Evolving Spinal Cord Stimulation Technologies and Clinical Implications in Chronic Pain Management
- 77 Downloads
Purpose of Review
Spinal cord stimulation (SCS), based on the gate theory of nociception, has been shown to be effective in the management of chronic pain conditions. While early-generation technology offered many patients improvement in their pain and symptoms, limitations including paresthesia, dependence on mapping, decreased chronological efficacy, and inadequate coverage left many patients with persistent pain and overt therapeutic failure.
New advances in neuromodulation technology circumvent many of these previous limitations and offer patients improved pain relief and quality of life.
In this review, an update on recent technological developments in the field of SCS and peripheral neuromodulation is presented with discussion on differentiating characteristics which may help guide applicability to individual patient needs.
KeywordsSpinal cord stimulation Neuromodulation HF-10 Dorsal root ganglion stimulation Burst stimulation Wireless spinal cord stimulation
Compliance with Ethical Standards
Conflict of Interest
Omar Viswanath, Ivan Urits, Emily Bouley, Jacquelin M. Peck, and William Thompson declares no conflict of interest. Dr. Kaye discloses that he is on the Speakers Bureau for Depomed, Inc. and Merck.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 8.•• Deer T, Slavin KV, Amirdelfan K, North RB, Burton AW, Yearwood TL, et al. Success Using Neuromodulation With BURST (SUNBURST) study: results from a prospective, randomized controlled trial using a novel burst waveform. Neuromodulation. 2018;21:56–66 Results from the prospective RCT SUNBURST study on neuromodulation with burst waveform technology. CrossRefGoogle Scholar
- 11.Medtronic. Spinal cord stimulation systems - Intellis platform [Internet]. Hist. | Medtronic. 2018.Google Scholar
- 12.Williamson BD, Gohn DC, Ramza BM, Singh B, Zhong Y, Li S, et al. Real-world evaluation of magnetic resonance imaging in patients with a magnetic resonance imaging conditional pacemaker system: results of 4-year prospective follow-up in 2,629 patients. JACC Clin Electrophysiol. 2017;3:1231–9.CrossRefGoogle Scholar
- 15.•• Kapural L, Yu C, Doust MW, Gliner BE, Vallejo R, Sitzman BT, et al. Comparison of 10-kHz high-frequency and traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain. Neurosurgery. 2016;79:667–77 A RCT study with a 24-month follow-up comparing results of HF-10 therapy to traditional low-frequency SCS. CrossRefGoogle Scholar
- 16.Nevro Corp. Procedure benefits [Internet]. Nevro - about us - who we are. 2018.Google Scholar
- 17.Kapural L, Yu C, Doust MW, Gliner BE, Vallejo R, Sitzman BT, et al. Novel 10-kHz high-frequency therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: the SENZA-RCT randomized controlled trial. Anesthesiology. 2015;123:851–60.CrossRefGoogle Scholar
- 18.Liem L. Stimulation of the dorsal root ganglion. Prog Neurol Surg. 2015;213–224.Google Scholar
- 27.Thomson S. Spinal cord stimulation for neuropathic pain. Int Neuromodulation Soc. 2017Google Scholar
- 29.Perryman LT. Wireless neuromodulation in the management of chronic refractory FBSS back pain: preliminary prospective experience with different stimulation targets and waveforms. Anesth Perioper Manag J. 2018;2:1–4.Google Scholar