title: Cervical and cervicomedullary spinal cord stimulation for chronic pain: efficacy and outcomes.
abstract: BACKGROUND
  The role for spinal cord stimulation (SCS) in the management of chronic spinal cord forms of pain involving cervical dermatomes or the cervicomedullary junction (CMJ) for facial pain remains largely uncharted.
  
  
  OBJECTIVE
  To review outcomes with cervical and CMJ SCS performed by a single surgeon, with particular emphasis on complications and efficacy.
  
  
  METHODS
  All patients that underwent cervical or CMJ SCS by the lead author were identified and follow-up obtained by telephone questionnaires. Patient demographics, surgical details, outcomes and complications for all patients identified were critically reviewed.
  
  
  RESULTS
  Of 121 patients identified that underwent at least trial SCS, 100 underwent permanent lead implantation. Indications for cervical SCS included brachial plexus lesions (8), complex regional pain syndrome (33), degenerative disc disease (4), failed neck surgery syndrome (23), chronic radiculopathy (6) and post-herpetic neuralgia (PHN) (1); for CMJ SCS, indications included trigeminal deafferetiation pain (10), trigeminal neuropathic pain (4), PHN (4) and occipital neuralgia (7). Pain relief was greater along the extremities than axially, and less in the occipital area than in the head or face. Mean pain reduction averaged 56.6% at a mean follow-up of 4.2 years. Of 24 revision surgeries required, 8 were for presumed lead migration or fracture. Complications included 4 CSF leaks, 5 wound infections, and 4 cases of persistent numbness or pain. Pain relief lasted an average of 3.6 years.
  
  
  CONCLUSIONS
  Cervical and CMJ SCS are safe and efficacious and may provide greater relief along the upper extremities than axially, and in the head rather than in the occipital region.
authors.affiliation: Department of Neurological Surgery, University of California Los Angeles Health System, 757 Westwood Plaza, Los Angeles 90095, USA. Electronic address: chivukula@ucla.edu.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Chivukula
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh 15213, USA.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Tempel
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh 15213, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Weiner
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh 15213, USA.
authors.forename: Abhiram V
authors.initials: AV
authors.lastname: Gande
authors.affiliation: Department of Neurological Surgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, USA.
authors.forename: Ching-Jen
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Department of Neurological Surgery, University of Virginia Health System, 1215 Lee Street, Charlottesville, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh 15213, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Moossy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D059350:Chronic Pain / Q000628:therapy*; D004567:Electrodes, Implanted; D005157:Facial Pain / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D017060:Patient Satisfaction; D010523:Peripheral Nervous System Diseases / Q000628:therapy; D062187:Spinal Cord Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cervical; Chronic pain; Efficacy; Neuromodulation; Spinal cord stimulation