Spinal Cord Stimulator

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A spinal cord stimulator is an implanted device that sends low levels of electricity directly into the spinal cord to relieve pain. Spinal cord stimulators comprise thin wires (the electrodes) and a small, pacemaker-like battery pack (the generator). We place the electrodes between the spinal cord and the vertebrae (the epidural space) and we place the generator under the skin, usually near the buttocks or abdomen. Spinal cord stimulators allow patients to send the electrical impulses using a remote control when they feel pain. Both the remote control and its antenna are outside the body.

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How do Spinal Cord Stimulators Work

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SCS may sound complicated, but it’s actually pretty simple. Spinal cord stimulators consist of thin wires (the electrodes) and a small, pacemaker-like battery pack (the generator). The electrodes are placed between the spinal cord and the vertebrae (the epidural space), and the generator is placed under the skin, usually near the buttocks or abdomen. Spinal cord stimulators allow patients to send electrical impulses using a remote control when they feel pain. Both the remote control and its antenna are outside the body.

A remote control allows you to turn stimulation on and off, increase and decrease the level of stimulation, and target different pain areas in your body using settings or programs designed specifically for you. This stimulation does not get rid of what’s causing the pain. It changes the way the brain perceives it. SCS therapy may use a gentle tingling or fluttering sensation to replace the pain. Other forms of SCS therapy don’t cause any sensation at all. The amount of pain relief you feel is different for everyone, but the therapy is considered successful if it reduces your pain by at least 50%.

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Why Get A Spinal Cord Stimulator

 

Spinal cord stimulation is used most often after nonsurgical pain treatment options have failed to provide sufficient relief. Spinal cord stimulation can improve the overall quality of life and sleep, and reduce the need for pain medicines. It is typically used along with other pain management treatments, including medications, exercise, physical therapy, and relaxation methods. Spinal cord stimulators may be used to treat or manage different types of chronic pain, including:

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• Back pain, especially back pain that continues even after surgery (failed back surgery syndrome)

• Post-surgical pain

• Injuries to the spinal cord

• Nerve-related pain (such as severe diabetic neuropathy and cancer-related neuropathy from radiation, surgery, or chemotherapy)

• Peripheral vascular disease

• Complex regional pain syndrome

• Pain after an amputation 

• Visceral abdominal pain and perineal pain

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When to Get A Spinal Cord Stimulator

 

As with all treatments, your doctor will want to make sure spinal cord stimulation is right for you ⁠— and that it is likely to provide significant relief from your chronic pain. To make this recommendation, your pain specialist will likely order imaging tests and psychological screening. Some insurance companies require psychological screening to ensure disorders like depression or anxiety aren’t worsening your pain.

 

Each patient is different, but generally, people who benefit the most from spinal cord stimulation are those who: (1) have not experienced sufficient pain relief with medications, less-invasive therapies, or prior surgeries and (2) do not have psychiatric disorders that would decrease the effectiveness of the procedure.

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Spinal Cord Stimulator Surgery Information

 

Spinal cord stimulators require two procedures to test and implant the device: the trial and the implantation.

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Spinal Cord Stimulator Trial

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The first step is a trial period. Your surgeon will implant a temporary device for you to test out. Guided by a specific type of X-ray called fluoroscopy, 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 best position the electrodes.

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This trial procedure typically requires only one incision in your lower back to place the electrodes. The generator/battery will be outside the body, typically on a belt, you’ll wear around your waist. For about a week, you will evaluate how well the device reduces your pain. The trial is considered a success if you experience a 50% or greater reduction in pain level.

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If unsuccessful, the wires can easily be removed in the clinic without damage to the spinal cord or nerves. If successful, surgery is scheduled to permanently implant the device.

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Spinal Cord Stimulator Implantation

 

During the permanent implantation procedure, the generator is placed underneath the skin and the trial electrodes are replaced with sterile electrodes. Unlike the trial electrodes, these will be anchored by sutures to minimize movement.

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The implantation can take about 1-2 hours and is typically performed as an outpatient procedure.

After the local anesthesia has been administered, your surgeon will make one incision (typically along your lower abdomen or buttocks) to hold the generator and another incision (along your spine) to insert the permanent electrodes. The incisions are about the length of a driver’s license. As in the trial procedure, fluoroscopy is used to determine where the electrodes are placed.

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Once the electrodes and generator are connected and running, your surgeon will close the incisions.

Your surgeon may provide sedation to keep you comfortable and ask for your feedback during the placement of the electrodes.

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Recovery

 

Most patients leave the same day as their procedure — once the anesthesia has worn off. For several days after surgery, your incisions may be painful. Try not to stretch, twist or reach, which could pull at the incisions. Dressings will be placed over the incision sites, which can be removed after about 3 days. In most cases, incisions heal within about 2-4 weeks after surgery. Your doctor will discuss your recovery plan, but generally lighter activity is recommended for about 2 weeks after surgery.

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Once your surgeon approves you for regular activity, you can return to work and drive again (with the stimulator turned off). This is typically 1-2 weeks after surgery.

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Possible Complications

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Complications of spinal cord stimulator surgery are rare, but no procedure is without risk. A small percentage of patients may experience:

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• Infection, which may occur in the first 2-8 weeks.

• Bleeding.

• Device migration (i.e., the electrodes move from their original location and the stimulator doesn’t block pain as effectively). This often requires a follow-up surgery to put the electrodes back in the proper spot.

• Device damage (e.g., a fall or intense physical activity breaks the stimulator).

• Dural puncture. The dura mater surrounds the spinal cord. Spinal cord stimulators are inserted in the epidural space, the area just outside the dura mater. If a needle or electrode goes too deep and pierces it, cerebrospinal fluid may leak out. These punctures can cause severe headaches.

• Spinal cord trauma. Although extremely rare, spinal cord stimulator insertion can cause nerve injury and paralysis.

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Spinal Cord Stimulator Removal

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Yes, a spinal cord stimulator can be removed safely if you are unsatisfied with the level of pain relief it provides or if there is an infection or mechanical problem with your system.