Jijun Xu1, Aijun Liu, Jianguo Cheng. 1. aDepartment of Pain Management bDepartment of Immunology, Cleveland Clinic, Cleveland, Ohio, USA cDepartment of Neurosurgery, First Affiliated Hospital of PLA General Hospital, Beijing, China dDepartment of Neurosciences, Cleveland Clinic, Cleveland, Ohio, USA.
Abstract
PURPOSE OF REVIEW: To update the recent development of spinal cord stimulation (SCS) technology in the management of chronic pain. RECENT FINDINGS: Efficacy of SCS therapy has been significantly improved by the recent development of high frequency (HF-10 kHz) stimulation, burst stimulation, and dorsal root ganglion (DRG) stimulation. A few latest SCS modalities are in clinical trial. New approaches to guide lead placement and advances in surgical lead are introduced. SUMMARY: HF-10 SCS is free of paresthesia and associated with significantly better coverage of axial lower back pain. Burst stimulation invokes minimal paresthesia and provides better coverage of low back pain. DRG stimulation results in better outcomes in patients with complex regional pain syndrome. It requires less energy and delivers consistent stimulation regardless of postural variations. Clinical trials with new SCS modalities, such as Stimwaves, are under way to make SCS wireless. Intraoperative neuromonitoring and paresthesia atlas may be used to guide lead placement. Multicolumn surgical paddle leads enable a combination of independent current control with up to 32 contacts for better programming and better coverage.
PURPOSE OF REVIEW: To update the recent development of spinal cord stimulation (SCS) technology in the management of chronic pain. RECENT FINDINGS: Efficacy of SCS therapy has been significantly improved by the recent development of high frequency (HF-10 kHz) stimulation, burst stimulation, and dorsal root ganglion (DRG) stimulation. A few latest SCS modalities are in clinical trial. New approaches to guide lead placement and advances in surgical lead are introduced. SUMMARY: HF-10 SCS is free of paresthesia and associated with significantly better coverage of axial lower back pain. Burst stimulation invokes minimal paresthesia and provides better coverage of low back pain. DRG stimulation results in better outcomes in patients with complex regional pain syndrome. It requires less energy and delivers consistent stimulation regardless of postural variations. Clinical trials with new SCS modalities, such as Stimwaves, are under way to make SCS wireless. Intraoperative neuromonitoring and paresthesia atlas may be used to guide lead placement. Multicolumn surgical paddle leads enable a combination of independent current control with up to 32 contacts for better programming and better coverage.
Authors: Ken P Ehrhardt; Susan M Mothersele; Andrew J Brunk; Jeremy B Green; Mark R Jones; Craig B Billeaud; Alan David Kaye Journal: Curr Pain Headache Rep Date: 2018-03-19