Spinal Cord Stimulation
Spinal Cord Stimulation
Spinal Cord Stimulation & Back Pain
A spinal cord stimulator is an implanted device that relieves pain by sending low doses of electricity directly to the spinal cord.
WHAT YOU SHOULD KNOW
When nonsurgical pain therapy approaches have failed to offer adequate relief, spinal cord stimulation is performed.
To test and implant a spinal cord stimulator, two operations are required: the trial and the implantation.
Spinal cord stimulation can improve the general quality of life and sleep while also lowering the need for painkillers. It’s usually used in conjunction with other pain-relieving medications.
Spinal cord stimulation may be an alternative treatment if other pain therapies have failed. Spinal cord stimulation is a method that uses low-level electrical signals to inhibit pain signals from reaching the brain by sending them to the spinal cord or specific nerves.
What is a spinal cord stimulator and how does it work?
Spinal cord stimulators are made up of thin wires (electrodes) and a compact battery pack that looks like a pacemaker (the generator). The electrodes are put in the epidural space, which is the region between the spinal cord and the vertebrae, and the generator is placed beneath the skin, usually towards the buttocks or abdomen. Patients using spinal cord stimulators can use a remote control to emit electrical impulses when they are in pain. The remote control, as well as its antenna, are located on the outside of the body.
Experts aren’t sure exactly how spinal cord stimulation work, but they do know that it can target several muscle groups directly from the spine and even change how the brain perceives pain.
Traditional spinal cord stimulators replace pain with a gentle tingling sensation known as paresthesia. For patients who are bothered by these paresthesias, modern gadgets provide “sub-perception” stimulation that is not felt.
Many of the latest devices are implanted under X-ray or ultrasound guidance by surgeons with advanced training in interventional pain management.
What is spinal cord stimulation used for?
When nonsurgical pain therapy approaches have failed to offer adequate relief, spinal cord stimulation is performed. Different types of chronic pain may be treated or managed with spinal cord stimulators, including:
- Back pain, particularly back pain that persists after surgery (failed back surgery syndrome)
- Pain after surgery
- Arachnoiditis (painful inflammation of the arachnoid, a thin membrane that covers the brain and spinal cord)
- Heart pain (angina) untreatable by other means
- Injuries to the spinal cord
- Nerve-related pain (such as severe diabetic neuropathy and cancer-related neuropathy from radiation, surgery or chemotherapy)
- Peripheral vascular disease
- Complex regional pain syndrome
- Pain after an amputation
- Visceral abdominal pain and perineal pain
Spinal cord stimulation can improve the general quality of life and sleep while also lowering the need for painkillers. It’s usually combined with other pain-relieving treatments like drugs, exercise, physical therapy, and relaxation techniques.
Who can get a spinal cord stimulator?
As with any treatment, your doctor will want to make sure that spinal cord stimulation is correct for you, and that it will likely provide significant pain relief. Your pain doctor will most likely conduct imaging testing and psychiatric assessment in order to make this referral. Some insurers need psychological testing to ensure that problems such as sadness or anxiety aren’t exacerbating your discomfort.
Although each patient is unique, those who benefit the most from spinal cord stimulation are those who:
- Have not had enough pain relief from drugs, non-invasive therapy, or previous surgeries?
- Have no psychiatric issues that would make the surgery less successful.
Spinal Cord Stimulator Types
There are three types of spinal cord stimulators:
- Conventional implantable pulse generator (IPG). This is a traditional spinal cord stimulator. During a procedure, a battery is implanted in the spine. When the battery dies, another surgery is required to replace it. Because of its reduced electrical output, this device may be a useful solution for persons who have discomfort in only one body part.
- Rechargeable IPG. These function similarly to traditional IPGs, with the exception that the battery can be recharged without the need for additional surgery. These simulators can produce more electricity because the energy source is rechargeable. Because the electrical signal may reach further, this may be a better option for persons who have discomfort in their lower back or one or both legs.
- Radiofrequency stimulator. This stimulator is powered by an external battery. Because of improved designs and technologies, this stimulator is rarely utilised nowadays. It includes rechargeable batteries, and because of the device’s power, it may be better for persons with lower back and leg pain than rechargeable IPGs.
Your surgeon will show you how to use the stimulator and modify the intensity of the electrical signal, which is supported by all three types. Different bodily positions may necessitate different stimulator settings, for example, one setting for sitting and another for walking. Most systems allow doctors to save two or three preset programmes to make it easier to retrieve the most often used settings. High frequency, burst, and high-density stimulation is among the waveforms used by some contemporary devices for electrical delivery.
Spinal Cord Stimulator Surgery
To test and implant a spinal cord stimulator, two operations are required: the trial and the implantation.
Spinal Cord Stimulator Trial. A trial period is an initial step. A temporary device will be implanted by your surgeon for you to try out. Your surgeon will carefully place the electrodes in the epidural area of the spine, guided by a sort of X-ray called fluoroscopy. The position of these electrodes along the spine is determined by the location of your pain. During the surgery, your surgeon may ask for your opinion in order to best position the electrodes.
