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Stimulation analgésique médullaire antérieure et postérieure par technique d'implantation percutanée

Anterior and posterior medullary pain-relieving stimulation by means of a percutaneous implantation technique

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Résumé

La technique d'implantation percutanée d'un stimulateur analgésique minimise considérablement l'intervention chirurgicale. Cet avantage est cependant atténué par l'absence de précision dans la mise en place des électrodes épidurales et par le risque de déplacement secondaire pouvant aboutir à une stimulation inadéquate. Pour pallier cet inconvénient, les auteurs proposent une technique intermédiaire avec la technique ouverte classique: il s'agit de la technique interépineuse particulièrement justifiée pour les implantations au niveau de la charnière cervico-dorsale. Sur 12 cas implantés par technique percutanée, 5 cas reçoivent, du fait de la situation des électrodes épidurales, une stimulation électrique médullaire antérieure, qui crée une analgésie sans provoquer de paresthésies dans le territoire de la douleur. Les résultats obtenus ne permettent cependant pas de conclure à la supériorité de la stimulation médullaire antérieure sur la stimulation des cordons postérieurs.

Summary

The technique of percutaneous implantation of a pain-relieving stimulator reduces the surgical procedure considerably. This advantage is, however, lessened by the absence of precision in placing epidural electrodes, and by the risk of their later displacement leading to inadequate stimulation. To reduce this disadvantage the authors suggest a technique that is a modification of the classical open procedure: it is particularly suitable for implantation at the cervico-dorsal junction. In 12 patients treated by percutaneous implantation, 5 received, from epidural electrodes, an anterior medullary electrical stimulation which caused analgesia without paraesthesiae in the painful area. The results, however, do not justify a conclusion that anterior medullary stimulation is better than posterior colunm stimulation.

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En décembre 1977, les auteurs confirment leurs résultats avec 20 cas d'implantation médullaire par technique percutanée.

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Lazorthes, Y., Verdie, J.C. & Arbus, L. Stimulation analgésique médullaire antérieure et postérieure par technique d'implantation percutanée. Acta neurochir 40, 253–276 (1978). https://doi.org/10.1007/BF01774751

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  • DOI: https://doi.org/10.1007/BF01774751

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