Spinal cord stimulation: percutaneous implantation techniques
Neuromodulation therapies such as spinal cord, dorsal root ganglion, and peripheral nerve stimulation are used to treat chronic pain syndromes such as intractable back pain, diabetic neuropathy, spinal radiculopathies, and complex regional pain syndrome. Since the publication of the first edition ov...
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| Format: | Buch |
| Sprache: | English |
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New York, NY, United States of America
Oxford University Press
[2023]
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| Ausgabe: | Second edition |
| Schlagworte: | |
| Online-Zugang: | Cover original Inhaltsverzeichnis Klappentext |
| Zusammenfassung: | Neuromodulation therapies such as spinal cord, dorsal root ganglion, and peripheral nerve stimulation are used to treat chronic pain syndromes such as intractable back pain, diabetic neuropathy, spinal radiculopathies, and complex regional pain syndrome. Since the publication of the first edition over a decade ago, there has been unprecedented progress in understanding neuromodulation and technological advances in clinical applications.Spinal Cord Stimulation is intended as an essential guide to the clinical fundamentals required for safe and effective implantation of neuromodulation devices. Implantation of these devices is performed by physicians from various disciplines, requiring a multidisciplinary skill set that presents a challenge for surgical and non-surgical pain practitioners alike. This authoritative resource integrates the basic multidisciplinary information necessary for understanding spinal cord stimulation, dorsal root ganglion (DRG), and peripheral nerve stimulation (PNS) with up-to-date implantation techniques for clinicians to use in their daily practice. It also features updated advice for appropriate medical decision making, patient education, safe use of radiation, and managing adverse events, with new chapters dedicated toward DRG stimulation and PNS. |
| Beschreibung: | XIX, 196 Seiten Illustrationen 222 x 286 mm |
| ISBN: | 9780190095086 0190095083 |
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| 245 | 1 | 0 | |a Spinal cord stimulation |b percutaneous implantation techniques |c edited by Paul G. Kreis, Scott G. Pritzlaff, David J. Copenhaver, and Scott M. Fishman |
| 250 | |a Second edition | ||
| 264 | 1 | |a New York, NY, United States of America |b Oxford University Press |c [2023] | |
| 300 | |a XIX, 196 Seiten |b Illustrationen |c 222 x 286 mm | ||
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| 520 | |a Neuromodulation therapies such as spinal cord, dorsal root ganglion, and peripheral nerve stimulation are used to treat chronic pain syndromes such as intractable back pain, diabetic neuropathy, spinal radiculopathies, and complex regional pain syndrome. Since the publication of the first edition over a decade ago, there has been unprecedented progress in understanding neuromodulation and technological advances in clinical applications.Spinal Cord Stimulation is intended as an essential guide to the clinical fundamentals required for safe and effective implantation of neuromodulation devices. Implantation of these devices is performed by physicians from various disciplines, requiring a multidisciplinary skill set that presents a challenge for surgical and non-surgical pain practitioners alike. This authoritative resource integrates the basic multidisciplinary information necessary for understanding spinal cord stimulation, dorsal root ganglion (DRG), and peripheral nerve stimulation (PNS) with up-to-date implantation techniques for clinicians to use in their daily practice. It also features updated advice for appropriate medical decision making, patient education, safe use of radiation, and managing adverse events, with new chapters dedicated toward DRG stimulation and PNS. | ||
| 650 | 4 | |a Autism & Asperger’s Syndrome / BIC2 | |
| 650 | 4 | |a Anaesthetics / BIC2 | |
| 650 | 4 | |a Pain & pain management / BIC2 | |
| 700 | 1 | |a Kreis, Paul G. |0 (DE-588)1049816110 |4 edt |4 wpr |4 aut | |
| 700 | 1 | |a Pritzlaff, Scott G. |4 edt |4 wpr |4 aut | |
| 700 | 1 | |a Copenhaver, David J. |4 edt |4 wpr | |
