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

Choosing a Trial Electrode

What type of electrode should be used for the screening trial?

Percutaneous electrode placement under fluoroscopy provides access to many levels of the spine with the use of a single epidural needle.  This allows mapping of paresthesia/pain overlap to determine the optimal longitudinal level for the electrode.  A surgical plate/paddle electrode inserted by laminectomy or laminotomy limits this access and, thus, compromises mapping.  Accordingly, most screening trials involve placement of a percutaneous catheter electrode.

A surgical plate/paddle electrode is required for screening if a percutaneous catheter electrode fails to access the epidural space satisfactorily.  A surgical plate/paddle electrode might also be useful if a percutaneous catheter electrode causes excessive side effects or fails to provide sufficient pain/paresthesia overlap to allow assessment of the potential for SCS to provide pain relief.

In a minority of patients, e.g., those in whom a previous laminectomy or posterior fusion blocks access to the epidural space or in whom the target area (viz., C1) is otherwise inaccessible, it is evident from the outset that the screening trial will require a surgical plate/paddle electrode.

Strength of recommendation Evidence source(s)/rationale
A = Recommended or required
Valid, useful, or non-negotiable
  • Weighing risk versus potential benefit and expert consensus reveals a high likelihood of a favorable outcome
  • Only option (in some cases)

North RB, Fischell TA, Long DM. Chronic dorsal column stimulation via percutaneously inserted epidural electrodes: preliminary results in 31 patients. Appl Neurophysiol 40(2-4):184-191, 1977.
Abstract | Wikistim Entry

North RB, Fischell TA, Long DM. Chronic stimulation via percutaneously inserted epidural electrodes. Neurosurgery 1(2):215-218, 1977.
Abstract | Wikistim Entry

Krainick JU, Thoden U, Riechert T. Spinal cord stimulation in post-amputation pain. Surg Neurol 4(1):167-170, 1975.
Abstract | Wikistim Entry

Hosobuchi Y, Adams JE, Weinstein PR: Preliminary percutaneous dorsal column stimulation prior to permanent implantation. J Neurosurg 17:242-245, 1972.
Abstract | Wikistim Entry

Hoppenstein R. Percutaneous implantation of chronic spinal cord electrodes for control of intractable pain: preliminary report. Surg Neurol 4(1):195-198, 1975.
Abstract | Wikistim Entry

Hoppenstein R. Electrical stimulation of the ventral and dorsal columns of the spinal cord for relief of chronic intractable pain: preliminary report. Surg Neurol 4(1):187-194, 1975.
Abstract | Wikistim Entry

Erickson DL. Percutaneous trial of stimulation for patient selection for implantable stimulating devices. J Neurosurg 34:440-444, 1975.
Abstract | Wikistim Entry