SPINAL CORD STIMULATION
Spinal cord stimulation (SCS) is a relatively new technology that can help manage chronic pain when the cause cannot be removed or the injury cannot be repaired. A spinal cord stimulator is an implanted device that sends low levels of electricity directly into the spinal cord to relieve pain. Spinal cord stimulation is the most commonly used treatment (after non-surgical management) for the treatment of pain. Spinal cord stimulation can improve overall quality of life and sleep, and reduce the need for pain medicines.
Dr. Ammar Anwer uses electrical pulses delivered to the spinal cord by a tiny device that looks like a pacemaker. It aids in the management of chronic pain and the reduction of the usage of opioid drugs. If you have persistent back, leg, or arm pain and have tried everything else and still haven’t found relief, it could be worth a try.
- Back pain, especially back pain that continues even after surgery (failed back surgery syndrome)
- Post-surgical pain
- 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 (phantom limb syndrome)
- Visceral abdominal pain and perineal pain
Spinal cord stimulation can improve overall quality of life and sleep, and reduce the need for pain medicines. It is typically used along with other pain management treatments, including medications, exercise, physical therapy and relaxation methods.
Procedure:
The device consists of a stimulating wire or “electrode” or connected to control unit or “generator.” By placing a stimulating electrode over the spinal cord, the pain signal cannot be sent up from the spine to the brain. After a patient has been evaluated and non-surgical treatments have been used, spinal cord stimulation is considered to help manage chronic pain. A patient will often undergo mental health testing and counseling so they understand how an implanted device will be managed. A trial is done by placing one or two wires into the space outside the spinal cord and controlling them from a unit outside of the patient’s body. This is usually kept in place for about a week and the patient is able to test how well stimulation through the wire helps their pain. The stimulation is a very mild electrical pulse that the patient usually does not feel. These electrical pulses mask the pain signal and can be adjusted over the course of the trial to get the greatest improvement in pain. Trials are considered successful if they can remove half of a patient’s pain.
A successful trial is then followed by surgery to place a permanent stimulator. This is usually done by making a small cut in the back and another near the waist. A small, flat electrode or wire is placed through the incision on the back to the space behind the spinal cord. The wire is then tunneled under the skin to the incision near the waist where it is connected to a small battery powered generator. The generator is placed under the skin at the waist incision. The system is tested and if all is found to be working properly, the incisions are closed and the surgery is finished. The stimulator is controlled with a small hand-held remote, which can be used to make adjustments as needed. Some generators’ batteries need to be recharged every few days and some don’t need to be recharged at all. Those that are not rechargeable usually need to be replaced about every 3-5 years while rechargeable batteries can last for more than 10-15 years.
Complications:
- Unwanted stimulation changes (perhaps due to cellular changes in the tissue around the electrodes, changes in electrode location, weak electrical connections, and/or lead failure)
- Epidural bleeding
- Hematoma,
- Infection,
- Spinal cord compression,
- Failure of the battery and/or battery leaking
- A leak of cerebrospinal fluid
- Pain at the electrode or stimulator location
- Allergy to implant materials