| 700 | 1 | |a Fishman, Scott M. |d 1959- |0 (DE-588)137800703 |4 edt |4 wpr |4 aut | |
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| 856 | 4 | 2 | |m Digitalisierung UB Regensburg - ADAM Catalogue Enrichment |q application/pdf |u http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034990224&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA |3 Klappentext |
Datensatz im Suchindex
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CONTENTS xm Foreword to the Second Edition James E. Boggan xv Preface Paul G. Kreis, Scott G, Pritzlaff, David J. Copenhaver, and Scott Μ. Fishman Editors and Contributors xvii Disclosures of Conflicts of interest xix 1. THE DEVELOPMENT OF SPINAL CORD STIMULATION 1 Paul G. Kreis, Ammon A. Hills, and Scott Μ. Fishman Medical Considerations 19 Anticoagulation and Coagulopathy 19 Infection 20 Suppressed Immune Response 21 Tobacco Abuse 21 Establishing Medical Necessity 21 Psychosocial Considerations 22 Psychological Contraindications and Testing 22 Patient Education 23 23 Psychological Preparation Introduction 1 Procedural Information 24 History 2 Informed Consent 25 The Gate Theory of Pain Reduction 2 References Mechanism of Action 4 Appendix A: Sample Letter of Medical Necessity for Spinal Cord Stimulation 27 Equipment Overview 7 Current Status 9 Appendix B: Frequently Asked Questions About Spinal Cord Stimulation 28 Favorable Patient Characteristics 9 Appendix C: Checklist of Patient Education Topics Efficacy 10 3. RADIATION SAFETY Cost-Effectiveness 11 Warnings 11 J. Anthony Seibert, Scott Μ. Fishman, and Paul G. Kreis References 12 Introduction 2. SCS SCREENING TRIAL: PATIENT SELECTION AND PREPARATION 25 29 31 31 31 Background 14 Terminology Paul G. Kreis, Ammon A. Hills, Ravi Prasad, and Scott Μ. Fishman 31 X-Ray Interactions 32 X-Ray Production 32 Introduction 14 Patient Selection 14 X-Ray Image Formation, Detection, and Presentation Indications for Spinal Cord Stimulation 15 The X-Ray Image Intensifier Detector FDA-Approved Indications 15 The Flat-Panel Digital
Detector Budapest Clinical Diagnostic Criteria for CRPS 16 Collimation and Filtration of the X-Ray Beam 33 33 34 35 Off-Label Applications 17 Recording Radiation Dose Metrics 35 Related Applications 17 Image Quality 36 Unsuccessful Applications 17 Distortion Errors 36 Contraindications 17 Parallax Error 36 Anatomic Considerations 18 Vignetting 36 18 Epidural Access and Stenosis Spine Abnormalities 18 Pincushion Distortion in Image Intensifier Detectors Spondylosis 19 “S" Distortion 37 Previous Spine Surgery 19 Advantages of Flat Panel Detectors 37 Spinal Stenosis 19 Biologic Effects of Radiation 36 37
38 Monopolar Stimulation Minimizing Effects on the Torso and Legs 39 Bipolar Stimulation 59 Minimizing Effects on the Thyroid 40 Tripolar Stimulation 60 Reducing Exposure to Radiation Minimizing Effects on the Hands 40 Minimizing Effects on the Eyes 40 Fluoroscopy for Spinal Cord Stimulation 41 Patient-Informed Consent for Radiation Exposure 41 Acknowledgments 42 References 42 4. STERILE TECHNIQUE 43 Paul G. Kreis, Ammon A. Hills, and Joseph Μ. Galante Introduction The Importance of Sterile Technique in Infection Control 43 43 Surgical Site Infections 44 Risk Factors for Surgical Site Infection 44 Principles of Aseptic and Sterile Technique 45 Terms and Concepts 45 Cleaning and Antiseptic Agents 45 Other Principles Prophylactic Antibiotics Operative Preparation: Scrubbing and Draping Physician Preparation: Hand Scrubbing. Gowning, and Gloving References 5. ELECTRICITY AND SPINAL CORD STIMULATION 60 Electrode Spacing 61 Pulse Generators 61 Electrical Stimulation Technology 61 PowerSources: Rechargeable, Non-rechargeable, and Radiofrequency 47 62 Pacemakers and Implanted Pulse Generators: Are They Compatible? 63 Current Versus Voltage Control 63 Independently Controlled Current Delivery 63 63 Stimulation Waveforms 64 Evoked Compound Action Potentials 64 References 66 6. TRIAL OF SPINAL CORD STIMULATION: BASIC CONSIDERATIONS 69 Scott G. Pritzlaff, Paul G. Kreis, and Scott Μ. Fishman 47 Introduction 69 48 Percutaneous Versus Tunneled Trials 69 48 Advantages of Percutaneous Trials 70 Disadvantages of Percutaneous Trials 70 49 50 52 Scott G. Pritzlaff, Ammon A. Hills, and Paul G.
