Skip to main content

Advertisement

Log in

Spinal Cord Stimulation: A Review

  • Anesthetic Techniques in Pain Management (GJ Brenner, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Spinal cord stimulation (SCS) is a safe and effective treatment of a variety of chronic pain conditions. As our understanding of the mechanisms of action and potential uses of SCS has evolved, clinical and technological advancements have followed. This review provides an overview of potential mechanisms of action of SCS, evidence for its effectiveness, potential complications, and highlights of developing areas of interest.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kane K, Taub A. A history of local electrical analgesia. Pain. 1975;1:125–38.

    Article  PubMed  CAS  Google Scholar 

  2. Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967;46:489–91.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Schechtmann G, Song Z, Ultenius C, et al. Cholinergic mechanisms involved in the pain relieving effect of spinal cord stimulation in a model of neuropathy. Pain. 2008;139:136–45.

    Article  PubMed  CAS  Google Scholar 

  6. Song Z, Ultenius C, Meyerson BA, Linderoth B. Pain relief by spinal cord stimulation involves serotonergic mechanisms: an experimental study in a rat model of mononeuropathy. Pain. 2009;147:241–8.

    Article  PubMed  CAS  Google Scholar 

  7. Song Z, Meyerson BA, Linderoth B. Spinal 5-HT receptors that contribute to the pain-relieving effects of spinal cord stimulation in a rat model of neuropathy. Pain. 2011;152:1666–73.

    Article  PubMed  CAS  Google Scholar 

  8. Buonocore M, Bonezzi C, Barolat G. Neurophysiological evidence of antidromic activation of large myelinated fibres in lower limbs during spinal cord stimulation. Spine (Phila Pa 1976) 2008;33:E90–E93.

    Google Scholar 

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

    Article  Google Scholar 

  10. Holsheimer J. Which neuronal elements are activated directly by spinal cord stimulation. Neuromodulation. 2002;5:25–31.

    Article  PubMed  Google Scholar 

  11. Holsheimer J, Barolat G, Struijk JJ, He J. Significance of the spinal cord position in spinal cord stimulation. Acta Neurochir Suppl. 1995;64:119–24.

    PubMed  CAS  Google Scholar 

  12. Kemler MA, Barendse GA, van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med. 2000;343:618–24.

    Article  PubMed  CAS  Google Scholar 

  13. Kemler MA, De Vet HC, Barendse GA, et al. The effect of spinal cord stimulation in patients with chronic reflex sympathetic dystrophy: two years' follow-up of the randomized controlled trial. Ann Neurol. 2004;55:13–8.

    Article  PubMed  Google Scholar 

  14. Kemler MA, De Vet HC, Barendse GA, et al. Effect of spinal cord stimulation for chronic complex regional pain syndrome Type I: five-year final follow-up of patients in a randomized controlled trial. J Neurosurg. 2008;108:292–8.

    Article  PubMed  Google Scholar 

  15. Forouzanfar T, Kemler MA, Weber WE, et al. Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar devices are comparably effective. Br J Anaesth. 2004;92:348–53.

    Article  PubMed  CAS  Google Scholar 

  16. Harke H, Gretenkort P, Ladleif HU, Rahman S. Spinal cord stimulation in sympathetically maintained complex regional pain syndrome type I with severe disability. A prospective clinical study. Eur J Pain. 2005;9:363–73.

    Article  PubMed  Google Scholar 

  17. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56:98–106.

    PubMed  Google Scholar 

  18. 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 

  19. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132:179–88.

    Article  PubMed  Google Scholar 

  20. North RB, Kidd D, Shipley J, Taylor RS. Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery. 2007;61:361–8.

    Article  PubMed  Google Scholar 

  21. Simpson EL, Duenas A, Holmes MW, et al. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation. Health Tech Assess. 2009;13(17):iii, ix–x, 1–154.

    Google Scholar 

  22. •• Kemler MA, Raphael JH, Bentley A, et al. The cost-effectiveness of spinal cord stimulation for complex regional pain syndrome. Value Health 2010;13:735–742. The cost-analysis performed in this article reveals that SCS for CRPS is cost-effective versus CMM alone.

