Current Practice of Spinal Cord Stimulation for Pain in Japan

Shinichi Goto, MD

Director, Pain Management Surgery, Department of Neurosurgery

Kumamoto Takumadai Rehabilitation Hospital, Kumamoto, Japan

(Introduction)

I will talk aboutsome of the new features ofthree different types of apinal cord stimulation (SCS) devices, which having been introduced in Japan during the past few years.

  1. S-lead (perctaneous paddle)EpiducerSystem: St. Jude Medical

Spinal cord stimulator electrodes are placed into the epidural space either percutaneously or via small laminectomy. Percutaneous (cylindrical) leads are less invasive; however, they have been shown to have higher lead migration tendency. The new minimally invasive perctaneous implanted paddle lead can solve these ambivalent problems via the Seldinger technique through a single needle placement.

  1. Bionic NAVIGATORProgramming,Multiple Independent Current Control (MICC): Boston Scientific

This system virtually visualizes electrical field stimulation on a monitor and enables power discharge not by 0 or 100% but gradually from 0% to 100% on each electrode with its independent current controlling system. It helps us to obtain adequate stimulation on the trunk of the body or the lumbar area more easily even for a short time during implant surgery.

  1. VectrisLeads and SureScanIPGs (MRIConditional SCS System), AdaptiveStim: Medtronic

This system is acceptable for patients undergoingwhole-body MRI at 1.5Tesla or less. Thus, the stimulator is applicable for patients with pain with progressive neuronal disease or patients with central poststroke pain havinga higher requirement for MRI scans.In addition,IPG also automatically adjusts stimulation to patients’ optimal settings with internal motion sensors.

(Summary)

Which stimulator is the best?Each stimulator is suitable and has been established for pain management by its manufacturer.The stimulators have very different platforms and different types of limitations, and it is difficult to compare these independent factors. Thus, it is suggested that there is no straightforward answer to this question. This presenter operated on total 37 patients with intractable pain using these new SCSsystems (cases of implantation: Medtronic 16, Boston 14, St. Jude 7) around this year. From this experience, we understand that it seems quite difficult to say which one is the best system; however, we(doctors and patients)can choose the most suitable SCS system depending on each case forobtainingthebest result to help relieve pain.