ABSTRACT
Forty-eight spinal cord injury victims were implanted with an epidural spinal cord stimulation system to treat spasms that had not satisfactorily responded to medical therapy. All the patients were at least 6 months after the injury. The protocol included assessment by independent examiners preoperatively and at 3, 6, 12 and 24 months after the implant. Pre- and postoperative data collection included the frequency and severity of the spasms. Combining the frequency and intensity scores into a 'severity' score provided a more accurate clinical picture. No patient observed neurological deterioration following the surgical procedure or the neurostimulation treatment. A statistically significant reduction in the severity of the spasms was observed in the follow-up evaluations, with results that progressively increased in time. It is appears that spinal cord stimulation is an effective and safe alternative in the management of spasms in spinal cord injury victims. Its exact role in relation to intrathecal baclofen infusion and ablative procedures remains to be defined.
Subject(s)
Electric Stimulation Therapy , Muscle Spasticity/therapy , Spinal Cord Injuries/complications , Adolescent , Adult , Aged , Electric Stimulation Therapy/adverse effects , Female , Follow-Up Studies , Humans , Male , Middle Aged , Muscle Spasticity/etiology , Prospective Studies , Treatment OutcomeABSTRACT
A spinal cord stimulator was implanted in the epidural space in 33 spinal-cord-injured patients for the treatment of severe extremity spasticity. We prospectively evaluated the effect of the stimulator on the lower urinary tract in these patients. Urodynamic evaluation was performed preoperatively, and in 23 patients 3 months to 1 year after implantation. Postoperative changes in the lower urinary tract function were noted in 6 patients. One patient converted from detrusor areflexia to detrusor hyperreflexia, and 1 patient converted from detrusor hyperreflexia to detrusor areflexia. Four patients demonstrated changes in the duration of detrusor contraction and external sphincter dyssynergia. In 2 of these 4 patients, the changes in the duration of detrusor contraction and external sphincter dyssynergia were related to the activation and deactivation of the stimulator. Urodynamic parameters did not change significantly following implantation in the remaining 17 patients. We conclude that epidural stimulator implanted for the treatment of spasticity may alter the lower urinary tract function. Patients with postoperative changes in the lower tract function should be evaluated with the stimulator activated and deactivated.
