Providing Guidance on Safe Physical Therapy for Patients With Spinal Cord Stimulators: A Call to Action.

Abstract

A fundamental goal of chronic pain management is ensuring patients stay functionally and physically active despite their pain. Spinal cord stimulation (SCS) has been used since 1967 to help manage neuropathic pain conditions, such as complex regional pain syndrome and failed back surgery syndrome.1 SCS involves placing electrodes at specific anatomical levels in the epidural space correlating to a patient’s pain location. Depending on the electrode type, these electrodes are secured either with strain relief loops or anchors directly sutured into the spinal fascia, and resulting scar tissue formation eventually further holds them in place. The electrodes are connected subcutaneously to an implantable pulse generator placed in the gluteal/flank region that delivers electrical signals to modulate pain pathways in the spinal cord and brain.1 The location of these electrodes is very important for the success of this therapy, and movement of these electrodes can result in loss of therapy effectiveness, with potential need for repeat invasive revision surgery. Electrode migration or fracture is a common complication associated with SCS, with rates reported to be as high as 21.4% and 7%, respectively.2 Migration or fracture can occur for many reasons, with adverse and inadvertent positional movements of the spine being an important risk factor.3