Spinal Cord Stimulator
Spinal cord stimulator is an implanted device that can deliver low levels of electric signals directly into the spinal cord, which helps to relieve pain. Spinal cord stimulation is often used after nonsurgical pain treatment options fail to provide sufficient relief. Spinal cord stimulators require two procedures for testing as well as implanting the device, the trial and the implantation. It can help one to improve their overall quality of life and it also reduces the need to use any kind of pain medicines. It is typically used with other pain management treatments.
Purpose
Spinal cord stimulation is used if nonsurgical pain treatment options fail to provide enough relief. Spinal cord stimulators are used for treating or managing various types of chronic pain, which includes:
- Back pain, that continues even after surgery (failed back surgery syndrome)
- Post-surgical pain
- Heart pain (angina) untreatable by other means
- Arachnoiditis (painful inflammation of the arachnoid)
- Injuries to the spinal cord
- Peripheral vascular disease
- Nerve-related pain (which can include severe diabetic neuropathy and cancer-related neuropathy from radiation, surgery or chemotherapy)
- Complex regional pain syndrome
- Pain after an amputation
- Visceral abdominal pain and perineal pain
Spinal cord stimulation can help you improve your overall quality of life and sleep as well as reduce the need for pain medicines. It can be used along with other kinds of pain management treatments, which include medications, physical therapy, exercise and relaxation methods.
Spinal Cord Stimulator Types
Spinal cord stimulators can be of various types:
Conventional implantable pulse generator (IPG), a spinal cord stimulator which is operated by battery. During the operation, the batter is placed in the spine. When it runs out, the battery needs to be replaced with a different surgery. This device is usually a good choice for people who are experiencing pain in just one body part due to its lower electrical output.
Rechargeable IPG functions similarly to the conventional device. Its difference is that the battery can be recharged without the need for another surgery. As the energy source is rechargeable, these stimulators are able to put out more electricity. This option is better for people experiencing pain in the lower back or in one or both legs, as the signal can reach further.
Radiofrequency stimulator uses a battery located outside the body. Due to newer designs and better technology, this stimulator is used quite rarely today. It has rechargeable batteries and is similar to the rechargeable IPGs. It is a better option for people with pain in the lower back and legs due to the device’s power.
Your surgeon will be explaining how to operate the device as well as adjust the intensity of the electrical signal, which all three types of stimulators are able to support. Different stimulator settings are required for different body positions. One setting can work better for sitting and another one for walking.
In order to help you easily access the settings which are used mostly, most devices allow doctors to save two or three preset programs. Some newer devices feature several waveforms for electricity delivery, which includes high frequency, burst as well as high-density stimulation.
Procedure
The procedure for spinal cord stimulation requires two steps to test and implant the device: the trial and the implantation. It is usually performed on an outpatient basis.
Spinal Cord Stimulator Trial
The first step is considered a trial period. In this step, your surgeon will implant a temporary device which will be testing out. You will be guided by a particular kind of X-ray called fluoroscopy. Then your surgeon will carefully insert the electrodes in the epidural space of the spine. The location of your pain affects where these electrodes will be placed along the spine. Your surgeon may ask for your feedback during the procedure to position the electrodes in the most effective way.
This trial procedure usually requires just one incision in your lower back for placing the electrodes. The generator/battery will be outside your body, typically on a belt which you will be wearing around your waist.
For around a week, you will evaluate how well the device can reduce your pain. The trial can be considered a success if you experience at least a 50 percent reduction in your pain level.
However, if it is unsuccessful, the wires can be removed quite easily in the clinic without causing any damage to the spinal cord or nerves. If successful, then surgery will be scheduled to implant the device permanently.
Spinal Cord Stimulator Implantation
Next comes the permanent implantation procedure, where the generator will be placed underneath your skin and the trial electrodes will be replaced with sterile electrodes. Unlike the trial ones, these will need to be anchored by sutures so that their movement can be minimized.
Typically around 1-2 hours can be required for the implantation.
First local anesthesia will be administered, after which your surgeon will make one incision for holding the generator and another one for inserting the permanent electrodes. Fluoroscopy will also be used in order to determine where the electrodes need to be placed.
Once the generator and the electrodes are connected to and running, your surgeon will be closing the incisions.
Your surgeon might provide sedation so that you remain comfortable. He/she might also ask for your feedback during the placement of the electrodes.
Recovery
Once the anesthesia has worn off, most patients are able to leave the same day as their procedure. For several days after your surgery, your incisions can cause some pain. Dressings will be placed over your incision sites and they will remain for about 3 days. The incisions should heal within 15-30 days after the surgery.
Your doctor will next discuss your recovery plan with you and might recommend you lighter activity for around 2 weeks after the surgery.
After your surgeon approves you for any kind of regular activity, you will be able to return to work and drive again.
Risks and complications
Although rare, spinal cord stimulator surgery has few risks and complications. Few patients might experience any of the following:
- Bleeding
- Infection, which can occur in the first 15-60 days
- Device migration (i.e. the electrodes moving from their original location which can make the stimulator unable to block pain as effectively). This might require a follow-up surgery so that the electrodes can be put back in their proper spot.
- Device damage (e.g., sometimes, the stimulator can break due to a fall or intense physical activity).
- Dural puncture- The dura mater surrounds your spinal cord. Spinal cord stimulators are inserted in the epidural space, the area which is just outside your dura mater. If a needle or electrode goes too deep and pierces it, this can lead to cerebrospinal fluid leaking out. These punctures can lead to severe headaches.
- Spinal cord trauma- Although it is rare, spinal cord stimulator insertion can sometimes lead to nerve injury and sometimes even paralysis.
Before going through the operation, it is best to discuss with your doctor regarding the benefits and the risks of the procedure.