Spinal Cord Stimulator Implant
Definition- A Spinal Cord Stimulator system generates mild electrical pulses and sends them to your spinal cord via implanted leads that are attached to the generator, which is normally implanted just above the buttocks. The electrical pulses, when received by the spinal cord, replace the feeling of pain with a tingling or massaging sensation, thus reducing or eliminating the patient's pain. The patient is always in control. Patients can control the level of stimulation using any of the multiple custom programs that they set up with their physician. Patients can have a stimulation program for when they are working, standing, sitting, sleeping, etc., based on their levels of pain during these normal activities. Stimulation does not eliminate the source of pain, it simply interferes with the signal to the brain, and so the amount of pain relief varies for each person.
1) Implanting the stimulator is typically done using a local anesthetic and a sedative
2) Bone is removed (lamina) at the appropriate level, to facilitate placement of the spinal cord stimulator implant paddle electrodes (medtronic - mdt) behind the dura (covering of the spinal cord).
3) The spinal cord stimulator implant electrodes are now connected to a pulse generator (medtronic - mdt), and with the patient awake, stimulation is begun.
4) Now the patient can determine whether a certain pattern of firing of the implant electrodes successfully relieves his/her pain. Because of the design of the medtronic implant electrodes (medtronic - mdt), there are actually four contact points on each side, and this provides the ability to cover varying amounts of spinal cord within the area of stimulation.
5) Seen in the x ray (taken from a C arm fluoroscopy unit in the operating room), the two columns of four implant electrodes are seen overlying the L1 vertebral body (note: the lowest level in the thoracic spine (T12) has ribs coming off of it). One can determine, through the stimulator box, which electrode will be positive (+) and which will be negative (-) and accordingly, the amplitude and frequency of the pulses to the spinal cord stimulator implant (medtronic - mdt) can be set.
6) The leads are brought out through an incision several inches away from the open surgical site.
1) After implantation, the patient may feel moderate discomfort and swelling at the incision site for several days.
2) Scar tissue (fibrosis) developing around the electrode.
3) Pain gradually moving beyond the reach of the nerve stimulator.
4) Breakage of an electrode or hardware failure.
6) Leakage of spinal fluid.
8) Bladder problems.
9) Getting used to the stimulation, making it less effective.
1) Avoid these activities for 6 to 8 weeks to prevent movement of the leads:
a) Do not bend, twist, stretch, far-reaching, pulling, sudden movement or lift objects over 5 pounds
b) Do not raise arms above your head
c) Do not sleep on your stomach
d) do not climb too many stairs or sit for long periods of time
2) Do not drive for 2 to 4 weeks after surgery or until discussed with your surgeon.
3) Housework and yard-work are not permitted until the first follow-up office visit. This includes gardening, mowing, vacuuming, ironing, and loading/unloading the dishwasher, washer, or dryer.
4) Gradually return to your normal activities. Walking is encouraged; start with a short distance during the 1st two weeks and then gradually increase to 1 to 2 miles daily.
5) A physical therapy program may be recommended.
Prognosis- The outcomes of Spinal cord stimulation show good to excellent long-term relief in 40 to 70% of patients suffering from chronic pain. 24% of patients improved sufficiently to return to gainful employment or housework with stimulation alone or supplemented by occasional oral pain medication