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Spinal cord stimulator
Spinal Cord Stimulator (SCS) or Dorsal Column Stimulator (DCS) is an implantable medical device used to treat chronic pain of neurologic origin. An electric impulse generated by the device near the dorsal surface of the spinal cord provides a paresthesia ("tingling") sensation that alters the perception of pain by the patient. A pain medicine specialist or a surgeon introduces the spinal cord stimulator lead into the epidural space either by percutaneous approach or by surgical laminectomy or laminotomy. A pulse generator or RF receiver is implanted in the abdomen or buttocks. A wire harness connects the lead to the pulse generator.
Additional recommended knowledge
First report of a spinal cord stimulator implantation was in 1967 by Shealy. Studies since then have demonstrated efficacy of SCS in relieving select chronic pain disorders including failed back syndrome, complex regional pain syndrome and peripheral neuropathy.
Randomized controlled trials have shown efficacy of spinal cord stimulator in failed-back syndrome.
Complications are generally related to the surgical procedure and can include lead migration, infection, epidural hematoma, paralysis, dural tap, and in extremely rare cases, death. The possibility of lead migration is lessened when placed by laminectomy.
A trial is usually done before the permanent unit is placed. A temporary percutaneous lead is used and is connected to an external pulse generator. The trial is from 3 to 7 days. If the patient has at least 50% improvement in pain during the trial, the patient is considered a candidate for the permanent unit.
Patients with SCS units are not able to have MRI procedures due to heating of the implanted electrodes which can cause spinal cord damage. Other medical scans such as ultrasound, CT and plain x-ray can be performed.
People with SCS should avoid areas and performing tasks which are linked with strong electromagnetic interference, examples incluide electricity substations and activities such as arc welding.
Types of Equipment
There are three types of SCS units:
The patient is provided a remote control to turn on and off the stimulator, and depending on the device and the surgeon's preference, allows for limited programming of the stimulation patterns. The surgeon has a programming device that provides a wide range of stimulation settings.
Current and Voltage Configuration
SCS comes in constant current, variable voltage ([Boston Scientific] and ANS) or constant voltage, variable current (Medtronic). A distinction is also made with respect to the number of independent power sources incorporated within the device. The are single source devices and multiple-source devices. Medtronic manufactures single-source voltage-controlled systems, ANS manufactures single-source current-controlled systems, and Boston Scientific manufactures 16-source current-controlled systems. The manufacturers disagree over the relative efficacy of their respective current and voltage configurations.
Proposed mechanisms of action
Among the proposed mechanism of action of SCS in pain relief include 
SCS units have been used to treat patients with frequent migraines. The leads are implanted in the bilateral suboccipital region.
Pain Relief Communities
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Spinal_cord_stimulator". A list of authors is available in Wikipedia.|