    Article  PubMed  Google Scholar 

  23. •• Taylor RS, Ryan J, O'Donnell R, et al. The cost-effectiveness of spinal cord stimulation in the treatment of failed back surgery syndrome. Clin J Pain 2010;26:463–469. This article concludes that SCS is cost-effective for FBSS, both as an adjunct to CMM and as compared to reoperation.

    Article  PubMed  Google Scholar 

  24. National Institute for Health and Clinical Experience. Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin. Available at http://www.nice.org.uk/nicemedia/live/12082/42367/42367.pdf. Accessed August 2011.

  25. Hollingworth W, Turner JA, Welton NJ, et al. Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: an observational study in a workers' compensation population [published online ahead of print July 5 2011]. Spine(Phila Pa 1976);2011.

  26. North R, Shipley J, Prager J, et al. Practice parameters for the use of spinal cord stimulation in the treatment of chronic neuropathic pain. Pain Med. 2007;8:S200–75.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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 

  29. Rosenow JM, Stanton-Hicks M, Rezai AR, Henderson JM. Failure modes of spinal cord stimulation hardware. J Neurosurg Spine. 2006;5:183–90.

    Article  PubMed  Google Scholar 

  30. Rathmell JP, Lake T, Ramundo MB. Infectious risks of chronic pain treatments: injection therapy, surgical implants, and intradiscal techniques. Reg Anesth Pain Med. 2006;31:346–52.

    PubMed  Google Scholar 

  31. Padubidri AN, Yetman R, Browne E, et al. Complications of postmastectomy breast reconstruction in smokers, ex-smokers, and nonsmokers. Plast Reconstr Surg. 2001;107:350–1.

    Article  PubMed  Google Scholar 

  32. Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999;22:1408–14.

    Article  PubMed  CAS  Google Scholar 

  33. Wick EC, Hirose K, Shore AD, et al. Surgical site infections and cost in obese patients undergoing colorectal surgery [published online ahead of print May 16 2011]. Arch Surg 2011.

  34. Lee JS, Terjimanian MN, Tishberg LM, et al. Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline laparotomy. J Am Coll Surg. 2011;213:236–44.

    Article  PubMed  Google Scholar 

  35. De Oliveira JC, Martinelli M, Nishioka SA, et al. Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: results of a large, prospective, randomized, double-blinded, placebo-controlled trial. Circ Arrhythm Electrophysiol. 2009;2:29–34.

    Article  PubMed  Google Scholar 

  36. Da Costa A, Kirkorian G, Cucherat M, et al. Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation. 1998;97:1796–801.

    PubMed  Google Scholar 

  37. Gyssens IC. Preventing postoperative infections: current treatment recommendations. Drugs. 1999;57:175–85.

    Article  PubMed  CAS  Google Scholar 

  38. Rabih O, Darouiche MD, Matthew J, et al. Chlorhexidine–alcohol versus povidone–iodine for surgical-site antisepsis. N Engl J Med. 2010;362:18–26.

    Article  Google Scholar 

  39. • Deer T. Complications of spinal cord stimulation: identification, treatment, and prevention. Pain Med. 2008;9: S93–S101. This article provides a good review of SCS complications and their management.

    Article  Google Scholar 

  40. Kumar K, Buchser E, Linderoth B, et al. Avoiding complications from spinal cord stimulation: practical recommendations from an international panel of experts. Neuromodulation. 2007;10:24–33.

    Article  PubMed  Google Scholar 

  41. Henderson JM, Schade CM, Sasaki J, et al. Prevention of mechanical failures in implanted spinal cord stimulation systems. Neuromodulation. 2006;9:183–91.

    Article  PubMed  Google Scholar 

  42. Kumar K, Wilson JR, Taylor RS, Gupta S. Complications of spinal cord stimulation, suggestions to improve outcome, and financial impact. J Neurosurg Spine. 2006;5:191–203.

