Spinal Cord Stimulation
Used to treat chronic pain, spinal cord stimulation implants a device designed to intercept the nerve pulses that make the patient feel pain.
What is Spinal Cord Stimulation?
- Relieves chronic and debilitating pain that has failed to resolve after previous surgeries and/or many other methods of treatment, both conservative and invasive
- Involves a two-step process including a trial for placement and then the permanent phase
- Permanent system is placed entirely under the skin and is not visually noticeable
- Is minimally-invasive
Spinal cord stimulation using dorsal column stimulators is a two-part procedure that may help relieve patients' chronic and debilitating back pain. This procedure is only considered if previous conservative and surgical procedures have failed to help with pain.
Spinal cord stimulation may be some patients' last pain relief option. Many patients have lived with failed back surgery syndrome for years, which is chronic pain felt after one or more previous procedures. Common symptoms patients with chronic pain experience may include weakness and numbness in the extremities, sciatica pain, radicular pain, difficulty walking, standing straight, or sitting, and constant pain of varying strength.
Chronic pain is a symptom of one or more spinal conditions that compress or impinge on a spinal nerve and/or the spinal cord. Spinal cord stimulation does not treat patients' spinal conditions. Instead, the system delivers low voltage stimulation to the spinal nerve(s) and/or area of the spinal cord that is compressed. Effectively, the system blocks the pain signals. The brain feels a tingling sensation instead of pain.
Spinal cord stimulation is done in two parts. The first part is an out-patient procedure trial, in which the patient is temporarily implanted with the device of electrodes, wires, and a pulse generator. A preset pattern of stimulation is tested through the generator to confirm if the system is effective for the patient. If effective, the permanent implantation is then carried out. The pulse generator that carries out the signals is implanted above the buttocks under the patient's skin.
Once the system is implanted, about 50 to 70% of patients experience a significant reduction in pain. Patients may enjoy an increased quality of life and more manageable daily activities.
What does it treat?
- Failed back surgery syndrome
- Neuropathy (disorders in which nerve damage have occurred)
- Regional pain syndrome (disease of the nervous system after injuries or surgery)
- Post-traumatic neuritis (nerve pain occurs after injuries or surgery)
Who are good candidates?
Ideal candidates for spinal cord stimulation may come from a variety of backgrounds and have a wide range of symptoms. Candidates should have exhausted all other recommended methods of pain treatment and experience one or more of the following symptoms:
- Chronic pain of varying strength in either the cervical area or lumbar area that is dull, deep, shooting, sharp, throbbing, radiating, or burning
- Weakness and/or numbness in the extremities
- Sciatica in the lower extremities that is felt in the buttocks, legs, calves, feet, and/or toes
- Trouble walking, standing straight, and/or sitting
- Pain that is felt for a majority of the day and impedes on daily activities
- Life that is constricted by chronic and sometimes constant pain
- History of one or more unsuccessful surgeries intended to relieve pain and/or heal a spinal condition
Patients should be optimistic towards improvement and also be free from depression or any other psychiatric ailments. Additionally, patients must not have a cardiac pacemaker, which can interfere with the stimulator.
What is the procedure like?
The procedure is split into two parts. The trial (first) stage takes just 10 to 20 minutes for completion, and the permanent implantation (second) takes 1 to 2 hours. Both stages are out-patient procedures that are carried out by the patient's surgeon.
The following are the general steps for the first stage of spinal cord stimulation:
- Local anesthetic is applied to the area where the device will be implanted.
- A hollow needle is inserted into the area between the vertebrae. The leads (electrodes) are inserted through the needle and positioned.
- The leads are attached to hand-held external dual generator and power supply. Stimulation will occur for a determined amount of time to see if the system will be successful and well-tolerated.
If the trial is successful, the second procedure will follow. The following are the general steps for the second stage of spinal cord stimulation:
- Local anesthetic is applied to the area where the device will be permanently implanted, and the area above the buttocks for the generator.
- A small incision is made in the affected area, exposing the vertebrae. A laminotomy is performed, in which a portion of the vertebrae is removed. This is so the leads can have room for implantation.
- The leads are properly placed above the spinal cord, and the surgeon will test the stimulation. After proper stimulation, the wires attaching the lead to the battery are placed under the skin.
- An incision is made above the buttocks so the battery can be implanted. The surgeon will then implant the generator and attach the wires to it.
- The surgeon will then close the incision with sutures and the procedure ends.