title: Evidence Gaps in the Use of Spinal Cord Stimulation for Treating Chronic Spine Conditions.
abstract: METHODS
  A review of literature.
  
  
  OBJECTIVE
  The aim of this study was to define and explore the current evidence gaps in the use of spinal cord stimulation (SCS) for treating chronic spine conditions.
  
  
  BACKGROUND
  Although over the last 40 years SCS therapy has undergone significant technological advancements, evidence gaps still exist.
  
  
  METHODS
  A literature review was conducted to define current evidence gaps for the use of SCS. Areas of focus included 1) treatment of cervical spine conditions, 2) treatment of lumbar spine conditions, 3) technological advancement and device selection, 4) appropriate patient selection, 5) the ability to curb pharmacological treatment, and 6) methods to prolong efficacy over time. New SCS strategies using advanced waveforms are explored.
  
  
  RESULTS
  The efficacy, safety, and cost-effectiveness of traditional SCS for chronic pain conditions are well-established. Evidence gaps do exist. Recently, advancement in waveforms and programming parameters have allowed for paresthesia-reduced/free stimulation that in specific clinical areas may improve clinical outcomes. New waveforms such as 10-kHz high-frequency have resulted in an improvement in back coverage. To date, clinical efficacy data are more prevalent for the treatment of painful conditions originating from the lumbar spine in comparison to the cervical spine.
  
  
  CONCLUSIONS
  Evidence gaps still exist that require appropriate study designs with long-term follow-up to better define and improve the use of this therapy for the treatment of chronic spine pain in both the cervical and lumbar regions.
  
  
  METHODS
  N/A.
authors.affiliation: Pain Diagnostics and Interventional Care, Sewickley, PA.
authors.forename: David A
authors.initials: DA
authors.lastname: Provenzano
authors.affiliation: IPM Medical Group, Inc., Walnut Creek, CA.
authors.forename: Kasra
authors.initials: K
authors.lastname: Amirdelfan
authors.affiliation: Carolina's Pain Institute, Winston Salem, NC.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Kapural
authors.affiliation: Advanced Pain Therapy, PLLC, Hattiesburg, MS.
authors.forename: B Todd
authors.initials: BT
authors.lastname: Sitzman
mesh_terms: D001416:Back Pain / Q000175:diagnosis / Q000628:therapy*; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards*; D006801:Humans; D008159:Lumbar Vertebrae; D010292:Paresthesia / Q000175:diagnosis / Q000628:therapy; D018579:Patient Selection; D013116:Spinal Cord / Q000502:physiology; D062187:Spinal Cord Stimulation / Q000379:methods / Q000592:standards*; D013122:Spinal Diseases / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome