![]() It is this approach that was utilized in the most recent prospective, multicenter, randomized, active sham-controlled clinical trial (ReActiv8-B trial), described below. The new midline approach was developed to mitigate the risk of conductor fracture. The implant technique was amended during the second study after an investigation determined that the lateral approach subjected the lead to a risk of tight bending and potential conductor fracture as it traversed two planes of fascia that move in opposing directions. This feasibility study led to a prospective multicenter clinical trial (ReActiv8-A) utilizing a novel four-electrode lead design developed to reduce the migration rate seen in the initial study. Stimulation of the lumbar medial branch of the dorsal ramus in order to effect multifidus contraction was first described by Deckers et al., utilizing a two-incision technique in which commercially available neurostimulation leads were placed bilaterally at the junction of the transverse process and superior articular process of 元 with the lead body parallel to the spinal column. Chronically Implanted Lead and Generator Placement The two unique approaches identified are detailed in the following text. was searched for entries related to the key word phrases “peripheral nerve stimulation” and “low back pain.” The search results were further filtered to focus on techniques that specifically target the lumbar medial branch nerves. The objective of this paper is to provide a short review of PNS techniques for CLBP. Both target the peripheral nervous system via the medial branch of the dorsal ramus. The ReActiv8 (Mainstay Medical Limited, Dublin, Ireland) chronically implanted system utilizes two percutaneously placed leads and an implanted pulse generator, whereas the SPRINT PNS (SPR Therapeutics, Inc., Cleveland, OH, USA) device is a percutaneous, temporarily implanted fine wire open-coil lead system. At present, there are two emerging techniques to PNS of the lumbar medial branches of the dorsal ramus for CLBP. The importance of muscular innervation is revisited when confirming correct PNS lead placement. ![]() The medial branch nerve fibers also innervate the fascicles of multifidus muscles attached to the spinous process of the corresponding vertebral body. Īrticular innervation to lumbar zygapophyseal joints (Z-joints) originates from medial branches of the dorsal rami. Innovative approaches utilizing peripheral nerve stimulation (PNS) for the treatment of CLBP are showing continued clinical improvement in pain, function, and quality of life with a reduced need for multiple interventions. Its prevalence in the United States has been recently estimated to be ∼13%, with afflicted individuals showing a higher likelihood of health care utilization. Neurostimulation for Peripheral Nerve Stimulation (PNS) using surgical leads – A Medtronic PNS neurostimulation system is indicated for PNS as an aid in the management of chronic, intractable pain of the trunk and/or limbs.Low Back Pain, Peripheral Nerve Stimulation, Medial Branch, Ultrasound, Fluoroscopy, Chronic Pain IntroductionĬhronic low back pain (CLBP) is often multifactorial and a complex condition to treat. * Neurostimulation for Peripheral Nerve Stimulation (PNS) using percutaneous leads - A Medtronic PNS neurostimulation system is indicated for PNS as an aid in the management of chronic, intractable pain of the posterior trunk. The Focus SM workflow is guidance only and physicians should use their medical judgment and product labelling to optimise therapy for individual patients, which may require discontinuation or modification of the workflow. Subcutaneous Stimulation as ADD-ON Therapy to Spinal Cord Stimulation Is Effective in Treating Low Back Pain in Patients With Failed Back Surgery Syndrome: A Multicenter Randomized Controlled Trial. Van Gorp E-JJAA, Teernstra OPM, Gultuna I, et al.Presented at the 9th World Congress of the World Institute of Pain, Dublin, Ireland, May 9-12, 2018. Predictors analysis of a prospective multicentre study on peripheral nerve field stimulation (PNFS) for chronic low back pain (CLBP): Results from the Austrian PNS Registry. Peripheral Nerve Field Stimulation (PNFS) in Chronic Low Back Pain: A Prospective Multicenter Study. Neuromodulation 2018 E-pub ahead of print. Randomized Controlled Trial of Subcutaneous Nerve Stimulation for Back Pain Due to Failed Back Surgery Syndrome: The SubQStim Study. Eldabe SS, Taylor RS, Goossens S, et al.
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