Alternate Intraspinal Targets for Spinal Cord Stimulation: A Systematic Review.
BACKGROUND
Conventional dorsal column spinal cord stimulation (SCS) provides less than optimal pain relief for certain pain syndromes and anatomic pain distributions. Practitioners have sought to treat these challenging therapeutic areas with stimulation of alternate intraspinal targets.


OBJECTIVE
To identify and systematically review the evidence for the value neuromodulating specific neuronal targets within the spinal canal to achieve relief of chronic pain.


METHODS
A systematic literature search was conducted using PubMed for clinical trials published from 1966 to March 1, 2015 to identify neurostimulation studies that employed non-dorsal column intraspinal stimulation to achieve pain relief. Identified studies on such targeted intraspinal stimulation were reviewed and graded using Evidence Based Interventional Pain Medicine criteria.


RESULTS
We found a total of 13 articles that satisfied our search criteria on targeted, non-dorsal column intraspinal stimulation for pain. We identified five studies on neurostimulation of the cervicomedullary junction, six studies on neurostimulation of the dorsal root ganglion, two studies on the neurostimulation of the conus medullaris, unfortunately none was found on intraspinal nerve root stimulation.


CONCLUSIONS
The limitations of this review include the relative paucity of well-designed prospective studies on targeted SCS.


CONCLUSIONS
Clinical use of intraspinal neurostimulation is expanding at a very fast pace. Intraspinal stimulation of non-dorsal column targets may well be the future of neurostimulation as it provides new clinically significant neuromodulation of specific therapeutic targets that are not well or not easily addressed with conventional dorsal column SCS. In addition, they may avoid undesired stimulation induced paraesthesia, particularly in non-painful areas of the body.
Pain Management, Ventura County Medical Center, Ventura, CA, USA.|Center for Regenerative Medicine, Southern California University of Health Sciences, Whittier, CA, USA.
George C
GC
Chang Chien
Evidence Based Pain Management Research, Cleveland Clinic, Cleveland, OH, USA.
Nagy
N
Mekhail
D059350:Chronic Pain / Q000628:therapy*; D006801:Humans; D059408:Pain Management / Q000379:methods*; D062187:Spinal Cord Stimulation / Q000379:methods*
Cervicomedullary spinal cord stimulation; conus medullaris spinal cord stimulation; dorsal root ganglion; neuromodulation; neurostimulation; pain; targeted intraspinal stimulation