Spinal Cord Stimulation

Original Editor - Sehriban Ozmen

Top Contributors - Sehriban Ozmen  

Introduction[edit | edit source]

Implantable Pulse Generator and Leads

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)

The important findings about these paradigms are:

  • 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. [2]

Clinical Use[edit | edit source]

Indications For Pain Management [2] Non-Pain-Related Indications [2] Absolute Contraindications [1] Relative Contraindications [1]
  • Severe thrombocytopenia
  • Uncontrolled coagulopathy
  • Active infection
  • Pacemaker
  • Cardiac defibrillator

Evidence[edit | edit source]

Stimulating the spine with epidural stimulation can bring about changes in the excitability of the spinal and supraspinal networks. By adjusting the stimulation parameters, it is possible to facilitate standing or stepping, as well as potentially enhancing several other functions related to sensory, motor and autonomic systems. [6]

A review study [7] that included 25 studies with total 103 participants with Parkinson's Disease (PD) concluded that, the gait of most PD patients with concurrent pain complaints improved with spinal cord stimulation.

Resources[edit | edit source]

Percutaneous Electrical Nerve Stimulation

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Dydyk AM, Tadi P. Spinal cord stimulator implant.
  2. 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.
  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.
  6. Hachmann JT, Yousak A, Wallner JJ, Gad PN, Edgerton VR, Gorgey AS. Epidural spinal cord stimulation as an intervention for motor recovery after motor complete spinal cord injury. Journal of Neurophysiology. 2021 Dec 1;126(6):1843-59.
  7. 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.