Future trends in spinal cord stimulation

Spinal cord stimulation (SCS) has been available for about 30 years, but only in the past five years has it met with widespread acceptance and recognition by the medical community. Traditionally performed by neurosurgeons, SCS is being increasingly utilized by anesthesiologists, orthopedic surgeons and physiatrists. Pain management continues to be the most widespread application of SCS. More sophisticated technology has allowed the implanters to successfully address more complex pain syndromes such as widespread reflex sympathetic dystrophy and the failed back syndrome. Other applications are being developed, combining the ability to stimulate the spinal cord, the nerve roots and the peripheral nerves. Examples include angina pectoris, urinary incontinence and occipital neuralgia. Computer-interactive programming is gaining popularity, especially due to the extreme complexity of the implanted stimulation devices. The ability to stimulate independently multiple channels as well as multiple arrays of electrodes is today a reality. This has increased greatly the efficacy, safety and reliability of the modality. In the future, SCS will undoubtedly move several steps up in the treatment ladder of chronic pain conditions, while new applications will be discovered. The future of neural implantable technologies is bright, with an increasingly important role in the medical management of chronic conditions affecting the nervous system.