Spinal Cord Stimulator Implant

BackPainChronic pain is long-standing pain that lingers beyond the typical recovery period or that is associated with a musculoskeletal or neurological condition. This pain interferes with working, eating, participating with usual activities, and quality of life. The spinal cord stimulator (SCS) is a device that delivers a low-voltage electrical current to the spinal cord on a continuous basis, which effectively blocks the sensation of pain. Worldwide, approximately 50,000 neurostimulators are implanted each year.

What are the types of SCS devices?

There are three types of SCS devices. These include:

  • Conventional systems – Require little effort for maintenance. A minor surgical procedure is necessary to periodically replace the power source.
  • Radiofrequency systems – Designed to sustain therapy for long periods of time with the highest output level, this system involves an external power source. This system is best for patients with complex pain that involves more than one extremity.
  • Rechargeable systems – With this system, the patient recharges the power source when it gets low. This system usually last longer than a conventional system.

What conditions are treated with spinal cord stimulation?

  • Failed back surgery syndrome (FBSS)
  • Arachnoiditis
  • Neuropathy, neuritis, or nerve damage
  • Complex regional pain syndrome (CRPS)

Who is a candidate for a SCS?                      

Patients considered for spinal cord stimulation must meet the following criteria:

  • Poor response to conservative treatment for at least six months
  • Pain is not associated with cancer
  • Revision surgery is not an option (as with some back procedures)Spinal Cord Stimulator3
  • The patient has no pacemaker or medical contraindications
  • The patient has no major psychiatric disorders

How is the SCS implantation procedure performed?

SCS implantation is a reversible procedure, but it is often referred to as a permanent treatment. However, the treatment can be discontinued at any time. You will be sedated with general anesthesia, and the surgeon will make a small incision in the back. The leads are surgical inserted in the epidural space above the spinal cord, but the precise location of the leads depends on your condition or site of pain. The generator is usually positioned in the abdomen or buttock region through a small incision. After the placement of the device and leads, the incisions are closed, and a dry, sterile dressing is applied.

What can I expect after the SCS implantation procedure?

After the spinal cord stimulator is implanted, you should avoid lifting, stretching, bending, or twisting, but light exercise (walking) is permitted to help build strength and relieve pain. There will be some soreness at the surgical incision areas, as they heal. Most patient report that they cannot feel the device under the skin.

What risks are associated with the SCS implantation procedure?

As with any surgery, there are a few risks associated with the SCS implantation, such as allergic reaction, infection, spinal fluid leakage, bleeding, headache, and worsened pain. Specific risks include stimulation that affects the wrong location, overstimulation, damaged leads that require removal or repositioning, poor system connection, stimulation stops or only works intermittently, and the device interacts with other devices or tests.

What precautions are related to spinal cord stimulation procedure and device?

  • You should not use heavy equipment or drive when the SCS is activated.

    spinal cord stimulator paddle

    spinal cord stimulator paddle

  • The device may set off a metal detector, so carry with you the special identification that certifies you have a SCS system.
  • The SCS magnet may damage certain items or erase magnetic strip information on credit cards, computer disks, and audio/videocassettes.
  • Anti-theft devices in stores can increase stimulation temporarily when you walk through, so be sure to turn off the stimulator before passing by these units.
  • Certain equipment and technology can damage or cause adverse effects to the SCS device, such as MRIs, defibrillators, ultrasound units, diathermy, and cardiac pacemakers.

Does spinal cord stimulation work?

Several clinical studies show the effectiveness of spinal cord stimulation for reduction of pain and improvement of functional status.

  • Study #1 – Because little was known about the role of SCS in managing chronic spinal cord pain that involved the cervical dermatones and the cervicomedullary junction (CMH), researchers conducted a clinical study of 121 patients who used at least one trial of SCS. The scientists found that SCS was safe and effective for treating pain of the upper extremities and head regions.
  • Study #2 – In a study to assess the efficacy of SCS against the leg pain associated with lumbar spinal stenosis (LSS), researchers studied 91 patients who had a SCS trial. Almost two-thirds of the participants experienced a 50% or greater pain relief response, and 95% reported “good” response.
  • Study #3 – The cost-effectiveness of rechargeable implanted SCS was investigatedin 2008 in the U.K. Researchers found that for select patients with FBSS, SCS was cost-effective when used as an adjunct to conventional medicine or as an alternative to another surgery.

Resources

Chivukula, S, Tempel, ZJ, Weiner, GM, et al. (2014). Cervical and cervicomedullary spinal cord stimulation for chronic pain: Efficacy and outcomes. Clinical Neurology Neurosurgeon, 127, 33-41. doi: 10.1016/j.clineuro.2014.09.023. Epub 2014 Oct 2.

Kaminhara, M, Nakano, S, Fukunaga, T, et al. (2014). Spinal cord stimulation for treatment of leg pain associated with lumbar spinal stenosis. Neuromodulation, 17(4), 340-344. doi: 10.1111/ner.12092. Epub 2013 Aug 6.

Taylor, RS, Ryan, J, O’Donnel, R., et al. (2010). The cost-effectiveness of spinal cord stimulation in the treatment of failed back surgery syndrome. Clinical Journal of Pain, 26(6), 463-469. doi: 10.1097/AJP.0b013e3181daccec.