Dorsal column stimulator applications

Abstract

Background:Spinal cord stimulation (SCS) has been used to treat neuropathic pain since 1967. Following that, technological progress, among other advances, helped SCS become an effective tool to reduce pain.Methods:This article is a non-systematic review of the mechanism of action, indications, results, programming parameters, complications, and cost-effectiveness of SCS.Results:In spite of the existence of several studies that try to prove the mechanism of action of SCS, it still remains unknown. The mechanism of action of SCS would be based on the antidromic activation of the dorsal column fibers, which activate the inhibitory interneurons within the dorsal horn. At present, the indications of SCS are being revised constantly, while new applications are being proposed and researched worldwide. Failed back surgery syndrome (FBSS) is the most common indication for SCS, whereas, the complex regional pain syndrome (CRPS) is the second one. Also, this technique is useful in patients with refractory angina and critical limb ischemia, in whom surgical or endovascular treatment cannot be performed. Further indications may be phantom limb pain, chronic intractable pain located in the head, face, neck, or upper extremities, spinal lumbar stenosis in patients who are not surgical candidates, and others.Conclusion:Spinal cord stimulation is a useful tool for neuromodulation, if an accurate patient selection is carried out prior, which should include a trial period. Undoubtedly, this proper selection and a better knowledge of its underlying mechanisms of action, will allow this cutting edge technique to be more acceptable among pain physicians.

Spinal cord stimulation for Parkinson’s disease: a systematic review

“…When applied to the cervical spinal cord, it causes bronchodilation, while SCS delivered to the low thoracic and sacral levels causes vasodilatation and increased bladder volume tolerance [33,45,46,62]. Stimulation of the dorsal portion of the spinal cord can also provoke antidromic inhibition of efferent sympathetic activity, leading to a reduction in peripheral vasoconstriction; additionally, it may induce a peripheral release of vasoactive substances such as calcitonin gene-related peptide and nitric oxide, with consequent peripheral vasodilatation [4,12,33,40,41,45,46,51].…”

Advances in Spinal Cord Stimulation for Treatment of Chronic Pain

“…Complications reported to date are not limited to, but include, the need for revision, infection, defective leads or electrodes, generator or extension cable problems, spinal cord injury, allergic dermatitis caused by the generator, epidural and subcutaneous hematomas, and cerebrospinal fluid leaks [9,10,15,18]. SCS appears to have good clinical outcomes in treatment of FBSS on the basis of the reported cases and limited RCTs published to date.…”

“…Phantom limb pain is another variant of neuropathic pain, with phantom sensations reported in up to 80 % of amputees, with the exact percentage being controversial between studies [9]. In some cases, the pain does not affect the patient's quality of life; however, in others it is excruciatingly debilitating and nonresponsive to conservative measures, including medication, psychotherapy, modalities, and surgical interventions.…”

“…The incidence of FBSS ranges from 10 to 40 % in spinal surgery patients [9]. Numerous case studies on SCS for treatment of FBSS and a series of randomized controlled trials (RCTs) have been published over the last 30 years.…”

Spinal stimulator peri-electrode masses: case report

“…34 Since that time, thousands of devices have been implanted for an expanding list of indications, including failed back surgery syndrome, complex regional pain syndrome, ischemic limb pain, neuropathic pain, chronic low-back pain, refractory angina, and many other less common indications. 2,27,28,38,42 Complications associated with the procedure may include electrode migration, infection, hardware malfunction, hematoma, and, rarely, neurological deficit. 2,29,35,38 Allergic reactions with cutaneous manifestations to the components of SCS systems have been reported.…”