Spinal Cord Stimulation: Difference between revisions
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== Introduction == | == Introduction == | ||
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.] | 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> | </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" /> | 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" /> | ||
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. | 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. | ||
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* 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> | * 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> | ||
* 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> | * 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> | ||
* 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> | * Burst Stimulation provides greater pain relief over tonic stimulation. <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> | ||
* | * High Frequency Stimulation may be more comfortable over tonic stimulation because of the absence of paraesthesia. | ||
== Indications == | == Indications == | ||
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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 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 over tonic stimulation. [5]
- High Frequency Stimulation may be more comfortable over tonic stimulation because of the absence of paraesthesia.
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]
Contraindications[edit | edit source]
Physiotherapy Relevance[edit | edit source]
Resources[edit | edit source]
Percutaneous Electrical Nerve Stimulation
References[edit | edit source]
- ↑ 1.0 1.1 Dydyk AM, Tadi P. Spinal cord stimulator implant.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
