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Spinal Cord stimulator Implant
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Spinal cord stimulation uses low voltage stimulation to the spinal nerves to block the pain. It helps a patient to better manage pain and potentially decrease the amount of pain medication. It can also be considered an option if the patient has have chronic leg or arm pain but have not found relief with conservative methods. A small battery-operated generator implanted in the body transmits an electrical current to the spinal cord. The result is a tingling sensation instead of pain. By interrupting pain signals, the procedure has succeeded in returning some people to a more active lifestyle.
What is a spinal cord stimulator?
A spinal cord stimulator (SCS) is a device, surgically placed under the skin to send a mild electric current to the spinal cord. A small wire transmits the current from a pulse generator to the nerve fibers of the spinal cord. When started, the stimulation feels like a tingling in the area where pain is felt. The pain is reduced because the electrical current flow interrupts the pain signal from reaching the brain. Stimulation does not eliminate the source of pain, but simply interferes with the signal, and so the amount of pain relief varies for each person. Also, certain patients find the tingling sensation unpleasant. For these reasons, a trial stimulation is performed before the device is permanently implanted. The goal for spinal cord stimulation is a 50-70% reduction in pain. However, even a small amount of pain reduction can be significant if it helps you one perform daily activities with less pain and reduces the intake of pain medication. Stimulation does not work for everyone. If unsuccessful, the implant can be removed and does not damage the spinal cord or nerves.
There are many types of stimulation systems. A SCS system consists of:
- An implantable pulse generator with battery that produces electrical pulses.
- A lead with a number of electrodes to deliver electrical pulses to the spinal cord.
- An extension wire that connects the pulse generator to the lead.
- A hand-held remote control that turns the pulse generator on and off and adjusts the pulses.
The battery inside the pulse generator delivers low voltage and needs to be surgically replaced every 2 to 5 years if it is a standard battery. Rechargeable battery systems may last up to 10 years, depending on usage. Your doctor will select the best type of system for you during the trial stimulation.
Who is a candidate for SCS surgery?
Before concluding if spinal cord stimulation (SCS) is an option, the patient’s condition will be thoroughly evaluated and assessed. A detailed evaluation of pain history will determine if goals of pain management are appropriate to proceed with treatment. Because pain also has psychological effects, a psychologist may assess the condition to increase the probability of a successful outcome. A neurosurgeon, pain specialist, or physiatrist will evaluate current medication regime and physical condition. The doctor will want to review all previous treatments including medication, physical therapy, injections, and surgeries. Patients selected for the procedure are usually suffering from a disability for more than 12 months and have pain in their lower back and leg.
A person may be considered a candidate for the surgery if, he has undergone conservative therapies but has not got better, source of pain has been verified, would not benefit from additional surgery, is not seriously dependent on pain medication or other drugs, does not have depression or other psychiatric conditions that contribute to pain, has no medical conditions to keep him from undergoing implantation, has had a successful trial stimulation.
Neurosurgeons and doctors specialized in pain management and spine disorders implant spinal cord stimulators perform the operation.
Determining whether a spinal cord stimulator will be a good pain management option is a complex process. Before a permanent stimulator can be implanted, the patient has to undergo a trial to see if the device decreases level of pain. The surgery is performed on an outpatient basis in two stages: Stage 1 is a trial and Stage 2 is permanent implantation of the device.
Stage 1- Trial stimulation
It is very important to determine if the procedure will be successful. It tells if stimulation is correct for the type, location, and severity of pain. It also evaluates the effectiveness of various stimulation settings. The insertion of a trial lead is typically performed under a local anesthetic. A hollow needle is inserted through the skin into the epidural space between the bony vertebra and the spinal cord using fluoroscopy. The lead is properly positioned and then attached to an external generator and power supply (worn on a belt).
After the trial procedure, the patient will be sent home with instructions on how to use the trial stimulator and care for incision site. Keep a written log of the stimulation settings during different activities and the level of pain relief. After 3 to 5 days, the patient will return to the doctor’s office to discuss permanently implanting the stimulator or removing the trial leads.
Stage 2. Permanent implantation
If the trial is successful and the patient experienced a greater than 50% improvement in pain, he/she can be scheduled for surgery. During the trial stimulation, your doctor gathered information about the number of electrodes needed and the type of stimulation that works best.
What happens before surgery?
The patient may be scheduled for pre-surgical tests like blood test, electrocardiogram, chest X-ray etc, several days before the surgery. In the doctor’s office, he will sign consent and other forms so that the surgeon knows medical history. The patient should discuss all medications with the healthcare provider. Stop taking all non-steroidal anti-inflammatory medicines and blood thinners 1 to 2 weeks before surgery as directed by the doctor. Stop smoking, chewing tobacco, and drinking alcohol a week before and 2 weeks after the surgery, because these activities can cause bleeding. No food or drink is permitted past midnight the night before surgery.
What is the outcome?
The results of spinal cord stimulation depend on strict patient selection, proper surgical technique, intra- and postoperative testing, and patient education. Stimulation does not cure the condition causing pain; it helps patients to tolerate pain. Recent results of spinal cord stimulation show good to excellent long-term relief in 40 to 70% of patients suffering from chronic pain.