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Spinal cord stimulation

Spinal cord stimulation uses low voltage stimulation of the spinal nerves to block the feeling of pain. It may be an option if you have long-term (chronic) back and leg pain and have not found relief through traditional methods. A small generator, implanted in your back or abdomen, transmits an electrical current to your spinal cord, resulting in a tingling sensation instead of pain. By interrupting the pain signal, the procedure has shown success in returning some people to an active lifestyle. This surgical procedure can help treat chronic pain caused by:

  • Failed back surgery syndrome: failure of one or more surgeries to control persistent leg pain (sciatica)
  • Reflex sympathetic dystrophy: a progressive disease of the nervous system in which patients feel constant chronic burning pain
  • Causalgia: a burning pain caused by peripherial nerve injury
  • Arachnoiditis: painful inflammation and scarring of the meninges (protective layers) of the spinal nerves

What is Spinal Cord Stimulation?

Spinal cord stimulation (also known as dorsal column stimulation) uses a device that is surgically placed under your skin to send mild electric shocks to your spinal cord. A small wire called a lead carries the shocks from a generator/battery implanted in your abdomen to the nerve fibers of the spinal cord causing pain. When turned on, the stimulation feels like a mild tingling. Your pain is reduced because the mild electrical shocks interrupt the pain signal to your brain.

Stimulation does not eliminate the source of pain, it simply interferes with the signal, 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. Stimulation does not work for everyone. The implant is removable and does not damage the spinal cord or nerves.

The Stimulation System

There are two types of stimulation systems: an internal pulse generator/battery or an external radiofrequency/transmitter. Both systems consist of:

  • A lead wire with a number of electrodes (4-16) that is implanted above the spinal cord to deliver electrical pulses
  • An extension that carries the electrical pulses from the power supply to the lead
  • A power supply that generates the electrical pulses
The internal battery system, which delivers low voltage, needs to be surgically replaced every 2 to 5 years depending on usage. If higher voltage or multi-lead therapy is needed for pain relief, an external radio-frequency (RF) system may be chosen. In an RF system, the pulse generator is implanted and the power source is worn on a belt with an antenna over the receiver. Our physician will be able to select the best type of system for you during the trial stimulation.

The transmitter stimulator has three parameters: frequency, pulse width, and pulse amplitude. Each of these can be repeatedly adjusted for best results. Once the amplitude, electrode pulse width, and frequency for your symptoms have been determined, you are sent home with instructions for regulating the stimulation program by controlling only the amplitude and the length of each stimulation period.

Usually one or two hours of stimulation, three to four times a day are enough to relieve pain for the remainder of the day. Your doctor may alter the pulse width, amplitude and frequencies on follow-up visits if necessary.

Am I a Candidate?

Before determining if spinal cord stimulation is an option, your condition will be thoroughly evaluated and assessed. NY Spine Medicine's doctor will want to review all previous treatments including medication, physical therapy, injections, and surgeries.

Patients selected for this procedure usually have had a disability for more than 12 months and have pain in their lower back and leg (sciatica). The typical candidate has had one or more failed spinal surgeries.

There are seven criteria that you must meet before you have the operation

  • Conservative therapies have failed.
  • The source of your pain has been verified by your doctor.
  • You would not benefit from additional surgery.
  • You are not seriously dependent on pain medication or other drugs.
  • You do not have psychological problems.
  • There are no medical conditions that would keep you from undergoing implantation.
  • A trial stimulation was successful.
If your pain is caused by a correctable condition, then this must be fixed first. Also, if you have a cardiac pacemaker, you cannot have a stimulator.

Stage 1. Trial Stimulation

Trial stimulation is very important to determine if the procedure will be successful. It will tell if stimulation is correct for the type, location, and severity of your pain. It will also evaluate the effectiveness of various stimulation settings of the device. The insertion of trial leads is performed under light sedation (see Step 2 below). The lead is then attached to an external generator/power supply (worn on a belt) and stimulation settings are programmed.

After the trial procedure, you will be sent home with instructions on how to use the trial stimulator and care for your incision site. Keep a written log of the stimulation settings during different activities and the level of pain relief. After 3-5 days, you will return to the doctor's office to discuss permanently implanting the generator/receiver or removing the trial leads.

Stage 2. Permanent Implantation

During the trial stimulation, your doctor gathered information about the number of electrodes needed and the type of stimulation that works best for you. You will either have an internal pulse generator system or an external radio-frequency (RF) system.

Results

The results of neurostimulation depend on strict patient selection, proper surgical technique, intra- and postoperative testing, and patient education. Neurostimulation does not cure the condition causing pain; it helps patients to tolerate pain.

What Are the Risks?

Research has shown that the stimulator does not damage the spinal cord or spinal nerves. However, as with any surgery, there are risks involved, including infection or complications of anesthesia. Depending on how often the stimulator is used, the battery will eventually need to be replaced every 2 to 5 years. The 9 volt batteries in the RF receiver should be replaced frequently.

Conditions for which you might need additional surgery include movement of the lead or failure of the device, although these possibilities are rare. Reasons for removal of the device include infection, failure to relieve pain, and patient misuse.

Living with a Stimulator

You control the time and duration of the stimulator with a handheld controller. Most patients turn the stimulator on during the day and off at night. Some patients turn it on at night in order to sleep. Everyone's pain is different. Do not use the stimulator while driving.

Just like a cardiac pacemaker, other devices such as cellular phones, pagers, microwaves, security doors, and anti theft sensors will not affect your stimulator.

Be sure to carry your implanted device identification card when flying, since the device is detected at airport security gates.

To avoid damage or adverse effects to your spinal cord stimulator, avoid the following medical procedures: MRI, defibrillator, electrocautery, diathermy, and cardiac pacemakers. Also, chiropractic manipulation may cause the lead to move. Consult your surgeon first.