in all patients on both sides (2 degrees on a 4 degree scale). Muscle tonus (Ashworth scale) deminished to an extent deteriorating gate performance (n = 4). Only one patient responded well with improved motor performance. As a consequence intrathecal baclofen is effective in reducing spasticity secondary to stroke but improves motor performance only in those cases where remaining underlying motor ability is covered by spastic pattern.
Ichie, M
SURFACE APPLIED FES SYSTEM TO THE LOWER EXTREMITY OF STROKE PATIENTS FOR GAIT IMPROVEMENT Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 078, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_078,
title = {SURFACE APPLIED FES SYSTEM TO THE LOWER EXTREMITY OF STROKE PATIENTS FOR GAIT IMPROVEMENT},
author = {M Ichie},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_078_Ichie.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {078},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Therapeutic electrical stimulation (TES) by using two-channel stimulator through surface electrodes was applied to the lower extremities of 10 hemiparetic patients in chronic stage of stroke. Profile of the patients was as follows; aged 13 to 72 (mean: 49.1) years, 10 males, the third to fifth grades in Brunnstrom's recovery stages, 17 to 156 (mean : 56.8) months passed from onset. The paired electrodes were put on the surface of the rectus femoris and common peroneal nerve (through head of fibula to the tibialis anterior), respectively. Alternate electrical stimulation of 15 seconds each to these two muscles was given by commercially available two channel stimulator (PULSE CURE PRO : OG GIKEN Co. Ltd.). Pulse width and frequency were set at 0.3 ms and 30 Hz, respectively. The session of the alternate electrical stimulation was done for fifteen minutes two times per day, usually in the morning and evening. Walking speed, step length, Brunnstrom's stages, straight leg rising (SLR), range of motion (ROM) of the ankle, knee and hip joint were evaluated. These evaluation were done at the start and every four weeks during 12 weeks' session. After the TES session, walking speed, step length and active & passive SLR were improved. In another session, TES by using 30- channels portable FES system (FESMATE1000 : NEC Co. Ltd.) through percu-taneous implantable electrode was applied to 38 hemiparetic patients. In comparison with the data, implantable TES showed improvement of walking speed, step length, Brunnstrom's stages and ROM of the ankle joint. Differences of TES system, surface and implantable electrode, were not so large in effect. Both of methods showed improvement of walking ability even in the chronic stage of stroke.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Therapeutic electrical stimulation (TES) by using two-channel stimulator through surface electrodes was applied to the lower extremities of 10 hemiparetic patients in chronic stage of stroke. Profile of the patients was as follows; aged 13 to 72 (mean: 49.1) years, 10 males, the third to fifth grades in Brunnstrom's recovery stages, 17 to 156 (mean : 56.8) months passed from onset. The paired electrodes were put on the surface of the rectus femoris and common peroneal nerve (through head of fibula to the tibialis anterior), respectively. Alternate electrical stimulation of 15 seconds each to these two muscles was given by commercially available two channel stimulator (PULSE CURE PRO : OG GIKEN Co. Ltd.). Pulse width and frequency were set at 0.3 ms and 30 Hz, respectively. The session of the alternate electrical stimulation was done for fifteen minutes two times per day, usually in the morning and evening. Walking speed, step length, Brunnstrom's stages, straight leg rising (SLR), range of motion (ROM) of the ankle, knee and hip joint were evaluated. These evaluation were done at the start and every four weeks during 12 weeks' session. After the TES session, walking speed, step length and active & passive SLR were improved. In another session, TES by using 30- channels portable FES system (FESMATE1000 : NEC Co. Ltd.) through percu-taneous implantable electrode was applied to 38 hemiparetic patients. In comparison with the data, implantable TES showed improvement of walking speed, step length, Brunnstrom's stages and ROM of the ankle joint. Differences of TES system, surface and implantable electrode, were not so large in effect. Both of methods showed improvement of walking ability even in the chronic stage of stroke.
Schon, L C; Easley, M E; Lam, PW-C.; Anderson, C D; Trnka, H J; Lumsden, D B; Levin, G; Shanker, J
SURGICAL MANAGEMENT OF CHRONIC LOWER EXTREMITY NEUROPATHIC PAIN Inproceedings
In: Bijak, Manfred; Mayr, Winfried (Ed.): pp. 022, IFESS_1998, Luzern, Switzerland, 1998, ISBN: 3-900928-04-5.
