Presented at the North American Neuromodulation Society Annual Meeting, December 7 - 10, 2006

Successful Control of Back and Leg Pain with a Next Generation Spinal Cord Stimulation (SCS) Device Following Initial Treatment Failure: Case Reports
Jeffrey Epstein, MD1 Richard M. Rosenthal, MD2 Saqib B. Khan, MD3 Allison Foster, PhD4 Ani Khodavirdi, PhD4
1

Comprehensive Pain Care, Babylon, NY Nexus Pain Care, Provo UT Healthcare Center of Tampa, Tampa FL Advanced Bionics, Valencia CA

INTRODUCTION
Spinal cord stimulation (SCS) is an effective treatment for chronic intractable back and leg pain in patients who have exhausted both surgical and non-surgical therapeutic options1. SCS systems produced by different manufacturers vary in their technical capabilities. These differences, which include current vs. voltage control and independent contact control vs. splitting pulses between contacts, may determine the ability of a given SCS system to address particular pain patterns. The subsequent consequences for therapeutic outcomes and satisfaction with treatment have not been investigated systematically. These case reports illustrate the importance of device selection in achieving a satisfactory outcome.

Can different SCS systems provide different therapeutic outcomes?

METHODS
Case reports were gathered in medical practice. Outcomes were reported after replacement of each patients original constant voltage (Cases 1 and 2) or constant current (Case 3) SCS system with an SCS system with 16 independently currentcontrolled contacts (Precision, Advanced Bionics Corporation, Valencia, CA; Figure 1).

RESULTS
Case #1

Figure 1: The Precision implantable pulse generator and two percutaneous leads.

Two SCS systems were trialed sequentially in the operating room. With the first system, coverage of painful areas could not be achieved. With the second system, complete coverage was achieved almost immediately. Case #2 The patient classified paresthesia with the Precision system as a massage, with a broader and more complete coverage of painful areas. Moreover, he described reduced use of medications, and 100% improvement in quality of life. Case #3 Three months after SCS system replacement, the patient reported complete discontinuation of pain medications, a dramatic increase in quality of life, and stimulation perceived as smoother and softer.

CONCLUSIONS
The SCS system technologies of different manufacturers may produce differences in pain coverage and sensations of paresthesia in the same patients.
Selecting the best system for each individual can have implications for quality of life and concomitant health care utilization, such as medication use. We suggest judicious consideration of technical capabilities when selecting an SCS system.

References
1. 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. 2006;58:481-496.