Spinal Cord Stimulation
What is Spinal Cord Stimulation as a Treatment for Pain?
The use of spinal cord stimulation (SCS) for pain has a long history. With time, the equipment has gotten better and the treatment has become more effective. Spinal cord stimulation is used extensively by the armed forces for war injuries. A spinal cord stimulator is a device that has two parts. One part is the leads that are placed in the epidural space, which is the space where medication is placed with an epidural injection. The second part is the battery and waveform generator. The battery has to be replaced every seven to ten years. The leads stay in until removed.
What is the Purpose of Spinal Cord Stimulation?
This is an effective method of pain control for both back and leg pain of any origin. It is used for back pain without leg pain, leg pain of any cause without back pain, or in patients with both.
Are you a Candidate?
Any patient with back or leg pain of any cause is a candidate. It is used when other procedures have failed or medication is not effective in relieving pain.
How is the Procedure Performed?
There are two phases in treating pain with spinal cord stimulation. The first is a trial period of one week where the leads are implanted on a temporary basis, but the battery is not. The patient has wires coming out of the skin that are attached to a trial simulator, which functions like the implanted battery. The patient can increase or decrease the stimulation, change programs, or even turn it off if it is bothersome for certain activities. After the one-week trial, the stimulator leads are removed. If the patient gets good results, a permanent stimulator is scheduled for implant.
The leads are placed using a needle under x-ray guidance, so you will be required to lie face down during the procedure.
All insurance companies require a psychological evaluation before they will authorize the trial. This is to be sure there are no psychological problems that are severe enough to prevent the patient form getting relief from the stimulator.
Will the Procedure be Painful?
There is not much pain associated with the trial. When the permanent stimulator is implanted, there is some pain, but usually intravenous sedation is used.
What are the Risks and Side Effects?
There are no side effects of spinal cord stimulation. Some patients do not tolerate the stimulation from some stimulator companies. Bleeding and infection are possible whenever a needle goes through the skin. The patient is given antibiotics to reduce the risk of infection. It is possible for the needle to pierce the lining that keeps the spinal fluid in place. This results in a spinal fluid leak, but it is rare and can be treated.
How Long Does it Take for the Procedure to Work?
The pain relief occurs the same day or the next day after the procedure.
What Restrictions Will I Have on the Day of the Procedure?
You will be asked not to do excessive bending or twisting. The dressing during the trial must be kept dry.