Spinal Cord Stimulation

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Spinal Cord Stimulation

This is a procedure that is utilized when all else has failed and there is continued pain. The technique is indicated for the following conditions:

  • Continued back and/or leg pain after surgery
  • Intractable back pain
  • Nerve pain due to injury
  • Neck/Arm Pain
  • Conditions such as Arachnoiditis and Reflex Sympathetic Dystrophy
The theory is that electrical stimulation from a small electrode placed over the spinal cord will “short circuit” the pain impulses as they travel from the painful area to the brain.

The procedure is done in two steps (or phases)

The first phase is the TRIAL phase. Small electrodes are placed under fluoroscopic (Xray) guidance in order to ensure exact placement. This is done under local anesthetic with the patient awake. No incisions are made and there is usually very little pain involved. When the temporary electrodes are in place, they are turned on and the patient lets us know if the area of their usual pain is covered by the electrode’s “tingle”. When the electrodes are in the right place, they are taped to the skin and the procedure is over.

The patient will keep the temporary electrodes in place for about a week and carry on their usual activities (with some exceptions). They will control the stimulation with a small device the size of a transistor radio. During this TRIAL phase, they will evaluate how much the stimulation decreases their pain. If the benefits are significant, they may elect to enter phase 2.

 

Phase 2 is the Implantation phase. This occurs about 3-4 weeks after phase 1. It involves actually implanting a spinal cord stimulator system into the patient. The patient is brought into the hospital and taken to the operating room. Under local anesthesia, with sedation provided by an anesthesiologist, a small incision is made in the mid-back. The electrodes are placed and then implanted under the skin. At the same time, the battery pack (about the size of a small pacemaker) is implanted into the upper buttock. The system is now completely under the skin. A hand-held device periodically placed over the battery pack can control stimulation.

The patient may be observed over night or allowed to go home the same day. The amount of discomfort is usually minimal.