Chapter 15 Spinal Cord Stimulation
Spinal cord stimulation (SCS) has been used for a wide variety of conditions (see later discussion of indications). The procedure is effective in patients who have chronic intractable pain of the trunk or limbs. Neuropathic pain responds well to SCS, whereas the procedure is usually ineffective in treating nociceptive pain and central pain. SCS has been used with increasing effectiveness because of improvements in patient selection criteria, lead placement accuracy, and devices (multipolar and multichannel). Studies have now shown that SCS is cost effective in comparison with conventional medical management, especially in the treatment of failed back surgery syndrome [1]. Kumar and associates [1], who conducted a 22-year study, reported effective long-term pain control, with a mean follow-up of 97.6 months, in 59.3% of all patients screened and 74.1% of the 328 patients in whom the hardware systems were internalized.
Treatment objectives
Indications
General considerations in the selection of SCS for a particular patient are as follows:
Special indications for this procedure include the following:
Contraindications
Absolute contraindications to SCS are as follows:
The following conditions are relative contraindications to SCS:
Radiologic anatomy
Figure 15-1 shows examples of the radiographic films that should be obtained in order to evaluate the following aspects of the thoracolumbar spine:
Instrumentation
The following instruments and equipment are needed for a trial of SCS :
The equipments for implantation of pulse generator are as follows: