Spinal Cord Stimulation
Original Editor - Sehriban Ozmen
Top Contributors - Sehriban Ozmen, Rucha Gadgil and Angeliki Chorti
Introduction
Spinal cord stimulation (SCS) is a treatment method which targets 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]
In this method, the spinal cord is exposed to electrical stimulation either invasively (Epidural Spinal Cord Stimulation, eSCS) or noninvasively (Transcutaneous Spinal Cord Stimulation, tSCS).
The eSCS involves the implantation of a pulse generator that applies electric impulses, and stimulation leads, a cable to connect the leads to a generator. [1] In TSCS, surface electrodes are used instead. [3]
Stimulation Paradigms
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 paresthesia-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.[4]
| 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) |
The important findings about these paradigms are:
- Tonic Stimulation generates paraesthesia in the target area. [5]
- Burst Stimulation activates some brain areas such as the dorsal anterior cingulate and the dorsolateral precentral cortex. [6]
- Burst Stimulation provides greater pain relief over tonic stimulation. [7]
- High Frequency Stimulation may be more comfortable over tonic stimulation because of the absence of paraesthesia. [2]
Clinical Use
| Indications For Pain Management [2] | Non-Pain-Related Indications [2] | Absolute Contraindications [1] | Relative Contraindications [1] |
|---|---|---|---|
|
|
|
|
Evidence
The results from a very recent systematic review study [8] which encompasses 64 studies (a total of 306 patients with spinal cord injury and undergone epidural stimulation surgery) indicated:
- Significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in over ground walking.
- Better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements.
The study also concluded that epidural spinal cord stimulation is one of the upcoming effective treatments for chronic spinal cord injuries along with physical therapy. [8]
A review study [9] that included 25 studies with total 103 participants with Parkinson's Disease (PD) also concluded that, the gait of most PD patients with concurrent pain complaints improved with spinal cord stimulation.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Dydyk AM, Tadi P. Spinal Cord Stimulator Implant(Archived) [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan
- ↑ 2.0 2.1 2.2 2.3 2.4 Pérez JT. Spinal cord stimulation: beyond pain management. Neurología (English Edition). 2022 Sep 1;37(7):586-95.
- ↑ Meyer C, Hofstoetter US, Hubli M, Hassani RH, Rinaldo C, Curt A, Bolliger M. Immediate effects of transcutaneous spinal cord stimulation on motor function in chronic, sensorimotor incomplete spinal cord injury. Journal of clinical medicine. 2020 Nov 2;9(11):3541.
- ↑ Aydin EF, Zengĺn R. Analyzing Spinal Cord Stimulation With Different Electrode Configurations: A Numerical Study. International Journal for Numerical Methods in Biomedical Engineering. 2025 Jan;41(1):e3894.
- ↑ 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.
- ↑ 8.0 8.1 Chalif JI, Chavarro VS, Mensah E, Johnston B, Fields DP, Chalif EJ, Chiang M, Sutton O, Yong R, Trumbower R, Lu Y. Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review. Journal of Clinical Medicine. 2024 Feb 14;13(4):1090.
- ↑ Streumer J, Selvaraj AK, Kurt E, Bloem BR, Esselink RA, Bartels RH, Georgiev D, Vinke RS. Does spinal cord stimulation improve gait in Parkinson's disease: A comprehensive review. Parkinsonism & Related Disorders. 2023 Feb 27:105331.