Spinal Cord Stimulation—Hybrid Lead Array: Epidural and Peripheral Nerve Field Stimulation Trial

Abstract

Spinal cord stimulation (SCS) is an advanced modality in contemporary pain management. It is commonly used to treat complex pain conditions of the lumbar spine and lower extremities. However, one of the shortcomings of this treatment is poor coverage of axial back pain. Despite recent advances in improving axial low back pain coverage, such as high-frequency spinal cord stimulation, it is still challenging to treat this type of pain distribution. One of the successful approaches to resolve this problem is the use of peripheral nerve field stimulation (PNFS). PNFS involves placement of cylindrical stimulation leads subcutaneously over the painful areas. PNFS evokes a sense of paresthesia, which should cover the painful region for adequate treatment to be delivered. This chapter discusses procedural details of trials involving PNFS, SCS, and both modalities to create a hybrid system to treat nociceptive and neuropathic low back pain. It also provides the scientific and clinical rationale for placing PNFS electrodes in isolation or with SCS placement. Results of published studies on the use of PNFS in the management of low back pain are summarized, and the criteria for proper patient selection are listed. The published studies provide evidence that PNFS is a safe and well-tolerated pain control option for intractable pain conditions, including chronic low back pain. Efficacious pain relief relies on correct patient selection and the optimal placement of the leads, ensuring a lead depth of 10–12 mm from the surface of the skin to maximize the target sensation of PNFS and provide effective pain relief.