Spinal Cord Stimulator
What is a Spinal Cord Stimulator?
A spinal cord stimulator is a device that sends electrical impulses to the areas of the spinal cord causing pain and interferes with the transmission of pain signals to the brain. It blocks the brain's ability to sense pain in the stimulated areas, thus relieving pain without the side effects that medications can cause. The electrical impulses can be targeted to specific locations and, as pain changes or improves, stimulation can be adjusted as necessary.
Indications for a Spinal Cord Stimulator
- Failed Back Surgical Syndrome/Multiple Back Operations: Nerve compression can cause back and leg pain. Among other causes, scar tissue around the nerves or chronic inflammation of the nerves such as arachnoiditis may cause leg and back pain.
- When your spine surgeon feels that previous surgical intervention has healed and additional open surgery to decompress the nerves is unlikely to help the pain, an operation to implant a spinal cord stimulator may be suggested.
- Degenerative disc disease (DDD)/herniated disc pain refractory to conservative and surgical interventions: Disc degeneration or herniation can impact nerves traveling in the neck into the arms or low back into the legs. When these disc changes are not responding to conservative treatmentoptions and/or surgical intervention is not an option or too risky to perform, spinal cord stimulation may be an option
- Complex regional pain syndrome (CRPS), reflex sympathetic dystrophy (RSD), or causalgia: Condition caused by improper healing of small nerve fibers as a result of an injury, sprain/strain, surgical intervention
- Diabetic peripheral neuropathy of the lower extremities refractory to medications
Preparation for Spinal Cord Stimulation
To prepare for spinal cord stimulation trial:
- Your doctor will have you undergo a neuropsychological examination (insurance requirement).
- Additional imaging studies will be obtained to evaluate your spine anatomy.
- Quit smoking
- Inform your doctor if you:
- Are or might be pregnant
- Have had any previous health conditions
- Are taking any blood-thinning medications such as Warfarin, Xarelto, Eliquis, Plavix etc.
- Are allergic to any medications or anesthesia
- Additional clearance from your other physicians (primary care physician and specialists etc.) depending on your medical co-morbidities
- Do not stop taking your regular medications until instructed by your doctor
- Arrange for someone to drive you home
Procedure for Spinal Cord Stimulation
The procedure for spinal cord stimulation is performed in 2 steps that include a trial procedure and implant procedure:
Step 1:
- This is a trial procedure that begins with the insertion of electrodes.
- You will be instructed to lie on the observation table and anesthesia will be injected to make the site of insertion numb.
- Using a fluoroscope/x-ray, a needle will be guided into the epidural space.
- Through the needle, the electrodes are inserted and placed along the targeted nerve(s).
- The electrode wires are connected to an external stimulator which you can control to produce the impulses.
- A test may be conducted to ensure adequate coverage of the painful areas has been obtained.
- Following insertion of the electrodes, you will be kept under observation in the recovery room and can return home the same day.
- The representative from the company will contact you daily to monitor your progress and make adjustments to get you the best pain relief possible.
- Monitor for improvement in quality of life which includes pain, sleep, mood, function and reduction in your use of pain medication.
- Refrain from bending, lifting greater than 10 lbs and twisting to prevent lead migration which could impact your trial results.
- Take oral antibiotics to prevent infection of the lead site. Refrain from showering or getting the electrodes wet.
- The trial lasts for about a week and if you have significant relief (greater than 50% overall improvement in quality of life) and are happy with the results, the second step is performed. The trial also helps your doctor determine the right amount of stimulation for ideal pain relief.
Step 2:
- You will be referred to a surgeon for permanent implantation.
- During this procedure, you will be placed under general anesthesia at an Ambulatory Surgery Center or Hospital.
- The electrodes will be placed in the same location as the trial with a permanent battery underneath your skin. You can discuss the location of the battery with the surgeon prior to the procedure.
Post Operative Care for Spinal Cord Stimulator Implant
After a period of recovery, you will usually be able to return home the same day. The stimulation device is programmed for ideal pain control. Your surgeon will prescribe medication for pain at the incision site. Recovery from this procedure is approximately 7-14 days and mainly consists of incisional discomfort. You will follow up with the surgeon following the implant as directed and with your pain physician 4 to 6 weeks after implant.
Long Term Care for Spinal Cord Stimulation
Follow up with the pain physician 2-3 times a year to ensure the device is working properly. You may still require non opioid medication to assist in management of your symptoms. Periodically, the device may need to be reprogrammed, with assistance of the device company’s representatives, to get better coverage of your pain. The battery will need to be changed every 6-10 years based on your usage.
Advantages
The spinal cord stimulator can easily be accessed and targeted to treat pain from specific areas of the body. The intensity of stimulation is usually low and targets only a part of the neural network.
Risks and complications
The spinal cord stimulator device is surgically implanted which carries risks such as bleeding, infection and nerve injury.
Summary
Spinal cord stimulation offers hope to those suffering from chronic neuropathic pain which can be difficult and complicated to manage. The procedure is relatively safe with minimal side effects and is found to be very effective for pain control.
