title: Occipital nerve stimulation for refractory occipital pain after occipitocervical fusion: expanding indications.
abstract: BACKGROUND
  Occipital nerve stimulation is being used for various pain syndromes. Here, we expand its use for the treatment of refractory occipital pain after occipitocervical fusion.
  
  
  METHODS
  We describe a case of occipital neuralgia in a 60-year-old man following posterior occipitocervical fusion. The maximum pain intensity was rated 9/10 on the visual analogue scale (VAS). Since pain proved to be refractory to analgetic medication, two quadripolar electrodes (Resume II, Medtronic) were implanted in the occipital region to stimulate the occipital nerve bilaterally. The patient experienced a dramatic response during test stimulation for 10 days with externalized electrodes, and a pacemaker (Synergy, Medtronic) was connected to the electrodes. While on chronic stimulation (bipolar 6 V, 210 mus, 130 Hz) improvement of pain was maintained, reflected by a decrease in the VAS score to 1/10 at 12 months of follow-up.
  
  
  CONCLUSIONS
  Occipital nerve stimulation for medical refractory occipital neuralgia after occipitocervical fusion is an effective method expanding the indications for its use.
authors.affiliation: Department of Neurosurgery, University of Medical Science, Birjand, Iran.
authors.forename: Kazem
authors.initials: K
authors.lastname: Ghaemi
authors.forename: Hans-Holger
authors.initials: HH
authors.lastname: Capelle
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kinfe
authors.forename: Joachim K
authors.initials: JK
authors.lastname: Krauss
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D009777:Occipital Bone / Q000294:innervation* / Q000473:pathology / Q000601:surgery*; D010148:Intractable Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*