The SCS can also be placed to cover exiting nerve roots in the epidural space, in addition to or instead of posterior placement over dorsal columns. One to four leads are placed in the epidural space in the cervical, thoracic or lumbar regions as appropriate, either percutaneously or via a small laminotomy. Surgical techniques for SCS implantation are largely similar regardless of indication and are typically performed in two stages. They are increasingly applied to other conditions including intractable angina and ischemic pain secondary to peripheral vascular disease, though long-term efficacy remains undetermined.
These devices are an important treatment modality for chronic neuropathic pain conditions refractory to conservative management, including complex regional pain syndrome, radiculopathies, failed back syndrome, phantom limb pain, and post-herpetic neuralgia. The SCS system consists of 3 components: an electrode array which is implanted in the epidural space overlying the dorsal columns of the spinal cord an implantable pulse generator (IPG) which consists of an electrical generator, battery, transmitter/receiver and a minicomputer, which is placed beneath the skin and controlled transcutaneously by the patient and insulating wiring connecting the electrodes to the IPG. Spinal cord neuromodulation using implantable electrodes placed over the dorsal columns in the epidural space can be an effective strategy for the control of severe, longstanding, neuropathic pain.
Safety guidelines do not yet exist however, for implanted electronic spinal cord stimulators (SCS). Given the increasing use of these devices for a broad range of medical applications, recommendations have been developed regarding the safe delivery of RT with such devices in-situ. However, RT can interfere with and potentially damage implanted electronic devices such as cardiac pacemakers or implanted cardioverter-defibrillators (ICD).
Radiotherapy (RT) is a major cancer treatment modality, applied to approximately 60% of patients at some point in their natural history for curative and palliative intent.