Dorsal Column Stimulation
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What is DCS and which conditions are treated with DCS?
Dorsal Column Spinal cord stimulation (DCS) is a technique used in the management of certain chronic pain syndromes. Through an implanted electrode, electricity is delivered to the posterior elements of the spinal cord in order to relieve the pain associated with failed-back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS). Other conditions where DCS is used are refractory angina pectoris and peripheral vascular disease.
What does it do?
The aim of DCS is to reduce the intensity, duration, and frequency of pain associated with the above conditions. There are three components of the DCS system: the stimulating electrodes, an electrical pulse generator with the conducting wires connecting the electrodes to the generator , and the generator remote control.
After implantation of the system, electricity is delivered on the posterior part of the spinal cord through the stimulating electrodes, resulting in improvement of pain. The whole system is controlled by the patient with the use of the generator remote control.
Although DCS was developed on the basis of the gate control theory, the exact mechanisms of action are not fully understood.
Can DCS cure the underlying conditions?
DCS is not a cure for the disease that causes the pain. It is an implantable neuromodulation modality, aiming to decrease the intensity and frequency of the pain.
What should I expect after DCS?
Although the response to any treatment varies from individual to individual, the outcomes after application of DCS reported in the literature are quite satisfactory. For example: Up to 62% of patients receiving DCS for refractory neuropathic back and leg pain or FBSS have been reported to achieve 50% or more pain relief and up to 53% of patients no longer required analgesic drugs. Up to 70% of patients who underwent DCS were satisfied with their treatment, and 75% of patients said they would have the procedure again if they had known their outcome before implantation
How is it treated?
All patients are evaluated by a multidisciplinary team to confirm the suitability for the procedure.
The patients selected for possible DCS would undergo a trial period of stimulation for 4 to 7 days to assess their response to the treatment. If the results are satisfactory the patient would be scheduled for the surgical procedure of implantation of the DCS system.
As mentioned above, the implantable part of the DCS system consists of these components: the stimulating electrodes, an electrical pulse generator and the conducting wires connecting the electrodes to the generator.
Under local anesthesia, the epidural electrodes are implanted in the epidural space, above the posterior elements of the spinal cord. This can be done either percutaneously (through radiographic guidance) or under direct vision through a small incision in the back of the patient and removal of the posterior bony part of the spinal canal. The proper placement of the electrodes is confirmed intraoperatively with the evaluation of satisfactory coverage of the affected areas after electrical stimulation of the spinal cord through the implanted electrodes.
Then the electrical pulse generator is implanted in the lower abdominal area or the gluteal region and is connected to the implanted electrodes through the conducting wires.
The procedure is generally very well tolerated and the patient would return home the same or the next day.
Nevertheless, as in any surgical intervention, a risk is involved for a number of conditions such as displacement/fracture of electrode or other hardware malfunction, subcutaneous hematomas, infection, cerebrospinal fluid leak, rotation of the pulse generator, discomfort at the pulse generator site, development of epidural hematomas etc.