Sacral stimulation of the S3 nerve is used to manage urinary urge incontinence and faecal incontinence. Neuromodulation techniques are also indicated in non-painful conditions. This is reflected by a steady increase in the implantation rates over the last decade in Europe and the USA. More advanced implantable pulse generators (IPGs) and programmable systems have led to improved effectiveness and versatility. The techniques have evolved to less invasive percutaneous lead insertion with multiple electrodes in the epidural space. The early interventions were effective, but were associated with multiple complications. In more recent years, it has been called SCS. They called it ‘Dorsal Column Stimulation’. A bipolar plate was placed directly over the spinal cord in cancer patients. In 1967, Shealy and colleagues 1 proposed that electrical stimulation of these A-fibres in the dorsal columns (DCs) could activate the inhibitory interneurones in the dorsal horn and influence pain transmission. They proposed that transmission of pain signals could be regulated at the level of the dorsal horn by inhibitory interneurones activated by A-fibres. Melzack and Wall presented the Gate Control Theory of Pain in 1965.

The position of SCS in the treatment algorithm has progressed, and for specific neuropathic and ischaemic pain conditions, there is moderate to strong evidence supporting its use. While the initial cost of spinal cord stimulation (SCS) is considered high, both its clinical and cost-effectiveness are now well established. Significant technological advances in SCS (rechargeable batteries, accelerometer technology, new lead design) may improve effectiveness.Ĭhronic pain conditions that fail to improve with conventional medical management (CMM) are a significant burden for the individual and society.

Spinal cord stimulation (SCS) is a cost-effective treatment of some common neuropathic and ischaemic pain syndromes.įailed back surgery syndrome is the most common indication for SCS.Īppropriate patient selection and education is key to successful SCS.ĭifferent stimulation regimens (frequency, pulse width, amplitude) are used to target the relevant dorsal column fibres.

Dorsal column stimulator type