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Spinal Cord Stimulation

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Abstract

Spinal cord stimulation (SCS) was introduced nearly 40 years ago and has since rapidly evolved, with expanding indications and with high-quality evidence to support its safety and efficacy. Spinal cord stimulation and peripheral nerve stimulation (PNS) therapies have become instrumental in the treatment of pain and are becoming increasingly employed earlier in the treatment algorithms for many disease processes, often in lieu of surgery or chronic opioid therapy.

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References

  1. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O’Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson J, North RB. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomized controlled trial in patients with failed back surgery syndrome. Pain. 2007;132:179–88.

    PubMed  Google Scholar 

  2. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, O’Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson J, North RB. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery. 2008;63:762–70.

    PubMed  Google Scholar 

  3. Krames ES, Monis S, Poree L, Deer T, Levey R. Using the safe principles when evaluating electrical stimulation therapies for failed back surgery syndrome. Neuromodulation. 2011;14:299–311.

    PubMed  Google Scholar 

  4. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, O’Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson J, North RB. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomized controlled trial in patients with failed back surgery syndrome. Pain. 2007;132:179–88.

    PubMed  Google Scholar 

  5. Baysinger CL, Pope JE, Lockhart EM, Mercaldo ND. The management of accidental dural puncture and postdural puncture headache: a North American survey. J Clin Anesth. 2011;23(5):349–60. https://doi.org/10.1016/j.jclinane.2011.04.003. Epub 22 Jun 2011.

    Article  PubMed  Google Scholar 

  6. North RB, Kidd DH, Olin J, Sieraki JM, Farrokhi F, Petrucci L, Cutchis PN. Spinal cord stimulation for axial low back pain. A prospective, controlled trial comparing dual with single percutaneous electrodes. Spine. 2005;30:1412–8.

    PubMed  Google Scholar 

  7. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971–9.

    CAS  PubMed  Google Scholar 

  8. Kumar K, Toth C, Nath RK, Laing P. Epidural spinal cord stimulation for treatment of chronic pain some predictors of success: a 15-year experience. Surg Neurol. 1998;50:110–21.

    CAS  PubMed  Google Scholar 

  9. Linderoth B, Meyerson BA. Spinal cord stimulation: exploration of the physiological basis of a widely used therapy. Anesthesiology. 2010;113:1265–7.

    PubMed  Google Scholar 

  10. Guan Y, Wacnik PW, Yang F, et al. Spinal cord stimulation-induced analgesia: electrical stimulation of dorsal column and dorsal roots attenuates dorsal horn neuronal excitability in neuropathic rats. Anesthesiology. 2010;113:1392–405.

    PubMed  Google Scholar 

  11. Stiller CO, Cui JG, O’Connor WT, Brodin E, Meyerson BA, Linderoth B. Release of GABA in the dorsal horn and suppression of tactile allodynia by spinal cord stimulation in mononeuropathic rats. Neurosurgery. 1996;39:367–75.

    CAS  PubMed  Google Scholar 

  12. Cui JG, O’Connor WT, Ungerstedt U, Meyerson BA, Linderoth B. Spinal cord stimulation attenuates augmented dorsal horn release of excitatory amino acids in mononeuropathy via a GABAergic mechanism. Pain. 1997;73:87–95.

    CAS  PubMed  Google Scholar 

  13. Ultenius C, Song Z, Lin P, Meyerson BA, Linderoth B. Spinal GABAergic mechanisms in the effects of spinal cord stimulation in a rodent model of neuropathic pain: is GABA synthesis involved? Neuromodulation. 2013;16:114–20.

    PubMed  Google Scholar 

  14. Cui JG, Linderoth B, Meyerson BA. Effects of spinal cord stimulation on touch evoked allodynia involve GABAergic mechanisms. An experimental study in the mononeuropathic rat. Pain. 1996;66:287–95.

    CAS  PubMed  Google Scholar 

  15. Cui JG, Meyerson BA, Sollevi A, Linderoth B. Effects of spinal cord stimulation on tactile hypersensitivity in mononeuropathic rats is potentiated by GABA-B and adenosine receptor activation. Neurosci Lett. 1998;247:183–6.

    CAS  PubMed  Google Scholar 

  16. Schechtmann G, Wallin J, Meyerson BA, Linderoth B. Intrathecal clonidine potentiates suppression of tactile hypersensitivity by spinal cord stimulation in a model of neuropathy. Anesth Analg. 2004;99:135–9.

    CAS  PubMed  Google Scholar 

  17. Schechtmann G, Song Z, Ultenius C, Meyerson BA, Linderoth B. Cholinergic mechanisms in the pain relieving effect of spinal cord stimulation in a model of neuropathy. Pain. 2008;139:136–14.

