Spinal cord peripheral electrical nerve stimulation system implantation is a surgical procedure of spinal cord electrical nerve stimulation therapy, hereinafter referred to as spinal cord peripheral electrical stimulation therapy.
I. Introduction to Spinal Cord Peripheral Electrical Stimulation Therapy.
Spinal Cord Stimulation (SCS) is an internationally recognized advanced therapy for the treatment of chronic intractable pain. The emergence of SCS has enabled numerous patients with chronic and intractable pain to get rid of their pain and regain their life.
The peripheral spinal cord electrical stimulation system consists of three components: electrodes implanted in the epidural space of the patient’s spinal cord, a stimulator that delivers electrical impulses implanted subcutaneously in the abdomen or buttocks, and an extension lead that connects the two.
The principle of peripheral spinal cord electrical stimulation therapy is primarily based on the gating theory proposed by Melzak and Wall in 1965.
The theory is that electrical stimulation delivered by electrodes implanted in the spinal epidural space blocks the transmission of pain signals through the spinal cord to the brain, preventing pain signals from reaching the cerebral cortex and thus achieving pain control.
Spinal Cord Peripheral Electrical Stimulation System implantation is a minimally invasive procedure. The electrodes are placed in specific segments of the spinal cord epidural space through a puncture or a small bone window in the spine, guided by imaging equipment. The location of the stimulation coverage and the degree of pain improvement are then observed through a temporary stimulator outside the body, and the electrodes are adjusted to achieve optimal stimulation based on the test.
The patient remains awake during this procedure to cooperate with the test. After a successful test, the patient returns to the ward with the temporary stimulator for a test period of about two to seven days to observe the improvement in pain and daily activities (e.g., sleeping, walking, etc.). If pain relief is good and the patient is more satisfied with the treatment, the entire stimulation system (extension lead and stimulator) is implanted. The spinal cord stimulation system is set up and adjusted non-invasively by the physician and the professional technician using an external programmer after the procedure, and can be adjusted by the patient within the range set by the physician using the patient programmer, which is very convenient and flexible.
II. Indications for peripheral spinal cord electrical stimulation therapy
Spinal cord peripheral electrical stimulation is mainly used for the treatment of chronic intractable neurogenic pain. The main indications are.
1.Recalcitrant low back and leg pain after back surgery.
1.1 Chronic low back and leg pain ranks third among the most common chronic disabling diseases, after heart disease and arthritis
1.2 About 5% of people have low back pain once a year, and 60C80% of people experience low back pain in their lifetime.
1.3 The prevalence of low back pain in the United States is about 8C56%, of which 28% experience chronic low back pain in their daily lives, 14% have had an episode in the past 2 weeks, and 8% are unable to work as a result. 35% have required medication in the past 6 months.
2. complex focal pain syndromes, such as pain following some peripheral nerve injuries.
3. peripheral ischemic pain, such as diabetic foot, Raynaud’s disease, etc.
4., Intractable angina pectoris.
5 .Stump pain, phantom limb pain.
6. Other, such as postherpetic neuralgia, radiculopathy, arachnoiditis, etc.
6.1 The incidence of herpes zoster is between 1.4 and 4.8 per 1000 of the population, and there is a tendency to increase gradually. About 10% of patients with herpes zoster can have postherpetic neuralgia, and the incidence of postherpetic neuralgia is highest in elderly patients over 60 years of age, reaching 50% to 75%. As the population ages, the incidence of herpes zoster and postherpetic neuralgia increases significantly. The acute phase of herpes zoster is associated with pain in more than 80% of patients, and the abnormal pain and nociceptive hypersensitivity of postherpetic neuralgia are more difficult to treat.