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| image = Anterior thoracic SCS.jpg |
| image = Anterior thoracic SCS.jpg |
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| caption = Anterior view X-ray of a spinal cord stimulator (SCS) implanted in the thoracic spine |
| caption = Anterior view X-ray of a spinal cord stimulator (SCS) implanted in the thoracic spine |
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A '''spinal cord stimulator''' (SCS) or Dorsal Column Stimulator (DCS) is a type of implantable [[neuromodulation]] device that is approved by the [[Food and Drug Administration]] (FDA) used to apply electrical signals to the [[spinal cord]] for the treatment of [[chronic pain]], pain in the extremities, or pain from a [[Failed Back Surgery Syndrome]]<ref>{{Cite journal|last=Song|first=Jason J.|last2=Popescu|first2=Adrian|last3=Bell|first3=Russell L.|date=May 2014|title=Present and potential use of spinal cord stimulation to control chronic pain|url=https://www.ncbi.nlm.nih.gov/pubmed/24850105|journal=Pain Physician|volume=17|issue=3|pages=235–246|issn=2150-1149|pmid=24850105}}</ref>. SCS is not effective for all types of pain, and may not be effective for every patient, thus SCS is considered for patients who have chronic pain that have failed conservative therapies. In the United States Failed Back Surgery Syndrome is the most common indication while in Europe the most common indication is peripheral ischemia.<ref>{{Cite journal|last=Eldabe|first=Sam|last2=Kumar|first2=Krishna|last3=Buchser|first3=Eric|last4=Taylor|first4=Rod S.|date=July 2010|title=An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management|url=https://www.ncbi.nlm.nih.gov/pubmed/21992833|journal=Neuromodulation: Journal of the International Neuromodulation Society|volume=13|issue=3|pages=201–209|doi=10.1111/j.1525-1403.2009.00271.x|issn=1525-1403|pmid=21992833}}</ref> |
A '''spinal cord stimulator''' (SCS) or Dorsal Column Stimulator (DCS) is a type of implantable [[neuromodulation]] device that is approved by the [[Food and Drug Administration]] (FDA) used to apply electrical signals to the [[spinal cord]] for the treatment of [[chronic pain]], pain in the extremities, or pain from a [[Failed Back Surgery Syndrome]]<ref>{{Cite journal|last=Song|first=Jason J.|last2=Popescu|first2=Adrian|last3=Bell|first3=Russell L.|date=May 2014|title=Present and potential use of spinal cord stimulation to control chronic pain|url=https://www.ncbi.nlm.nih.gov/pubmed/24850105|journal=Pain Physician|volume=17|issue=3|pages=235–246|issn=2150-1149|pmid=24850105}}</ref>. SCS is not effective for all types of pain, and may not be effective for every patient, thus SCS is considered for patients who have chronic pain that have failed conservative therapies. In the United States Failed Back Surgery Syndrome is the most common indication while in Europe the most common indication is peripheral ischemia.<ref>{{Cite journal|last=Eldabe|first=Sam|last2=Kumar|first2=Krishna|last3=Buchser|first3=Eric|last4=Taylor|first4=Rod S.|date=July 2010|title=An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management|url=https://www.ncbi.nlm.nih.gov/pubmed/21992833|journal=Neuromodulation: Journal of the International Neuromodulation Society|volume=13|issue=3|pages=201–209|doi=10.1111/j.1525-1403.2009.00271.x|issn=1525-1403|pmid=21992833}}</ref> |
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Revision as of 17:47, 8 August 2017
Spinal Cord Stimulator Sandbox
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 Anterior view X-ray of a spinal cord stimulator (SCS) implanted in the thoracic spine |
A spinal cord stimulator (SCS) or Dorsal Column Stimulator (DCS) is a type of implantable neuromodulation device that is approved by the Food and Drug Administration (FDA) used to apply electrical signals to the spinal cord for the treatment of chronic pain, pain in the extremities, or pain from a Failed Back Surgery Syndrome[1]. SCS is not effective for all types of pain, and may not be effective for every patient, thus SCS is considered for patients who have chronic pain that have failed conservative therapies. In the United States Failed Back Surgery Syndrome is the most common indication while in Europe the most common indication is peripheral ischemia.[2]
Medical uses
Mechanism of Action
The mechanism by which spinal cord stimulators elicit their action is not well understood, but it is theorized that it is multifactorial. The initial theory behind the analgesia provided from an SCS is Gate Control Theory, but the pain relief is now considered to be more complex.[3] While there are new advances in the types of neuromodulation, the objective of traditional SCS therapy is to "mask" or replace pain sensation with paresthesia or comfortable tingling. In order to do this, a technician or device representative must map the area of stimulation to the areas of nociceptive or neuropathic pain. Based upon the Gate Control Theory, it is theorized that the electrical current from the device alters the pain processing of the Central Nervous System with paresthesias. Although, a significant number of patients report the paresthesias are unpleasant. [4][5]
Contra-indications
Currently there is no FDA approval for spinal cord stimulation only for lower back pain. [6]
Contraindications are conditions or factors that suggest that a particular technique should not be used. In the case of spinal cord stimulation, the most concerning contraindications include coagulopathy[7], infection[8], pacemaker[9], imaging studies indicating difficulty in placement, or concerns that arise during psychological evaluation.
