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Spinal Cord Stimulator
Daniel Pak, MD; Paul Guillod, MD
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KEY FACTS

  • Introduction

    • Terminology

      • Spinal Cord Stimulation Indications

        • Outcomes

          TERMINOLOGY

          • Basic

            • Neuromodulation: Alteration of nerve activity with targeted delivery of electrical signals or chemical agents to restore or relieve neurological symptoms
            • Gate control theory: Proposed mechanism of stimulation therapy that activation of nonnociceptive sensory fibers interrupts, or gates, nociceptive input; does not fully explain basis of subperceptive stimulation therapy, which is under investigation
          • Stimulation Types

            • Transcutaneous nerve stimulation (TENS): Noninvasive stimulation therapy using external pads placed across area of pain
            • Spinal cord stimulation (SCS): Percutaneous or surgical placement of electrodes into epidural space conventionally along dorsal column of spinal cord for stimulation therapy
              • Dorsal root ganglion (DRG) stimulation: Placement of electrodes along primary sensory neuron bodies at dorsal nerve roots for stimulation of focused areas that are difficult to treat with traditional dorsal column SCS, such as foot, knee, and groin
            • Peripheral nerve stimulation (PNS): Implantation of electrodes along peripheral nerves when pain is isolated to single identifiable nerve distribution
          • Most Common Indications for Spinal Cord Stimulation

            • Failed back surgery syndrome (FBSS): Chronic low back pain ± radicular symptoms following surgical intervention
            • Chronic regional pain syndrome (CRPS): Chronic pain condition most often affecting one limb typically following injury; type I: Without confirmed nerve injury, a.k.a. reflex sympathetic dystrophy; type II: Evidence of nerve injury, a.k.a. causalgia
            • Intractable angina: Severe chest pain secondary to coronary artery disease not relieved with conventional treatments
            • Peripheral neuropathy
            • Ischemic pain secondary to peripheral vascular disease
            • Phantom limb pain

          Stimulators

          • Spinal Cord Stimulators

            • Peripheral Nerve Stimulators

              Preprocedure

              • Spinal Cord Stimulation Indications

                • Contraindications

                  • Imaging

                    • Evaluation

                      Procedure

                      • Percutaneous Dorsal Column Spinal Cord Stimulation: Temporary Trial

                        • Percutaneous Dorsal Column Spinal Cord Stimulation: Lead Anchoring for Implantation

                          • Paddle Lead Placement

                            • Implantable Pulse Generator Pocket Creation

                              • Dorsal Root Ganglion Spinal Cord Stimulation: Temporary Trial

                                • Dorsal Root Ganglion Spinal Cord Stimulation: Implant

                                  • Peripheral Nerve Stimulation Placement

                                    Post Procedure

                                    • Considerations

                                      Outcomes

                                      • Clinical Trials

                                        • Complications

                                          Selected References

                                          1. Al-Kaisy A et al: Prospective, randomized, sham-control, double blind, crossover trial of subthreshold spinal cord stimulation at various kilohertz frequencies in subjects suffering from failed back surgery syndrome (SCS frequency study). Neuromodulation. 21(5):457-65, 2018
                                          2. Deer T et al: Success Using neuromodulation with BURST (SUNBURST) study: results from a prospective, randomized controlled trial using a novel burst waveform. Neuromodulation. 21(1):56-66, 2018
                                          3. Haider N et al: Spinal cord stimulation (SCS) trial outcomes after conversion to a multiple waveform SCS System. Neuromodulation. 21(5):504-7, 2018
                                          4. Thomson SJ et al: Effects of rate on analgesia in kilohertz frequency spinal cord stimulation: results of the PROCO randomized controlled trial. Neuromodulation. 21(1):67-76, 2018
                                          5. Deer TR et al: Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain. 158(4):669-81, 2017
                                          6. Deer, Tr et al. Atlas of Implantable Therapies for Pain Management. 2nd ed. Springer-Verlag New York, 2016
                                          7. Kapural L et al: Novel 10-kHz High-frequency Therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial. Anesthesiology. 123(4):851-60, 2015
                                          8. Babu R et al: Outcomes of percutaneous and paddle lead implantation for spinal cord stimulation: a comparative analysis of complications, reoperation rates, and health-care costs. Neuromodulation. 16(5):418-26; discussion 426-7, 2013
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Introduction

