Summary
For patient selection, psychological factors like fear avoidance, depression, secondary gain or refusal to be weaned off narcotics should be avoided. Trial Stimulation is an important tool to reduce the rate of failed permanent implants, and to improve cost-effectiveness. The etiology of pain has a strong influence on the success rate. The success rate is inversely proportional to the time interval from the initial onset of symptoms to the time of implantation. Multi-polar and multi-channel systems improve the long-term reliability and success rate and have proven to reduce the incidence of open surgery in case of electrode displacement. Third party coverage like the Worker’s Compensation negatively affects the long term success. Reducing the complication rate directly benefits long term success rates. The electrode fracture rate can be reduced by using the paramedian approach, the use of three wing silicone anchor placed immediately at the point of exit of the lead from the deep fascia and avoiding a hard plastic twist lock anchor. The displacements can be reduced by fixing the anchor to the deep fascia firmly, supplemented by the use of silicone glue, and by placing the implantable pulse generator (IPG) in the abdominal wall, instead of the gluteal region. The use of prophylactic antibiotics tends to reduce the infection rate.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Alo KM, Yland MJ, Kramer DL et al (1998) Computer assisted and patient interactive programming of dual octode spinal cord stimulation in the treatment of chronic pain. Neuromodulation 1: 30–45
Allergi M, Arachi G, Barbieri M et al (2004) Prospective study of the success and efficacy of spinal cord stimulation. Minerva Anestesiol Mar 70(3): 117–124
Bel S, Bauer BL (1991) Dorsal column stimulation (DCS) Cost to benefit analysis. Acta Neurochir Suppl 52: 121–123
Bell GK, Kidd D, North RB (1997) Cost-effectiveness analysis of spinal cord stimulation in treatment of failed back syndrome. J Pain Symptom Manage 13: 286–295
Broseta J, Barbera J, de Vera JA, Barcia-Salorio JL, Garcia-March G, Gonzalez-Darder J, Rovaina F, Joanes V (1986) Spinal cord stimulation in peripheral arterial disease. J Neurosurg 64: 71–80
Budd K (2002) Spinal cord stimulation: cost-benefit study. Neuromodulation 5(2): 75–78
Burchiel KJ, Anderson VC, Brown FD, Fessler RG, Friedman WA, Pelofsky S, Weiner RL, Oakley J, Shatin D (1996) Prospective, multicenter study of spinal cord stimulation for relief of chronic back and extremity pain. Spine 21: 2786–2794
Cameron C (2004) Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20 year literature review. J Neurosurg (Spine 3) 100L254–100L267
Carlsson AM (1983) Assessment of chronic pain: aspects of reliability and validity of visual analogue scale. Pain 16: 87–101
Fiume D, Palombi M, Sciassa V, Tamorri M (1989) Spinal cord stimulation (SCS) in peripheral ischemic pain. PACE 12: 698–704
Horsch S, Schulte S, Hess S (2004) Spinal cord stimulation in the treatment of peripheral vascular disease: results of a single-center study of 258 patients. Angiology 55(2): 111–118
Kay AD, McIntyre MD, MacRae WA, Varma TRK (2001) Spinal cord stimulation — a long-term evaluation in patients with chronic pain. Brit J Neurosurg 15(4): 335–341
Kemler MA, Barendse GA, van Kleef M, de Vet HC, Rijks CP, Furnee CA, van den Wildenberg FA (2000) Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 343(9): 618–624
Khan YN, Raza SS, Khan EA (2005) Application of spinal cord stimulation for the treatment of abdominal visceral pain syndromes: cases reports. Neuromodulation 8: 14
Kumar K, Toth C, Nath RK, Verma AK, Burgess JJ (1997) Improvement of limb circulation in peripheral vascular disease using epidural spinal cord stimulation: a prospective study. J Neurosurg 86: 662–669
Kumar K, Toth C, Nath RK, Laing P (1998) Epidural spinal cord stimulation for treatment of chronic pain — some predictors of success. A fifteen year experience. Surg Neurol 50: 110–121
Kumar K, Hunter G, Demeria D (2006) Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and current status, a 22-year experience. Neurosurgery (in press)
Mannheimer C, Eliasson T, Augustinsson L, Blomstrand C, Emanuelsson H, Larsson S, Norrsell H, Hjalmarsson A (1998) Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study. Circulation 97: 1157–1163
Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150: 971–979
North RB, Kidd DH, Zahurak M, James CS, Long DM (1993) Spinal cord stimulation for chronic intractable pain: experience over two decades. Neurosurgery 32: 384–394
North RB, Ewend MG, Lawton MT, Piantadosi S (1991) Spinal cord stimulation for chronic intractable pain: superiority of “multichannel” devices. Pain 44: 119–130
North RB, Wetzel FT (2002) Spinal cord stimulation for chronic pain of spinal origin. Spine 27(22): 2584–2591
Pineda A (1975) Dorsal column stimulation and its prospects. Surg Neurol 4: 157–163
Quigley DG, Arnoid J, Eldridge PR, Cameron H et al (2003) Long-term outcome of spinal cord stimulation and hardware complications. Sterotact Funct Neurosurg 81: 50–56
Shealy S, Mortimer JT, Reswick JB (1967) Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Ansth Analog 46: 489–491
Turner JA, Loeser JD, Bell KG (1995) Spinal cord stimulation for chronic low back pain: a systematic literature synthesis. Neurosurgery 37: 1088–1096
Turner JA, Loeser JD, Deyo RA et al (2004) Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain 108: 137–147
Vaarwerk I, Staal MJ (1998) Spinal cord stimulation in chronic pain syndromes. Spinal Cord 36: 671–682
Van Buyten JP, Van Zundert J, Vueghs P, Vanduffel L (2001) Efficacy of spinal cord stimulation: 10 years of experience in a pain centre in Belgium. Euro J Pain 5: 299–307
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Springer-Verlag
About this chapter
Cite this chapter
Kumar, K., Wilson, J.R. (2007). Factors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate. In: Sakas, D.E., Simpson, B.A., Krames, E.S. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/1. Springer, Vienna. https://doi.org/10.1007/978-3-211-33079-1_12
Download citation
DOI: https://doi.org/10.1007/978-3-211-33079-1_12
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-33078-4
Online ISBN: 978-3-211-33079-1
eBook Packages: MedicineMedicine (R0)