    CAS  PubMed  Google Scholar 

  18. Song Z, Meyerson BA, Linderoth B. Muscarinic receptor activation potentiates the effect of spinal cord stimulation on pain related behaviour in rats with mononeuropathy. Neurosci Lett. 2008;436:7–12.

    CAS  PubMed  Google Scholar 

  19. Linderoth B, Gazelius B, Franck J, Brodin E. Dorsal column stimulation induces release of serotonin and substance P in the cat dorsal horn. Neurosurgery. 1992;31:289–97.

    CAS  PubMed  Google Scholar 

  20. Linderoth B, Foreman RD. Physiology of spinal cord stimulation. Review and update. Neuromodulation. 1999;2:150–64.

    CAS  PubMed  Google Scholar 

  21. Linderoth B, Foreman RD. Mechanisms of spinal cord stimulation in painful syndromes: role of animal models. Pain Med. 2006;7:S14–26.

    Google Scholar 

  22. Saade NE, Tabet MS, Soueidan SA, Bitar M, Atweh SF, Jabbur SJ. Supraspinal modulation of nociception in awake rats by stimulation of the dorsal column nuclei. Brain Res. 1986;369:307–10.

    CAS  PubMed  Google Scholar 

  23. Saade NE, Jabbur SJ. Nociceptive behavior in animal models for peripheral neuropathy: spinal and supraspinal mechanisms. Prog Neurobiol. 2008;86:22–47.

    PubMed  Google Scholar 

  24. El-Khoury C, Hawwa C, Baliki M, Atweh SF, Jabbur SJ, Saade NE. Attenuation of neuropathic pain by segmental and supraspinal activation of the dorsal column system in awake rats. Neuroscience. 2002;112:541–53.

    CAS  PubMed  Google Scholar 

  25. Yakhnitsa V, Linderoth B, Meyerson BA. Modulation of dorsal horn neuronal activity by spinal cord stimulation in a rat model of neuropathy: the role of the dorsal funicles. Neurophysiology. 1998;30:424–7.

    Google Scholar 

  26. Atkinson L, Sundaraj SR, Brooker V, Callaghan JO, Teddy P, Salmon J, Semple T, Majedi PM. Recommendations for patient selection in spinal cord stimulation. J Clin Neurosci. 2011;18(10):1295–302.

    CAS  PubMed  Google Scholar 

  27. Deer T, Pope J. Atlas of implantable therapies for pain management. 2nd ed. New York: Springer; 2016. ISBN 978-1-4939-2109-6.

    Google Scholar 

  28. Linderoth B, Foreman R. Conventional and novel spinal stimulation algorithms: hypothetical mechanisms of action and comments on outcomes. Neuromodulation. 2017;20:535–3.

    Google Scholar 

  29. Deer T, Slavin KV, Amirdelfan K, North RB, Burton AW, Yearwood TL, Tavel E, Staats P, Falowski S, Pope J, Justiz R, Fabi AY, Taghva A, Paicius R, Houden T, Wilson D. Success using neuromodulation with BURST (SUNBURST) study: results from a prospective, randomized controlled trial using a novel burst waveform. Neuromodulation. 2017;21:56. https://doi.org/10.1111/ner.12698.

    Article  PubMed  Google Scholar 

  30. De Ridder D, Perera S, Vanneste S. Are 10kHz stimulation and burst stimulation fundamentally the same? Neuromodulation. 2017;20:650–3.

    PubMed  Google Scholar 

  31. Chakravarthy K, Richter H, Christo PJ, Williams K, Guan Y. Spinal cord stimulation for treating chronic pain: reviewing preclinical and clinical data on paresthesia-free high-frequency therapy. Neuromodulation. 2017;21:10. https://doi.org/10.1111/ner.12721.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hou S, Kemp K, Grabois M. A systematic evaluation of burst spinal cord stimulation for chronic Back and limb pain. Neuromodulation. 2016;19:398–405.

    PubMed  Google Scholar 

  33. Kulkarni B, Bentley DE, Elliott R, Youell P, Watson A, Derbyshire SW, Frackowiak RS, Friston KJ, Jones AK. Attention to pain localization and unpleasantness discriminates the functions of the medial and lateral pain systems. Eur J Neurosci. 2005;21:3133–42.

    CAS  PubMed  Google Scholar 

  34. DeRidder D, Plazier M, Kamerling N, Menovsky T, Vanneste S. Burst spinal cord stimulation for limb and back pain. World Neurosurg. 2013;80(5):642–9.

