Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Spinal Cord/Nerve injury

What is the incidence, time to appearance of symptoms, usual resolution and impact on therapy, and worst case adverse sequelae of spinal cord injury following SCS treatment, and how can this risk be reduced?

  • Incidence: rare
  • Time to appearance of symptoms: variable
  • Treatment: surgical decompression as necessary
  • Usual resolution and impact on therapy: variable
  • Worst case adverse sequelae: paralysis, bladder/bowel/sexual dysfunction
  • Risk reduction: Before implanting a surgical plate/paddle electrode and in cases of suspected stenosis or another anatomic condition that might increase risk, obtain an MRI of the target spinal level(s). 
Strength of recommendation Evidence source(s)/rationale
B = Recommended
Uncertain validity, apparently useful
  • Consensus

Wada E, Kawai H Late onset cervical myelopathy secondary to fibrous scar tissue formation around the spinal cord stimulation electrode. Spinal Cord 48:646-648 2010.
Abstract | Wikistim Entry

Smith CC. Lin JL, Shokat M, Dosanjh SS, Casthely D A report of paraparesis following spinal cord stimulator trial, implantation and revision. Pain Phys 13:357-363 2010.
Abstract | Wikistim Entry

Reynolds AF, Shetter AG Scarring around cervical epidural stimulating electrode. Neurosurgery 13:63-65 1983.
Abstract | Wikistim Entry

Meyer SC, Swartz K, Johnson JP Quadriparesis and spinal cord stimulation: case report . Spine 32:E565-568 2007.
Abstract | Wikistim Entry

Meglio M, Cioni B, Rossi GF. Spinal cord stimulation in management of chronic pain. A 9-year experience. J Neurosurg 70(4):519-524, 1989.
Abstract | Wikistim Entry

Levy R, Henderson J, Slavin K, Simpson BA, Barolat G, Shipley J, North R Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads. Neuromodulation 14:412-422, 2011.
Abstract | Wikistim Entry

Law JD Hypothesis about the etiology of unexplained painful myelopathy after minor trauma in the spinal canal. Stereotact Funct Neurosurg 65:117-119 1995.

Krainick JU, Thoden U, Riechert T. Pain reduction in amputees by long-term spinal cord stimulation. Long-term follow-up study over 5 years. J Neurosurg 52(3):346-350, 1980.
Abstract | Wikistim Entry

Dam-Hieu P, Magro E, Seizeur R, Simon A, Quinio B Cervical cord compression due to delayed scarring around epidural electrodes used in spinal cord stimulation: report of 2 cases. J Neurosurg Spine 12:409-412 2010.
Abstract | Wikistim Entry