Prospective, multicenter study of spinal cord stimulation for relief of chronic back and extremity pain.

STUDY DESIGN: This prospective, multicenter study was designed to investigate the efficacy and outcome of spinal cord stimulation using a variety of clinical and psychosocial outcome measures. Data were collected before implantation and at regular intervals after implantation. This report focuses on 70 patients who had undergone 1 year of follow-up treatment at the time of data analysis. OBJECTIVES: To provide a more generalizable assessment of long-term spinal cord stimulation outcome by comparing a variety of pain and functional/quality-of-life measures before and after management. This report details results after 1 year of stimulation. SUMMARY OF BACKGROUND DATA: The historically diverse methods, patient selection criteria, and outcome measures reported in the spinal cord stimulation literature have made interpretation and comparison of results difficult. Although short-term outcomes are generally consistent, long-term outcomes of spinal cord stimulation, as determined by prospective studies that assess multidimensional aspects of the pain complaint among a relatively homogeneous population, are not well established. METHODS: Two hundred nineteen patients were entered at six centers throughout the United States. All patients underwent a trial of stimulation before implant of the permanent system. Most were psychologically screened. One hundred eighty-two patients were implanted with a permanent stimulating system. At the time of this report, complete 1-year follow-up data were available on 70 patients, 88% of whom reported pain in the back or lower extremities. Patient evaluation of pain and functional levels was completed before implantation and 3, 6, 12, and 24 months after implantation. Complications, medication usage, and work status also were monitored. RESULTS: All pain and quality-of-life measures showed statistically significant improvement during the treatment year. These included the average pain visual analogue scale, the McGill Pain Questionnaire, the Oswestry Disability Questionnaire, the Sickness Impact Profile, and the Back Depression Inventory. Overall success of the therapy was defined as at least 50% pain relief and patient assessment of the procedure as fully or partially beneficial and worthwhile. Using this definition, spinal cord stimulation successfully managed pain in 55% of patients on whom 1-year follow-up is available. Complications requiring surgical intervention were reported by 17% (12 of 70) of patients. Medication usage and work status were not changed significantly. CONCLUSIONS: This prospective, multicenter study confirms that spinal cord stimulation can be an effective therapy for management of chronic low back and extremity pain. Significant improvements in many aspects of the pain condition were measured, and complications were minimal.

Classification of autogenous skull grafts in cranial reconstruction.

Although the literature provides a general description of various techniques of reconstruction of the cranium with autogenous bone grafts, no classification exists outlining the options in an orderly fashion. A classification of autogenous skull grafts in cranial reconstruction is hereby presented. These grafts include bone dust, shave, sliding, transpositional, full-thickness split, and vascularized pedicle. The uses of each graft and its advantages and disadvantages are discussed. The location of the defect, the size, and the thickness of the skull are variables that must be considered in utilizing these grafts. Often a combination of grafts is required to provide the best cranial contour. Understanding the characteristics of these types of grafts provides the surgeon with the versatility necessary in reconstructing cranial defects.

Classification of autogenous skull grafts in cranial reconstruction.

We have presented a classification of autogenous skull grafts in cranial reconstruction: transpositional, sliding, full thickness split, shave, bone dust, and vascular pedicle. The advantages, uses and disadvantages are discussed. It is shown that each type has characteristics that make it the treatment of choice for cranial defects in specific areas. However, a combination of these techniques also can be used in dealing with some cranial defects.

Adaptation of rigid fixation to cranial flap replacement.

The use of titanium craniofacial plates and the principles of rigid fixation have been adapted to cranial flap replacement. The technique has been in use for more than 18 months with no complications related to the technique or implant. The advantages of using titanium screws and plates to achieve superior healing and cosmesis, as well as the reduction of postoperative artifacts on magnetic resonance imaging and computed tomographic scans, are of benefit to neurosurgical patients.

Polar spongioblastoma of the cervical spinal cord: case report.

Polar spongioblastomas are rare, histologically distinctive glial neoplasms that have been reported to involve the brain stem, third ventricle, aqueduct, and fourth ventricle. In this case report we describe a polar spongioblastoma of the cervical spinal cord in a patient who has survived 2 1/2 years without evidence of recurrent neoplasm.