Article
Neurogenic Thoracic Outlet Syndrome: Results from 52 surgically treated patients
Search Medline for
Authors
Published: | February 6, 2020 |
---|
Outline
Text
Objectives/Interrogation: Central nerve stimulation (CNS) already has proved its efficacy for treatment of chronic severe pain. The aim of our clinical study was to prove the effectiveness of Peripheral Nerve Stimulation (PNS) with implanted systems for treatment of chronic neuropathic pain syndrome (CRPS2) of the extremities.
Methods: In sum we selected 31 patients (19 female, 12 male) suffering from CRPS2 for treatment, two patients suffering from causalgia due to complete posttraumatic brachial plexus lesion including root avulsion. Each patient had a history of microsurgical interventions to the nerves and every conservative treatment which was possible, but without any effect on the problem of neuropathic pain. None of the patients was able to use the extremity functionally. In all patients the VAS was in mean 9, even at rest. Stimulation leads were implanted close to the peripheral nerves (fascicles of the brachial plexus or sciatic or femoral nerve) and connected with percutaneous leads for temporary testing. Pain reduction of more than 4 points on the VAS scale gave indication for implantation of a pulse generator for continuous PNS.
Results and Conclusions: 28 patients were supported with the whole system. PNS was effective to reduce pain from VAS mean 9 to VAS mean 3 and to regain functional use of the extremity in most of the cases. Several technical complications, mostly electrode dislocation had to be noted. Relief from pain occurred immediately after onset of stimulation. The positive effect was directly correlated with PNS, and stable over years. On a scale from -5 to +5 patients rated +4.2 in answering the question if they would undergo the procedure again.
PNS reduced pain deriving from peripheral nerves reliable and effective. Regarding our follow up period of 3,5 years PNS produced a stable, nearby pain free interval in all patients. Positioning of the electrodes direct to the fascicles of the brachial plexus and close to the sciatic nerve at mid-thigh allowed movement of shoulder and hip at a nearby normal ROM. PNS seems to represent an important technology for treatment of chronic neuropathic pain in selected cases.