11.7\ Spinal Cord Stimulators

11.7.1\ Discussion

Spinal cord stimulators are used to treat patients with intractable pain and are positioned against the dorsal column. The models that consist of paddle electrodes require laminectomy for electrode positioning, while strip electrode models can be inserted percutaneously essentially at any level of the spine (Fig. 11.121). Spinal cord stimulators consist of a battery

a

pack and pulse generator either kept externally or buried in the subcutaneous tissues, connected to an electrode that is inserted into the epidural space adjacent to the dorsal column or dorsal root ganglion. About 50% of patients experience pain relief. Complications related to spinal cord stimulators include intracranial/spinal hypotension secondary to cerebrospinal fluid leakage, migration or malposition, decreased effectiveness over time secondary to the formation of scar tissue, epidural hematoma, and infection (Fig. 11.122).

b

Fig. 11.121  Thoracic spinal cord stimulator. Lateral (a) and frontal (b) radiographs show the battery pack in the lower back and the electrodes in the thoracic spinal canal (arrow). Photographs of the battery packs on the left and

various models of spinal cord stimulators, with strip electrodes shown on top right and paddle electrodes shown on the bottom right (c)