Kreis Advantages of Tunneled Trials 70 Disadvantages of Tunneled Trials 70 General Information About Percutaneous Trials 71 71 Equipment Introduction 52 Relevant Anatomy of the Epidural Space SCS Leads 72 52 Lead Locations in the Spine 73 Percutaneous Leads 52 Loss-of-Resistance Technique 74 Surgical (Paddle) Leads 53 Mechanics of the Loss-of-Resistance Technique 74 53 Fluoroscopic Guidance 75 Perception Threshold 53 Local Anesthesia 75 Fibrosis 53 Anesthesia Epidural Space 54 Management During the Tria! 75 CSF Layer 54 Assessment of Trial 75 Time Since Implant 54 References 76 Other Factors 54 Appendix: Sample Dictation—SCS Trial Anodes and Cathodes 54 Ohm's Law (V = IR) Dorsal Column Anatomy 55 Frequency, Amplitude, and Pulse Width 56 Template 77 7. PERCUTANEOUS TRIAL OF SPINAL CORD 57 STIMULATION 57 Scott G. Pritzlaff, Paul G. Kreis, and Scott Μ. Fishman 58 58 Contact Combinations 59 76 77 Pulse Width (Microseconds) Single Versus Dual Leads 75 Recommendations Amplitude (Current/Voltage) Frequency (Hertz) VIM Dual or Complex Cathodes, Current Steering, and Interleaving Interleaved Pulses in Non-independently Controlled Current/VoltageDelivery Systems 43 The Development of Sterile Technique Preoperative Preparation: Home Preparation 59 79 Introduction 79 Anterograde Lead Placement for Stimulation of Low Back and Legs 79 CONTENTS
Patient Positioning 79 Weitlaner Retractor Operative Procedure 79 Adson Cerebellar Retractor 104 Senn Retractor and Skin Hook 104 Army-Navy Retractor 104 Anterograde Lead Placement for Stimulation of Upper Extremities Patient Positioning Operative Procedure 82 82 83 Lead Manipulation 87 Intraoperative Lead and Stimulation Testing 88 Anchoring the Lead Externally 89 After the Procedure 91 References 91 S. TUNNELED TRIAL OF SPINAL CORD STIMULATION 92 Scott G. Pritzlaff, Paul G. Kreis, and Scott Μ. Fishman Performing a Tunneled Trial 92 Creating the Midline Cut-Down Incision 92 Placing the Leads Prior to the Cut-Down Incision 92 Operative Procedure 92 Choosing Incision Location 93 One-Lead Placement 93 Two-Lead Placement 93 Two Needles at Same Vertebral Level on Opposite Sides of Midline Option A: Placing a Single Vertical Incision Between the Two Needles (Figure 8.1) Option B: Use a Transverse Incision, Thereby Incorporating the Needles into the Incision (Figure 8.2) Two Needles on the Same Side at Same or Different Vertebra) Levels Forceps 104 105 Tunneling 106 Suction Equipment 107 Sponges 107 Needles and Sutures 108 Basic Suture Instruments 108 Needle Holders (Drivers) 108 Needle Pickups 108 Suture Scissors 108 Suture Material 108 Suture Handling 108 Natural Versus Synthetic Material 109 Absorbable Versus Nonabsorbable Sutures 109 Monofilament Versus Multifilament Sutures 109 Suture Size 109 Surgical Needles 110 Needle Anatomy 110 93 Curved Versus Straight Needles 110 93 Taper Point, Cutting, or Reverse Cutting Needles 111 Conventional Cutting Needles 111 Reverse Cutting
