Neurons in the spinal dorsal horn process sensory information, which is then transmitted to several brain regions, including those responsible for pain perception. The dorsal horn of the human spinal cord is recognized as a key site for initial pain processing. However, in recent years, the attention of researchers has turned to non-axonal stimulation targets, such as dorsal columns, dorsal roots, and dorsal horns. Conventional techniques have focused on axons in the dorsal column. Technological advances in stimulator design and treatment protocols have not correlated with significant improvements in clinical outcomes, and we may be reaching the limits of what can be achieved using established techniques. 1 However, our incomplete understanding of the mechanisms underlying pain relief by SCS has led to a plateau in efficacy. Spinal cord stimulation (SCS) is an established technique for the treatment of chronic pain associated with many different disease entities, including neuropathic pain, intractable pain, headache, and angina pain, and its clinical efficacy is well documented. Proc Natl.Acad Sci U.S.President, International Neuromodulation Societyĭirector of Hunter Pain Specialists, Hamilton Day Surgery Centre, Genesis Research Services, Broadmeadow, AustraliaĬo-Director, Innervate Pain Management Program, Newcastle, AustraliaĬhronic pain is a heterogenous, complex condition that is associated with significant burdens for both patients and the healthcare systems. (1999) A visceral pain pathway in the dorsal column of the spinal cord. Willis W D, Al Chaer E D, Quast M J et al. Wang CC, Willis WD, Westlund KN (1999) Ascending projections from the area around the spinal cord central canal: A Phaseolus vulgaris leucoagglutinin study in rats. Rustioni A (1973) Non-primary afferents to the nucleus gracilis from the lumbar cord of the cat. Petit D (1972) Postsynaptic fibres in the dorsal columns and their relay in the nucleus gracilis. Case report and review of the literature. (1997) Surgical interruption of a midline dorsal column visceral pain pathway.
![postsynaptic dorsal column spinal cord stimulation postsynaptic dorsal column spinal cord stimulation](https://i0.wp.com/www.floridasurgeryconsultants.com/wp-content/uploads/2019/02/Screen-Shot-2019-02-28-at-4.42.32-PM.jpg)
Kim YS, Kwon SJ (2000) High thoracic midline dorsal column myelotomy for severe visceral pain due to advanced stomach cancer. Honda CN, Lee CL (1985) Immunohistochemistry of synaptic input and functional characterizations of neurons near the spinal central canal. Honda CN (1985) Visceral and somatic afferent convergence onto neurons near the central canal in the sacral spinal cord of the cat.
![postsynaptic dorsal column spinal cord stimulation postsynaptic dorsal column spinal cord stimulation](https://images.infobloom.com/spinal-cord-and-vertabrae.jpg)
Hitchcock E (1970) Stereotactic cervical myelotomy. (1996) Is there a pathway in the posterior funiculus that signals visceral pain? Pain 67:291–305 Hirshberg RM, Al Chaer ED, Lawand NB et al. Gildenberg PL, Hirshberg RM (1984) Limited myelotomy for the treatment of intractable cancer pain. Evidence against an important role in nociception. Giesler GJ Jr, Cliffer KD (1985) Postsynaptic dorsal column pathway of the rat. Giesler GJ Jr, Nahin RL, Madsen AM (1984) Postsynaptic dorsal column pathway of the rat. (1983) Receptive field organization and response properties of spinal neurones with axons ascending the dorsal columns in the cat. J Neurophysiol 76:2675–2690īrown AG, Brown PB, Fyffe RE et al. (1996) Pelvic visceral input into the nucleus gracilis is largely mediated by the postsynaptic dorsal column pathway. Al-Chaer ED, Lawand NB, Westlund KN et al.