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Spinal Cord Stimulator therapy is a revolutionary treatment for patients suffering from chronic back pain. A small electronic device is surgically implanted close to the spinal cord in the epidural space. Low-level electrical impulses emitted from the device interfere with pain messages transmitted by nerves, blocking the sensation of pain. Implanting a spinal cord stimulator may be effective in helping patients return to a more active and healthy lifestyle.
Conditions that are treated with SCS include:
Nerve Root Compression
Failed Back Surgery Syndrome
Lumbar Radiculitis or Sciatica
Degenerative Disk Disease
Also referred to as a Dorsal Column Stimulator, a Spinal Cord Stimulator system is composed of a pulse generator implanted under the skin of the abdomen or buttock and an extension wire that connects to a pulse generator to the lead implanted close to the spinal cord. The pulse generator is powered by a battery that must be surgically replaced every two to five years, unless it is rechargeable. The lead is a flexible, thin wire with anywhere from 4-16 electrodes. An extension wire attaches the lead to the pulse generator, and a hand-held remote control is used by the patient to program the pulse generator.
The procedure is performed in two stages. First is the insertion of a temporary trial implant. You will be positioned lying on your side or stomach, and then given a local anesthetic and light sedation to prepare for the SCS implant insertion. The surgeon will make a small incision in the middle of your back. Using fluoroscopy guidance (X-Ray), the doctor will insert SCS leads into your epidural space. Sutures are used to keep the leads secure above the spinal cord. At this time, a trial stimulator, rather than a permanent implant, is worn for a week to assess effectiveness of spinal cord stimulation in treating your pain. The trial stimulator will be taped to your back. If the SCS is successful in relieving pain, a second surgery is performed. During this second surgery, the extension wire is tunneled under the skin from the epidural space to the location of the generator implant (either abdomen or buttock). The surgeon makes a four to six inch incision to place the generator between the skin and muscle, where it is sutured securely. After the procedure, you should be able to go home that day.
The spinal cord stimulator produces a low voltage current which keeps the brain from being able to sense pain. Instead of pain, you will feel a tingling sensation. Using the remote, you will be able to control the intensity of the stimulator or turn the system on and off. The spinal cord stimulator has been proven to relieve lumbar back pain in patients with a variety of conditions, especially Failed Back Surgery Syndrome. Patients who receive a spinal cord stimulator implant rely less on pain medication.
Just as with any surgical procedure, possible risks include:
Infection at the surgical site
Scar tissue formation
Failure of electronic device to operate properly
Unpleasant sensations or motor disturbances, such as uncontrolled movement caused by the electrical stimulation of the device
Battery leakage or failure
Leaking of the cerebrospinal fluid from the epidural space
Migration of the leads, making the nerve stimulation ineffective
Skin breakdown at the site of the generator
Rarely, surgical intervention may be needed to fix problems with the device or leads.
Once the SCS device is in place, your doctor will work with you to be able to find the best pulse strength to help you. You will be taught how to use the stimulator remote at home. Typically, patients use the spinal cord stimulation for one or two hours at a time, three to four times a day. The spinal cord stimulator should be turned off while driving and swimming. SCS pulse generators have three programmable settings.
You may find that the device feels differently depending on whether you are sitting down or standing up. This is because the electrical impulses spread differently depending on how the leads and wires move with your body.
According to the American Society of Interventional Pain Physicians, there is evidence that you will experience strong relief short-term, and moderate relief long-term with this surgery. The SCS implant may be effective in helping those who suffer from chronic back pain lead a more active lifestyle. However, there may be a gradual decline in effectiveness of SCS, as your body can develop tolerance to the treatment.
Spinal Cord Stimulator Implants – PainDoctor.com
Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch M.D. Spinal Cord Stimulator. Retrieved from http://arizonapain.com/pain-center/pain-treatments/spinal-cord-stimulator-scs/
WebMD. (January 20, 2011). Spinal Cord Stimulation for Chronic Pain. Retrieved from http://www.webmd.com/back-pain/spinal-cord-stimulation-for-low-back-pain
Mayfield Clinic for Brain & Spine. (February 1, 2010). Spinal Cord Stimulation. Retrieved from http://www.mayfieldclinic.com/PE-STIM.htm