Spinal Cord Stimulation
What is spinal cord stimulation?
Spinal cord stimulation (SCS) uses low voltage stimulation of the spinal nerves to block the feeling of pain. It helps you to better manage your pain and potentially decrease the amount of pain medication. This treatment method involves implanting a small, battery-powered generator in the body, which transmits an electrical current to your spinal cord. The result is a tingling sensation instead of pain. By interrupting pain signals, the procedure has shown success in returning some people to a more active lifestyle.
Will SCS eliminate my pain?
Stimulation does not eliminate the source of pain, it simply interferes with the signal to the brain, and so the amount of pain relief varies for each person. Also, 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.
Who is a good candidate for spinal cord stimulation?
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. A neurosurgeon, pain specialist, or physiatrist will evaluate your current medication regime and physical condition. The doctor 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). They’ve typically had one or more failed spinal surgeries.
How spinal cord stimulation works
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
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 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.
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 3 to 5 days, you will return to the doctor’s office to discuss permanently implanting the stimulator or removing the trial leads.
Stage 2. Permanent implantation
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.
Before your surgery is scheduled, your doctor will walk you through the steps of the procedure, which generally takes 3 to 4 hours.
Are there risks?
No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. If you are selected for surgery, your doctor will discuss the potential risk complications related to SCS.