CURRENT STATUS OF EPIDURAL SPINAL-CORD STIMULATION

Spinal cord stimulation is the most widespread application of neurostimulation, which includes electrical stimulation of the sensory-motor cortex, thalamus, spinal cord, sacral roots, peripheral nerves, and vagus nerve. Its popularity, although with variable acceptance over the past two decades, has steadily increased and is now a well-established part of the pain specialist's armamentarium. Several published studies (none of which, however, is prospective) have consistently shown a 50% efficacy in producing a satisfactory degree of long-term pain relief in a variety of chronic pain conditions. In Europe the most widely accepted application is for the management of peripheral vascular disease in the lower extremities. The effects on ischemic pain have been reported consistently to be very positive. Intractable pain due to angina pectoris is also showing promising results. The role of spinal cord stimulation in the management of hypertonic motor disorders has been controversial and has recently been overshadowed by the development of intrathecal baclofen infusion. In the author's experience, spinal cord stimulation remains the procedure of choice for athetosis or dystonia. Some evidence also exists that spinal cord stimulation might have a role in regulating the blood flow to the brain. This has been confirmed by animal experimental studies. Isolated reports have also shown some beneficial effects in persistent vegetative status due to brain injury or stroke.