Spinal cord stimulation is a therapy that covers pain signals before they enter the brain. A small device is implanted in the body to send electrical pulses to the spinal cord. It helps patients manage their symptoms of chronic pain and decrease the use of opioid medications.
What is a spinal cord stimulator?
A spinal cord stimulator (SCS) device is surgically implanted under your skin and sends 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. When turned on, the SCS stimulates the nerves in the area affected. Pain is decreased because the electrical pulses replace and cover the pain signal from reaching your brain.
Who is a candidate?
An in-depth assessment of your physical condition, past medications, and pain history will determine whether you are a candidate for SCS. A neurosurgeon, physiatrist, or pain management specialist is the person who is responsible for reviewing all previous treatments and surgeries of the patient. Because chronic pain can also affect you emotionally, a psychologist will assess your condition to maximize the probability of a successful outcome.
Patients that are chosen for SCS usually have had chronic disabling pain for more than 3 months in the lower back, leg, or arm. They may also have had one or more spinal surgeries.
You must have these following reasons to be a candidate for SCS:
- Conservative therapies have failed.
- The pain is caused by a correctable problem and should be fixed.
- You do not want further surgery because of the risks or long recovery. Sometimes SCS may be chosen over a large, complex spine surgery.
- You do not have untreated depression or drug addiction; these should be treated prior to having an SCS.
- You have no medical conditions that would keep you from undergoing implantation.
- You have had a successful SCS trial.
- SCS works better in the earlier stages of a chronic condition before a cycle of pain-suffering-disability-pain is established.
An SCS can aid in reducing chronic pain caused by
- Severe leg or arm pain: ongoing, persistent pain caused by arthritis, spinal stenosis, or by nerve damage.
- Unsuccessful back surgery syndrome: failure of one or more surgeries to relieve persistent arm or leg pain
- Complex regional pain syndrome: a continuous disease in which patients feel constant, severe burning pain, usually in the foot or hand.
- Arachnoiditis: painful inflammation and scarring of the protective lining of the spinal nerves
What happens before surgery?
You may set an appointment for presurgical tests such as blood test several days before surgery. In the doctor's office, you will sign consent and other forms so that the surgeon knows your medical history like allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries. You should let your surgeon know all the medications that you’re taking.
Stop taking non-steroidal anti-inflammatory medicines such as Naprosyn, Advil, Motrin, Nuprin, Aleve and blood thinners like Coumadin, and Plavix usually 1 to 2 weeks prior to surgery as directed by the physician. You should also stop smoking, chewing tobacco, and drinking alcohol 1 week before and 2 weeks after surgery because these vices can cause bleeding problems. You should also fast from food or drink past midnight the night before surgery.
Morning of surgery
- Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
- Wear shoes with no heel and they are closed backs.
- If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
- Remove makeup, hairpins, contacts, body piercings, nail polish
- Leave all valuables and jewelry at home. Jewelry is strictly not allowed.
- Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
- Bring a list of allergies to medication or foods.
- Arrive at the hospital 2 hours prior to your scheduled surgery time.
What happens after surgery?
You will wake up in the recovery area. Your vital signs such as your blood pressure, heart rate, and respiration will be monitored, and your pain will be addressed. Most patients are discharged on the same day or the next morning. The pulse generator will be programmed before you leave. You will be given written instructions to follow at home.
Approximately 10 days after surgery you will visit your doctor to have the sutures or staples removed. Make sure to work with your doctor to adjust your medications and refine the programming of the stimulator.
Your pain specialist and device representative will work with you to fine-tune adjustments to the SCS.
What are the results?
The results of SCS depend on careful patient selection, successful trial stimulation, proper surgical technique, and patient education. Stimulation manages the pain instead of eradicating it. SCS is considered successful if pain is reduced by at 50%.
Published studies of spinal cord stimulation show good to excellent long-term relief in 50 to 80% of patients suffering from severe chronic pain. One study reports that 24% of patients improved sufficiently to return to gainful employment or housework with stimulation alone or with the addition of occasional oral pain medication.
SCS therapy is reversible. If a patient decides at any time to discontinue, the electrode wires and generator can all be removed.