The epidural space is at its fullest at the L2 vertebra it starts superiorly with the base of the skull at the foramen magnum, then descends inferiorly until the sacrum at the sacral hiatus. Nerve roots are bathed with cerebrospinal fluid lie within the sac. The epidural space anatomically lies within the dural sac. Blood vessels, lymph nodes, and fat also make up the posterior wall. The dura mater lies anteriorly and the vertebral wall posteriorly to the epidural space. Spinal cord stimulator leads are placed within the epidural space. Revision of the stimulator implantation is very common secondary to lead migration and breakage. Chronic monitoring of the patient following implantation, including adjustment to the stimulator settings and battery replacement is often necessary. Mental healthcare disorders are associated with worse outcomes after spinal cord stimulator implantation. Many insurance companies require psychological screening before the placement of the stimulator. Although severe complications following the installation of a spinal cord stimulator are rare, they can be significant. Various types of stimulators and electrical impulses are used to provide pain relief.įurther research will determine if one type of stimulator is superior compared to another. There are various indications for implanting a stimulator, but it is most commonly done following failed back surgery. After a percutaneous trial, a permanent stimulator is installed. Patients can have long-lasting pain relief following the procedure. Stimulators have been used for the treatment of both neuropathic and ischemic pain. Spinal cord stimulator implantation is usually reserved for patients who have failed various forms of conservative and pharmacological treatment options. The implantable device offers a nonpharmacological approach to various pain conditions. Spinal cord stimulators are designed to treat chronic pain.
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