Prospective trials with rigorous statistical designs are needed. Mild-moderate stenosis, predominate leg pain, and "positive" exercise treadmill appear to be positive predictors. The dorsal column, also known as the medial lemniscal pathway, is an ascending pathway of the spinal cord (meaning it is responsible only for sending information from receptors and elsewhere in the peripheral nervous system up toward the brain) and is located on the posterior portion of the spinal cord. Spinal cord stimulation is a promising nondestructive alternative in the treatment of symptomatic spinal stenosis. Verbal pain scores, narcotic intake, and function were monitored. Twelve elected to not receive implant despite "successful trial". We suggest that evidence in favour of the dorsal columns or dorsal roots as the primary mediators of SCS is weak and propose that the dorsal horn is the crucial site of action. Twenty-one underwent subsequent permanent implantation with success rate of 67% at 1.5 years. Dorsal columns, dorsal roots and dorsal horns have each been proposed as spinal sites of action of SCS. This retrospective cohort of 55 patients receiving spinal cord stimulation was selected from a total of 72 patients presenting with spinal stenosis over a 4 year period. Spinal cord stimulation has a long safe efficacious history in the treatment of neuropathic extremity pain but has never been evaluated in the treatment of spinal stenosis. The stimulator is also called a dorsal column stimulator, or DCS. Nonsurgical approaches including epidural steroids and percutaneous adhesiolysis have not been completely evaluated. This surgical procedure involves placing a spinal cord stimulator, or SCS, to treat pain in the back, arms or legs caused by nerve damage or low blood flow. Furthermore review of the literature indicates mixed results even in optimal populations. Options are limited for the stenotic patient classified as a "poor surgical risk". Thirty thousand decompressive procedures are performed annually and this number is expected to increase as the American population ages. Surgical decompression has been considered the gold standard for the symptomatic spinal stenotic patient.
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