The electrodes are usually placed through a single incision in your lower back during this trial operation. The generator/battery will be mounted on a belt that you will wear around your waist.
You’ll test how well the device relieves your discomfort for roughly a week. If you have a 50% or more reduction in pain, the study is deemed a success.
If the procedure is unsuccessful, the wires can be simply withdrawn in the clinic without causing any damage to the spinal cord or neurons. If the procedure is successful, the device will be implanted permanently.
Spinal Cord Stimulator Implantation. The generator is implanted beneath the skin, and the trial electrodes are replaced with sterile electrodes during the permanent implantation operation. These electrodes, unlike the trial electrodes, will be sutured to prevent mobility.
The operation usually takes around 1-2 hours and is done as an outpatient procedure.
Your surgeon will make one incision (usually along with your lower abdomen or buttocks) to hold the generator and another incision (along your spine) to install the permanent electrodes once the local anaesthetic has been provided. The incisions are around the size of a driver’s licence. Fluoroscopy is utilised to determine where the electrodes are implanted, just as it was in the trial process.
Your surgeon will close the incisions once the electrodes and generator are attached and working.
During the implantation of the electrodes, your surgeon may administer sedation to keep you comfortable and ask for your input.
To test an implanted spinal cord stimulator, two operations are required: the trial and the implantation.
Spinal Cord Stimulator Recovery
To test and implant a spinal cord stimulator, two operations are required: the trial and the implantation.
When the anaesthetic wears off, most patients are able to depart on the same day as their treatment. Your incisions may hurt for a few days following surgery. Stretching, twisting, or reaching may cause the incisions to strain. Dressings will be applied to the incision areas, which will be removed in 3 days. Incisions usually heal within 2-4 weeks after surgery in the majority of situations.
Your doctor will go over your rehabilitation plan with you, but for the first two weeks after surgery, light activity is encouraged.
You can return to work and drive once your surgeon has cleared you for regular exercise (with the stimulator turned off). It usually takes 1-2 weeks following surgery for this to happen.
Complications
To test and implant a spinal cord stimulator, two operations are required: the trial and the implantation.
Although spinal cord stimulator surgery has a low risk of complications, no procedure is without risk. A tiny fraction of patients may have the following symptoms:
- Infection can happen in the first two to eight weeks.
- Bleeding.
- The electrodes migrate from their initial place, and the stimulator no longer blocks pain as efficiently. This frequently necessitates a second procedure to reposition the electrodes.
- Damage to the device (e.g., a fall or intense physical activity breaks the stimulator).
- Puncture of the dura mater. The spinal cord is surrounded by the dura mater. The epidural space, which is just outside the dura mater, is where spinal cord stimulators are implanted. Cerebrospinal fluid may leak if a needle or electrode pierces it too deeply. These punctures might result in excruciating headaches.
- Trauma to the spinal cord. The insertion of a spinal cord stimulator can result in nerve damage and paralysis, albeit this is extremely rare.
Living with a Spinal Cord Stimulator
To test and implant a spinal cord stimulator, two operations are required: the trial and the implantation.
In general, spinal cord stimulators provide pain relief that allows patients to perform considerably more than they could before surgery, but there are some limitations to be aware of.
Can I have X-rays and CT scans with a spinal cord stimulator?
X-rays and CT scans are generally safe as long as your spinal cord stimulator is turned off. Always inform your doctor, nurse, or technician that you have a spinal cord stimulator before undergoing any scan.
Are spinal cord stimulators MRI compatible?
No, MRIs aren’t always safe for people who use spinal cord stimulators. Some newer devices are compatible with specific MRI machine models and scan sites, but your doctor will need to assess your stimulator’s details first. MRIs might cause serious harm if your gadget is not MRI compatible.
Before undergoing any operation, consult with your pain expert to determine whether it will interfere with or harm your stimulator model.
Will my spinal cord stimulator set off airport security?
Although airport security scanners will identify your stimulator, your doctor will provide you with an identification card that may allow you to skip the machine.
Some users report that airport security scanners interfere with their stimulators in an unsettling (but harmless) way. If you can’t avoid going through the security checkpoint, turn off your gadget before proceeding.
Can I drive with a spinal cord stimulator?
When driving or using heavy machinery, you should turn off your stimulator since rapid variations in stimulation levels can create attention.
Can a spinal cord stimulator be removed?
Yes, a spinal cord stimulator can be safely removed if you are unhappy with the level of pain relief it provides or if your device is infected or has a mechanical problem.
Learn more about removing a spinal cord stimulator.
Can I swim with a spinal cord stimulator?
With a permanent, implanted generator, you can swim, but you can’t get your temporary stimulator wet. During the trial time, you must refrain from taking baths or showers.