    Article  PubMed  Google Scholar 

  43. Hayek SM, Hefzy MS. Single incision spinal cord stimulator implant. International Neuromodulation Society Meeting Abstracts, 2011.

  44. Meyer SC, Swartz K, Johnson JP. Quadriparesis and spinal cord stimulation: case report. Spine (Phila Pa 1976). 2007;32:E565–8.

    Article  Google Scholar 

  45. Sundaraj SR, Johnstone C, Noore F, et al. Spinal cord stimulation: a seven-year audit. J Clin Neurosci. 2005;12:264–70.

    Article  PubMed  CAS  Google Scholar 

  46. Van Buyten JP, Van Zundert J, Vueghs P, Vanduffel L. Efficacy of spinal cord stimulation: 10 years of experience in a pain centre in Belgium. Eur J Pain. 2001;5:299–307.

    Article  PubMed  Google Scholar 

  47. Kumar K, Wilson JR. Factors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate. Acta Neurochir Suppl. 2007;97:91–9.

    Article  PubMed  CAS  Google Scholar 

  48. Hale LA, Pal J, Becker I. Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer. Arch Phys Med Rehabil. 2008;89:1765–71.

    Article  PubMed  Google Scholar 

  49. • De Ridder D, Vanneste S, Plazier M, et al. Burst spinal cord stimulation: toward paresthesia-free pain suppression. Neurosurgery 2010;66:986–990. This article illustrates an effective stimulation method without the mandatory paresthesia traditionally required.

    Article  PubMed  Google Scholar 

  50. Krames E, Mousad D. Spinal cord stimulation reverses pain and diarrheal episodes of irritable bowel syndrome: a case report. Neuromodulation. 2004;7:82–8.

    Article  PubMed  Google Scholar 

  51. Tedesco A, D’Addato M. Spinal cord stimulation for patients with critical limb ischemia: immediate and long-term clinical outcome from the prospective Italian register. Neuromodulation. 2004;7:97–102.

    Article  PubMed  Google Scholar 

  52. Eddicks S, Maier-Hauff K, Schenk M, et al. Thoracic spinal cord stimulation improves functional status and relieves symptoms in patients with refractory angina pectoris: the first placebo-controlled randomised study. Heart. 2007;93:585–90.

    Article  PubMed  Google Scholar 

  53. Lanza GA, Grimaldi R, Greco S, et al. Spinal cord stimulation for the treatment of refractory angina pectoris: a multicenter randomized single-blind study (the SCS-ITA trial). Pain. 2011;152:45–52.

    Article  PubMed  Google Scholar 

  54. Kapural L, Hayek SM, Stanton-Hicks M, Mekhail N. Decreased insulin requirements with spinal cord stimulation in a patient with diabetes. Anesth Analg. 2004;98:745–6.

    Article  PubMed  Google Scholar 

  55. Buonocore M, Demartini L, Bonezzi C. Lumbar spinal cord stimulation can improve muscle strength and gait independently of analgesic effect: a case report. Neuromodulation. 2006;9:309–13.

    Article  PubMed  Google Scholar 

  56. • Harkema S, Gerasimenko Y, Hodes J, et al. Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Lancet 2011;377:1938–1947. This remarkable case study reveals the use of SCS to partially reverse paralysis.

    Article  PubMed  Google Scholar 

  57. Kapural L, Nagen H, Tlucek H, Sessler DI. Spinal cord stimulation for chronic visceral abdominal pain. Pain Med. 2010;11:347–55.

    Article  PubMed  Google Scholar 

  58. Kapural L, Cywinski JB, Sparks DA. Spinal cord stimulation for visceral pain from chronic pancreatitis [published online ahead of print August 19, 2011]. Neuromodulation 2011.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Salim M. Hayek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Compton, A.K., Shah, B. & Hayek, S.M. Spinal Cord Stimulation: A Review. Curr Pain Headache Rep 16, 35–42 (2012). https://doi.org/10.1007/s11916-011-0238-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-011-0238-7

Keywords

Navigation