Functional magnetic resonance imaging: a potential tool for the evaluation of spinal cord stimulation: technical case report.

OBJECTIVE AND IMPORTANCE The management of chronic pain of spinal origin continues to represent a challenge for neurosurgeons. Spinal cord stimulation for chronic intractable pain is an effective therapy in approximately 50% of patients. The present study uses a novel imaging approach, functional magnetic resonance imaging (fMRI), to examine the central effects of spinal cord stimulation. CLINICAL PRESENTATION Three patients, each with a chronic history of intractable pain, were treated at the Toronto Hospital with a trial of dorsal column stimulation (DCS). For all patients, significant improvement in pain symptoms was achieved with DCS. INTERVENTION fMRI on a 1.5-T conventional magnetic resonance system was used to study the effects of DCS in these patients. Images were collected while the stimulator was activated and deactivated. CONCLUSION This report is the first to describe the cerebral effects of exogenous spinal cord stimulation with fMRI. fMRI allows for the objective examination of the effects of DCS and may provide an objective means of evaluating the efficacy of DCS as a therapy for intractable pain of spinal origin.

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