• David A Provenzano, Kasra Amirdelfan, Leonardo Kapural, and B Todd Sitzman.
• *Pain Diagnostics and Interventional Care, Sewickley, PA †IPM Medical Group, Inc., Walnut Creek, CA ‡Carolina's Pain Institute, Winston Salem, NC §Advanced Pain Therapy, PLLC, Hattiesburg, MS.
• Spine. 2017 Jul 15; 42 Suppl 14: S80-S92.

Study DesignA review of literature.ObjectiveThe aim of this study was to define and explore the current evidence gaps in the use of spinal cord stimulation (SCS) for treating chronic spine conditions.Summary Of Background DataAlthough over the last 40 years SCS therapy has undergone significant technological advancements, evidence gaps still exist.MethodsA literature review was conducted to define current evidence gaps for the use of SCS. Areas of focus included 1) treatment of cervical spine conditions, 2) treatment of lumbar spine conditions, 3) technological advancement and device selection, 4) appropriate patient selection, 5) the ability to curb pharmacological treatment, and 6) methods to prolong efficacy over time. New SCS strategies using advanced waveforms are explored.ResultsThe efficacy, safety, and cost-effectiveness of traditional SCS for chronic pain conditions are well-established. Evidence gaps do exist. Recently, advancement in waveforms and programming parameters have allowed for paresthesia-reduced/free stimulation that in specific clinical areas may improve clinical outcomes. New waveforms such as 10-kHz high-frequency have resulted in an improvement in back coverage. To date, clinical efficacy data are more prevalent for the treatment of painful conditions originating from the lumbar spine in comparison to the cervical spine.ConclusionEvidence gaps still exist that require appropriate study designs with long-term follow-up to better define and improve the use of this therapy for the treatment of chronic spine pain in both the cervical and lumbar regions.Level Of EvidenceN/A.

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