Risks/Complications
The most common complications involve hardware related issues and the majority of complications are not life threatening.[10]
PMID: 28535554, 26814260
Technique
Each patient must be screened to determine candidacy for this procedure. Screening of individuals includes evaluation for a medically indicated diagnosis as well as a history and physical examination to rule out medical conditions that would increase the risk for failure or complications. Often a psychiatric evaluation may be performed to determine appropriate candidates as well.
Spinal Cord Stimulation Trial
For the procedure, patients are under light sedation and are assessed to be wide awake and responsive to commands throughout the entire procedure.
The placement technique traditionally involves placing two leads in the epidural space of the spinal cord at a site lower than the desired position, often beginning at the L1-L2 spinal level. Access to the epidural space is gained with an angulated needle and the leads are then guided into the epidural space and advanced to the desired position. [6]
Spinal Cord Stimulator Implant
Burst
High Frequency
PMI: 27139915 Burst stimulation
Recovery or Rehabilitation
Patients are typically asked to return to clinic within one week of the implantation to ensure the wound is healing well, and to ensure there is no infection. In addition to ruling out surgical complications, the device may often need reprogramming during the first few post-operative follow ups.
History
Society and culture
Special populations
Other animals
 | This is a user sandbox of Khrisfaiss. You can use it for testing or practicing edits. This is not the sandbox where you should draft your assigned article for a dashboard.wikiedu.org course. To find the right sandbox for your assignment, visit your Dashboard course page and follow the Sandbox Draft link for your assigned article in the My Articles section. |
- ^ Song, Jason J.; Popescu, Adrian; Bell, Russell L. (May 2014). "Present and potential use of spinal cord stimulation to control chronic pain". Pain Physician. 17 (3): 235–246. ISSN 2150-1149. PMID 24850105.
- ^ Eldabe, Sam; Kumar, Krishna; Buchser, Eric; Taylor, Rod S. (July 2010). "An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management". Neuromodulation: Journal of the International Neuromodulation Society. 13 (3): 201–209. doi:10.1111/j.1525-1403.2009.00271.x. ISSN 1525-1403. PMID 21992833.
- ^ Melzack, R.; Wall, P. D. (1965-11-19). "Pain mechanisms: a new theory". Science (New York, N.Y.). 150 (3699): 971–979. ISSN 0036-8075. PMID 5320816.
- ^ Deer, Timothy R.; Krames, Elliot; Mekhail, Nagy; Pope, Jason; Leong, Michael; Stanton-Hicks, Michael; Golovac, Stan; Kapural, Leo; Alo, Ken (August 2014). "The appropriate use of neurostimulation: new and evolving neurostimulation therapies and applicable treatment for chronic pain and selected disease states. Neuromodulation Appropriateness Consensus Committee". Neuromodulation: Journal of the International Neuromodulation Society. 17 (6): 599–615, discussion 615. doi:10.1111/ner.12204. ISSN 1525-1403. PMID 25112892.
- ^ Sinclair, Chantelle; Verrills, Paul; Barnard, Adele (2016-07-01). "A review of spinal cord stimulation systems for chronic pain". Journal of Pain Research. Volume 9: 481–492. doi:10.2147/jpr.s108884.
{{cite journal}}:|volume=has extra text (help)CS1 maint: unflagged free DOI (link) - ^ a b Patel, Vikram B.; Wasserman, Ronald; Imani, Farnad (2015-08-22). "Interventional Therapies for Chronic Low Back Pain: A Focused Review (Efficacy and Outcomes)". Anesthesiology and Pain Medicine. 5 (4). doi:10.5812/aapm.29716. ISSN 2228-7523. PMC 4604560. PMID 26484298.
{{cite journal}}: CS1 maint: PMC format (link) - ^ Narouze, Samer; Benzon, Honorio T.; Provenzano, David A.; Buvanendran, Asokumar; De Andres, José; Deer, Timothy R.; Rauck, Richard; Huntoon, Marc A. (May 2015). "Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain". Regional Anesthesia and Pain Medicine. 40 (3): 182–212. doi:10.1097/AAP.0000000000000223. ISSN 1532-8651. PMID 25899949.
- ^ Knezevic, Nebojsa N.; Candido, Kenneth D.; Rana, Shalini; Knezevic, Ivana (July 2015). "The Use of Spinal Cord Neuromodulation in the Management of HIV-Related Polyneuropathy". Pain Physician. 18 (4): E643–650. ISSN 2150-1149. PMID 26218955.
- ^ Deer, Timothy R.; Mekhail, Nagy; Provenzano, David; Pope, Jason; Krames, Elliot; Leong, Michael; Levy, Robert M.; Abejon, David; Buchser, Eric (August 2014). "The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee". Neuromodulation: Journal of the International Neuromodulation Society. 17 (6): 515–550, discussion 550. doi:10.1111/ner.12208. ISSN 1525-1403. PMID 25112889.
- ^ Hayek, Salim M.; Veizi, Elias; Hanes, Michael (October 2015). "Treatment-Limiting Complications of Percutaneous Spinal Cord Stimulator Implants: A Review of Eight Years of Experience From an Academic Center Database". Neuromodulation: Journal of the International Neuromodulation Society. 18 (7): 603–608, discussion 608–609. doi:10.1111/ner.12312. ISSN 1525-1403. PMID 26053499.