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, 3 (Suppl 4), S275-89

Dorsal Column Stimulator Applications

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Dorsal Column Stimulator Applications

Claudio Yampolsky et al. Surg Neurol Int.

Abstract

Background: Spinal cord stimulation (SCS) has been used to treat neuropathic pain since 1967. Following that, technological progress, among other advances, helped SCS become an effective tool to reduce pain.

Methods: This article is a non-systematic review of the mechanism of action, indications, results, programming parameters, complications, and cost-effectiveness of SCS.

Results: In spite of the existence of several studies that try to prove the mechanism of action of SCS, it still remains unknown. The mechanism of action of SCS would be based on the antidromic activation of the dorsal column fibers, which activate the inhibitory interneurons within the dorsal horn. At present, the indications of SCS are being revised constantly, while new applications are being proposed and researched worldwide. Failed back surgery syndrome (FBSS) is the most common indication for SCS, whereas, the complex regional pain syndrome (CRPS) is the second one. Also, this technique is useful in patients with refractory angina and critical limb ischemia, in whom surgical or endovascular treatment cannot be performed. Further indications may be phantom limb pain, chronic intractable pain located in the head, face, neck, or upper extremities, spinal lumbar stenosis in patients who are not surgical candidates, and others.

Conclusion: Spinal cord stimulation is a useful tool for neuromodulation, if an accurate patient selection is carried out prior, which should include a trial period. Undoubtedly, this proper selection and a better knowledge of its underlying mechanisms of action, will allow this cutting edge technique to be more acceptable among pain physicians.

Keywords: Failed back surgery syndrome; indications; neuromodulation; review; spinal cord stimulation.

Figures

Figure 1
Figure 1
A case of failed back surgery syndrome is described. (a) A patient underwent lumbar microdiscectomy because of radicular pain. A left L5-S1 herniated disk was detected in the preoperative images. (b and c) The patient continued with radicular and lumbar pain after the surgery. Although magnetic resonance imaging showed arachnoiditis surrounding the root (b), he underwent posterior lumbar instrumentation (c). (d): The second surgery did not produce pain relief. Subsequently, the patient was referred to our Neurosurgical Department. A paddle-type lead with eight contacts was placed and Spinal cord stimulation led to pain relief

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