• Journal of Korean Neurosurgical Society
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• v.47 no.2
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• pp.151-154
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• 2010

The efficacy of spinal cord stimulation (SCS) for treatment of various chronic painful conditions is well established. Very few reports have documented the use of SCS for treatment of chronic pain after spinal cord injury. We present a case showing a good outcome after such treatment, and suggest that high cervical stimulation may be efficacious. A 53-year-old male underwent SCS on the C1-3 level for treatment of intractable neuropathic pain below the T3 level, and in the upper extremities, arising from spinal cord injury resulting from transverse myelitis caused by schistosomiasis. High cervical SCS significantly improved the pain in the upper extremities and at the T3-T10 dermatome level. The patient continues to report excellent pain relief 9 months later. The present case suggests that high cervical stimulation may improve chronic pain in the upper extremities and the T3-T10 dermatome level arising from spinal cord injury.

• Journal of Korean Physical Therapy Science
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• v.8 no.2
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• pp.1005-1013
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• 2001

The present study was designed to investigate the effect of low power GaAlAs laser on spinal Fos expression related to the anti-nociceptive effect of laser stimulation. Low power GaAlAs laser was applied to either acupoint or non-acupoint for 2 hour under light inhalation anesthesia. Spinal Fos expression in the dorsal horn was compared to that obtained in inhalation anesthesia control group. Furthermore, we analyzed the effect of the local treatment of lidocaine on the spinal Fos expression evoked by low power GaAlAs laser stimulation. The results were summarized as follows: 1. In the normal animals, only a few Fos like immunoreactive(Fos-IR) neurons were evident in the lumbar spinal cord dorsal horn. Similarly, following prolonged inhalation anesthesia, Fos-IR neurons were absent in the dorsal horn of the lumbar spinal cord. In animals treated with laser stimulation, Fos immunoreactive neurons were increased mainly in the medial half of ipsilateral laminae I-III at lumbar segments L3-5. These findings directly indicated that prolonged anesthesia used in this study did not affect the Fos expression in the spinal cord dorsal horn of intact animals and low power laser stimulation dramatically produced Fos expression in the spinal cord laminae that are related to the anti-nociceptive effect of laser stimulation. 2. In acupoint stimulated animals, 10mW of laser stimulation, not 3mW and 6mW intensity, significantly increased the number of Fos immunoreactive neurons in the spinal dorsal horn(p<0.05). However, laser stimulation on acupoint more dramatically increased the number of Fos immunoreactive neurons in the spinal cord rather than laser stimulatin on non acupoint. These result suggested that laser stimulatin on acupoint was more effective treatment to activate the spinal neuron than non acupoint stimulation. 3. The local treatment of lidocaine totally suppressed the activity of spinal neurons that were induced by lower power 1aser stimulation. These data indicated that the anti-nociceptive effect of laser stimulation was absolutely dependent upon the peripheral nerve activity in the stimulated location. In conclusion, these data indicate that 10mW of low power laser stimulation into acupoint is capable of inducing the spinal Fos expression in the dorsal horn related to the anti-nociceptive effect of laser stimulation, Furthermore, the induction of spinal Fos expression was totally related to the peripheral nerve activity in the laser stimulated area.

• Journal of Korean Physical Therapy Science
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• v.7 no.2
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• pp.545-558
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• 2000

