SPINAL CORD STIMULATION
Spinal cord stimulation uses low voltage stimulation of the spinal nerves to block the feeling of pain. It helps to manage pain and potentially decrease the amount of pain medication. It may be an option if you have long-term (chronic) leg, back, neck, or arm pain, and have not found relief through traditional methods. A small battery-powered generator implanted in the body transmits an electrical current to your spinal cord. By interrupting pain signals, the procedure has shown success in returning some people to a more active lifestyle.
What is a spinal cord stimulator?
A spinal cord stimulator (SCS), also known as a dorsal column stimulator, is a device surgically placed under your skin to send a mild electric current to your spinal cord. A small wire carries the current from a pulse generator to the nerve fibers of the spinal cord. There are two types of stimulators. The first type, when turned on, feels like a mild tingling in the area where pain is felt. The second type delivers impulses at a frequency higher than your brain can detect. This means there is no tingling, only pain relief. Your pain is reduced because the electrical current interrupts the pain signal from reaching your brain.
Stimulation does not eliminate the source of pain. The amount of pain relief varies for each person. Some patients find the tingling sensation unpleasant. For these reasons a trial stimulation is performed before the device is permanently implanted. The goal for spinal cord stimulation is a 50-70% reduction in pain. However, even a small amount of pain reduction can be significant if it helps you to perform your daily activities with less pain and reduces the amount of pain medication you take. Stimulation does not work for everyone. If unsuccessful, the implant can be removed and does not damage the spinal cord or nerves.
There are many types of stimulation systems. The most common is an internal pulse generator with a battery. A SCS system consists of :
- An implantable pulse generator with battery that creates electrical pulses.
- A lead with a number of electrodes (4-16) that delivers electrical pulses to the spinal cord.
- An extension wire that connects the pulse generator to the lead.
- A hand-held remote control that turns the pulse generator on and off and adjusts the pulses.
The battery inside the pulse generator delivers low voltage and needs to be surgically replaced every 2 to 5 years if it is a standard battery. Rechargeable battery systems may last up to 10 years, depending on usage. Your doctor will select the best type of system for you during the trial stimulation.
The pulse generator is programmable by the doctor and has three settings:
- Frequency (rate): number of times stimulation is delivered per second. Too few results in no sensation. Too many results in a washboard or bumpy effect.
- Pulse width: determines size of area stimulation will cover.
- Pulse amplitude: determines threshold of perception to pain.
Who is a candidate?
Before determining if spinal cord stimulation (SCS) is an option, your condition will be thoroughly evaluated and assessed. A comprehensive evaluation of your pain history will determine if your goals of pain management are appropriate to proceed with treatment.
Because pain also has psychological effects, a psychologist may assess your condition to increase the probability of a successful outcome. Dr. Jameson will evaluate your current medication regime and physical condition. She will want to review all previous treatments including medication, physical therapy, injections, and surgeries.
Patients selected for this procedure usually have had a disability for more than 12 months and have pain in their lower back and leg (sciatica) or neck and arm. They’ve typically had one or more failed spinal surgeries.
You may be a candidate for SCS if you meet the following criteria:
- Conservative therapies have failed
- Your source of pain has been verified
- You would not benefit from additional surgery or surgery may not result in pain relief
- You are not seriously dependent on pain medication or other drugs
- You do not have depression or other psychiatric conditions that contribute to your pain
- You have no medical conditions that would keep you from undergoing implantation
- You have had a successful trial stimulation
An SCS can help lessen chronic pain caused by:
- Chronic back, neck, leg (sciatica) or arm pain: Ongoing, persistent pain caused by degenerative conditions like arthritis or spinal stenosis.
- Failed back surgery syndrome: failure of one or more surgeries to control persistent back, neck, arm, or leg pain (sciatica), but not technical failure of the original procedure.
- Complex regional pain syndrome (CRPS): a progressive disease of the nervous system in which patients feel constant chronic burning pain, typically in the foot or the hand. Formerly called reflex sympathetic dystrophy (RSD).
- Arachnoiditis: painful inflammation and scarring of the meninges (protective layers) of the spinal nerves.
- Other: stump pain, angina, peripheral vascular disease, multiple sclerosis, spinal cord injury.
If your pain is caused by a correctable condition, then this must be fixed first.
Who performs the procedure?
Dr. Jameson will perform the trial as well as implant the spinal cord stimulator.
The surgical decision
Determining whether a spinal cord stimulator will be a good pain management option for you is a complex process. Before a permanent stimulator can be implanted, you must undergo a trial to see if the device decreases your level of pain. The surgery is performed on an outpatient basis in two stages: Stage 1 is a trial stimulation and Stage 2 is implantation of the permanent device.
STAGE 1. TRIAL STIMULATION—PERFORMED BY DR JAMESON
Trial stimulation is very important to determine if the procedure will be successful. It will tell if stimulation is correct for the type, location, and severity of your pain. It will also evaluate the effectiveness of various stimulation settings.
The insertion of a trial lead is typically performed under a local anesthetic. A hollow needle is inserted through the skin (percutaneous) into the epidural space between the bony vertebra and the spinal cord using fluoroscopy (a type of X-ray). The lead is properly positioned and then attached to an external generator and power supply (worn on a belt).
After the trial procedure, you will be sent home with instructions on how to use the trial stimulator and care for your incision site. Keep a written log of the stimulation settings during different activities and the level of pain relief. After 5 to 7 days, you will return to the doctor’s office to discuss permanently implanting the stimulator. At that time the trial leads will be removed.
STAGE 2. PERMANENT IMPLANTATION–PERFORMED BY DR JAMESON
If the trial is successful and you experienced a greater than 50% improvement in pain, you can be scheduled for surgery. During the trial stimulation, your doctor gathered information about the number of electrodes needed and the type of stimulation that works best for you.
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