Anatomical Considerations for Placing Spinal Cord Stimulators in Patients with Coronary Vascular Disease and Cardiomegaly

Abstract

Background: The Spinal Column Stimulator (SCS) of the dorsal columns was first used in 1967 as a nonpharmacologic option for treating chronic intractable cancer pain. It works by blocking pain signals before they reach the brain. The device sends electrical pulses to electrodes placed over the spinal cord. These pulses modify the pain signals, which either make them imperceptible or replace them with a tingling sensation. It is important to note that spinal cord stimulation does not eliminate the source of pain, but rather changes how the brain perceives it. The placement of the electrode leads varies depending on the conditions being treated. SCS has become widely used both as an effective and practical option for the management of refractory chronic pain that is unresponsive to conventional treatments. Results: While medical students were dissecting the body of a 91-year-old male donor who died of atherosclerotic coronary vascular disease and cardiomegaly, they encountered an implanted SCS device. Further dissection showed electrodes from the pulse generator reaching midthoracic level; the anodes and cathode leads were in the dorsal epidural space. The fact that the leads were in the midthoracic region and the donor had chronic atherosclerotic coronary vascular disease and cardiomegaly, he was probably treated for pain related to his cardiac conditions (refractory angina pectoris). Conclusions: In the SCS procedure, numerous anatomical structures within the spinal canal, such as the fatty tissue inside the epidural space, membranes of the dural sac, cerebrospinal fluid (CSF), and spinal cord nerve roots and rootlets, could affect the outcome for the patient. KEYWORDS: Spinal Cord Stimulators; Anatomy of the spinal canal; Treating chronic intractable pain; Neural mechanism of pain perception.