Spinal Cord Stimulation: Difference between revisions

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== Description ==
== Introduction ==
Spinal cord stimulation (SCS) is a surgical treatment involving implantation of a device that applies electric impulses to the spinal cord. Based on the [[Gate Control Theory of Pain|gate control theory of pain]], the first device for SCS was introduced in 1968. <ref name=":0" />
Spinal cord stimulation (SCS) is a surgery that involves implantation of pulse generator that applies electric impulses, and stimulation leads, a cable to connect the leads to a generator, to stimulate the spinal cord for various conditions. <ref name=":1">Dydyk AM, Tadi P. [https://www.ncbi.nlm.nih.gov/books/NBK555994/#:~:text=The%20equipment%20needed%20for%20spinal,are%20various%20types%20of%20generators. Spinal cord stimulator implant.]
 
</ref> Based on the [[Gate Control Theory of Pain|gate control theory of pain]], the first device for SCS was introduced in 1968. <ref name=":0">Pérez JT. [https://www.sciencedirect.com/science/article/pii/S2173580821000663?via%3Dihub#bib0105 Spinal cord stimulation: beyond pain management]. Neurología (English Edition). 2022 Sep 1;37(7):586-95.</ref>


== Stimulation Paradigms ==
== Stimulation Paradigms ==
The electrical impulses created by the pulse generator can be modified after the surgery. <ref name=":1" /> The stimulation can be applied through different stimulation paradigms including tonic (conventional), burst (also known as paraesthesia-free stimulation) and high-frequency stimulation. <ref name=":0" />


=== Tonic / Conventional Stimulation ===
The table below is an example of  the frequency, pulse width and amplitude numbers that can be used in the three different modes of the SCS.
 
{| class="wikitable"
* Generates paraesthesia in the target area. <ref>Miller JP, Eldabe S, Buchser E, Johanek LM, Guan Y, Linderoth B. Parameters of spinal cord stimulation and their role in electrical charge delivery: a review. Neuromodulation: Technology at the Neural Interface. 2016 Jun 1;19(4):373-84.</ref>
|+
* Frequency: 35-80 Hz
!
* Pulse width: 200-450 μs
!'''Tonic (Conventional) Stimulation'''
* Amplitude: 5-6 mA
!'''Burst Stimulation'''
 
!'''High Frequency Stimulation'''
=== Burst Stimulation ===
|-
 
|'''Frequency'''
* Also known as paraesthesia-free stimulation. <ref name=":0">Pérez JT. [https://www.sciencedirect.com/science/article/pii/S2173580821000663?via%3Dihub#bib0105 Spinal cord stimulation: beyond pain management]. Neurología (English Edition). 2022 Sep 1;37(7):586-95.</ref>
|35-80 Hz
* Activates some brain areas, including the dorsal anterior cingulate and the dorsolateral precentral cortex.
|Low frequencies (40 Hz) with 5 closely spaced pulses (1 ms) at 500 Hz per burst, or 3 pulses at 100 Hz, followed by a repolarisation phase.  
* Low frequencies (40 Hz) with 5 closely spaced pulses (1 ms) at 500 Hz per burst, or 3 pulses at 100 Hz, followed by a repolarisation phase.
|10 000 Hz
* Compared to tonic stimulation, provides a lower charge per pulse and, at the same time, a higher charge per second. The higher charge per second modulates the neurons involved in pain transmission.
|-
* Provides greater pain relief over tonic stimulation in multiple studies. <ref>Kirketeig T, Schultheis C, Zuidema X, Hunter CW, Deer T. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544556/ Burst spinal cord stimulation: a clinical review. Pain Medicine]. 2019 Jun 1;20(Supplement_1):S31-40.</ref>
|'''Pulse width'''
 
|200-450 μs
=== High Frequency Stimulation ===
|
|30 ms
|-
|'''Amplitude'''
|5-6 mA
|
|Low amplitude (approximately 2-3 A)
|}
Studies showed that:


