# Spinal Cord Stimulation (SCS)

> Spinal cord stimulation (SCS) for refractory chronic pain: neuropathic pain, failed back surgery syndrome, ischaemic pain. Care for national and international patients.

URL: https://brainandspine-bcn.com/en/treatments/spinal-cord-stimulation/
Fuente: Brain & Spine Barcelona — https://brainandspine-bcn.com

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# Spinal Cord Stimulation (SCS)

Electrical neuromodulation of the spinal cord for patients with chronic pain refractory to conventional medical treatment.

## Pain control without continuous oral medication

**Spinal cord stimulation (SCS)** involves implanting epidural electrodes connected to a programmable generator. The electrical pulses modulate the transmission of pain to the brain, reducing its intensity without affecting normal sensation.

### Main indications

- **Failed back surgery syndrome (FBSS):** chronic pain after spinal surgery with no new surgical cause.
- **Neuropathic pain** localised in the limbs (chronic radiculopathy, postherpetic neuralgia).
- **Complex regional pain syndrome** (CRPS I and II).
- **Peripheral ischaemic pain** refractory in the lower limbs.

Trial phase:
before the definitive implant, a trial phase is carried out with external electrodes for 7-14 days. The permanent system is only implanted if the trial significantly reduces pain (typically ≥50%).

## Step by step of spinal cord stimulation implantation

1. 1 · Pain assessment Coordinated study with the pain unit: history, pain mapping, scales (VAS, ODI, SF-36), imaging and psychological assessment. Confirmation that this is refractory neuropathic pain that is a candidate for neuromodulation.
2. 2 · Trial phase Temporary implantation of an epidural electrode by puncture under sedation and radiological guidance. The cable is externalised and the patient uses an external stimulator for **7-14 days** to assess the real response in their daily life.
3. 3 · Decision based on results If pain reduction exceeds **50%** and functional improvement is achieved, the definitive implant proceeds. If the response is insufficient, the temporary electrode is removed without consequences.
4. 4 · Definitive implant Placement of the paddle lead in the epidural space (percutaneous or surgical with minimal laminotomy) and the pulse generator (IPG) under the skin (upper gluteal or abdominal area). The cable between the two is subcutaneously tunnelled.
5. 5 · Personalised programming Adjustment of amplitude, frequency and patterns (tonic, Burst, high frequency) according to the patient's painful area. Programming is refined in the first weeks until the optimal pattern is found.
6. 6 · Long-term follow-up Periodic reviews with the pain unit. Rechargeable or replaceable IPG battery every 5-9 years depending on the model. Reprogramming when the pain pattern changes.

## Neurosurgeons who implant spinal cord stimulation

### Dr. Jhon A. Hoyos Castro

Neurosurgeon · Spine and pain surgery
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### Dr. Pedro Roldán Ramos

Neurosurgeon · Neuromodulation and functional
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### Dra. María Elena Filadoro

Neurosurgeon · Minimally invasive spine and neuromodulation
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