A5073508271- Pain Management and Treatment
- Musculoskeletal pain and rehabilitation
- Transcranial Magnetic Stimulation Studies
- Spine and Intervertebral Disc Pathology
- Pain Mechanisms and Treatments
- Anesthesia and Pain Management
- Myofascial pain diagnosis and treatment
- Neurological disorders and treatments
- Pain Management and Opioid Use
- Cardiac, Anesthesia and Surgical Outcomes
- Nerve Injury and Rehabilitation
- Cardiovascular Syncope and Autonomic Disorders
- Botulinum Toxin and Related Neurological Disorders
- Migraine and Headache Studies
- Spinal Hematomas and Complications
- Glioma Diagnosis and Treatment
- Intraoperative Neuromonitoring and Anesthetic Effects
- Stroke Rehabilitation and Recovery
- Aortic Disease and Treatment Approaches
- Pain Management and Placebo Effect
- Muscle activation and electromyography studies
- Management of metastatic bone disease
- Spinal Dysraphism and Malformations
- Cervical and Thoracic Myelopathy
- Epilepsy research and treatment
Johns Hopkins University
2016-2025
Johns Hopkins Medicine
2016-2025
International Neuromodulation Society
2010-2024
The University of Texas MD Anderson Cancer Center
2023
University of Oxford
2019
Albany Medical Center Hospital
2019
Neurological Surgery
2019
University of Rochester
2019
West Virginia University
2019
Ocean Medical Center
2019
Patients with neuropathic pain secondary to failed back surgery syndrome (FBSS) typically experience persistent pain, disability, and reduced quality of life. We hypothesised that spinal cord stimulation (SCS) is an effective therapy in addition conventional medical management (CMM) this patient population. randomised 100 FBSS patients predominant leg radicular origin receive plus (SCS group) or alone (CMM for at least 6 months. The primary outcome was the proportion achieving 50% more...
Persistent or recurrent radicular pain after lumbosacral spine surgery is often associated with nerve root compression and treated by repeated operation or, as a last resort, spinal cord stimulation (SCS). We conducted prospective, randomized, controlled trial to test our hypothesis that SCS more likely than reoperation result in successful outcome standard measures of relief treatment outcome, including subsequent use health care resources.For an average 3 years postoperatively,...
OBJECTIVE After randomizing 100 failed back surgery syndrome patients to receive spinal cord stimulation (SCS) plus conventional medical management (CMM) or CMM alone, the results of 6-month Prospective Randomized Controlled Multicenter Trial Effectiveness Spinal Cord Stimulation (i.e., PROCESS) showed that SCS offered superior pain relief, health-related quality life, and functional capacity. Because rate crossover favoring beyond 6 months would bias a long-term randomized group comparison,...
Abstract The indications for repeated operation in patients with persistent or recurrent pain after lumbosacral spine surgery are not well established. Long-term results have been reported infrequently, and no case has mean follow-up exceeded 3 years. We report 5-year a series of operations performed between 1979 1983. Patient characteristics modes treatment assessed as predictors long-term outcome. One hundred two “failed back syndrome” (averaging 2.4 previous operations), who underwent...
For many medical professionals dealing with patients persistent pain following spine surgery, the term Failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading, and potentially troublesome. It misrepresents causation. Alternative terms have been suggested, but none has replaced FBSS. The International Association for Study of Pain (IASP) published revised classification chronic pain, part new Classification Diseases (ICD-11), which accepted by World Health...
Spinal cord stimulation has evolved over the past 20 years into an easily implemented technique, with low morbidity, for treatment of intractable, chronic pain in properly selected patients. We report our experience a series 62 patients implanted between 1983 and 1987, percutaneous laminectomy electrodes, single- “multi-channel” (programmable, multi-contact) devices. Fifty had chronic, intractable back leg (“failed surgery syndrome,” lumbar arachnoid fibrosis), five spinal injuries, seven...
