Spinal Cord Stimulation: Technical Implantation, Update and Challenges

Spinal cord stimulation (SCS) is a neuromodulation technique and minimal invasive procedure that is safe,effective, and reversible method used to treat neuropathic and sympathetically mediated chronic pain.It was found to be superior to traditional conservative management in recent clinical trials. Whenpharmacological, psychological, physical and occupational therapies or surgery fail to reduce chronicneuropathic pain, patients may be a candidate for spinal cord stimulation implantation. The superiority of thistherapeutic strategy is in part due to the many benefits, such as decreased use of prescription painmedications, cost-effectiveness, and improvement in patient quality of life.Spinal cord stimulation consists of the transcutaneous or surgical implantation of different types of electrodesin the epidural space; electrodes are then connected to an Implanted Pulse Generator (IPG) that generatesstimulating currents.The percutaneous technique allows for decreased operative times and thus reduced anesthesia, as well asdecreased post-operative pain due to less tissue and muscle dissection. Additionally, the percutaneous leadshave a smaller footprint in the epidural space, allowing more patients with mild spinal canal stenosis to receivethis therapeutic device, which generally precludes paddle placement. These features make the percutaneousmethod an appealing alternative to the traditional laminectomy technique.For this reason, we will discuss the technical features and some clinical considerations about the implantationof spinal cord stimulator.