Procedure: Spinal Cord Stimulator
What is a Spinal Cord Stimulator?
A spinal cord stimulator (SCS) is a specialized device that stimulates the spinal cord and spinal nerves by tiny electrical impulses via a small electrical wire placed behind and just outside the spinal cord in the epidural space. The electrical wire or lead contains a series of four to eight evenly spaced elctrodes that can be programmed to generate an electrical field.
What is the purpose of a SCS?
A spinal cord stimulator generates a low level electric field to interrupt nerve conduction of pain signals to the brain.
Am I a candidate for a SCS?
Spinal cord stimulators are most often used for patients with chronic and severe neuropathic pain, who have not responded to other more conservative treatments. Neuropathic pain is pain due to damaged nerve tissues. Common examples include patients with post-laminectomy nerve damage, radiculopathy, diabetic neuropathy, and reflex sympathetic dystrophy.
What is the difference between a SCS trial and a SCS permanent implantation?
Typically, after patients have failed more conservative treatment options, consideration is given to a trial of spinal cord stimulation. Rather than putting an expensive device into a patient, a temporary SCS wire is placed in a patient for anywhere between several days to a week. This temporary wire gives the patient an opportunity to experience the SCS without having to undergo a full implantation. If this trial is successful in relieving pain, a permanent device can be placed under the skin at another date.
What determines if a SCS trial is successful?
Usually the patient who has had a successful trial notes a clear reduction in pain intensity along with an approved ability to function. Most patients who are not sure that the SCS trial has helped will not get a permanent SCS. Typically, the physician is looking for a significant increase in activity tolerance and/or a significant decrease in the need for pain medication or some combination of both.
How long does the SCS trial/permanent placement take?
Placement of a trial stimulator usually takes between 30 minutes to an hour. Placement of a permanent SCS wire and a subcutaneous pulse generator or battery takes from 45 minutes to two hours.
How is a SCS trial lean placement performed?
The patient is monitored with an EKG, blood pressure cuff and an oxygen-monitoring device. The procedure is performed under sterile conditions. In a SCS trial, temporary electrodes are placed and then the patient uses an external device to generate electrical current. The electrodes are placed under x-ray guidance with the patient lying on his belly. A local anesthetic is used to numb the skin and deeper tissues. An introducer needle is passed into the epidural space. The electrodes are inserted through the introducer needle. The position of the spinal cord stimulator electrodes is adjusted until stimulation covers as much of the painful area as possible. When this is accomplished, the introducer needle is removed and the temporary wire is secured to the skin with a small stitch and a large sticky bandage. Note that one or two wires may be placed, depending on the painful areas being treated.
Will the SCS placement hurt?
Due to the procedure involving inserting an introducer needle through skin and deeper tissues, there is some pain involved. Most patients also receive intravenous sedation that makes the procedure easier to tolerate.
Will I be “Put Out” for the SCS?
The placement of the trial electrodes is done under local anesthesia with patients mildly sedated. This is necessary to ensure proper placement of the wires. The amount of sedation given generally depends upon the patients tolerance. The patient is conscious although some will have enough amnesia that they may not remember parts of the procedure. In a permanent placement, once the wires or electrodes are in good position, the patient is often sedated more heavily to place the pulse generator or battery.
What should I expect after the SCS?
If the procedure is successful, the patient's pain may be gone or quite less. The patient will usually feel a constant sensation of stimulation, often described as warm or tingly. The patient may have soreness due to the needle placement for a day or two. Most patients with successful stimulation take less, not more, pain medication after the placement.
What should I do after the procedure?
This procedure is an outpatient procedure. The patient will need a driver in the building during the procedure. The patient should plan to take it easy for a day or so after the procedure. The patient can do most activities but is generally advised to avoid a lot of bending or twisting of the spine.
What are the risks and side effects of a SCS?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. Common side effects are bruising and soreness. Less common risks are short-term weakness or numbness, headache, bleeding or infection.
Who should not have a SCS?
Patients on a blood thinning medication, patients with an active infection going on, and patients with poorly controlled diabetes or heart disease should not have the procedure or at least consider postponing it if postponing would improve the overall medical condition.
Can a SCS be removed?
Yes. Even though Coastal Bend Pain Management often considers the placement permanent, the spinal cord stimulator wire or lead and battery can usually be removed with relative ease.