Spinal Cord Stimulator


Spinal Cord Stimulator

As an intervention for chronic back and/or leg pain, spinal cord stimulation can be an effective alternative or adjunct treatment to other therapies that have failed to manage pain on their own. Spinal cord stimulation (SCS) is a pain relief technique that delivers a low-voltage electrical current continuously to the spinal cord.  Pain signals are inhibited before they reach the brain and replaced with a tingling sensation (parasthesia) that covers the specific areas where the pain was felt.

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. Also, some 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 to perform your daily activities with less pain and reduces the amount of pain medication you take.



Conditions Treated by Spinal Cord Stimulation

Spinal cord stimulation can be used to treat patients with severe, chronic pain due to a variety of conditions, including failed back surgery/arachnoiditis, neuropathic pain/neuropathy and complex regional pain syndrome/reflex sympathetic dystrophy.

Benefits of Spinal Cord Stimulation

Unlike most surgical procedures, spinal cord stimulation therapy is reversible. If a person decides at any time to discontinue the therapy, the electrical contacts, wires, and generator can all be removed and there are no permanent changes to the spine. Other potential advantages of SCS include: Adjustable pain relief.

The Procedure

There are two parts to the procedure: placement of the lead in the epidural space of the spine and placement of the pulse generator in the buttock or abdomen. The surgery generally takes 1 to 2 hours.

Step 1: prepare the patient 
You will lie on your stomach on the table and be given light sedation. Next, the areas of your back and buttock are prepped where the leads and generator are to be placed. Local anesthetic will be used to numb the incisions.

Step 2: place the leads 
The electrode leads are inserted with the aid of fluoroscopy (a type of X-ray). A small skin incision is made in the middle of your back, and the bony vertebra is exposed.

A portion of the bony arch is removed (laminotomy) to allow room to place the leads. The leads are secured with sutures in the epidural space above the spinal cord.

Step 3: test stimulation
You will be awakened so that you can help the doctor determine how well the stimulation covers your pain pattern. Several stimulation settings will be tried, and you will be asked to describe the location of any tingling you feel. These settings will be used to program the pulse generator at the end of surgery, so your feedback is important to ensure the best pain relief.

In some cases, if the leads implanted during the trial are positioned perfectly, there is no need to reposition or insert new leads.

Step 4. tunnel the wire
Once the leads are in place, sedation is again given. The lead wire is passed under the skin from the spine to the buttock, where the generator will be implanted.

Step 5. place the pulse generator
A small skin incision is made below the waistline. The surgeon creates a pocket for the generator beneath the skin. The lead wire is attached to the pulse generator. The generator is then correctly positioned within the skin pocket.

Step 6. close the incisions 
The incisions are closed with sutures or staples and a dressing is applied.

Results

The results of SCS depend on careful patient selection, successful trial stimulation, proper surgical technique, and patient education. Stimulation does not cure the condition that is causing pain. Rather, it helps patients manage the pain. SCS is considered successful if pain is reduced by at least half.

Published studies of spinal cord stimulation show good to excellent long-term relief in 50 to 80% of patients suffering from 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.

More Information

If you have questions about spinal stenosis or the minimally invasive spine procedures offered by DISC of Louisiana, please contact us to schedule an evaluation at one of our clinics across the south Louisiana region.

DISC of Louisiana Locations

New Orleans | Hammond | Slidell | Covington | Metairie | Baton Rouge | Gonzales

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