SPINAL CORD NEUROSTIMULATION
Spinal Cord Neurostimulation allows, through implantable systems under the skin consisting of one or more electrodes and an impulse generator (pacemaker), to create an electromagnetic field around the spinal cord, capable of modulating chronic pain conduction.
The electrodes are placed at the level of the epidural space through a percutaneous incision under local anaesthesia, then connected to the pulse generator, which is placed inside a subcutaneous pocket in the supragluteal region.
One of the mechanisms of action on which spinal cord neurostimulation is based is the famous ‘gate control’ theory of Melzack and Wall, which states that the activity of large diameter A-beta skin fibres inhibits the transmission of pain information to the brain. Spinal cord neurostimulation activates these large fibres by suppressing the secondary neurons activated by the small fibres (C and Aδ) that transmit pain.
The operation, under local anesthesia, has no particular contraindications or side effects and consists of two phases:
- A first ‘trial’ phase consists of implanting only the electrode to test its effectiveness in controlling pain.
- In the second phase, once its antalgic efficacy has been established after a few weeks, the generator is implanted permanently in a subcutaneous location.
When is its use indicated?
- Neuropathic pain
- Spinal stenosis
- Chronic post-surgical pain
- Radiculopathy (lumbosciatalgia and cervicobrachialgia) resistant to therapy
- Reflex sympathetic dystrophy or complex regional syndrome (CRPS)
- Peripheral arteriopathies
The device is programmed (amplitude, pulse width, intensity and waveform) by specialised engineers via a dedicated tablet. Subsequently, the patient himself can manage the intensity with a remote control.
PERIPHERAL PERCUTANEOUS ELECTRICAL NEUROMODULATION
Peripheral percutaneous electrical neuromodulation is a method used to treat peripheral neuropathy, occipital neuralgia, postherpetic neuralgia and chronic post-surgical pain. Using one or more sensors placed under local anaesthesia just under the skin, a low-voltage electric field is generated that alters the ‘damaged’ state of the nerves, resulting in pain relief.
