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

Dural Puncture

What is the incidence, time to appearance of symptoms, usual resolution and impact on therapy, and worst case adverse sequelae of dural puncture following SCS treatment, and how can this risk be reduced?

  • Incidence: less than 5%
  • Time to appearance of symptoms: variable, generally within a few hours
  • Treatment: bed rest, hydration, and administration of caffeine; if these are ineffective, consider an epidural blood patch
  • Usual resolution and impact on therapy: usually not symptomatic, but if so, bed rest could compromise the screening trial
  • Worst case adverse sequelae: headache, subdural hematoma
  • Risk reduction: Use an anesthetic technique that allows the patient to provide feedback during insertion or implantation of the electrode(s).  When possible, avoid needle placement in areas with preexisting scarring.  In cases of suspected stenosis or another anatomic condition that might increase risk or before implanting a surgical plate/paddle electrode, obtain an MRI of the target spinal level(s).
Strength of Recommendation Evidence source(s)/rationale
B = Recommended
Uncertain validity, apparently useful
  • Consensus
  • Cohort studies
  • Retrospective case series
  • Case reports 

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Abstract | Wikistim Entry

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

Kemler MA, Barendse GA, van Kleef M, de Vet HC, Rijks CP, Furnee CA, van den Wildenberg FA. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 343(9):618-624, 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

Eldrige JS, Weingarten TN, Rho RH. Management of cerebral spinal fluid leak complicating spinal cord stimulator implantation. Pain Pract 6(4):285-288, 2006.
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