What You Need to Know About Spinal Cord Stimulation

What is a Spinal Cord Stimulator?

A spinal cord stimulator (SCS) is a medical device, designed to ease chronic pain. It consists of thin wires, known as electrodes, and a small battery pack that is like a pacemaker, referred to as an implantable pulse generator (IPG). These components are implanted just beneath the skin.

The electrodes are carefully positioned on the spinal cord, specifically in the epidural space, using X-ray guidance. This is the same, safe area where medication is injected during an epidural steroid injection.

Spinal cord stimulation has substantial evidence supporting its ability to provide long-term relief from chronic pain. Importantly, the device can be removed if necessary and does not alter the spine's structure. Additionally, it offers multiple programming options to adapt to changing pain patterns.

How Does Spinal Cord Stimulation Work?

Spinal cord stimulation generally works by distracting the brain from perceiving pain. The electrodes are placed over the region of the spinal cord that corresponds with the painful area in the body. Traditional spinal cord stimulators replace painful sensations with a mild, tingling sensation known as paresthesia. Alternatively, sub-perception stimulation can achieve similar results without the patient feeling paresthesia.

What Conditions Can Spinal Cord Stimulators Treat?

Spinal cord stimulation is FDA-approved and has Level 1 evidence for several diagnoses. It can be used to treat:

• Back and/or leg pain following back surgery

• Non-surgical back and/or leg pain

• Painful peripheral neuropathy

• Complex Regional Pain Syndrome (CRPS)

• Post-surgical pain (e.g., after knee or hip replacement)

• Pain after amputation

• Post-herpetic neuralgia

• Arachnoiditis (painful inflammation of the membrane covering the brain and spinal cord)

• Other chronic pain conditions

Utilizing spinal cord stimulators can enhance overall quality of life, improve function and sleep, and reduce reliance on pain medications.

Who is a Good Candidate for SCS?

Every patient is unique, and a thorough evaluation with a healthcare provider is essential to determine if SCS is suitable. Generally, individuals who may benefit most from spinal cord stimulation include those who have not found significant pain relief from medications, less-invasive therapies, or previous surgeries.

How is the Spinal Cord Stimulator Placed?

Before undergoing an implant, patients typically go through a trial phase.

Trial Phase:

• The spinal cord stimulator trial is less invasive than surgery and resembles an injection. This takes about 15-30 minutes.

• No large incisions or sutures are required.

• Two electrodes are placed into the epidural space using X-ray guidance via two needles.

• These electrodes connect to an external battery/generator that is taped to your back.

• For approximately one week, patients assess the device's effectiveness. A trial is deemed successful if there is a 50% or greater reduction in pain.

• The wires can be easily removed in a clinic without causing harm to the nerves or spinal cord.

• If the trial is successful, patients can opt for the permanent implant.

Implant Phase:

• The SCS implant procedure involves placing the IPG beneath the skin and connecting two sterile electrodes. This takes about 1-2 hours.

• The procedure results in two small incisions: one for the electrodes and another for the IPG. These incisions are superficial, and deeper structures such as muscles and bones are not affected.

• The implant procedure is performed under sedation or general anesthesia for patient comfort.

What are the Potential Complications?

Although complications are rare, all procedures carry risks. A small percentage of patients may experience:

• Infection

• Bleeding

• Electrode migration

• Device damage

• Severe headaches

• Spinal cord trauma

What Happens if the Stimulator Stops Working?

The spinal cord stimulator has numerous adjustable settings, many of which are accessible via a remote control. These preset settings can be modified with the assistance of a device representative, which may help regain pain relief. If adjustments do not work, the stimulator can be safely removed or left in place and turned off.

What is it Like to Live with a Spinal Cord Stimulator?

Patients with an SCS can have X-rays and CT scans with the device turned off. Newer spinal cord stimulators are usually compatible with most MRI machines, while older models may not be safe for MRI procedures.

For airport security, patients will receive an identification card that may facilitate bypassing security checks. If passing through security cannot be avoided, the device should be turned off beforehand.

After the initial healing period following the implant, patients can return to most activities including swimming and submerging underwater.

If you think you may benefit from a spinal cord stimulator and/or would like a consultation:

Please call 425-291-1477 and ask for a consultation with Dr. Daniel Oh to discuss spinal cord stimulation.

I look forward to meeting with you and hope we can give you options moving forward!