gms | German Medical Science

Objective: Since its introduction in 1967, spinal cord stimulation (SCS) has been used worldwide for the treatment of chronic pain. The effect of cervical SCS leading to improved cerebral perfusion has mostly been shown in experimental settings. The aim of this preliminary study was to assess the hemodynamic effect of cervical SCS in human focusing on extent and locoregional distribution of cerebral blood flow increase.

Method: 53-year-old male patient was treated with cervical neurostimulation because of complex regional pain syndrome of the left distal arm occurred following surgical treatment of carpal tunnel syndrome. The electrode was placed epidurally on the posterior surface of the spinal cord at C4–6 leading to significant improvement of the pain. By agreement of the patient, single-photon emission computerized tomography (SPECT) scanning using Tc-HMPAO was performed to assess the cerebral perfusion without and with cervical SCS.

Results: Under continued cervical SCS, significant increase in cerebral blood flow was detected in both cerebral hemispheres as followed: nucleus lentiformis and caudatus, thalamus, sensorimotor cortex, superior parietal lobule, frontal and temporal lobe including insular region and brainstem.

Conclusions: This study shows that cervical SCS leads to significant increase in cerebral blood flow, especially in brain regions supplied by media cerebral artery. Although the exact mechanism is not known, cervical SCS may represent a useful adjunct in the prevention of cerebral vasospasm following subarachnoid hemorrhage or acute cerebral ischemia.