                                            • Terminology

                                              • Spinal Cord Stimulation Indications

                                                • Outcomes

                                                  TERMINOLOGY

                                                  • Basic

                                                    • Neuromodulation: Alteration of nerve activity with targeted delivery of electrical signals or chemical agents to restore or relieve neurological symptoms
                                                    • Gate control theory: Proposed mechanism of stimulation therapy that activation of nonnociceptive sensory fibers interrupts, or gates, nociceptive input; does not fully explain basis of subperceptive stimulation therapy, which is under investigation
                                                  • Stimulation Types

                                                    • Transcutaneous nerve stimulation (TENS): Noninvasive stimulation therapy using external pads placed across area of pain
                                                    • Spinal cord stimulation (SCS): Percutaneous or surgical placement of electrodes into epidural space conventionally along dorsal column of spinal cord for stimulation therapy
                                                      • Dorsal root ganglion (DRG) stimulation: Placement of electrodes along primary sensory neuron bodies at dorsal nerve roots for stimulation of focused areas that are difficult to treat with traditional dorsal column SCS, such as foot, knee, and groin
                                                    • Peripheral nerve stimulation (PNS): Implantation of electrodes along peripheral nerves when pain is isolated to single identifiable nerve distribution
                                                  • Most Common Indications for Spinal Cord Stimulation

                                                    • Failed back surgery syndrome (FBSS): Chronic low back pain ± radicular symptoms following surgical intervention
                                                    • Chronic regional pain syndrome (CRPS): Chronic pain condition most often affecting one limb typically following injury; type I: Without confirmed nerve injury, a.k.a. reflex sympathetic dystrophy; type II: Evidence of nerve injury, a.k.a. causalgia
                                                    • Intractable angina: Severe chest pain secondary to coronary artery disease not relieved with conventional treatments
                                                    • Peripheral neuropathy
                                                    • Ischemic pain secondary to peripheral vascular disease
                                                    • Phantom limb pain

                                                  Stimulators

                                                  • Spinal Cord Stimulators

                                                    • Peripheral Nerve Stimulators

                                                      Preprocedure

                                                      • Spinal Cord Stimulation Indications

                                                        • Contraindications

                                                          • Imaging

                                                            • Evaluation

                                                              Procedure

                                                              • Percutaneous Dorsal Column Spinal Cord Stimulation: Temporary Trial

                                                                • Percutaneous Dorsal Column Spinal Cord Stimulation: Lead Anchoring for Implantation

                                                                  • Paddle Lead Placement

                                                                    • Implantable Pulse Generator Pocket Creation

                                                                      • Dorsal Root Ganglion Spinal Cord Stimulation: Temporary Trial

                                                                        • Dorsal Root Ganglion Spinal Cord Stimulation: Implant

                                                                          • Peripheral Nerve Stimulation Placement

                                                                            Post Procedure

                                                                            • Considerations

                                                                              Outcomes

                                                                              • Clinical Trials

                                                                                • Complications

                                                                                  Selected References

                                                                                  1. Al-Kaisy A et al: Prospective, randomized, sham-control, double blind, crossover trial of subthreshold spinal cord stimulation at various kilohertz frequencies in subjects suffering from failed back surgery syndrome (SCS frequency study). Neuromodulation. 21(5):457-65, 2018
                                                                                  2. Deer T et al: Success Using neuromodulation with BURST (SUNBURST) study: results from a prospective, randomized controlled trial using a novel burst waveform. Neuromodulation. 21(1):56-66, 2018
                                                                                  3. Haider N et al: Spinal cord stimulation (SCS) trial outcomes after conversion to a multiple waveform SCS System. Neuromodulation. 21(5):504-7, 2018
                                                                                  4. Thomson SJ et al: Effects of rate on analgesia in kilohertz frequency spinal cord stimulation: results of the PROCO randomized controlled trial. Neuromodulation. 21(1):67-76, 2018
                                                                                  5. Deer TR et al: Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain. 158(4):669-81, 2017
                                                                                  6. Deer, Tr et al. Atlas of Implantable Therapies for Pain Management. 2nd ed. Springer-Verlag New York, 2016
                                                                                  7. Kapural L et al: Novel 10-kHz High-frequency Therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial. Anesthesiology. 123(4):851-60, 2015
                                                                                  8. Babu R et al: Outcomes of percutaneous and paddle lead implantation for spinal cord stimulation: a comparative analysis of complications, reoperation rates, and health-care costs. Neuromodulation. 16(5):418-26; discussion 426-7, 2013