Introduction: Spinal cord stimulation for neuropathic pain has been used for the last five decades.There are technological advancements in spinal cord stimulator(SCS), but there is no advancement in technical procedure.The current trend is, a selected patient undergoes for trial for a period of 3-10 days, with percutaneous electrodes of SCS and if the pain is controlled by 50-60% then a permanent spinal cord stimulator is placed, after weeks to months of trial.The whole process involves: two procedures with uncertanity of placing the permanent electrodes on similar position as they were during the trial, wastage of trial electrodes and a period of weeks to months of patient's suffering occur due to gap between trial and permanent SCS. These problems can be resolved by performing a two stage procedure of the spinal cord stimulator (SCS). We have performed 17 two stage SCS procedures at Guthrie Clinic, Robert Packer Hospital and Troy Community Hospital in Pennsylvania, during the period of Aug. 2012 to Mar. 2014. After patient selection an open laminotomy paddle spinal cord stimulator trial was performed for 3-7 days and if the pain control is achieved more than 60% and the patient is satisfied with pain control, then the trial paddle is converted to permanent spinal cord stimulator implant by disconnecting the extension wires from the paddle and the paddle electrodes are connected to battery and generator/IPG.

Methods: This is a retrospective study performed at Guthrie Clinic, Robert Packer Hospital and Troy Community Hospital in Pennsylvania, during the period of Aug. 2012 to Mar. 2014.

Results: Seventeen patients were selected. Eight were male and 9 were female.The age range was 31 to 83 years with mean 57 years. The follow up was one month to eighteen months.All seventeen patients were satisified with their pain control, which was 90-100% and all were converted to permanent SCS. The infection rate was zero and there was no complication.

Conclusions: Two stage procedure of spinal cord stimulator is feasible, economical and it has higer success rate of pain control.This is a small series of 17 patients.A mulitcener study with large number of patients is needed in future.

Patient Care: Two stage procedure of SCS will provide continuity of pain control, during and after trial. It is more economical and it has higher success rate to control pain.

Learning Objectives: Learn the technique of two stage procedure of spinal cord stimulator

References: 1)Mekhial NA, Mathews M, Nageeb F et al. Retrospective review of 707 cases of spinal cord stimulation: Indications and complications. Pain Pract. 2011;11:148-53 2)Claudio Yampolsky, Santiago Hem, Damian Bendersky.Dorsal column stimulator applications.Surg Neurol Int. 2012;3(Suppl 4): S275-S289. 3)Kumar K, Taylor RS, Jacques L, et al.The efects of spinal cord stimulation in neuropathic pain are sustained: A 24 months follow up of the prospective randomized controlled trial of effectiveness of spinal cord stimulation. Neurosurgery. 2008; 63: 762-70