A spinal cord stimulator (SCS), also known as a dorsal column stimulator, (DCS) is an implantable medical device used to treat chronic neurological pain. An electric impulse generated by the device produces a tingling sensation that alters the perception. The device is implanted into the epidural space either by percutaneous approach or by surgical laminectomy or laminotomy. A pulse generator or RF receiver is implanted in the abdomen or buttocks. A wire harness connects the lead to the pulse generator.

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Advantages:

This therapy aims at pain relief in patients who are refractory to all other treatment modalities. They are very tough group to get good results. There are many advantages of using this therapy like:

  1. It’s a simple percutaneous/ surgical procedure.
  2. It’s a non-destructive procedure. No permanent surgical or chemical interruption of nerve pathway is done.
  3. A trial therapy checks whether patient is going to get pain relief or not.
  4. The procedure is reversible; if patient is not relieved of his symptoms, the stimulator can be removed. There will not be any side effects.
  5. From patient’s point of view:
    1. Significant reduction in pain intensity
    2. Reduction in opioids or other drug intake
    3. Improvement of quality of life.

Selection criteria:

This therapy aims at pain relief in patients who are refractory to all other treatment modalities. They are very tough group to get good results. There are many advantages of using this therapy like:

  1. The pain syndrome should be established & patient should have radiating pain.
  2. The conservation treatments have failed.
  3. Drug addiction/alcohol abuse should be ruled out.
  4. There should be no major.
  5. Trial stimulation should be successful.

Indications:

  1. Failed back surgery syndrome/ perineural fibrosis
  2. Adhesive arachnoiditis
  3. CRPS type I & CRPS type II
  4. Post herpetic neuralgia
  5. Peripheral neuropathy
  6. Phantom limb pain/stump pain
  7. Peripheral vascular insufficiency
  8. Angina
  9. Cerebral palsy
  10. Multiple sclerosis

Absolute Contraindications:

The major contraindications are same as mentioned for any procedure:

  1. Infection
  2. Anticoagulants / coagulopathy
  3. Previous surgery or trauma that obliterates spinal cord.

Relative contraindications

  1. Pacemaker in situ.
  2. Major psychiatric problem
  3. Spinal bifida