The Evolution of Surgical Technique in Spinal Cord Stimulation: A Scoping Review

Introduction: Since the advent of spinal cord stimulation (SCS), its operative technique has consistently advanced. We performed a scoping review of the literature regarding SCS operative techniques to highlight key advancements. The objective of this review is to review, summarize, and highlight key changes in SCS implantation techniques since its inception.

Methods: The authors performed a MEDLINE search inclusive of articles from 1967 to June 2023 including human and modeling studies written in English examining the role of trialing, intraoperative neuromonitoring (IONM) and surgical adaptations. Using the Rayyan platform, two reviewers performed a blinded title screen. Of the 960 articles, 197 were included in the title screen, 107 were included in the abstract review, and ultimately 69 articles met inclusion criteria.

Results: The thirteen articles on trialing revealed that 20-50% of trialed patients did not proceed to permanent implant. Patients with > 10-day trial had an infection incidence of 24.1% vs. 1.4%. A recent publication shows no difference in NRS in patients that were and were not trialed. Thirteen articles on IONM were identified with the most recent discussing results. IONM led to lead repositioning in 16% of cases and surgeon action was necessitated in 5% of cases where SSEPs were reduced. OR time was reduced with IONM for paddle leads and outcomes up to 22 months are similar to procedures performed awake. The remaining articles highlight technique improvements that led to significant reductions in infection, lead migration, and inadequate pain relief.

Conclusion : Physicians implanting SCS systems for chronic pain management must continually refine their surgical techniques to keep up with this rapidly evolving therapy. Additionally, through collaborative efforts of neuromodulators and industry, SCS is safer and more effective for patients suffering from chronic pain.