Spinal cord stimulation (SCS) has been recognized as the most commonly used form of pain management treatment after nonsurgical treatments have failed for patients. This treatment has been used and studied for hundreds of years and made its debut in medical publications in the 1960s. SCS has a high success rate with 50%-80% of patients experiencing long-term relief. Neuropathic pain is often seen as a result of nerve damage or a malfunctioning nervous system. Spinal cord stimulators are able to directly interfere with the nerves that are sending pain signals resulting in patients’ pain relief.
There are two main types of spinal cord stimulators. Conventional implantable pulse generators (IPG) are battery operated. The battery is implanted in the spine during the procedure, however, once the battery dies, it needs to be replaced with another surgery. This may be recommended for patients with pain in just one specific body part as this type of stimulator has a lower electrical output.
Rechargeable IPG is almost identical to the conventional IPG except for it being rechargeable. The battery is able to recharge meaning the patient does not have to undergo a second surgery to replace the battery. These simulators also have the ability for a higher electrical output.
There are two steps to a spinal cord stimulation procedure. The first step is the trial. During this outpatient procedure, the surgeon will make an incision in the lower back and use an imaging tool called fluoroscopy to insert electrodes. Electrodes are the thin wires that will output the electrical pulses that prevent pain. The location of the patient’s pain will determine exactly where these electrodes are placed, but they are always placed in the spaces between the vertebrae and the spinal cord known as the epidural space. The generator portion will not be implanted at this time but worn on the outside of the body, typically on a belt.
Patients are able to manage their pain by sending electrical impulses through the electrodes with a small hand-held remote. These electrical impulses stop pain signals from being sent from the spine to the brain. If after one week the patient’s pain is reduced by 50% or more they will likely be able to move forward with a permanent SCS implantation.
The permanent procedure is very similar to the trial. The trial electrodes will be replaced with new, sterilized electrodes. These new electrodes will be secured in place with sutures to minimize the chance of them moving. The generator will be implanted just under the skin. All the technology will operate in the same manner, this time, it’s just permanent. The procedure is outpatient and typically lasts 1-2 hours. Patients are under local anesthesia and mild sedation so that they are comfortable during the surgery but able to provide feedback to ensure the leads are placed in the best possible area to provide long-term comfort.
As this is an outpatient procedure, patients can go home the same day. The incision sites may be sore for a few days. Dressings will be placed over the incision sites and can be removed after three days. The incision sites typically heal within 2-4 weeks. For the two weeks immediately following the procedure patients are encouraged to keep activity light. Patients are typically cleared to resume normal activities such as work and driving within 1-2 weeks post-op.
As with any surgery, there are risks such as infection, bleeding, or device damage, however, these are rare outcomes. Patients typically experience long-term pain minimization or relief and are able to achieve a much higher quality of life with SCS treatment.
Sources:
Hopkins Medicine: Treating Pain with Spinal Cord Stimulators
