Spinal Cord Stimulation is an evolving implanted treatment used for patients suffering from a variety of painful ailments including Failed Back Syndrome, Diabetic Neuropathy, Reflex Sympathetic Dystrophy, Phantom Pain and Spinal Stenosis and Vascular Pain, to name a few. The concept dates back to 1965, and is based on the “Gate Theory of Pain”, whereby painful ascending nerve fibers are blocked by electrical impulses created by an implanted device that is inserted in the back and flank area.
Spinal Cord Stimulators utilize a process so that painful signals arriving from the body are blocked by the implant as they ascend to the brain where pain is perceived. The device, similar to a pacemaker, is located in the spine, and the patient experiences less pain or an alteration of the perception of pain by generated impulses. Additional benefits can occur when patients not only experience pain relief but also an improvement of symptoms of a painful condition such as RSD (CRPS 1). Research has found that not only does the spinal cord stimulator alter the perception of the pain through interference of intercellular communications along the ascending nerve columns of the spinal cord, but also creates biochemical changes to alter ion concentrations and cellular matrixes to improve the functionality of nerve cells. These changes can be seen with patients afflicted from RSD who suffer from painful, swollen, cyanotic appearing hands and feet. A Spinal Cord Stimulator can improve many symptoms of RSD, and the changes can be life altering. Similar effects can been seen with claudication and various types of neuropathy
The process of implanting a spinal cord stimulator is quite straightforward and is easily accomplished in two steps, a trial phase, which lasts three days and a permanent implant of the leads and impulse generator. The leads are small and flexible and are about the size of a pen inkwell. The generator is about the size of a silver dollar and usually charged once a week with a “charger” that is placed on the skin as the patients rests comfortably on a sofa.
For the trial phase, the patient enters the operating room and is positioned on the OR table. Light sedation is usually given for relaxation and ease of the procedure. Live x-ray and fluoroscopy are used to identify the spine and important boney landmarks. Strict adherence to sterility is always used. The skin of the back is prepped and draped. Local anesthesia is injected, then a larger needle, using the “percutaneous needle” approach, is carefully inserted in the back and placed in the epidural space. Then a thin flexible “lead” is carefully placed through the needle and gently guided up the spine into the correct position. The representative of the manufacture’s device along with the physician checks lead position this by delivering gentle current to block the body’s perception of pain. Minor adjustments are made depending on the response.
Once lead placement is accepted, the lead is secured, and bandages are applied. The patient is then given an external control to alter the current and fine tune adjustments within guidelines set by the doctor and the representative.
After three days, the lead is gently removed in the doctor’s office and discussion continues if the patient wishes to proceed with the permanent lead. If this is the case, then psychological counseling is required to evaluate long-term acceptance of the device.
In the permanent placement, a surgeon usually assists in the creation of a pocket for the implanted internal battery and tunneling of the leads under the skin. The procedure usually takes about an hour and a half, and patients are discharged the same day.
In summary, the spinal cord stimulator can have a beneficial impact on a patient’s life treating many conditions. The greatest advantage of this device is the three-day trial period. There is little downside in undergoing the trial. The leads can be easily turned off or removed if the patient wishes.
Patients can speak to their doctor for referral to a pain management specialist to see if this procedure is right for them.