A spinal cord stimulator (SCS) is a device used to exert pulsed electrical signals to the spinal cord to control chronic pain. SCS consists of stimulating electrodes, implanted in the epidural space, an electrical pulse generator, implanted in the lower abdominal area or gluteal region, conducting wires connecting the electrodes to the generator, and the generator remote control.
Indications for SCS:
Failed back surgery syndrome (FBSS)
Refractory angina pectoris
Peripheral vascular disease
Complex regional pain syndrome (CRPS) Type I.
Failed back surgery syndrome, classified as mixed pain syndrome (neuropathic and nociceptive), is the persistent or recurrent pain, mainly involving the lower back and/or legs after successful spinal surgery. It affects about 40% of patients who undergo spinal surgeries. Effective pain relief was obtained in 60 to 80% of patients with FBSS. These patients had significant improvements in quality of life and a significantly greater chance of returning to work than patients who did not undergo SCS.
Refractory angina pectoris is defined as a chronic condition characterized by the presence of angina, caused by coronary insufficiency in the presence of coronary artery disease, which cannot be adequately controlled by a combination of medical therapy, angioplasty, and coronary artery surgery. The use of SCS in patients with refractory angina pectoris resulted in significant decreases in chest pain and hospital admissions as well as increased exercise duration, with less morbidity than with open procedures that were performed for pain control only.
Peripheral vascular disease refers to a condition manifested by ischemic pain at rest, ulcers, or gangrene in one or both legs due to a proven arterial occlusive disease. Spinal cord stimulation is indicated when critical limb ischemia becomes inoperable. Patients with inoperable PVD also demonstrated significant improvements in pain relief, quality of life, and limb mobility.
Complex Regional Pain Syndrome (CRPS Type I), formerly called reflex sympathetic dystrophy (no known nerve injury is present). The goal of the treatment of CRPS Type I is to restore use of the affected limb as much as possible. Effective pain relief was obtained in 60 to 80% of patients with CRPS Type I. These patients had significant improvements in quality of life and a significantly greater chance of returning to work than patients who did not undergo SCS.
Reported complications were mostly related to hardware and were relatively minor.