Invasive techniques for spinal cord stimulation
Spinal cord stimulation (SCS) includes percutaneous placement of electric leads or surgical placement of a “paddle” lead in the posterior epidural space. The leads are secured in place and tunneled under the skin to a pulse generator implanted subcutaneously. The device sends electric impulses to the spinal cord with multiple possible pain relieving mechanisms, including alterations in wide dynamic range neuron function, facilitation of inhibition, changes in multiple neurotransmitters, and dorsal column activation to alter nociceptive processing at the spinal cord and brain. The devices are programmable with many parameters under patient control. A temporary preimplantation trial of SCS is typically performed prior to permanent system implantation. The technology is rapidly evolving with new waveforms and programming, hardware improvements, and new indications. SCS has evidence for efficacy in radicular pain, postlaminectomy pain syndrome, peripheral neuropathy, and CRPS. In postlaminectomy pain syndrome, SCS appears to be more efficacious than either reoperation or traditional medical management.