Abstract | Links | BibTeX | Tags: Abstracts
@inproceedings{IFESS1998_022,
title = {SURGICAL MANAGEMENT OF CHRONIC LOWER EXTREMITY NEUROPATHIC PAIN},
author = {L C Schon and M E Easley and PW-C. Lam and C D Anderson and H J Trnka and D B Lumsden and G Levin and J Shanker},
editor = {Manfred Bijak and Winfried Mayr},
url = {https://ifess.org/files/proceedings/IFESS1998/IFESS1998_022_Schon.pdf},
isbn = {3-900928-04-5},
year = {1998},
date = {1998-08-01},
pages = {022},
publisher = {IFESS_1998},
address = {Luzern, Switzerland},
abstract = {Purpose: To review the results of a surgical algorithm for managing intractable foot and ankle pain. Methods: We reviewed 145 lower extremity peripheral nerve procedures in 112 patients to develop a surgical algorithm and determine its efficacy. Duration of symptoms averaged 37 months (range, 6 to 120 months). Mechanisms of nerve injury included chronic transection (37 cases), crush (35), adhesive neuralgia (25), stretch (20), repetitive trauma (12), and idiopathic (13). The treatment algorithm included: transection/containment (61), with (25) or without peripheral nerve stimulation for crush, stretch, and chronic transection injuries; revision neurolysis with vein wrapping (37) for adhesive neuralgia; and primary (12) or revision neurolysis (12) for repetitive trauma. Patients were evaluated subjectively (questionnaire) and clinically. Pain and dysfunction were ranked from 0 (no pain/dysfunction) to 10 (pain prompting request for amputation/wheelchair use); preoperative and follow-up work status were documented. Result: Follow-up averaged 38 months (range, 24 to 96 months). Average pain scores improved from 8.8 points (range, 5 to 10 points) to 5.6 points (range, 0 to 10 points); average dysfunction improved from 7.6 points (range, 2 to 10 points) to 5.0 points (range, 0 to 10 points). Of the 112 patients, 52 (46%) improved their work status, including 33/85 (40%) involved in workman's compensation. One-way ANOVAs (comparing outcome based on mechanism of nerve injury or type of procedure) revealed no statistically significant differences (p > 0.05). Conclusion: Intractable foot and ankle pain can be improved with treatment via a surgical algorithm.},
keywords = {Abstracts},
pubstate = {published},
tppubtype = {inproceedings}
}
Purpose: To review the results of a surgical algorithm for managing intractable foot and ankle pain. Methods: We reviewed 145 lower extremity peripheral nerve procedures in 112 patients to develop a surgical algorithm and determine its efficacy. Duration of symptoms averaged 37 months (range, 6 to 120 months). Mechanisms of nerve injury included chronic transection (37 cases), crush (35), adhesive neuralgia (25), stretch (20), repetitive trauma (12), and idiopathic (13). The treatment algorithm included: transection/containment (61), with (25) or without peripheral nerve stimulation for crush, stretch, and chronic transection injuries; revision neurolysis with vein wrapping (37) for adhesive neuralgia; and primary (12) or revision neurolysis (12) for repetitive trauma. Patients were evaluated subjectively (questionnaire) and clinically. Pain and dysfunction were ranked from 0 (no pain/dysfunction) to 10 (pain prompting request for amputation/wheelchair use); preoperative and follow-up work status were documented. Result: Follow-up averaged 38 months (range, 24 to 96 months). Average pain scores improved from 8.8 points (range, 5 to 10 points) to 5.6 points (range, 0 to 10 points); average dysfunction improved from 7.6 points (range, 2 to 10 points) to 5.0 points (range, 0 to 10 points). Of the 112 patients, 52 (46%) improved their work status, including 33/85 (40%) involved in workman's compensation. One-way ANOVAs (comparing outcome based on mechanism of nerve injury or type of procedure) revealed no statistically significant differences (p > 0.05). Conclusion: Intractable foot and ankle pain can be improved with treatment via a surgical algorithm.