Percutaneous Lumbar Stimulation

Abstract

The technology behind percutaneous lumbar spinal cord stimulation (SCS), a successful therapy used to treat both chronic axial and radicular spinal pain, has been refined over the last 40 years. Globally, approximately 40,000 spinal cord stimulators are implanted each year. Patient outcomes have been rigorously studied, and there is advocacy for the use of SCS earlier in treatment algorithms for chronic pain conditions. The last two decades of research on SCS has demonstrated potential superiority for use in axial and radicular chronic lumbar spine pain compared to traditional spinal surgery and pharmacologic therapy. Among the strongest evidence is for the use of lumbar SCS in treating failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS). FBSS is a well-studied indication for SCS and is responsible for 70% of all implants. Substantial innovation in hardware, software, and novel waveforms has made SCS a viable option for multiple pain conditions. This chapter reviews the most salient topics regarding the indications and evidence for percutaneous lumbar spinal cord stimulation.