The Traditional Method: Cervical SCS
Once a patient is deemed a suitable candidate for cervical SCS, they undergo a trial period to assess response before the device is permanently implanted.
“Spinal cord stimulation is one of the few therapies in medicine that can be tested and then tried out, or test driven, before the decision is made to implant the device,” Dr McRoberts pointed out.
During the trial, a cylindrical percutaneous lead is typically guided via needle through an entry site, often located between the T1 and T3 interspaces, into the cervical spine in the posterior epidural space. The device is then tested for a period ranging from a few days to a few weeks. If adequate pain control is achieved and the trial is deemed successful, permanent implantation is performed within 2 to 3 weeks.
Overall data suggests that cervical SCS is effective for reducing hand pain, thereby improving patient function and quality of life. However, most of the evidence comes from retrospective studies, systemic literature reviews, and case reports; high-level data has been difficult to generate due to the wide variety of devices used to treat pain of many different etiologies.
“Right now, when we do spinal cord stimulation for hand and arm pain, it’s not because we have tons of high-level peer-reviewed scientific evidence yet to support it, but because our clinical experience and lots of other anecdotal evidence have shown many patients do very well with this treatment,” Dr Roberts said.
High-level evidence already exists to support the use of SCS for treating pain in other areas of the body, including the lower back, legs, and feet. According to Dr. McRoberts, prospective studies are currently underway to assess its utility in hand and neck pain.
One such study, which is still recruiting patients, has been designed to assess the safety and efficacy of the Senza SCS system (made by Nevro Corp) in patients with chronic, intractable pain of the upper limbs or neck.2 The Senza system has already been approved by the FDA to help manage chronic intractable pain of the trunk and lower limbs.3