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Spinal Cord Stimulators

 

What is a spinal cord stimulator?

A spinal cord stimulator is a medical device that can be inserted into the epidural space surrounding the spine. This device comes in several different types and can be an alternative to other forms of treatment, such as steroid injections.

Who needs a spinal cord stimulator?

Chronic pain can happen for many reasons, such as:

  • Back pain
  • Post-surgical pain
  • Arachnoiditis
  • Injuries to the spinal cord
  • Complex regional pain syndrome
  • Diabetes-related neuropathy and other nerve-related pain
  • Pain after an amputation

Before initiating spinal cord stimulation, your provider may have you try alternative forms of treatment, like physical therapy or medication injections. If those don’t work, SCS may be the solution. Before undergoing this procedure, you will undergo lab, imaging, and diagnostic tests to ensure you are healthy for surgery and rule out any circumstances that may prevent you from having this procedure.

You will also need to see several healthcare providers and specialists before undergoing this surgery. With The Iowa Clinic coordinated care – this can be done easily.

  • Neurologist – these providers often diagnose the pain-related condition that causes you to need SCS.
  • Pain Management Specialist – will determine if less-invasive treatments haven’t treated the problem, and whether you are ready to have this procedure.
  • Neurosurgeon – this provider can do the surgery to implant the spinal cord stimulator.
  • Psychiatrist/Psychologist – Chronic pain can influence anyone’s mental health. Some mental health conditions reduce the odds that spinal cord stimulation will work in the long run, so diagnosing and treating these conditions is important.

What should I expect during a spinal cord stimulator?

Spinal cord stimulator implantation is a process that usually involves two procedures.

Trial Procedure

The first is a “trial” procedure. In the trial period, your surgeon will implant a temporary device for you to test out. Guided by a specific type of x-ray, your surgeon will carefully insert the electrodes in the epidural space of the spine. Once the leads are in place, your provider will secure the device, program the device, and start testing to see whether the stimulator works without having to do a full surgery.

This trial will typically last between a few days to a few weeks. Experts consider a stimulator trial test successful if you have at least 50% decrease in pain level. If the trial is successful, you will undergo the next step, implantation surgery, about a week or two after the trial procedure.

Implantation Procedure

During the implantation procedure, your provider will start with an incision over your spine, creating the space for the electrode to pass through. The generator device is placed beneath the skin and thread the near end of the lead to where a pulse generator will be placed.

Being able to reach the skin over the top of the pulse generator is important, depending on which type of generator you have implanted:

  • Conventional implantable pulse generator – battery-operated spinal cord stimulator. A batter is placed in the spine during the operation and must be replaced with another surgery when it runs out.
  • Rechargeable implantable pulse generator – battery-operated spinal cord stimulator that can be recharged without another surgery. This may be a better choice for those with pain in the lower back or one or both legs.
  • Radiofrequency stimulator – battery-operated from outside the body.

Once the electrodes and generator are connected and running, your surgeon will close the incisions. The implantation can take anywhere from 1-2 hours and is typically performed as an outpatient procedure.

What are risk factors for a spinal cord stimulator?

Although there are risks of complications following your spinal cord stimulator surgery, they are rare. Some patients may experience:

  • Infection, which may occur in the first 2-8 weeks.
  • Bleeding.
  • Leads moving out of position.
  • Leads breaking or malfunctioning.
  • Injuries from broken or displaced leads.
  • Pulse generator malfunction or failure.
  • Gradual loss of pain relief.

Your healthcare provider will schedule follow up visits periodically after your procedure. Possible complications can include a headache when you stand or sit up but goes away when you lie down. You should seek medical attention right away if you notice:

  • Sudden appearance of numbness, tingling, or muscle weakness.
  • Any of the symptoms of sepsis.

On average, about half of people see more than 50% improvement in their pain. Because of these risks and others, it’s important to consult your provider with any questions.