Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Lead/Cable Failure

What is the incidence, time to appearance of symptoms, usual resolution and impact on therapy, and worst case adverse sequelae of electromechanical failure of the lead or extension cable following SCS treatment, and how can this risk be reduced?

  • Incidence: rare
  • Time to appearance of symptoms: variable
  • Treatment: revision as necessary
  • Usual resolution and impact on therapy: Surgical revision restores SCS therapy.
  • Worst case adverse sequelae: Failure of the lead wire portion of an electrode assembly can require replacement of the entire assembly.
  • Risk reduction: Avoid using extra connectors (a potential source of failure that adds mechanical stress to adjacent cable or lead wire).  If extra connectors are used, locate them at or near existing points of fixation.  Create service loops from slack, redundant cable or lead wire and place them in locations where they can provide strain relief (e.g., within the fibrous pocket beneath the pulse generator).  Subject to patient preference and surgical judgment, avoid crossing mobile segments of the body with cable or lead wire, so as to reduce motion-stress from postural changes; for example, in patients with low thoracic electrodes, place the pulse generator in the flank or lateral abdomen at the same level as the electrode anchor.
Strength of recommendation Evidence source's/rationale
B = Recommended
Uncertain validity, apparently useful
  • Weighing risk versus potential benefit and expert consensus reveals a good likelihood of favorable outcome

van Buyten J-P, van Zundert J, Vueghs P, Vanduffel L. Efficacy of spinal cord stimulation: 10 years of experience in a pain centre in Belgium. Eur J Pain 5(3):299-307, 2001.
Abstract | Wikistim Entry

Vallejo R, Kramer J, Benyamin R. Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case series and review of the literature. Pain Physician 10(2):305-311, 2007.
Abstract | Wikistim Entry

Sundaraj SR, Johnstone C, Noore F, Wynn P, Castro M. Spinal cord stimulation: a seven-year audit. J Clin Neurosci 12(3):264-270, 2005.
Abstract | Wikistim Entry

Simpson BA, Bassett G, Davies K, Herbert C, Pierri M. Cervical spinal cord stimulation for pain: A report on 41 patients. Neuromodulation 6(1):20-26, 2003.
Abstract

Rosenow JM, Stanton-Hicks M, Rezai AR, Henderson JM. Failure modes of spinal cord stimulator hardware. Neurosurg Spine 5(3):183-190, 2006.
Abstract | Wikistim Entry

Racz GB, McCarron RF, Talboys P. Percutaneous dorsal column stimulator for chronic pain control. Spine 14(1):1-4, 1989.
Abstract | Wikistim Entry

Quigley DG, Arnold J, Eldridge PR, Cameron H, McIvor K, Miles JB, Varma TR. Long-term outcome of spinal cord stimulation and hardware complications. Stereotact Funct Neurosurg 81(1-4):50-56, 2003.
Abstract | Wikistim Entry

North RB, Kidd DH, Zahurak M, James CS, Long DM. Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 32(3):384-394, 1993.
Abstract | Wikistim Entry

North RB, Kidd DH, Farrokhi F, Piantadosi S. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain:a randomized, controlled trial. Neurosurgery 56(1):98-106, 2005.
Abstract | Wikistim Entry

Meglio M, Cioni B, Visocchi M, Tancredi A, Pentimalli L. Spinal cord stimulation in low back and leg pain. Stereotact Funct Neurosurg 62(1-4):263-266, 1994.
Abstract | Wikistim Entry

Meglio M, Cioni B, Rossi GF. Spinal cord stimulation in management of chronic pain. A 9-year experience. J Neurosurg 70(4):519-524, 1989.
Abstract | Wikistim Entry

May MS, Banks C, Thomson SJ. A retrospective, long-term, third-party follow-up of patients considered for spinal cord stimulation. Neuromodulation 5(3):137-144, 2002.
Abstract | Wikistim Entry

Lang P. The treatment of chronic pain by epidural spinal cord stimulation - a 15 year follow up: present status. Axon 71-73, 1997.
Abstract | Wikistim Entry

Kumar K, Toth C. The role of spinal cord stimulation in the treatment of chronic pain postlaminectomy. Curr Pain Headache Rep 2:85-92, 1998.

