Combined cervical and thoracic spinal cord stimulation for chronic pain: A systematic literature review

Abstract

ObjectivesSpinal cord stimulation (SCS) is conventionally placed at either cervical or thoracic spinal regions to treat chronic pain. However, for patients with multiarea pain, concomitant cervical and thoracic SCS (ctSCS) may be necessary to provide sufficient coverage. It remains unknown whether ctSCS is effective and safe. Thus, we aimed to survey the existing literature and assess the efficacy and safety of ctSCS.MethodsA systematic review of the literature was performed according to the 2020 PRISMA guidelines to investigate pain, functional, and safety outcomes related to ctSCS. Articles between 1990 and 2022 available through PubMed, Web of Science, Scopus, and Cochrane Library databases were included if they assessed these outcomes in the context of ctSCS. Data extracted from articles included study type, number of ctSCS implantations, stimulation parameters, indications for implantation, complications, and frequency. The Newcastle–Ottawa scale was used to assess risk of bias.ResultsThree primary studies met our inclusion criteria. Overall, ctSCS was effective in providing analgesia. Pain severity was captured with patient‐reported pain scales and changes in analgesic requirements. Various metrics were used to quantify quality of life and functional outcomes. Failed back surgery syndrome was the most common indication for ctSCS implantation. Implanted pulse generator pocket pain was the most common postoperative adverse event.ConclusionsDespite the limited evidence available, ctSCS seems to be effective and generally well tolerated. The dearth of relevant primary literature illustrates a knowledge gap, and future studies are needed to better clarify the efficacy and safety profile of this SCS variant.

Neuromodulation Techniques for Headache Management

“…Murray et al [36] Mean decrease in CCH attack frequency. Nowacki et al [37] Spinal Cord Stimulation -NI Pain; lead migraine; defective devices [45]. Decrease in migraine intensity and pain.…”

“…The SCS device is designed to send out pulsatile information that intercepts and diminishes this signaling [61]. This neuromodulation technique has broad applications and has been shown to be an effective analgesic for patients who suffer from chronic pain when targeting the thoracic and cervical spine [45]. One review article assessed SCS use across four studies on patients with migraine and found that all four studies reported a decrease in migraine intensity and pain [38].…”

“…The most cited adverse event associated with this therapy include pain at the site of implantation of the pulse generator [45]. Other adverse events reported include lead displacement and defective devices [45].…”

“…The most cited adverse event associated with this therapy include pain at the site of implantation of the pulse generator [45]. Other adverse events reported include lead displacement and defective devices [45]. Large cost savings associated with this surgery have been described elsewhere for back pain and general analgesic purposes, however no studies to date have explored cost savings related to headache management.…”

Neuromodulation Techniques for Headache Management

“…52 This neuromodulation technique has broad applications, and has been shown to be an effective analgesic for patients who suffer from chronic pain when targeting the thoracic and cervical spine. 53 One review article assessed SCS use across four studies on patients with migraine, and found that all four studies described a decrease in migraine intensity and pain. 54 However, given small sample sizes, the studies were limited and did not offer statistical significance for their findings, prompting the authors to conclude that there is low quality evidence to support the use of SCS for headache.…”