SCS Experiences please. Placement / Dermatomes?

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I recently sent Dr. Whitworth a question about Spinal Cord Stimulators. It's clear that there is a ton that I don't understand about them. I'll post my question and his answer here in the hopes that someone can benefit.

If you have any experience with SCS's, can you post here?

Thanks in advance for the help,

Mark

Originally Posted by Question for Dr. W

I have a client with Charite' at L5-S1 18 months ago with excellent results.

Several months ago, he started having significant foot pain. A local (Utah) pain management gave him a trial SCS that generated very positive results.

His most recent imaging shows potential problems at L4-5, not too bad yet, but enough to give pause and make me wonder if that could be the culprit.

My question is, if SCS in implanted to address leg pain at L5-S1, would positive results come only from issues below the stimulator? With a nerve block, I understand that it is effective only if the source of the pain is below the block. Does the same 'mapping' apply to SCS results?

Originally Posted by Reply from Dr. W

Mark, good to hear from you again. The distribution of pain relief from spinal cord stimulator placement is in the shape of a bell curve. To get the L4 and L5 dermatomes, the stimulation is performed in the thoracic spine at approximately levels T9 and T10. T8 or T11 will partially reduce pain, but not nearly so much as T9 and T10. There is a "sweet spot" that will maximize the pain relief, but this varies from person to person, thus the availability of electrodes with 8 to 16 closely spaced platinum-irridium electrodes that can be independently activated to find the sweet spot. At any given locus of stimulation on the spinal cord (eg. the level that will maximally stimulate the L5 dermatome), there will be some spillover of pain relief and stimulation sensation onto other nearby dermatomes (eg. L3, L4, and S1 for the L5 dermatome maximum stimulation). Hope this helps. Feel free to post this.

Again, any SCS experiences would be greatly appreciated.

Thanks,

Mark

I posted this over on Braintalk and with so much more traffic there, I expect there to be more replies. (Braintalk Thread)