Spinal Cord Stimulation
Spinal Cord Stimulation (SCS) is the electrical stimulation of a precise area of the spinal cord to generate paresthesia to an area in which a patient feels pain. Relying on the gate theory, SCS inhibits pain from reaching the brain by interfering with the spinal transmission of pains signals. More specifically, the gate theory proposes “stimulation of fibers of the spinal cord that do not transmit pain to the brain will reduce the input from the brain of those that do”. SCS is a method of treatment that is most commonly recommended only after other means of treating or eliminating the pain have been exhausted. Additionally patients must have an approved medical diagnosis that warrants the procedure. These diagnoses include:
- Failed Back Surgery Syndrome (FBBS)
- Adhesive Arachnoiditis
- Peripheral Causalgia/Neuropathy
- Reflex Sympathetic Dystrophy (RSD)
- Phantom Limb/Stump Pain
- Ischemic Pain of Vascular Origin (Simpson, 5).
Once the gate theory was discovered in 1965, researchers and surgeons began to explore the possibilities of treating pain utilizing electrical spinal cord stimulation. In March of 1967 the first “dorsal column stimulator” targeting ascending collaterals of the large gate-closing A beta fibers was implanted in a human subject . After which, SCS continued and sustained an undistinguished career for almost 15 years. During this time, the procedure was largely used to treat patients with back pain (70%) but was marginally unsuccessful. SCS, while in its infancy could not gain the medical stature it warranted for two specific reasons: the significance, and even the existence of neuropathic pain was not widely appreciated or understood at the time; and the hardware utilized in the procedure was unreliable and consistent and reliable data was hard to accumulate.
Since that time, the devices utilized in the SCS procedure have dramatically improved and clear and conclusive data has been attained. Studies now indicate that the success rate for this procedure is relatively high, although the field of SCS remains clouded by the “cure” for lower-back pain, this is particularly true in the United States. In Europe, however, SCS has evolved beyond the reduction of simple back pain and is now being used to successfully treat peripheral vascular disease (PVD).