What is SCS? 

Spinal Cord Stimulation (SCS) is a minimally invasive procedure that involves implanting a device that applies low currents of electrical stimulation to the spinal cord and/or its exiting nerves.

Spinal cord stimulation is referred to by some pain experts as a “pacemaker for pain”.  It works by sending small electrical impulses created by a compact generator through thin leads, or electrical cables, to the spinal cord, where they block pain signals traveling to the brain. Pain is replaced with a mild tingling or a massaging sensation, called paresthesias. A wireless remote control is used to adjust the location and degree of stimulation by selecting pre-programmed settings.  

Spinal Cord Stimulation

The core technology that is used in today’s SCS systems was developed in the mid-1960s.  Melzack and Wall developed the original theory for the mechanism of spinal cord stimulation in 1965 (1).  This “gate-control theory” for pain proposes that simultaneously triggered touch and vibratory sensation inhibits pain stimuli sensation due to their shared location in the spinal cord, the dorsal horn nucleus.  In essence this theory is the foundation for spinal cord stimulation.  An everyday example of this theory is seen when one has a headache.  Many people will rub their temples or another area of their head, stimulating the muscles of the head or sensory fibers of the skin.   When these areas are stimulated, to some degree they block the sharp pain perceived from an active headache.   This is also commonly seen when you accidently bump your knee, elbow, or finger and you rub the associated area inhibiting the acute painful stimuli to the brain. 

The first spinal cord stimulators were implanted directly on the dorsal column of the spinal cord of terminal cancer patients by Shealy et al. (2) in 1967.  Shortly after, Shimogi et al. were the first to publish the successful implementation of epidural spinal cord stimulation (3), which is a percutaneous, less invasive technique.  This avoids the complications of the original open surgery, which includes cerebrospinal fluid leakage, localized fibrosis, and arachnoiditis.  Another initial challenge was a limited area covered by the single, or monopolar electrode.  SCS leads today have evolved from monopolar (1 active electrode) to bipolar (2 active eletrodes), quadripolar (4 active electrodes), and octapolar (8 active elctrodes) leads.

Since then, SCS has been used in the treatment of cervical and lumbar post-laminectomy syndrome (failed back or neck surgery syndrome), cervical and lumbar radiculitis (neck and back radiating pain), complex regional pain syndromes (CRPS or RSD), intractable pain due to peripheral vascular disease, phantom limb pain, intractable pain due to angina, peripheral neuropathy, post-thoracotomy syndrome, neuropathic extremity pain, chronic visceral pain syndromes, and other pain conditions.

References

1)  Melzack, R., and Wall, P.D. (1965). Pain mechanisms: a new theory. Science, 150:971–979.

2)   Shealy, C.N., Mortimer, J.T., and Resnick, J. Electrical inhibition of pain by stimulation of the dorsal columns: Preliminary reports. J. Int. Anesth. Res. Soc, 46:489–491, 1967.

3)   Shimoji K, Higashi H, Kano T, Asai S, Morioka T. Electrical management of intractable pain. (1971) Masui (The Japanese journal of anesthesiology), 20: 444–447.

 

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