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Surgical and Other Procedures
Published in Harold G. Koenig, Chronic Pain, 2013
The spinal cord stimulator works through a small neurostimulation system that is surgically placed under the skin to send mild electrical impulses to the spinal cord. Electrical impulses are delivered through a medical wire (lead) that is surgically placed into the cord. These electrical impulses block the pain signals from reaching the brain. The peripheral nerve stimulator works in a similar way, but the medical wire is placed on the specific nerve causing the pain rather than near the spinal cord. Electrical impulses (felt as a tingling sensation) can be directed at the specific site where the pain is being felt. Makers of these devices claim they provide effective pain relief that can reduce or eliminate the need for repeat surgeries or pain medications.
Complex regional pain syndromes
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
Some 40 years has elapsed since the first spinal cord stimulator was implanted, but it is relatively recently that its place in the management of CRPS has been validated. Grabow et al.60[I] reviewed the available literature and concluded that spinal cord stimulation (SCS) is effective in the management of CRPS. However, they were unable to answer relevant questions, such as selection criteria and outcome measurement.
Neuropathic Pain †
Published in Gary W. Jay, Chronic Pain, 2007
Current evidence indicates that nonpharmacological approaches may be reasonable, obviate or reduce the need for potentially toxic medications, and improve the effectiveness of analgesic regimens. Spinal cord stimulation may reduce pain in selected patients. Less invasive techniques, including TENS units and percutaneous nerve stimulation, are also beneficial.
Anticipating and preventing complications in spinal cord stimulator implantation
Published in Expert Review of Medical Devices, 2023
Steven M. Falowski, Hao Tan, Joseph Parks, Alaa Abd-Elsayed, Ahmed Raslan, Jason Pope
The use and implantation of spinal cord stimulation has evolved significantly over the last 5–10 years. Focus has changed from external device features such as size of generators and number of contacts on leads, to the implementation and success of the therapy. Improvements in waveforms, device features, implant technique, and focus on success with the patient has led to an increase in its use and its long-term efficacy. Techniques such as intraoperative neuromonitoring in the asleep patient have led to improved safety, a more comfortable patient experience, and potentially more objective placement strategy. It is the authors opinion that continued focus on characteristics that improve the patient experience, lower complications, and ensure long-term efficacy will be the most important aspects of spinal cord stimulation for the future.
Multimodal Spinal Cord Mapping during Spinal Cord Stimulator Placement: Technical Note
Published in The Neurodiagnostic Journal, 2021
Geoffrey Allott, Satish Krishnamurthy
The implanted components of the spinal cord stimulation device consist of a paddle shaped electrode and battery pulse generator. Leads are placed between the dura and vertebral lamina in the epidural space. Traditionally, the permanent placement of spinal cord stimulator (SCS) leads (i.e., paddle electrodes) occurs following a brief trial period to ensure adequate patient response and appropriate lead positioning. SCS placement typically occurs under monitored anesthesia care (MAC), which is a form of awake analgesia that allows the patient to be comfortable but able to answer surgeon questions regarding pain coverage during the procedure. In MAC procedures, a combination of patient responses as well as radiographs are used to confirm the SCS leads are placed in the midline at the appropriate level. Unfortunately, due to the use of pain and sedation medications during the procedure, these responses and radiographs may be unreliable. Additionally, intraoperative x-ray imaging may be unreliable for determining midline positioning of SCS leads due to issues such as patient rotation or parallax error, which can affect the perceived positioning of the lead relative to the anatomic midline (Buckle et al. 2013).
Spinal cord stimulation for the treatment of neuropathic pain: expert opinion and 5-year outlook
Published in Expert Review of Medical Devices, 2020
Mark N. Malinowski, Sameer Jain, Navdeep Jassal, Timothy Deer
The two broad complications classes associated with spinal cord stimulation are biological and hardware-related complications. Biological complications can be further segregated into neurological, infectious, hematological, and habituation/tolerance. Hardware-related complications include hardware-related pain, lead migration, and painful stimulation. Neurological complications may range from mild to devastating. Neurological complications include dural puncture and post-dural puncture headache, traumatic nerve and/or spinal cord injury and paralysis. Hematological and infectious complications share similar disastrous effects, at least in the early stages. Compression of the spinal cord from mass effect of a hematoma or abscess may will likely lead to cord and/or nerve root ischemia. Infectious causes present with similar symptoms, but presentation will also be supported by clinical evidence for infection such as constitutional symptoms and meningeal symptoms, and blood work changes such as elevated erythrocyte sedimentation rate, inflammatory markers (e.g., C-reactive protein) and elevated white blood cell count.