Ventral Column Spinal Cord Stimulation for Pain Management: Mechanisms, Clinical Evidence, and Future Directions

Spinal cord stimulation (SCS) is a form of neuromodulation that delivers electrical impulses to the spinal cord, altering pain signals to provide relief from chronic pain. Since its introduction in the 1960s, SCS has primarily targeted the dorsal columns of the spinal cord. While SCS has proven effective for many neuropathic pain conditions, its limitations have driven exploration of alternative anatomical targets for electrical stimulation. Work in the 1970's suggested that ventral column spinal cord stimulation (VC-SCS) might offer superior pain relief by targeting the spinothalamic tracts (Hoppenstein, 1975). Several decades later, a study reported successful use of VC-SCS for visceral pain in 26 patients (Baranidharan et al, 2014). A recent case report demonstrated comparable outcomes between dorsal and ventrolateral SCS for post-laminectomy syndrome (van Acker and Kim, 2023). Noordin et al (2023) reported meaningful improvements in pain and function using VC-SCS in a patient with chronic visceral pain. Finally, Sheen et al (2024) demonstrated pain relief for 12 months in a patient with VC-SCS. VC-SCS represents a promising investigational approach for pain syndromes refractory to traditional dorsal column stimulation. Ongoing research should focus on refining techniques and addressing critical knowledge gaps regarding patient selection and the durability of outcomes.