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

Imaging Studies

What tests are used to reveal information about a patient's physical suitability to proceed to the screening trial?

Magnetic resonance imaging (MRI) and, as appropriate, flexion-extension x-rays, computed tomography, myelography, and/or discography can reveal abnormalities concordant with the patient's pain complaint and any surgically remediable cause of significant neurologic deficit. An MRI should be performed in any patient with suspected stenosis, disk herniation, or other anatomic abnormality that will increase the procedural risk of SCS. Some clinicians order an MRI before a patient undergoes any SCS procedure to gain information about the depth of dorsal cerebrospinal fluid and the position of the spinal cord, both of which vary among individuals. This information allows clinicians to optimize electrode selection, placement, and adjustment. Others, however, consider a routine pre-procedure MRI an unnecessary increase in the cost of SCS therapy.

Strength of recommendation Evidence sources/rationale
B = Recommended
Uncertain validity, apparently useful
  • Weighing risk versus potential benefit and expert consensus reveals a good likelihood of as favorable outcome

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Levy R, Henderson J, Slavin K, Simpson BA, Barolat G, Shipley J, North R Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads. Neuromodulation 14:412-422, 2011.
Abstract | Wikistim Entry

Holsheimer J, den Boer JA, Struijk JJ, Rozeboom AR. MR assessment of the normal position of the spinal cord in the spinal canal. AJNR Am J Neuroradiol 15(5):951-959, 1994.