Spinal cord stimulation for chronic pain of spinal origin: a valuable long-term solution.
METHODS
A literature review was conducted.


OBJECTIVE
To review the indications and efficacy of spinal cord stimulation, particularly in reference to chronic pain of spinal origin.


BACKGROUND
The first spinal cord stimulation was implanted by Shealy in 1967 via a subarachnoid route. Early systems were plagued with a high rate of complications and technical problems. With the evolving technology, especially the advent of multichannel programmable systems and more precise epidural placement, the ability of spinal cord stimulation to treat various pain syndromes improved. This article reviews the literature on spinal cord stimulation from 1967 to the present.


METHODS
The literature is reviewed, with a particular focus on recent studies investigating the efficacy of spinal cord stimulation for low back pain.


RESULTS
Most studies are limited by the same flaws, namely, retrospective study design. At this writing, the few published randomized prospective studies have suggested that spinal cord stimulation may be superior to repeat surgery. Complication rates have declined to approximately 8%, and reoperation is necessary in approximately 4% of patients. When current percutaneous techniques are used, a lead migration rate lower than 3% may be achieved. For certain topographies, laminotomy leads may be superior, particularly with regard to low back pain.


CONCLUSIONS
The ultimate efficacy of spinal cord stimulation remains to be determined, primarily because of limitations associated with the published literature. However, on the basis of the current evidence, it may represent a valuable treatment option, particularly for patients with chronic pain of predominantly neuropathic origin and topographical distribution involving the extremities. The potential treatment of other pain topographies and etiologies by spinal cord stimulation continues to be studied.
North
Richard B
RB
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. rnorth@jhmi.edu
Wetzel
F Todd
FT
D000818:Animals; D016022:Case-Control Studies; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D004599:Electric Stimulation Therapy; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy; D010146:Pain / Q000209:etiology; D059408:Pain Management; D011446:Prospective Studies; D013122:Spinal Diseases / Q000150:complications; D016896:Treatment Outcome