# spinal cord stimulation | Symptoms, Causes, Tests and Treatment | OSANG > SCS is a representative interventional treatment for chronic neuropathic pain that does not respond to drug treatment. Approximately 50-70% of patients experience pain r… - Official page: https://osns.co.kr/en/encyclopedia/spinal-cord-stimulation - Organization: OSANG Neurosurgery ## Page content Neuromodulation ## spinal cord stimulation Spinal Cord Stimulation Spinal cord stimulation (SCS) is a neuromodulation treatment that controls chronic pain by applying electrical stimulation to the dorsal column of the spinal cord by inserting electrodes into the epidural space. ## At a glance SCS is a representative interventional treatment for chronic neuropathic pain that does not respond to drug treatment. Approximately 50-70% of patients experience pain reduction of more than 50% in post-spine surgery pain syndrome (FBSS), CRPS, and diabetic neuropathy. Since the effect is confirmed through a trial stimulation period before permanent transplantation is decided, a reversible and patient-selective approach is possible. - 01Definition and Overview - 02Principle and mechanism - 03Indications - 04Procedure - 05treatment effect - 06Evolution of stimulation methods - 07Side effects and complications ## Definition and Overview Spinal cord stimulation (SCS) is an implantable neuromodulation treatment that modulates the transmission of chronic pain signals by delivering electrical stimulation to the posterior column of the spinal cord through electrodes placed in the epidural space. Since it was first implemented by Shealy et al. in 1967, more than half a century of clinical experience has been accumulated. More than 50,000 SCS cases are performed annually worldwide, and it has become a major treatment option for drug-refractory chronic neuropathic pain. ## Principle and mechanism ### gate control theory The classical mechanism of SCS is based on the gate control theory of Melzack and Wall. Electrically activating the thick myelinated nerves (Aβ fibers) in the posterior column inhibits the transmission of thin unmyelinated nerve fibers (C fibers) that transmit pain signals in the dorsal horn of the spinal cord. ### modern mechanism Recent studies have revealed multi-layered mechanisms such as promoting GABA secretion, suppressing excitatory amino acids, activating the serotonin and norepinephrine systems, and regulating the supraspinal pathway. High-frequency (10 kHz) stimulation and burst stimulation are presumed to have additional mechanisms that cannot be explained by the existing gate theory alone. ## Indications The main indications recognized by international guidelines are as follows. - Failed back surgery syndrome (FBSS): the most common indication - Complex Regional Pain Syndrome (CRPS): Type I and Type II - Diabetic Peripheral Neuropathy: Effectiveness Proven in Recent Randomized Controlled Trials - Ischemic pain due to peripheral vascular disease - Refractory angina ## Procedure ### test stimulus phase A percutaneous electrode is inserted into the epidural space under local anesthesia and under fluoroscopic guidance. Electrodes are placed at the spinal cord level corresponding to the painful area, and test stimulation is performed with an external stimulator for 7 to 14 days. During this period, a pain diary is recorded to evaluate the effectiveness. ### permanent implant If pain reduction and functional improvement of more than 50% are confirmed in the test stimulation, a permanent system is implanted. The electrodes are percutaneous cylindrical or surgical paddle type, and the stimulation generator (IPG) is implanted subcutaneously in the abdomen or buttocks. ### programming Optimize stimulation conditions (frequency, pulse width, current intensity, active contact point) according to the patient's pain pattern and activity pattern. Patients can adjust stimulation intensity or switch between preset programs using an external remote control. ## treatment effect ### FBSS In the PROCESS study, 48% of the SCS + conservative treatment group achieved a 50% or greater reduction in lower extremity pain, compared to only 9% of the conservative treatment alone group. The effect was maintained even at 24-month follow-up. ### CRPS In a randomized controlled trial, the visual pain scale (VAS) of the SCS group significantly decreased compared to the control group, and the effect persisted even at 5-year follow-up. ### diabetic neuropathy While 59% of the SCS group showed a pain reduction of more than 50%, only 7% of the optimal drug treatment group showed a pain reduction of more than 50%. ## Evolution of stimulation methods ### Conventional method (Tonic stimulation) This method replaces pain by causing abnormal sensations (tingling, paresthesia) in the painful area through low-frequency stimulation of 40 to 60 Hz. ### High frequency stimulation (HF10) 10 kHz high-frequency stimulation controls pain without abnormal sensations. In a randomized controlled trial, it was shown to be superior to the existing low-frequency method for both back pain and lower extremity pain. ### Burst stimulation It has been reported that high-frequency burst pattern stimulation modulates the inner pain pathway and even improves the emotional component of pain. ### Closed-loop stimulation It is the latest technology to automatically adjust stimulation intensity by measuring spinal cord evoked compound action potential (ECAP) in real time. ## Side effects and complications - Electrode migration: Occurs in approximately 10-15% of cases and may require a repositioning procedure. - Infection: Approximately 3-5%, mainly in the IPG pocket area. - Headache after dural puncture: approximately 1% - Device failure: broken extension cord, dead battery - Discomfort of abnormal sensations: Some patients complain about the existing low-frequency method. ## Frequently asked questions ### Q01What kind of pain is spinal cord stimulation effective for? It has been proven effective in treating lower extremity pain that persists after spine surgery (FBSS), complex regional pain syndrome (CRPS), diabetic peripheral neuropathy, and ischemic pain caused by peripheral vascular disease. It is mainly indicated for chronic neuropathic pain that does not respond to drug treatment and physical therapy. ### Q02How is the spinal cord stimulation procedure performed? First, a trial period is performed for 1 to 2 weeks. Temporary electrodes are inserted into the epidural space under local anesthesia, and the pain relief effect in daily life is evaluated. When pain reduction of more than 50% is confirmed, this procedure is performed to implant permanent electrodes and stimulation generators. ### Q03Are there any restrictions on daily life after the procedure? Excessive bending, twisting, and heavy lifting should be avoided for 4 to 6 weeks after transplantation. After recovery, most daily activities are possible. The intensity of stimulation can be adjusted by the patient using a remote control, and the program can be switched according to activity. ### Q04Are the effects of spinal cord stimulation permanent? In long-term follow-up studies, resistance with decreased effectiveness is reported in some patients over time. However, the effect can be recovered by changing the stimulation method (high frequency, burst, etc.), and significant pain reduction was maintained even at 24 months in the PROCESS study. ### Q05Is MRI scanning possible? The latest MRI-compatible systems are capable of full-body MRI imaging under certain conditions. However, because there are limitations to the imaging protocol, prior confirmation must be obtained from the medical staff in charge of the procedure. For older devices, MRI may be contraindicated. ## Related articles - Transcranial magnetic stimulation - Transcranial Direct Current Stimulation - Transcutaneous vagus nerve stimulation - Radiofrequency nerve block This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.