Spinal Cord Stimulation (SCS) is based on the theory of Melzack and Wall and was developed in the 1960s to treat chronic neuropathic pain. For most patients, SCS-placement is a two-staged process. Stage 1 is a trial implantation to determine the effect of stimulation, whereas stage 2 is the implantation of a long-term device (IPG). The trial stimulation is performed before permanent implantation in order to evaluate the effect of SCS. A pain reduction of at least 50% without intolerable side effects is considered to be a successful trial
stimulation, although other physicians consider a pain relief of 30% also as clinically significant (Farrar, Young, LaMoreaux, Werth, & Poole, 2001).
The actual pain reduction achieved after implantation is often less then experienced during the trial, though quality of life is significantly improved. Next to the analgesic effects, SCS provides improved function, less health care utilization, reduced intake of pain medication and improved quality of life (Deer, 2010).
SCS-electrodes can be inserted via percutaneous techniques or through a neurosurgical procedure. The electrodes that are implanted percutaneously are the traditional small electrodes, whereas the laminectomy-placed electrodes are paddle electrodes. The traditional surgical paddle leads require surgery where the neurosurgeon must perform an interlaminary approach to the desired level, or in more difficult cases fe due to extensive scar tissue formation a laminotomy or partial laminectomy.
However this is an invasive technique, it offers the advantages of greater stability and less propensity to migration of the electrode. Next to stability, several authors report a better treatment of the pain with lower energy consumption (Leveque, Villavicencio, Bulsara, Rubin, & Gorecki, 2001) and clinical outcome (Barolat et al., 2001; Kumar et al., 2008; North, Kidd, Petrucci, & Dorsi, 2005; Villavicencio, Leveque, Rubin, Bulsara, & Gorecki, 2000) with fewer adverse effects (North et al., 2005).