Kumar K, Toth C, Nath RK, Laing P. Epidural spinal cord stimulation for treatment of chronic pain--some predictors of success. A 15-year experience. Surg Neurol 50(2):110-120, 1998.
Abstract | Wikistim Entry

Kumar K, Nath RK, Toth C. Spinal cord stimulation is effective in the management of reflex sympathetic dystrophy. Neurosurgery 40(3):503-508, 1997.
Abstract | Wikistim Entry

Kumar K, Nath R, Wyant GM. Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience. J Neurosurg 75(3):402-407, 1991.
Abstract | Wikistim Entry

Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O’Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson, J, North RB The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery 63(4):762-768, 2008.
Abstract | Wikistim Entry

Kumar K, Hunter G, Demeria D. Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience. Neurosurgery 58(3):481-494, 2006.
Abstract | Wikistim Entry

Kumar K, Wilson JR, Taylor RS, Gupta S. Complications of spinal cord stimulation, suggestions to improve outcome, and financial impact. J Neurosurg Spine 5(3):191-203, 2006.
Abstract | Wikistim Entry

Kumar A, Felderhof C, Eljamel MS. Spinal cord stimulation for the treatment of refractory unilateral limb pain syndromes. Stereotact Funct Neurosurg 81(1-4):70-74, 2003.
Abstract | Wikistim Entry

Kumar K, Malik S, Demeria D. Treatment of chronic pain with spinal cord stimulation versus alternative therapies: cost-effectiveness analysis. Neurosurgery 51(1):106-116, 2002.
Abstract | Wikistim Entry

Kay AD, McIntyre MD, Macrae WA, Varma TR. Spinal cord stimulation--a long-term evaluation in patients with chronic pain. Br J Neurosurg 15(4):335-341, 2001.
Abstract | Wikistim Entry

Heidecke V, Rainov NG, Burkert W. Hardware failures in spinal cord stimulation for failed back surgery syndrome. Neuromodulation 3(1):27-30, 2000.
Abstract | Wikistim Entry

Forouzanfar T, Kemler MA, Weber WE, Kessels AG, van Kleef M. Spinal cord stimulation in complex regional pain syndrome: cervical and lumbar devices are comparably effective. Br J Anaesth 92(3):348-353, 2004.
Abstract | Wikistim Entry

de la Porte C, Siegfried J. Lumbosacral spinal fibrosis (spinal arachnoiditis). Its diagnosis and treatment by spinal cord stimulation. Spine 8(6):593-603, 1983.
Abstract | Wikistim Entry

De Andrés J, Quiroz C, Villanueva V, Valia JC, Lopez Alarcon D, Moliner S, Monsalve V. Patient satisfaction with spinal cord stimulation for failed back surgery syndrome [Spanish]. Rev Esp Anestesiol Reanim 54(1):17-22, 2007.
Abstract | Wikistim Entry

Burchiel KJ, Anderson VC, Brown FD, Fessler RG, Friedman WA, Pelofsky S, Weiner RL, Oakley J, Shatin D. Prospective, multicenter study of spinal cord stimulation for relief of chronic back and extremity pain. Spine 21(23):2786-2794, 1996.
Abstract | Wikistim Entry

Broseta J, Roldán P, González-Darder J, Bordes V, Barcia-Salorio JL. Chronic epidural dorsal column stimulation in the treatment of causalgic pain. Appl Neurophysiol 45:190-194, 1982.
Abstract | Wikistim Entry

Blond S, Armignies P, Parker F, Dupard T, Guieu JD, Duquesnoy B, Christiaens JL. Chronic sciatalgia caused by sensitive deafferentiation following surgery for lumbar disk hernia: Clinical and therapeutic aspects. Apropos of 110 patients [French]. Neurochirurgie 37(2):86-95, 1991.
Abstract | Wikistim Entry

Barolat G. Experience with 509 plate electrodes implanted epidurally from C1 to L1. Stereotact Funct Neurosurg 61(2):60-79, 1993.
Abstract | Wikistim Entry

Barolat G, Schwartzman R, Woo R. Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotact Funct Neurosurg 53(1):29-39, 1989.
Abstract | Wikistim Entry

Aló KM, Redko V, Charnov J. Four year follow-up of dual electrode spinal cord stimulation for chronic pain. Neuromodulation 5(2):79-99, 2002.
Abstract | Wikistim Entry