Spinal Cord Stimulation: An Overview

This St. Jude Penta lead has 20 contacts wired into 16 functional groups. The programing options are huge.

Spinal cord stimulation is the name applied to a group of related therapies which are require the surgical implantation of both pulse generator to provide the electrical energy and a set of leads (wires with multiple exposed contacts) to deliver the energy to precise targets of stimulation. The most common target of stimulation is in fact the dorsal columns of the spinal cord other clinically useful targets are the spinal nerve roots, cranial nerves, peripheral nerves and cutaneous fields.

While there is a large and continually growing list of potential indications for spinal cord stimulation, In the United States the only officially recognized indications are failed back syndrome, inoperable spinal radiculopathy and complex regional pain syndrome. In Europe there are many other officially recognized indications including various peripheral neuropathies, certain types of headaches, chronic functional abdominal and pelvic pain, certain spastic conditions and chronic ischemic pain of the lower extremities.

In all cases a period of trial stimulation to evaluate efficacy precedes actual surgical implantation. During the trial period leads placed using special needles are connected to an external pulse generator. Trials may last for a couple of days or up to two weeks and allow the implanting physician to evaluate a variety of lead placements and stimulation patterns.

There are currently three manufacturer of spinal cord stimulators and leads in the United States, Boston Scientific, Medtronic and Saint Jude Medical. We at Schlesinger Pain Centers work with all of the manufacturers and can discuss the relative merits of each system as well as patient factors, which may effect system selection.

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