Section 1.2: Patient Selection and Exclusion Criteria

Last modified by Max Gosey on 2010/06/13 17:24

IDEAL PATIENTS

Gender and Age

Literature has shown that the highest success rate and best prognosis is for males in their 40's. These tend to be the least medically complicated patients and have the physiologic reserve to heal very well.

Additionally, patients should be first-time operative patients.

Origin of Pain

Patients with pain originating in cervical spinal cord levels have proven to be easy to treat, whereas patients with pain originating from thoracic and lumbar levels have lower success rates.

The procedure is indicated strongly for pain of purely myelopathic origin. It is poorly indicated for pain of purely radiculopathic origin. As a rule, the more intervertebral spinal stenosis resolved on parasagittal MRI (and thus the greater the degree of radiculopathy), the poorer the indication for this procedure.

EXCLUSION CRITERIA

1. Prior history of surgery within two vertebral levels of spinal cord segments at which pain originates.
2. Age 80 or greater.
3. Dementia or other psychiatric diagnoses that interfere with measuring pain
4. Lack of exhaustive consideration of other treatments, both non-operative and operative (decompressive).

OTHER CONSIDERATIONS

Severity of pain should be the main determinant in ranking the order in which patients will be treated.

NOVEL INDICATIONS

Ischemic Injury

Research^{[insert citation]} has suggested that pain from ischemic spinal cord injury, such as that of transient anterior spinal artery occlusion, can be effectively treated with spinal cord stimulation. This deserves further consideration before wide implementation, but if extensively proven effective, it could be a beneficial option.