![]() spinal cord stimulation may also be used as a means of treating claudication related pain.The aim of this comprehensive review is to provide an instructional guide for providers regarding the parameters and programming of spinal cord stimulation (SCS) devices. Similarly, blockages in the leg can cause leg pain. When the blockages cannot be repaired, spinal cord stimulation is a treatment option for angina patients. ![]() Angina is a condition where heart blockages result in chest pain. Patients with vascular disease suffer from blockages to the arteries of the heart and limbs. There are several other less common, but still important indications for spinal cord stimulation. These include severe cognitive impairment, poorly controlled or untreated addiction, social dysfunction or other disorders. Spinal cord stimulation is only indicated when certain psychological conditions have been ruled out. If there is a surgically addressable cause, spinal cord stimulation is indicated only when the patient cannot tolerate the needed surgery. As a result, spinal cord stimulation is only indicated when there is no identifiable pain cause that can be addressed by surgery. It is important to note that there is little evidence to support the use of spinal cord stimulation as a final treatment option in chronic neck and back pain patients who have not tried another form of potentially definitive treatment. Nonetheless, a portion of these patients are being offered spinal cord stimulation as a treatment option. In the majority of cases, a careful analysis will determine the cause of chronic pain, called the “pain generator.” Injections, procedures or surgery can then be tailored to target the pain generator. When a spinal cord stimulator is implanted, it is successful in most cases that have been properly selected.Ĭhronic neck pain and low back pain is a condition where pain has been persistent for at least 12 weeks. It is common for CRPS patients to have a delayed diagnosis and to have tried many multiple injection procedures before being recommended for spinal cord stimulation. Patients with CRPS suffer from a heightened and uncomfortable skin sensitivity, alterations in limb temperature, swelling, weakness, changes in skin and other uncomfortable signs and symptoms. Most cases are seen after spinal surgery and probably are best classified as a form of FBSS.Ĭomplex regional pain syndrome (CRPS) is another indication for spinal cord stimulation.ĬRPS is a condition where an injury to a nerve in or out of the spine results in a complex and painful syndrome, usually affecting a limb. This inflammation in turn causes pain emanating from the nerve roots themselves. A layer of tissue enveloping the nerves, called the arachnoid layer, becomes inflamed. Arachnoiditis is a term describing chronic inflammation of the nerve roots traveling up and down the spine. However, newer technologies are now resulting in better outcomes for FBSS whose symptoms are primarily back pain.Īrachnoiditis is another indication for spinal cord stimulation. Back pain patients have traditionally been less successful at managing their symptoms with spinal cord stimulation. However, one must note that there are two types of FBSS patients those with nerve symptoms and those with back pain symptoms. spinal cord stimulation provides an opportunity for long lasting relief in both groups. In others, the cause of persistent or recurrent pain is not apparent. Some of these patients may be given the option to have an alternative surgical procedure. Unfortunately, their pain did not resolve with surgery. In FBSS patients have undergone a prior form of surgery to treat spinal pain. A common indication for spinal cord stimulation is failed back surgery syndrome, (or FBSS). Percutaneous Interspinous Spacer PlacementĪs the use of spinal cord stimulation has grown, so have the indications. Percutaneous Endoscopic Median Branch Avulsion Minimally Invasive Herniated Disc Surgery Intralaminar Lumbar Endoscopic Discectomy Endoscopic Assisted Transforaminal Lumbar Interbody FusionĮndoscopic Posterior Cervical Foraminotomy/DiscectomyĮndoscopic Transforaminal Lumbar Disectomy
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