The present study was designed to investigate the effect of low power GaAsAl laser on Fos expression in the spinal cord induced by noxious mechanical stimulation. Noxious mechanical stimulation was applied to the right hind paw following 30min of low power laser treatment using different intensity and treatment point and the resulting Fos expression in the spinal cord dorsal horn was compared to that obtained in rats exposed only to the noxious mechanical stimulation. The results were summarized as follows: 1. In intact control rats, only a few Fos like immunoreactive(Fos-IR) neurons were evident in the lumbar spinal cord dorsal horn. Similarly, following prolonged inhalation anesthesia, Fos-IR neurons were absent in the dorsal horn of the lumbar spinal cord. In animals treated with noxious mechanical stimulation, neurons with nuclei exhibiting Fos immunostaining were distributied mainly in the medial half of ipsilateral laminae I-V at lumbar segments L3-5. These findings directly indicated that prolonged anesthesia used in this study did not affect the Fos expression in the spinal cord dorsal horn of intact animals and noxious mechanical stimulation treated animals. 2. In acupoint treated animals, 10mW of laser stimulation, not 3mW intensity, significantly reduced the number of Fos immunoreactive neurons in the spinal dorsal horn induced by noxious mechanical stimulation(P<.01). However, the supressive effect of low power laser stimulatin was not observed in 3m Wand 10m W of laser stimulation into non-acupoint. These data indicate that 10mW of low power laser stimulation into acupoint is capable of inhibiting the expression of Fos in the dorsal horn induced by noxious mechanical stimulation. In conclusion, these findings raise the possibility that low power laser stimulation into acupoint may be a promising alternative medicine therapy for the mechanical stimulation induced pain in the clinical field.

• Journal of Korean Neurosurgical Society
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• v.43 no.2
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• pp.85-89
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• 2008

Objective: The purpose of this study is to identify the factors affecting the failure of trials (<50% pain reduction in pain for trial period) to improve success rate of spinal cord stimulation (SCS) trial. Methods: A retrospective review of the failed trials (44 patients, 36.1 %) among the patients (n=122) who underwent SCS trial between January 1990 and December 1998 was conducted. We reviewed the causes of failed trial stimulation, age, sex, etiology of pain, type of electrode, and third party support. Results: Of the 44 patients, 65.9% showed unacceptable pain relief in spite of sufficient paresthesia on the pain area with trial stimulation. Four of six patients felt insufficient paresthesia with stimulation had the lesions of the spinal cord. Seventy five percent of the patients experienced unpleasant or painful sensation during stimulation had allodynia dominant pain. Third-party involvement, sex, age and electrode type had no influence on the outcome. Conclusion: We conclude that SCS trial is less effective for patients with neuropathic pain of cord lesions, postherpetic neuropathy or post-amputation state. Further, patients with allodynia dominant pain can feel unpleasant or painful during trial stimulation.

• Journal of Korean Neurosurgical Society
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• v.54 no.4
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• pp.359-362
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• 2013

Chronic hypoventilation due to injury to the brain stem respiratory center or high cervical cord (above the C3 level) can result in dependence to prolonged mechanical ventilation with tracheostomy, frequent nosocomial pneumonia, and prolonged hospitalization. Diaphragm pacing through electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. We performed chronic phrenic nerve stimulation for diaphragm pacing with the spinal cord stimulator for pain control in a quadriplegic patient with central apnea due to complete spinal cord injury at the level of C2 from cervical epidural hematoma. After diaphragmatic pacing, the patient who was completely dependent on the mechanical ventilator could ambulate up to three hours every day without aid of mechanical ventilation during the 12 months of follow-up. Diaphragm pacing through unilateral phrenic nerve stimulation with spinal cord stimulator was feasible in an apneic patient with complete quadriplegia who was completely dependent on mechanical ventilation. Diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.186-189
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• 2007

The most important factors for successful stimulation of the spinal cord are strict patient selection and proper lead position. To ensure proper lead position, paresthesia produced by the stimulator should cover all of the areas in which pain is occurring. Until recently, only the quadripolar electrode lead has been used in for spinal cord stimulation in Korea, however, the 8 electrode lead was recently introduced to offer greater programming options and enhance the precision with which paresthesias is delivered to the desired sites. In addition, because the 8-electrode lead has a longer electrode span, it provides greater dermatomal coverage of up to 2 vertebral segments. Furthermore, the 8-electrode lead allows electronic repositioning of the stimulation to accommodate changing pain patterns, thereby reducing the need for lead revisions due to lead migration. Here, we present a case in which complex regional pain syndrome type I was successfully managed using an 8-electrode lead to induce spinal cord stimulation.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.10 no.2
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• pp.87-95
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• 2015