    Google Scholar 

  35. De Ridder D, Vanneste S, Plazier M, van der Loo E, Menovsky T. Burst spinal cord stimulation: toward paresthesia-free pain suppression. Neurosurgery. 2010;66:986–90.

    PubMed  Google Scholar 

  36. Pope J, Falowski S, Deer TR. Advanced waveforms and frequency with spinal cord stimulation: burst and high-frequency delivery. Expert Rev Med. 2015;12:431–7.

    CAS  Google Scholar 

  37. Crosby ND, Goodman Keiser MD, Smith JR, Zeeman ME, Winkelstein BA. Stimulation parameters define the effectiveness of burst spinal cord stimulation in a rat model of neuropathic pain. Neuromodulation. 2015;18:1–8.

    PubMed  Google Scholar 

  38. Crosby N, Weisshaar C, Smith J, Zeeman M, Goodman-Keiser M, Winkelstein B. Burst & tonic spinal cord stimulation differentially activate GABAergic mechanisms to attenuate pain in a rat model of cervical radiculopathy. IEEE Trans Biomed Eng. 2015;62:1604–13.

    PubMed  Google Scholar 

  39. Slavin KV, North RB, Deer TR, Staats P, Davis K, Diaz R. Tonic and burst spinal cord stimulation waveforms for the treatment of chronic, intractable pain: study protocol for a randomized controlled trial. Trials. 2016;17:569. https://doi.org/10.1186/s13063-016-1706-5.

    Article  PubMed  PubMed Central  Google Scholar 

  40. De Ridder D, Lenders MW, De Vos CC, et al. A two-center comparative study on tonic versus burst spinal cord stimulation: amount of responders and amount of pain suppression. Clin J Pain. 2015;3131:433–43.

    Google Scholar 

  41. De Ridder D, Vanneste S. Burst and tonic spinal cord stimulation: different and common brain mechanisms. Neuromodulation. 2016;19:47–59.

    PubMed  Google Scholar 

  42. Stancak A, Kozak J, Vrba I, et al. Functional magnetic resonance imaging of cerebral activation during spinal cord stimulation in failed back surgery syndrome patients. Eur J Pain. 2008;12:137–48.

    PubMed  Google Scholar 

  43. Eldabe S, Buchser E, Duarte RV. Complications of spinal cord stimulation and peripheral nerve stimulation techniques: a review of the literature. Pain Med. 2016;17(2):325–36.

    PubMed  Google Scholar 

  44. Kumar K, Hunter G, Demeria D. Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience. Neurosurgery. 2006;58:481–96.

    PubMed  Google Scholar 

  45. North RB, Kidd DH, Olin J, Sieracki JN, Petrucci L. Spinal cord stimulation for axial low back pain: a prospective controlled trial comparing 16-contact insulated electrodes with 4-contact percutaneous electrodes. Neuromodulation. 2006;9:56–67.

    PubMed  Google Scholar 

  46. Levy R, Henderson J, Slavin K, Simpson BA, Barolat G, Shipley J, North R. Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads. Neuromodulation. 2011;14:412–22. https://doi.org/10.1111/j.1525-1403.2011.00395.x.

    Article  PubMed  Google Scholar 

  47. Sator-Katzenshaclager S, Fiala K, Kress HG, Kofler A, Neuhold J, Kloimstein H, Ilias W, Mozes-Balla EM, Pinter M, Loining N, Fuchs W, Heinze G, Likar R. Subcutaneous target stimulation (STS) in chronic noncancer pain: a nationwide retrospective study. Pain Pract. 2010;10(4):279–86.

    Google Scholar 

  48. Verrills P, Vivian D, Mitchell B, Barnard A. Peripheral nerve field stimulation for chronic pain: 100 cases and review of the literature. Pain Med. 2011;12(9):1395–405.

    PubMed  Google Scholar 

  49. Cameron T. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. J Neurosurg. 2004;100:254–67.

    PubMed  Google Scholar 

  50. Turner JA, Loeser JD, Deyo RA, Sanders SB. Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain. 2004;108:137–47.

    PubMed  Google Scholar 

  51. Mekhail NA, Mathews M, Nageeb F, Guirguis M, Mekhail MN, Cheng J. Retrospective review of 707 cases of spinal cord stimulation: indications and complications. Pain Pract. 2011;11:148–53. https://doi.org/10.1111/j.1533-2500.2010.00407.x.

    Article  PubMed  Google Scholar 

  52. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O’Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson J, North RB. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery. 2008;63(4):762–70.

    PubMed  Google Scholar 

  53. Taylor RJ, Taylor RS. Spinal cord stimulation for failed back surgery syndrome: a decision-analytic model and cost-effectiveness analysis. Int J Technol Assess Health Care. 2005;21:351–8.

