The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Best Practices for Cervical Neurostimulation.

Introduction: The International Neuromodulation Society convened a multispecialty group of physicians based on expertise with international representation to establish evidence-based guidance on the use of neurostimulation in the cervical region to improve outcomes. This Neurostimulation Appropriateness Consensus Committee (NACC) project intends to provide evidence-based guidance for an often-overlooked area of neurostimulation practice.

Materials And Methods: Authors were chosen based upon their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature.

Can Central Sensitization After Injury Persist as an Autonomous Pain Generator? A Comprehensive Search for Evidence.

Objective: To conduct a comprehensive search for evidence with regard to whether central sensitization after an injury can act as a persistent autonomous pain generator after the inducing injury has healed.

Methods: We searched Medline on PubMed and the Cochrane Library, screening 3,572 abstracts, from which 937 full-text articles were obtained, with 186 of these discarded as irrelevant to the question being posed. The remaining 751 articles were studied for evidence.

Lead Migration in Neuromodulation.

We describe a simple technique of securing surgically implanted leads for spinal cord (SCS), dorsal root ganglion (DRG) and occipital nerve stimulation (ONS), for both primary surgical implantation and correcting lead migration. This technique could also be adapted for securing percutaneously implanted leads. Thirty-nine patients underwent neurosurgical implantation of SCS, DRG, and ONS devices utilizing titanium mini-plates to obtain secure anchorage of leads to adjacent laminae close to their exit point from the epidural space, thereby minimizing the risk of further lead migration or electrode displacement.

The effect of formal training on the clinical utility of transcranial Doppler ultrasound monitoring in patients with aneurysmal subarachnoid haemorrhage.

We have previously shown that the clinical utility of transcranial Doppler (TCD) ultrasound monitoring for vasospasm in patients with aneurysmal subarachnoid haemorrhage, as performed by untrained operators in a busy neurosurgical unit, is questionable, despite the recommendations for its use in the literature. We determined if formal training improved the utility of TCD. Twelve untrained operators and one trained operator performed a total of 206 TCD examinations.

Anti-stroke prophylaxis--the ethics of collateral damage.

Prophylactic anticoagulation therapy with agents such as dabigatran etexilate (as an alternative to warfarin) promises substantial benefits to both patients and monitoring physicians in the treatment of those at high risk of stroke from atrial fibrillation. Such treatment has, however, one potentially lethal consequence. There is, as yet, no easily administered rapid means of reversal in instances of acute surgical emergency.

The role of transcranial Doppler ultrasound monitoring in patients with aneurysmal subarachnoid haemorrhage.

The effect of transcranial Doppler (TCD) ultrasound monitoring of vasospasm on patient management following aneurysmal subarachnoid haemorrhage (aSAH) remains unclear. We reviewed our departmental use of TCD by retrospectively analysing 152 medical records. Results of investigations and management changes, including frequency of neurological monitoring and changes in triple H therapy, were examined.

Technical aspects of decompressive craniectomy for malignant middle cerebral artery infarction.

Decompressive craniectomy is considered a life-saving procedure for malignant middle cerebral artery territory infarction in selected patients. However, the procedure is associated with a significant risk of morbidity and mortality, and there is no universal agreement as to how this operation should be combined with optimal medical management. In this review we consider the goals of this procedure and the technical aspects which may be employed to optimise results.

Decompressive craniectomy for malignant middle cerebral artery infarction: evidence and controversies.

Malignant middle cerebral artery (MCA) infarction (MMI) is associated with a mortality rate of 80%. Decompressive craniectomy is considered a life-saving procedure for patients with this devastating condition. Preclinical and clinical data suggest that this procedure should be undertaken as early as possible, prompting increasing demand for emergency surgery.

Peripheral neuromodulation for pain.

The past decade (1999-2009) has witnessed a dramatic increase in the use of electrical stimulation to treat chronic, intractable pain. The implantation of electrodes in close proximity to peripheral nerves, known as peripheral nerve stimulation, has been enthusiastically adopted by neurosurgeons and interventional pain specialists. The most common conditions treated with this technique are headache and complex regional pain syndromes.

Low back pain in neurosurgical outpatients: an audit.

Low back pain is a common condition. This is a retrospective study of new referrals to neurosurgical outpatients at the Western Hospital, Victoria, Australia. Two hundred and fifteen histories were systematically reviewed.

Cord compression secondary to intradural ossification.

The authors describe two patients presenting with a previous history of spinal trauma and a several-year history of sensory changes secondary to spinal cord compression. Both patients underwent laminectomy and spinal decompression operations. In both cases intradural bone causing neural compression was removed at operation.

Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience.

Object: The authors prospectively evaluated the clinical and radiological outcomes after anterior cervical discectomy and fusion (ACDF) involving placement of a Solis cage and local autograft in patients who presented with symptomatic cervical spondylosis.

Methods: Twenty-two consecutive patients underwent ACDF for radiculopathy (13 cases), myeloradiculopathy (eight cases), or myelopathy alone (one case) and were assessed at 3, 6, and 12 months. Plain cervical spine radiography demonstrated a significant change in both local (p < 0.

Cervical dural arteriovenous fistulae manifesting as subarachnoid hemorrhage: report of two cases and literature review.

Dural arteriovenous fistulas (DAVFs) in the craniocervical junction are rare but clinically important. DAVFs can be associated with subarachnoid hemorrhage (SAH), a feature distinguishing them from DAVFs in the thoracolumbar region. These lesions are often overlooked at cerebral angiography performed to assess SAH and account for a small proportion of angiographically negative SAHs.

Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment.

Object: Cervical myelopathy may develop as a result of spinal cord compression with or without deformity. The effect of persistent kyphotic deformity on the ability of the cervical cord to recover following decompressive surgery is not known.

Methods: Between 1997 and 2000, a total of 28 patients with progressive myelopathy and kyphotic deformity underwent anterior decompression, deformity correction (0-4 degrees of lordosis), and fusion with anterior plating.

The application of implant technology for cybernetic systems.

Objective: To assess the usefulness, compatibility, and long-term operability of a microelectrode array into the median nerve of the left arm of a healthy volunteer, including perception of feedback stimulation and operation of an instrumented prosthetic hand.

Setting: The study was carried out from March 14 through June 18, 2002, in England and the United States.

Results: The blindfolded subject received feedback information, obtained from force and slip sensors on the prosthetic hand, and subsequently used the implanted device to control the hand by applying an appropriate force to grip an unseen object.

Spontaneous intracranial hypotension due to thoracic disc herniation. Case report.

Spontaneous intracranial hypotension is frequently idiopathic. The authors report on a patient presenting with symptomatic intracranial hypotension caused by a transdural calcified thoracic disc herniation. Cranial magnetic resonance (MR) imaging revealed classic signs of intracranial hypotension, and a combination of spinal MR and computerized tomography myelography confirmed a mid-thoracic transdural calcified herniated disc as the cause.