Neurosurgical pain therapy with epidural spinal cord stimulation (SCS)

Neurosurgical therapy for intractable pain with epidural implantable electrodes has become a widely used and efficient alternative when conservative or less invasive therapies are no longer effective. A complete interdisciplinary work-up is required before considering a patient as a candidate for a spinal cord stimulation (SCS) device. In more than 1300 patients we implanted an SCS device in our clinic; more than 52% reported a significant (>50%) long-term improvement for more than 3 years and a significant reduction in their analgesic drugs. Although placement of the electrode and implantation of the stimulator are technically easy to perform, they do carry a risk of potentially debilitating complications such as meningitis or component migration. Hence. SCS therapy should only be performed in specialized centers. In peripheral vascular disease (PVD) and angina, the initial results are very promising, but the long-term efficacy has to be proven by multicenter studies.