Needles 111 94 94 Skin Adhesive Wound Closure ill 112 Placing the Cut-Down Incision Prior to Lead Placement 95 Holding the Needle Driver and Grasping the Needle 112 Creating the Centra) Pocket 95 Interrupted Sutures for the Deep Layer 112 Anchoring the Lead 96 113 The Tunneling Procedure 97 Continuous (Running) Subcuticular Skin Closure 98 Avoid Tissue Trauma 114 References Surgeon's Knot and Square Knot 115 Two-Handed Surgical Tie 115 Two-Handed Square Knot 115 Instrument Tie 119 9. BASIC SURGICAL SKILLS FOR THE OPERATING ROOM 99 Paul G. Kreis, Julius 0. Ebinu, Kee D. Kim, and Eric 0. Klineberg Introduction 99 Surgical Instrumentation 99 Incising Instruments Electrosurgery 99 100 Monopolar (Unipolar) Electrosurgery 101 Bipolar Electrosurgery 101 Cut Versus Coagulation 101 Grounding Pad (Return Electrode) 102 Dissecting and Undermining 103 References 10. PERMANENT SPINAL CORD STIMULATOR PLACEMENT 121 Scott G. Pritziaff, Paul G. Kreis, and Scott Μ. Fishman Introduction 121 Temporary Versus Permanent Trial 121 Permanent Implantation Following a Successful Percutaneous Trial 121 Sharp Versus Blunt 103 How Much Additional Length Should Be Added for Strain Relief? Retractors 104 Anesthesia CONTENTS 120 122 122 IX
Anterograde Permanent Lead Placement at the Lumbar, Thoracic, and Cervical Levels Postoperative Care 122 Creating the Midline Pocket Incision Placing the Leads Prior to Cut-Down Incision and Midline Pocket Creation 122 122 Operative Procedure 123 Choosing Incision Location 123 Placing the Midline Pocket Cut-Down Incision Prior to Lead Placement 123 Creating the Central Pocket 123 Anchoring the Lead 123 Permanent Implantation Following Successful Tunneled Trial 123 136 Postoperative Antibiotics 136 Suture and/or Staple Removal 136 137 References 12. COMPLICATIONS AND ADVERSE EVENTS 138 Naileshni S. Singh, Paul G. Kreis, and Scott Μ. Fishman Postoperative Complications in the Modern World 138 Training 138 Complications and Adverse Events 139 Anesthesia Complications 140 Explantation of Temporary Extension 123 Monitoring 140 Where to Place the IPG Pocket 123 Local Anesthetic Toxicity 140 Placing the IPG 125 The Tunneling Procedure 126 Inadvertent Subarachnoid Injection: The Total Spinal Block 141 After the Procedure 127 References 127 127 Appendix 1: Sample Dictation Template 127 Consent Procedure 127 Disposition 128 Template 128 Postoperative Instructions for Patients Having Spinal Stimulator Implants, Revisions, and Expiants 130 Sample Preoperative Orders: Spinal Cord Stimulator Implant 130 Sample Preference Card 131 Preparation 131 Instruments 131 Supplies 131 Equipment 131 Sutures 131 Drugs 132 Dressings 132 11. WOUND HEALING, POSTOPERATIVE WOUND MANAGEMENT, AND DISCHARGE EDUCATION 133 Naileshni S. Singh, Paul G. Kreis, and Scott Μ. Fishman Introduction 133 Normal Wound
Healing 133 Phases of Wound Healing 133 Phase 1: Hemostasis and Inflammation 133 Phase 2: Proliferation and Fibroplasia 135 Phase 3: Maturation and Remodeling 135 Identifying the Patient at Risk for Wound Complications Malnutrition, Chronic Disease, Immune Compromise, and Lifestyle Factors X 136 Showering 135 135 141 Surgical Complications Infection 141 Preoperative Prevention 141 Postoperative Infection 143 144 Hematoma 144 Preoperative Prevention Postoperative Hematoma 144 Epidural Hematoma 145 Epidural Abscess 145 Hematoma of the Midline or IPG Pocket 145 Midline or IPG Pocket Seroma 146 146 Dural Punctures and CSF Hygromas Prevention 147 Responding to a Dural Puncture 147 148 Dehiscence Skin Erosion 148 Perforated Viscus: Tunneling 148 Cord Injury and Nerve Damage 149 149 Anxiolysis and Sedation 150 Stenosis Hardware Malfunction 150 MRI Compatibility 151 Explantation 151 Conclusions 152 References 152 13. PERIPHERAL NERVE STIMULATION 154 Scott G. Pritzlaff, Ammon A. Hills, Michael J. Jung, and Charles J. DeMesa Introduction Clinical Anatomy of the Peripheral Nervous System 154 155 Mechanism of Action 156 Indications for PNS Therapy 157 CONTENTS
