![]() Newer devices are targeting axial low back pain and foot pain, areas that have been reported to be more difficult to treat with traditional spinal cord stimulation. ![]() ![]() Despite the lack of a comprehensive mechanism, the technology and the complexity in which spinal cord stimulation is being utilized is growing. Furthermore, several cost analysis studies have demonstrated that spinal cord stimulation is cost effective for these approved conditions. It has also demonstrated clinical benefit in complex regional pain syndrome, critical limb ischemia, and refractory angina pectoris. Spinal cord stimulation has been reported to be superior to conservative medical management and reoperation when dealing with pain from failed back surgery syndrome. This narrative review presents the current evidence supporting the use of spinal cord stimulation for the approved indications and also discusses some emerging neuromodulation technologies that may potentially address pain conditions that traditional spinal cord stimulation has difficulty addressing. In Europe, it has additional approval for refractory angina pectoris and peripheral limb ischemia. It is currently approved by the FDA for chronic pain of the trunk and limbs, intractable low back pain, leg pain, and pain from failed back surgery syndrome. Spinal cord stimulation is an intervention that has become increasingly popular due to the growing body of literature showing its effectiveness in treating pain and the reversible nature of the treatment with implant removal. © 2015 International Neuromodulation Society. These data provide further evidence that tobacco cessation is important to surgical results. Whether that is because of issues with healing and our transmission of signals to the periphery warrants further exploration. Tobacco use correlates with less success with SCS at 6-month follow-up. In this cohort, worker's compensation status, BMI, and depression did not impact outcome. Further, there is a trend of correlation (phi = 0.289) between drug use and patients (N = 3) who underwent device removal (p = 0.045). Smoking status is correlated with both lead migration revisions (phi = 0.269) (p = 0.044) and with revision due to new pain symptoms (phi = 0.241) (p = 0.072). We report a phi correlation of 0.350 between smoking and failure (p = 0.017). The impact of body mass index (BMI), random drug screen results, workers' compensation status, depression, and smoking were assessed. ![]() A score of less than 5 was deemed a failure. Two providers who routinely saw the patients were asked to independently grade the patient's outcome in a blinded fashion on a Global Outcome Ratings scale of 1 to 10, with 5 being 50% improvement at 6 months postoperation. Six-month postoperative follow-up data were available for 57 patients. ![]() We perform a retrospective review of our prospective database of SCS patients undergoing surgery for routine indications. Why these patients either never receive adequate benefit or lose benefit remains elusive. As many as 30% of spinal cord stimulation (SCS) patients fail to obtain long-term pain coverage, even with the strictest parameters of a successful trial, unremarkable psychological assessment, and ideal placement of the permanent device. ![]()
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