Neurosurgery notes/Procedures/Cranial procedures/Functional cranial procedures/Management of pain/Spinal stimulation

Spinal stimulation

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Management of pain
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Spinal cord stimulation
Dorsal root ganglion stimulation
SCS emergencies

Mechanism of action

  • Mainly still unknown
  • Pain relief for neuropathic pain
    • Gate control theory
      • Neuronal gate controls the transmission of pain signals from the dorsal horn of the spinal cord to the brain
      • Excess of small-fiber afferent input opens the gate (C-fibres)
      • Large fibre afferent activity closes it (rubbing your knee/dorsal column stimulation by spinal cord stimulator)
        • Large fibers are easier to be depolarised Through low amplitude stimulation
          • If stimulated at the peripheral nerve area can also recruit motor fibres
          • If stimulated at the dorsal column, the prevents the motor fibres being activated. Stimulating the dorsal column allows for wide area of paresthesia
    • Activation of the dorsal columns is relayed to supraspinal centers, involved in pain modulation, probably via the descending fibers in the DLF.
      • The DLF is thought to play a significant role in the attenuation of pain-related signs by spinal cord stimulation
      • It causes long paresthesia effects: (30 mins SCS → 3 hrs of pain relief)
        • Through the releases of neurotransmitters (GABA, etc)
        The dorsal horn Figure 128-1 The extradurally placed multipolar lead excites fibers in the dorsal columns, resulting in orthodromic activity, giving rise to the paresthesia experienced by the patient, and in antidromic activation channeled into the underlying dorsal horns via large-diameter collaterals. In the dorsal horns, this evokes neurotransmitter changes that result in an increase of inhibitory activity and a decrease of pathologic hyperexcitability.
        The extradurally placed multipolar lead excites fibers in the dorsal columns, resulting in orthodromic activity, giving rise to the paresthesia experienced by the patient, and in antidromic activation channeled into the underlying dorsal horns via large-diameter collaterals. In the dorsal horns, this evokes neurotransmitter changes that result in an increase of inhibitory activity and a decrease of pathologic hyperexcitability.
  • Pain relief for ischaemic pain
    • Through unknown mechanism SCS inhibits sympathetic efferents → reduce vasoconstriction → reduce ischaemic pain
  • Pain relief for complex regional pain syndrome

Evidence it works