Peripheral Nerve Trauma 157 Hemiplegie Shoulder Pain (HSP) 158 Low Back Pain 158 Recommendations 173 Chronic and Acute Postsurgical Pain 160 Template 174 Complex Regional Pain Syndrome (CRPS) 160 Appendix B: Sample Dictation—PNS Permanent Implant with Ultrasound 14. DORSAL ROOT GANGLION STIMULATION 172 176 160 Scott G. Pritziaff, Ammon A. Hills, Michael J. Jung, and Charles J. DeMesa Equipment and Implantation Procedures 160 Introduction 176 Patient Selection 161 Clinical Anatomy and DRG Stimulation 177 Safety and Risk 162 Patient Selection 180 Diagnostic Local Anesthetic Blocks and Trials 163 Technique 181 Approaches to Nerves 163 Patient Position 182 Common Nerve Targets 164 Needle Placement for T10 to L3 182 Approach to the Suprascapular Nerve 164 Case Example 183 Approach to the Axillary Nerve 166 Needle Placement for L4 to L5 183 Other (Groin Pain, Intercostal Pain, Sacroiliac Pain, Chronic Migraine) Approach to the Sciatic, Common Peroneal, and Tibial Nerves 166 Needle Placement for SI and S2 185 Case Example 185 Tunneling 167 Sheath Delivery T10 to S2 185 Conclusions 168 References 168 Placing the Epidural Strain Relief Loop 186 Appendix A: Sample Dictation—PNS Percutaneous Trial/Temporary Implant with Ultrasound Removal of the Delivery System 170 Recommendations 171 Template 171 CONTENTS References 188 190 Index 191 XI
Neuromodulation therapies such as spinal cord, dorsal root ganglion, and peripheral nerve stimulation are used to treat chronic pain syndromes such as intractable back pain, diabetic neuropathy, spinal radiculopathies, and complex regional pain syndrome. Since the publication of the first edition over a decade ago, there has been unprecedented progress in understanding neuromodulation and techno logical advances in clinical applications. Spinal Cord Stimulation is intended as an essential guide to the clinical fundamentals required for safe and effective implantation of neuromodulation devices. Implantation of these devices is performed by physicians from various disciplines, requiring a multidisciplinary skill set that presents a challenge for surgical and non-surgical pain practitioners alike. This authoritative resource integrates the basic multidisciplinary information necessary for understanding spinal cord stimulation, dorsal root ganglion (DRG), and peripheral nerve stimulation (PNS) with up-to-date implantation techniques for clinicians to use in their daily practice. It also features updated advice for appropriate medical decision making, patient education, safe use of radiation, and managing adverse events, with new chapters dedicated toward DRG stimulation and PNS. PAUL G. KREIS is Professor Emeritus of Anesthesiology and Pain Medicine at the University of California, Davis. SCOTT G. PRITZLAFF is Associate Professor and Director of the Pain Medicine Fellowship in the Department of Anesthesiology and Pain Medicine at the University of California, Davis. DAVID J.