* Frequency: 10 000 Hz
* Tonic Stimulation generates paraesthesia in the target area. <ref>Miller JP, Eldabe S, Buchser E, Johanek LM, Guan Y, Linderoth B. Parameters of spinal cord stimulation and their role in electrical charge delivery: a review. Neuromodulation: Technology at the Neural Interface. 2016 Jun 1;19(4):373-84.</ref>
* Pulse width: 30 ms
* Burst Stimulation activates some brain areas such as the dorsal anterior cingulate and the dorsolateral precentral cortex. <ref>De Ridder D, Plazier M, Kamerling N, Menovsky T, Vanneste S. Burst spinal cord stimulation for limb and back pain. World neurosurgery. 2013 Nov 1;80(5):642-9.</ref>
* Low amplitude (approximately 2-3 A)
* Burst Stimulation provides greater pain relief <ref>Kirketeig T, Schultheis C, Zuidema X, Hunter CW, Deer T. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544556/ Burst spinal cord stimulation: a clinical review. Pain Medicine]. 2019 Jun 1;20(Supplement_1):S31-40.</ref> and lower charge per pulse and, at the same time, a higher charge per second  over tonic stimulation. The higher charge per second modulates the neurons involved in pain transmission.
* The advantages over tonic stimulation are still controversial, although it is clear that the absence of paraesthesia may make it more comfortable.  
* The absence of paraesthesia may make High Frequency Stimulation more comfortable over tonic stimulation.


== Indications  ==
== Indications  ==

Revision as of 15:54, 3 March 2024

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Introduction[edit | edit source]

Spinal cord stimulation (SCS) is a surgery that involves implantation of pulse generator that applies electric impulses, and stimulation leads, a cable to connect the leads to a generator, to stimulate the spinal cord for various conditions. [1] Based on the gate control theory of pain, the first device for SCS was introduced in 1968. [2]

Stimulation Paradigms[edit | edit source]

The electrical impulses created by the pulse generator can be modified after the surgery. [1] The stimulation can be applied through different stimulation paradigms including tonic (conventional), burst (also known as paraesthesia-free stimulation) and high-frequency stimulation. [2]

The table below is an example of the frequency, pulse width and amplitude numbers that can be used in the three different modes of the SCS.

Tonic (Conventional) Stimulation Burst Stimulation High Frequency Stimulation
Frequency 35-80 Hz Low frequencies (40 Hz) with 5 closely spaced pulses (1 ms) at 500 Hz per burst, or 3 pulses at 100 Hz, followed by a repolarisation phase. 10 000 Hz
Pulse width 200-450 μs 30 ms
Amplitude 5-6 mA Low amplitude (approximately 2-3 A)

Studies showed that:

  • Tonic Stimulation generates paraesthesia in the target area. [3]
  • Burst Stimulation activates some brain areas such as the dorsal anterior cingulate and the dorsolateral precentral cortex. [4]
  • Burst Stimulation provides greater pain relief [5] and lower charge per pulse and, at the same time, a higher charge per second over tonic stimulation. The higher charge per second modulates the neurons involved in pain transmission.
  • The absence of paraesthesia may make High Frequency Stimulation more comfortable over tonic stimulation.

Indications[edit | edit source]

Indications For Pain Management[edit | edit source]

  • Failed back surgery syndrome, radiculopathy, and lumbago
  • Complex regional pain syndrome
  • Diabetic neuropathy and other neuropathies
  • Phantom limb pain
  • Angina pectoris and peripheral vascular disease
  • Neuropathic pain secondary to tumour [2]

Non-Pain-Related Indications[edit | edit source]

  • Parkinson’s disease and other movement disorders
  • Spasticity
  • Spinal trauma rehabilitation [2]

Physiotherapy Relevance[edit | edit source]

Resources[edit | edit source]

Percutaneous Electrical Nerve Stimulation

References[edit | edit source]

  1. ↑ 1.0 1.1 Dydyk AM, Tadi P. Spinal cord stimulator implant.
  2. ↑ 2.0 2.1 2.2 2.3 Pérez JT. Spinal cord stimulation: beyond pain management. Neurología (English Edition). 2022 Sep 1;37(7):586-95.
  3. ↑ Miller JP, Eldabe S, Buchser E, Johanek LM, Guan Y, Linderoth B. Parameters of spinal cord stimulation and their role in electrical charge delivery: a review. Neuromodulation: Technology at the Neural Interface. 2016 Jun 1;19(4):373-84.
  4. ↑ De Ridder D, Plazier M, Kamerling N, Menovsky T, Vanneste S. Burst spinal cord stimulation for limb and back pain. World neurosurgery. 2013 Nov 1;80(5):642-9.
  5. ↑ Kirketeig T, Schultheis C, Zuidema X, Hunter CW, Deer T. Burst spinal cord stimulation: a clinical review. Pain Medicine. 2019 Jun 1;20(Supplement_1):S31-40.
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