Objectives : The purpose of this study was to evaluate the effects of spinal cord stimulation acupuncture therapy for lower limb numbness resulting from lumbar herniated intervertebral disc(HlVD). Methods : From 8th August, 2015 to 30th October, 2015, 1 male patient diagnosed as herniated intervertebral disc at L5/S1(Diffuse bulging disc with smooth ventral thecal sac indentation at L5-S1) was treated with spinal cord stimulation acupuncture and general Korean medicine therapy(acupuncture, herbal injection). Numerical Rating Scale(NRS) and Oswestry Disability Index(ODI) were recorded during the treatment. Results : 1. The patient's chief complaints were remarkably improved - Rt. lower limb numbness remained 15% compared before treatment, Rt. lower limb paresthesia and gait disturbance almost disappeared after 25 times of treatment during 3 months. 2. NRS score decreased from 7 to 3, ODI decreased from 16 to 7. Conclusions : This study demonstrates that spinal cord stimulation acupuncture therapy with Korean medicine treatment has notable effect in improving lower limb numbness induced by lumbar HlVD.

• The Korean Journal of Pain
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• v.25 no.2
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• pp.121-125
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• 2012

Refractory angina pectoris is defined as angina refractory to optimal medical treatment and standard coronary revascularization procedures. Despite recent therapeutic advances, patients with refractory angina pectoris are not adequately treated. Spinal cord stimulation is a minimally invasive and reversible technique which utilizes electrical neuromodulation by means of an electrode implanted in the epidural space. It has been reported to be an effective and safe treatment for refractory angina pectoris. We report a case of spinal cord stimulation which has effectively relieved chest pain due to coronary artery disease in a 40-year-old man. This is the first report of spinal cord stimulation for treatment of refractory angina pectoris in South Korea.

• The Korean Journal of Pain
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• v.25 no.3
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• pp.143-150
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• 2012

Spinal cord stimulation has become a widely used and efficient alternative for the management of refractory chronic pain that is unresponsive to conservative therapies. Technological improvements have been considerable and the current neuromodulation devices are both extremely sophisticated and reliable in obtaining good results for various clinical situations of chronic pain, such as failed back surgery syndrome, complex regional pain syndrome, ischemic and coronary artery disease. This technique is likely to possess a savings in costs compared with alternative therapy strategies despite its high initial cost. Spinal cord stimulation continues to be a valuable tool in the treatment of chronic disabling pain.

• The Journal of Korean Physical Therapy
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• v.23 no.1
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• pp.53-58
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• 2011

Purpose: The purpose of this study was to determine the effect of direct functional magnetic stimulation (FMS) of affected spinal cord on motor recovery following spinal cord injury in rats. Methods: After a contusion injury at the spinal level T9 using an NYU Impactor, functional magnetic stimulation was delivered by a magnetic stimulator through a round prototype coil (7 cm in diameter). Stimulation parameters were set as follows: repetition rate = 50 Hz (stimulus intensity 100% = 0.18 T), stimulation time = 20 min. Functional magnetic stimulation was administered twice a day, 5 days per week for 8 weeks starting 4 days after spinal cord injury. Functional magnetic stimulationwas delivered directly to the affected spinal cord. Outcomes of locomotor performance were assessed by the Basso Beattie Bresnahan (BBB) locomotor rating scale and by an inclined plane test weekly for 8 weeks. Results: In the BBB test, hindlimb motor function in the Functional magnetic stimulation group improved significantly more compared to the control group at 3, 4, 6, 7, and 8 weeks (p<0.05). In the inclined plane test, the angle of the plane in the functional magnetic stimulation group increased significantly more compared to the control group at 4, 5, 7, and 8 weeks (p<0.05). Conclusion: Our results demonstrate that direct Functional magnetic stimulation of the lesional site may have beneficial effects on motor improvement after spinal cord injury.