Spinal Cord Stimulators

How a Spinal Cord Stimulator Works

The spinal cord stimulator consists of a small pulse generator (similar to a pacemaker) that is implanted under the skin, usually in the abdomen or buttock area. This device is connected to electrodes that are placed near the spinal cord in the epidural space. The electrodes deliver mild electrical impulses to the spinal cord, which override the pain signals before they reach the brain.

Rather than completely eliminating pain, the spinal cord stimulator provides a sensation of tingling or paresthesia, which masks or replaces the pain. This is often referred to as the “pleasant tingling” effect. Some patients experience significant relief from chronic pain, while others find that it helps them manage their pain enough to improve their quality of life.

How Spinal Cord Stimulation is Done

1. Trial Phase:

   • Before the spinal cord stimulator is permanently implanted, a trial period is usually conducted to see if the device effectively reduces pain. During the trial, a temporary device is placed near the spinal cord to assess its effectiveness in managing pain. This allows both the patient and the doctor to determine if the stimulator provides enough relief to warrant permanent implantation.

2. Permanent Implantation:

   • If the trial is successful, the permanent spinal cord stimulator is implanted. The procedure typically involves:
     • Placement of Electrodes: The electrodes are inserted through a needle into the epidural space near the spinal cord.
     • Pulse Generator Implantation: The pulse generator is implanted under the skin, usually in the lower back, abdomen, or buttock.
     • Wiring: The electrodes are connected to the pulse generator, which is then programmed to deliver the appropriate electrical impulses.

3. Post-Procedure Care:

   • After implantation, the device is tested to ensure proper functioning. The patient is typically given a remote control to adjust the settings (e.g., the intensity or frequency of the stimulation).
   • Recovery time is usually short, and most patients can return to normal activities in a few days to weeks, although physical activity may be restricted during the healing period.

Indications for Spinal Cord Stimulation

Spinal cord stimulators are typically recommended for patients with chronic pain that has not responded well to other treatments, including medications, physical therapy, or surgery. Conditions that may benefit from spinal cord stimulation include:

1. Failed Back Surgery Syndrome (FBSS): Chronic pain that persists after back surgery.
2. Complex Regional Pain Syndrome (CRPS): A condition that causes severe pain, often after an injury.
3. Sciatica: Pain radiating from the lower back down through the legs.
4. Radicular Pain: Pain caused by irritation or compression of the spinal nerve roots.
5. Intractable Low Back Pain: Chronic pain in the lower back that does not respond to conventional treatments.
6. Peripheral Neuropathy: Nerve damage that causes pain, usually in the feet or legs.

Benefits of Spinal Cord Stimulation

• Pain Relief: Many patients experience significant pain relief, with some achieving 50% or more pain reduction.
• Reduced Need for Pain Medication: By effectively managing pain, spinal cord stimulators can reduce the need for opioid medications and other painkillers.
• Improved Quality of Life: The ability to reduce pain can help patients engage in daily activities, improve mobility, and enhance their overall quality of life.
• Adjustable Settings: The stimulator can be programmed and adjusted by the patient or physician to meet their specific pain management needs.

Risks and Side Effects

While spinal cord stimulators can be highly effective, there are some risks and potential side effects associated with the procedure:

• Infection: As with any surgical procedure, there is a risk of infection at the implantation site.
• Device Malfunction: The stimulator or electrodes may malfunction, requiring adjustments or replacement.
• Lead Migration: The electrodes may shift position, which can reduce the effectiveness of the stimulation.
• Pain or Discomfort: Some patients experience discomfort from the leads, pulse generator, or during adjustments to the device.
• Nerve Damage: In rare cases, the implantation of the device can cause nerve damage or other complications.
• Failure to Provide Adequate Pain Relief: Not all patients achieve significant pain relief, and some may not experience the desired level of symptom improvement.

Effectiveness of Spinal Cord Stimulators

Spinal cord stimulators are effective for many patients with chronic pain, but the results can vary. Some people experience dramatic pain relief, while others may experience more modest improvements. In general, studies show that about 50-70% of patients who undergo spinal cord stimulation achieve at least a 50% reduction in pain, which is considered a successful outcome. The success of spinal cord stimulation is influenced by factors such as the type of pain, the patient’s overall health, and whether the device is used as part of a comprehensive pain management plan.