Lindsay L. Bean BS1, Madison Goon BS1, Jesse J. McClure MD, PharmD, PhD2, Rodrigo S. T. Aguiar MD1, Nicholas Kato BS1, Marisa DiMarzio PhD1, Julie G. Pilitsis MD, PhD, MBA1 

1Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA  

2Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA 

 

• Dr. C. Norman Shealy performed the first SCS implantation procedure in 1967, based on the principles of Melzack and Wall’s gate control theory of pain.

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  • In the years since, SCS therapy has been used to successfully treat a variety of painful conditions including: failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), refractory angina pectoris, peripheral vascular disease, non-surgical back pain, and diabetic neuropathy. 

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  • In addition to the expansion of SCS indications, its hardware and surgical techniques have  evolved over time.

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  • We performed a scoping review of the literature regarding SCS operative techniques with the purpose of reviewing, summarizing, and highlighting key changes in SCS implantation techniques

   

   

  • We performed a MEDLINE search of articles from 1967 to June 2023.

   

   

   

   

   

   

   

  We included:

   

  • Papers written in English that involved treating chronic pain in adults and provided information regarding changes, trends, or innovations that impact the workflow of physicians implanting SCS devices for chronic pain management. 

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  We excluded:

   

  • papers that focused on changes in programming or hardware that did not significantly affect device implantation technique or focused solely on revision technique.

   

  • The flank region as a site for IPG was first described in 1978 and continues to be a commonly used. 

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  • Implanters had to develop techniques for rechargeable battery implants as these must be approximately 2cm beneath the skin. 

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  •  Lead implants have evolved from a single platinum electrode to a wide selection of percutaneous leads and multi-column paddles placed largely between T8-T10

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  •  Transition from four-contact percutaneous systems to eight-contact leads occurred and demonstrated a better long-term pain relief and greater quality of life and sleep improvement. 

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  • While paddle anchors remain similar to those used over the past two decades, percutaneous anchors have improved to reduce migration. 

  • This was done by pushing the nose of the anchor to through the fascia and secured with a 2-0 non-absorbable suture. 

   

  SCS has evolved in design, insertion technique, and even purpose over the last 50+ years. 

   

   

   

  Due to innovations and collaboration of neuromodulators with industry, SCS is continually becoming safer and more effective for patients suffering from chronic pain. 

   

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  Physicians implanting SCS systems for chronic pain management must continually refine their surgical techniques to keep up with the rapidly evolving therapy.