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Resumen Introduccion La estimulacion medular cronica es una tecnica ampliamente aceptada en el tratamiento del dolor lumbar resultante de una cirugia de espalda fallida. Clasicamente la estimulacion se ha venido realizando con electrodos percutaneos implantados bajo anestesia local y sedacion, sin embargo, la facilidad de migracion, asi como la dificultad de reproduccion de parestesias electricas en zonas amplias recogidas con los mismos, han hecho que cada vez mas se recurra a la utilizacion de electrodos planos quirurgicos, que presentaban como inconveniente la necesidad de una laminectomia y anestesia general para su implantacion. Objetivos Presentar los resultados clinicos, los detalles tecnicos, las ventajas y los beneficios de la implantacion de electrodos planos de estimulacion medular bajo anestesia espinal, en sindromes de cirugia de espalda fallida. Material y metodos La estimulacion medular se realizo en un total de 119 pacientes (52 hombres y 67 mujeres), con edades comprendidas entre los 31 y los 73 anos (47,3 de media). La anestesia epidural fue inducida con ropivacaina. En todos los casos, a traves de una laminectomia minima, se implanto en el espacio epidural un electrodo plano de 8 contactos o un electrodo plano de moderna generacion de 16 polos. La situacion definitiva de los electrodos se dispuso en funcion de la reproduccion de parestesias electricas en la zona dolorosa de los enfermos. Los electrodos se conectaron con posterioridad a generadores de impulsos electricos de doble canal o recargables. Resultados Despues de un seguimiento medio de 4,7 anos, el resultado en cuanto a la mejoria de la situacion dolorosa previa es satisfactorio, constatando una disminucion del dolor del 58% en el axial y del 60% en el radicular, en mas del 70% de los casos. Ninguno de los pacientes ha manifestado que el tiempo quirurgico fuera doloroso o desagradable. No se han recogido complicaciones serias en el grupo, y en 6 de los casos se ha tenido que explantar el sistema por ineficacia o intolerancia de la neuroestimulacion a largo plazo. Conclusiones En este estudio, realizado en un numero importante de pacientes, se ha utilizado la anestesia epidural para la colocacion de electrodos planos de estimulacion medular en sindromes de cirugia fallida de espalda o poslaminectomia. La tecnica se ha mostrado segura, eficaz y satisfactoria.

Background In situ decompression and transposition are equally effective in cubital tunnel syndrome treatment. Both are traditionally performed in the supine position. Objective To validate our surgical technique for in situ decompression in the lateral decubitus position, comparing results with other techniques used in our institutions. Methods A retrospective study was performed from January 2009 to February 2016, of 188 patients with cubital tunnel syndrome 115 males, 73 females; mean age, 53.44 ± 12.12 years standard deviation (range, 18–84 years) treated with in situ decompression in the lateral or supine positions or transposition (subcutaneous or submuscular). The lateral decubitus group received local anesthesia and the remainder received a brachial plexus block. Clinical and electrophysiologic results between these 4 groups were compared. Results There were no statistically significant demographic differences between groups. Results were better in in situ decompression groups compared with transpositions. Mean follow-up was 1511.1 ± 770.57 days standard deviation (range, 310–4203 days). There were no recurrences or residual elbow pain/dysesthesia/anesthetic scar/hyperesthesia/neuroma in the lateral decubitus group. Complication and recurrence rates were in direct correlation to incision size. The worst results were seen in transpositions, particularly in the submuscular group. In situ decompression in the supine position had better results than transpositions but worse than those performed in lateral decubitus. Smaller surgical wound correlates with a reduction in operating time, costs, complication rates, and time out of work. Conclusions In situ decompression is equally as effective as ulnar nerve transpositions but with fewer complications and recurrences. In the lateral decubitus position, the retroepicondylar tunnel is more accessible, allowing smaller incisions and better results.

Background Spinal cord stimulation (SCS) is used to treat chronic pain and requires an awake patient for optimized lead positioning to locate paresthesias. Epidural anesthesia may be a suitable anesthetic but has not been evaluated. Methods We performed an open-label, prospective, observational, single-center study to evaluate the safety and efficacy of laminectomy lead placement under epidural anesthesia for the treatment of neuropathic chronic pain. Results The results in our study demonstrate that epidural anesthesia is a suitable technique for SCS lead implant. Conclusions This is the first study using epidural anesthesia for SCS lead implants by laminectomy. The technique seems to be safe and effective.

Spinal cord stimulation is a widely-accepted technique in the treatment of back pain resulting from failed back surgery. Classically, stimulation has been carried out with percutaneous electrodes implanted under local anaesthesia and sedation. However, the ease of migration and the difficulty of reproducing electrical paresthesias in large areas with such electrodes has led to increasing use of surgical plate leads, which have the disadvantage of the need for general anaesthesia and a laminectomy for implantation.Our objective was to report the clinical results, technical details, advantages and benefits of laminectomy lead placement under epidural anaesthesia in failed back surgery syndrome cases.Spinal cord stimulation was performed in a total of 119 patients (52 men and 67 women), aged between 31 and 73 years (average, 47.3). Epidural anaesthesia was induced with ropivacaine. In all cases we inserted the octapolar or 16-polar lead in the epidural space through a small laminectomy. The final position of the leads was the vertebral level that provided coverage of the patient's pain. The electrodes were connected at dual-channel or rechargeable pulse generators.After a mean follow-up of 4.7 years, the results in terms of improvement of the previous painful situation was satisfactory, with an analgesia level of 58% of axial pain and 60% of radicular pain in more than 70% of cases. None of the patients said that the surgery stage was painful or unpleasant. No serious complications were included in the group, but in 6 cases the system had to be explanted because of ineffectiveness or intolerance of long-term neurostimulation.This study, with a significant number of patients, used epidural anaesthesia for spinal cord stimulation of lead implants by laminectomy in failed back surgery syndromes. The technique seems to be safe and effective.