This procedure is for patients with spine and extremity pain that has not responded to other treatments. SCS is a technique that uses tiny electrical leads to block pain signals. These leads are placed over the spinal cord where the pain signals are converging. Temporary leads are placed initially, and a permanent system can be implanted if the temporary leads result in significant relief over a 3 – 5 day trial period. Once implanted it is useful for almost up to 8-10 years because very advanced battery with life up to 10 years.

The commonest indications are

• Failed back surgery syndrome (Pain after spine surgery) - FBSS
• Vascular ischemia leading to severe pain or impending amputation of the limbs (can avoid amputation in most cases),
• Persistent angina pain in spite of optimum medical, interventional & surgical treatment,
• Post herpetic neuralgia etc.

Spinal Cord Stimulator

A spinal cord stimu lator is a device used to exert pulsed electrical signals to the spinal cord to control chronic pain. Spinal cord stimulation (SCS), in the simplest form, consists of stimulating electrodes, implanted in the epidural space, an electrical pulse generator, implanted in the lower abdominal area or gluteal region, conducting wires connecting the electrodes to the generator, and the generator remote control. SCS has notable analgesic properties and, at the present, is used mostly in the treatment of failed back surgery syndrome, complex regional pain syndrome and refractory pain due to ischemia.

Mechanism of action

The neurophysiologic mechanisms of action of spinal cord stimulation are not completely understood yet.it has been noted that the mechanism of analgesia when SCS is applied in neuropathic pain states may be very different from that involved in analgesia due to limb ischemia.
In neuropathic pain states, experimental evidence show that SCS alters the local neurochemistry in dorsal horn, suppressing the hyperexcitability of the neurons.
Specifically, there is some evidence for increased levels of GABA release, serotonin, and perhaps suppression of levels of some excitatory amino acids, including glutamate and aspartate.
In the case of ischemic pain, analgesia seems to derive from restoration of the oxygen demand supply. This effect could be mediated by inhibition of the sympathetic system, although vasodilation is another possibility. It is also probable that a combination of the two abovementioned mechanisms is involved
SCS, in simplest form, consists of a pulse generator with its remote controls, implanted stimulating electrodes and conducting wires connecting the electrodes to the generato