Cervicomedullary junction spinal cord stimulation for head and facial pain.
OBJECTIVE
To review our experience with cervicomedullary junction spinal cord stimulation (SCS), to alleviate head and facial pain.


BACKGROUND
There is a dearth of literature regarding the use of spinal cord stimulation for treating head and facial pain.


METHODS
We performed a Boolean search of the electronic medical record (1990-2009) and identified 35 patients (9 men, 26 women) for whom the senior author (J.J.M) trialed paddle lead cervicomedullary junction stimulation (CMJ-S) for intractable head or facial pain. Twenty-five patients (71.4%) had a successful trial with subsequent implantation of SCS hardware and 10 patients (28.6%) experienced a failed trial. Pain syndromes were categorized into diagnostic groups: trigeminal deafferentation pain (TDP), trigeminal neuropathic pain (TNP), occipital pain/neuralgia, post-herpetic neuralgia (PHN), and post-stroke facial pain. Follow-up via structured telephone interview was obtained in 25 patients (71.4%).


RESULTS
Among the 25 patients available for follow-up, 16 patients (64%) underwent implantation and 9 patients (36%) had a failed trial of CMJ-S. The mean patient age and length of follow-up was 47.3 years old (20-78 years old) and 53.4 months (2-120 months), respectively. On a 0-10 pain intensity scale (0 being no pain and 10 being the worst degree of pain), a mean pretrial pain level of 9.6 (range 7-10) had been reduced to a mean of 4.8 (0-10) at follow-up. Successful trial and subsequent implantation occurred in 7 patients with TDP (70%), 4 patients with TNP (80%), both patients with PHN (100%), and in the single patient with post-stroke facial pain (100%) but in only 2 patients (28.6%) with occipital neuralgia/pain. At the time of telephone interview, 4 of the implanted patents (25%) had their hardware removed because of loss of effectiveness (3) and infection (1). The other 12 implanted patients (75%) continue to use CMJ-S on a daily basis and insist that it has improved their quality of life. Six current users (50%) of CMJ-S have been able to decrease their use of oral pain medications. Complications in the implanted group included infection (1), uncomfortable paresthesias from breakdown of connecting wire insulation (1), and gradual loss of effectiveness (3).


CONCLUSIONS
Our preliminary experience suggests that patients suffering from TDP, TNP, and PHN may respond favorably to CMJ-S whereas patients with occipital neuralgia/pain are rarely palliated by this neuromodulatory approach.
From the Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Nestor D
ND
Tomycz
From the Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Christopher P
CP
Deibert
From the Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
John J
JJ
Moossy
D000293:Adolescent; D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004824:Epidural Space; D005157:Facial Pain / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000503:physiopathology; D010147:Pain Measurement; D011788:Quality of Life; D012189:Retrospective Studies; D013116:Spinal Cord / Q000502:physiology*; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000503:physiopathology; D055815:Young Adult