Spinal Cord Stimulator Placement
Introduction
A spinal cord stimulator implant is a device that is implanted in the body to help manage chronic pain. The device works by sending electrical impulses to the spinal cord to replace or alter pain signals before they reach the brain. The spinal cord stimulator helps lower pain levels by 50% to 70% reducing the need for pain medications.
Indications
A Spinal cord stimulator may be an option if you have chronic pain in your back, leg or arm that has lasted at least 6 months and you have had not had optimal relief from surgery, pain medications, nerve blocks or physical therapy. A spinal cord stimulator may be used to treat pain due to conditions such as sciatica, complex regional pain syndrome, failed back surgery syndrome, peripheral vascular disease and multiple sclerosis.
Surgical procedure
The spinal cord stimulator device consists of a pulse generator similar to a pacemaker that produces electrical impulses with the help of a battery. The electrical signals pass through a lead wire and a system of electrodes to reach the spinal cord.
The level of stimulation by the pulse generator can be programmed according to the pattern and intensity of pain. Some devices respond to your body position to adjust stimulation levels. A handheld remote device is used to control settings. Pain may be replaced by a tingling sensation called paresthesia. For individuals who find it difficult to tolerate this sensation, the pulse generator can be set to a sub-paresthesia level.
Your doctor will first recommend a trial stimulation to evaluate if the treatment adequately relieves your pain. For this procedure, a local anesthetic is administered in the lower back. Under live X-ray imaging, a hollow needle is used to enter the epidural space between your spinal cord and vertebra. An electrode or lead is passed through the needle until it contacts a specific region of the spinal cord. The lead is connected to an external pulse generator worn on your belt. You are then sent home with instructions on how to control the stimulation settings to make treatment more effective. A log of your activities is kept including the level of stimulation necessary for pain relief at various times and paresthesia experienced, to provide your physician with valuable information. If you are happy with the results, your doctor will schedule the procedure to implant the stimulator.
The procedure involves implanting the leads at specific positions on the spinal cord and placing the pulse generator under the skin within the buttock, lower back or abdomen. You will lie face down for the procedure and areas on your back and buttocks are prepped and anesthetized to receive the implant. An incision is made in the middle of your back and part of the vertebral bone is removed to accommodate the leads. You will then be awoken to help your doctor determine the level of stimulation and the proper position of the leads to optimize pain relief. The lead wires are passed under the skin to reach the buttocks or abdomen where the pulse generator is implanted by making a pocket under the skin. The incisions are then closed and dressings applied. The pulse generator is programmed with the help of your feedback during surgery.
Post-operative care
Following the procedure, your doctor will prescribe medications to help ease any discomfort. Your doctor will give you instructions about how to care for your incisions and what activities you should avoid. Your doctor will advise you when you can go back to doing your usual activities. You will likely have some restrictions that are intended to allow your body to heal around the implanted system. You should always follow your doctor’s instructions during the recovery period.
If a non-rechargeable battery is used for the pulse generator, it may need to be replaced every 2-5 years. Spinal cord stimulators with chargeable batteries are usually charged daily and need replacement only once every 8-9 years.
Risks and Complications
As with any procedure, placement of a spinal cord stimulator may be associated with certain risks and complications including infection, bleeding, pain, cerebrospinal fluid leakage, shifting of components, battery failure, spinal cord injury and rarely paralysis.
Summary
A spinal cord stimulator implant procedure is recommended when chronic pain has affected your quality of life and the source of pain cannot be eliminated. Modern-day implants offer multiple programming options to optimize pain relief throughout the day and keep you active.