Abstract Spinal cord stimulation, in use for more than 20 years, has evolved into an easily implemented technique, with percutaneous methods electrode placement. We have reviewed our experience this technique treating “failed back surgery syndrome,” and assessed patient treatment characteristics as predictors of long-term outcome. A series 50 patients failed syndrome (averaging 3.1 previous operations), who underwent spinal stimulator implantation, was interviewed by impartial third parties,...
We analyzed the cost-effectiveness and cost-utility of treating failed back-surgery syndrome using spinal cord stimulation (SCS) versus reoperation.A disinterested third party collected charge data for first 42 patients in a randomized controlled crossover trial. computed difference cost with regard to success (cost-effectiveness) mean quality-adjusted life years (cost-utility). patient-charge respect intention treat (costs outcomes as group), treated intended randomized; failure assigned...
Abstract OBJECTIVE: Spinal cord stimulation, in use for more than 30 years, has evolved into an easily implemented technique involving percutaneous or laminectomy electrode placement. In a randomized comparison of four-contact and insulated electrodes placed at the same level dorsal, epidural midline, quantitative measures stimulator performance revealed significant technical advantages electrodes. Our prospective, randomized, controlled trial compares clinical results these patients....
Of 77 patients with supratentorial Grades I and II astrocytoma diagnosed from January 1975 to December 1984, 66 were treated postoperative radiation therapy. The received a tumor dose of 5000 5500 cGy in 180 fractions, five fractions per week, over 5.5 6 weeks. Overall actuarial survival at 2, 5, 10 years was 71%, 55%, 43%, respectively. Progression-free 69%, 50%, 39%, Survival for receiving therapy the range 4500 5900 78% 66% 2 5 years, Quality life determined two points time: 1...
Temporary nerve blocks using local anesthetic are employed extensively in the evaluation of pain problems, particularly lumbosacral spine disease. Their specificity and sensitivity localizing anatomic sources have never been studied formally, however, so their diagnostic prognostic value is questionable. There anecdotal reports relief by temporary directed to areas referral, as opposed documented underlying pathology; but there has no study define frequency or magnitude this effect. We...
Percutaneous radiofrequency lumbar facet denervation has been in use as a treatment for intractable, mechanical low back pain over 2 decades. A number of case series have reported with high rates success selected patients; however, there limited objective outcome assessment, long-term follow-up, and analysis prognostic factors. We reviewed our experience diagnostic blocks percutaneous at mean follow-up interval 3.2 years. Long-term assessed by disinterested third party interview. Of 82...
This article presents an analysis of the medical costs spinal cord stimulation (SCS) therapy in treatment patients with failed back surgery syndrome (FBSS).We compared SCS alternative regimen surgeries and other interventions.Externally powered (external) fully internalized (internal) systems were considered separately.Clinical management models each alternatives derived from clinical literature, retrospective data sets, expert opinion, published diagnostic protocols.No value was placed on...
Healthcare policy makers and payers require cost-effectiveness evidence to inform their treatment funding decisions. Thus, in 2008, the United Kingdom's National Institute of Health Clinical Excellence analyzed cost effectiveness spinal cord stimulation (SCS) compared with conventional medical management (CMM) reoperation recommended approval SCS selected patients failed back surgery syndrome (FBSS). We present previously unavailable details analysis an impact on rechargeable implanted pulse...
Introduction. Physicians, policy makers, and other interested parties require a synthesized, critical, clear compilation of the following information to optimize spinal cord stimulation (SCS) for neuropathic pain: 1) indications potential beneficial outcomes; 2) answers key clinical questions; 3) cost/resource use implications; 4) quality source evidence. This must be nonjudgmental noncoercive have sole objective increasing reader's expertise. Study Design. Evidence-based literature review...
Abstract Despite optimal medical management (OMM), low back pain (LBP) can be disabling, particularly after spinal surgery. Spinal cord stimulation (SCS) is effective in reducing neuropathic leg pain; however, evidence limited for LBP. This prospective, open-label, parallel-group trial randomized (1:1) failed surgery syndrome (FBSS) patients with predominant LBP to SCS plus OMM (SCS group) or alone (OMM at 28 sites Europe and the Americas. If was successful, a multicolumn system implanted....