COPENHAVER is Professor and Chief of the Division of Pain Medicine and Director of Cancer Pain Management and Supportive Care at the University of California, Davis. SCOTT Μ. FISHMAN is Professor of Anesthesiology and Pain Medicine and the Fullerton Endowed Chair in Pain Medicine at the University of California, Davis. |
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| discipline | Medizin |
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| id | DE-604.BV049646706 |
| illustrated | Illustrated |
| index_date | 2024-07-03T23:39:55Z |
| indexdate | 2024-07-20T07:54:41Z |
| institution | BVB |
| isbn | 9780190095086 0190095083 |
| language | English |
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| physical | XIX, 196 Seiten Illustrationen 222 x 286 mm |
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| publisher | Oxford University Press |
| record_format | marc |
| spelling | Spinal cord stimulation percutaneous implantation techniques edited by Paul G. Kreis, Scott G. Pritzlaff, David J. Copenhaver, and Scott M. Fishman Second edition New York, NY, United States of America Oxford University Press [2023] XIX, 196 Seiten Illustrationen 222 x 286 mm txt rdacontent n rdamedia nc rdacarrier Neuromodulation therapies such as spinal cord, dorsal root ganglion, and peripheral nerve stimulation are used to treat chronic pain syndromes such as intractable back pain, diabetic neuropathy, spinal radiculopathies, and complex regional pain syndrome. Since the publication of the first edition over a decade ago, there has been unprecedented progress in understanding neuromodulation and technological advances in clinical applications.Spinal Cord Stimulation is intended as an essential guide to the clinical fundamentals required for safe and effective implantation of neuromodulation devices. Implantation of these devices is performed by physicians from various disciplines, requiring a multidisciplinary skill set that presents a challenge for surgical and non-surgical pain practitioners alike. This authoritative resource integrates the basic multidisciplinary information necessary for understanding spinal cord stimulation, dorsal root ganglion (DRG), and peripheral nerve stimulation (PNS) with up-to-date implantation techniques for clinicians to use in their daily practice. It also features updated advice for appropriate medical decision making, patient education, safe use of radiation, and managing adverse events, with new chapters dedicated toward DRG stimulation and PNS. Autism & Asperger’s Syndrome / BIC2 Anaesthetics / BIC2 Pain & pain management / BIC2 Kreis, Paul G. (DE-588)1049816110 edt wpr aut Pritzlaff, Scott G. edt wpr aut Copenhaver, David J. edt wpr Fishman, Scott M. 1959- (DE-588)137800703 edt wpr aut Erscheint auch als Online-Ausgabe, EPUB 978-0-19-009510-9 https://www.lehmanns.de/media/109968623 Cover original Digitalisierung UB Regensburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034990224&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis Digitalisierung UB Regensburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034990224&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA Klappentext |
| spellingShingle | Spinal cord stimulation percutaneous implantation techniques Autism & Asperger’s Syndrome / BIC2 Anaesthetics / BIC2 Pain & pain management / BIC2 Kreis, Paul G. Pritzlaff, Scott G. Fishman, Scott M. 1959- |
| title | Spinal cord stimulation percutaneous implantation techniques |
| title_auth | Spinal cord stimulation percutaneous implantation techniques |
| title_exact_search | Spinal cord stimulation percutaneous implantation techniques |
| title_exact_search_txtP | Spinal Cord Stimulation Percutaneous Implantation Techniques |
| title_full | Spinal cord stimulation percutaneous implantation techniques edited by Paul G. Kreis, Scott G. Pritzlaff, David J. Copenhaver, and Scott M. Fishman |
| title_fullStr | Spinal cord stimulation percutaneous implantation techniques edited by Paul G. Kreis, Scott G. Pritzlaff, David J. Copenhaver, and Scott M. Fishman |
| title_full_unstemmed | Spinal cord stimulation percutaneous implantation techniques edited by Paul G. Kreis, Scott G. Pritzlaff, David J. Copenhaver, and Scott M. Fishman |
| title_short | Spinal cord stimulation |
| title_sort | spinal cord stimulation percutaneous implantation techniques |
| title_sub | percutaneous implantation techniques |
| topic | Autism & Asperger’s Syndrome / BIC2 Anaesthetics / BIC2 Pain & pain management / BIC2 |
| topic_facet | Autism & Asperger’s Syndrome / BIC2 Anaesthetics / BIC2 Pain & pain management / BIC2 |
| url | https://www.lehmanns.de/media/109968623 http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034990224&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034990224&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA |
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