    PubMed  Google Scholar 

  54. Taylor RS, Ryan J, O’Donnell R, Eldabe S, Kumar K, North RB. The cost effectiveness of spinal cord stimulation in the treatment of failed Back surgery syndrome. Clin J Pain. 2010;26(6):463–9.

    PubMed  Google Scholar 

  55. Follett KA, Boortz-Marx RL, Drake JM, Dupen S, Schneider SJ, Turner M, Coffey RJ. Prevention and management of intrathecal drug delivery and spinal cord stimulation system infections. Anesthesiology. 2004;100:1582–94.

    PubMed  Google Scholar 

  56. Deer TR, Levy RM, Kramer J, Poree L, Amirdelfan K, Grigsby E, Staats P, Burton AW, Burgher AH, Obray J, Scowcroft J, Golovac S, Kapural L, Paicius R, Kim C, Pope J, Yearwood T, Samuel S, McRoberts WP, Cassim H, Netherton M, Miller N, Schaufele M, Tavel E, Davis T, Davis K, Johnson L, Mekhail N. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain. 2017 Apr;158(4):669–81. https://doi.org/10.1097/j.pain.0000000000000814.

    Article  PubMed  Google Scholar 

  57. Kapural L, Yu C, Doust MW, Gliner BE, Vallejo R. 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. https://doi.org/10.1097/ALN.0000000000000774.

    Article  PubMed  Google Scholar 

  58. Deer T, Pope J. Disease indications. In: Atlas of implantable therapies. New York: Springer; 2016. p. 11–4.

    Google Scholar 

  59. Schu S, Slotty PJ, Bara G, Von Knop M, Edgar D, Vesper J. A prospective, randomised, double-blind, placebo-controlled study to examine the effectiveness of burst spinal cord stimulation patterns for the treatment of failed back surgery syndrome. Neuromodulation. 2014;17(5):443–50. https://doi.org/10.1111/ner.12197. Epub 19 Jun 2014.

    Article  PubMed  Google Scholar 

  60. Russo M, Cousins MJ, Brooker C, Taylor N, Boesel T, Sullivan R, Poree L, Shariati NH, Hanson E, Parker J. Effective relief of pain and associated symptoms with closed-loop spinal cord stimulation system: preliminary results of the Avalon study. Neuromodulation. 2017; https://doi.org/10.1111/ner.12684. [Epub ahead of print].

  61. Pope JE, Deer TR, Falowski S, et al. Multicenter retrospective study of neurostimulation with exit of therapy by explant. Neuromodulation. 2017;20(6):543–52.

    Google Scholar 

  62. Van Buyten JP, Wille F, Smet I, et al. Therapy-related explants after spinal cord stimulation: results of an international retrospective chart review study. Neuromodulation. 2017;20(7):642–9. https://doi.org/10.1111/ner.12642. Epub 18 Aug 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Deer TR, Provenzano DA, Hanes M, Pope JE, Thomson SJ, Russo MA, McJunkin T, Saulino M, Raso LJ, Lad SP, Narouze S, Falowski SM, Levy RM, Baranidharan G, Golovac S, Demesmin D, Witt WO, Simpson B, Krames E, Mehkail N. The Neurostimulation Appropriateness Consensus Committee (NACC) recommendations for infection prevention and management. Neuromodulation. 2017;20(1):31–50. https://doi.org/10.1111/ner.12565. Epub 2 Jan 2017.

    Article  PubMed  Google Scholar 

  64. Deer TR, Mekhail N, Provenzano D, Pope J, Krames E, Thomson S, Raso L, Burton A, DeAndres J, Buchser E, Buvanendran A, Liem L, Kumar K, Rizvi S, Feler C, Abejon D, Anderson J, Eldabe S, Kim P, Leong M, Hayek S, McDowell G, Poree L, Brooks ES, McJunkin T, Lynch P, Kapural L, Foreman RD, Caraway D, Alo K, Narouze S, Levy RM, North R. The appropriate use of neurostimulation: avoidance and treatment of complications of neurostimulation therapies for the treatment of chronic pain. Neuromodulation. 2014;17:571–98. https://doi.org/10.1111/ner.12206.

    Article  PubMed  Google Scholar 

  65. Kumar K, Buchser E, Linderoth B, Meglio M, Van Buyten JP. Avoiding complications from spinal cord stimulation: practical recommendations from an international panel of experts. Neuromodulation. 2007;10:24–33.

    PubMed  Google Scholar 

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Singh, A., Pope, J. (2019). Spinal Cord Stimulation. In: Khelemsky, Y., Malhotra, A., Gritsenko, K. (eds) Academic Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-18005-8_21

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