gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Neuromodulative treatment of neuropathic pain: experience with the Penta™ electrode

Meeting Abstract

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  • M.H. Morgalla - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • M. Tatagiba - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • G. Lepski - Neurochirurgische Klinik, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.11.09

DOI: 10.3205/12dgnc263, URN: urn:nbn:de:0183-12dgnc2632

Published: June 4, 2012

© 2012 Morgalla et al.
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Outline

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Objective: Precise positioning of the electrodes remains imperative when performing spinal cord stimulation in order to achieve a satisfying long term outcome. Dislocations of the electrodes due to the patient's movement have to be avoided at all costs. The PentaTM lead (St. Jude Medical) is new and currently the smallest electrode in order to achieve precise field control and broad lateral coverage. It was designed to enable selective nerve fibre stimulation and a predictable dermatomal activation. We examined this electrode prospectively.

Methods: The patients in our study had neuropathic pain (n = 8, 5 male, 3 female, age range 37–79 years, mean age 58 years, failed back surgery syndrome n = 5, cluster headache n = 1, persistent post-herniorrhaphy pain n = 1, CRPS 1 n = 1, postherpetic neuralgia n = 1). They were operated on using a flavectomy under general anaesthesia. The lead was positioned epidurally in the spinal canal. We examined the pain intensity by using the Visusal Analogue Scale (VAS), quality of life (QoL), SF 36 Scale, Brief Pain Inventory, Pain Disability Index and the drug consumption. The evaluations were conducted preoperatively on admission and three months later.

Results: The leads were located at the cervical level C1 (n = 1), C3 (n = 1), and at the thoracic level D8 (n = 5), D10 (n = 1). In 2 of the patients (persistent post-herniorrhaphy pain, CRPS 1) the postoperative test trial was unsuccessful and the lead had to be removed. Six patients received a permanent pulse generator. After 3 months, the VAS was remarkably decreased by > 50% in 5 of the patients and by 30% in one patient (p < 0,001). Three of the patients were able to discontinue their pain medication. No dislocation has occurred so far.

Conclusions: The PentaTM lead can be safely placed using a flavectomy. The broad lateral extension of the electrode compensates anatomical asymmetries as well as placement variations. The five column array also provides more flexibility in order to create a specific dermatomal activation. However, a general anaesthetic is necessary in order to place the electrode. An intraoperative test-trial cannot be carried out. Because of this, the PentaTM lead should therefore ideally be used in patients with dislocations after previous singular lead implantations where the location of the best stimulation result is already known.