A spinal cord stimulator (SCS) is a device that can help manage chronic pain by delivering mild electrical pulses to the spinal cord. These pulses interrupt pain signals before they reach the brain, which can provide significant relief for those with persistent pain that hasn’t responded well to other treatments.
What Conditions Can an SCS Help With?
Spinal cord stimulators are used for a variety of chronic pain conditions, including:
- Chronic back pain, including lumbar, thoracic, and cervical pain
- Pain after back surgery (Failed Back Surgery Syndrome)
- Complex Regional Pain Syndrome (CRPS)
- Neuropathic pain or nerve-related pain that hasn’t improved with other treatments
An SCS may be recommended after other non-surgical pain management options, such as medication, physical therapy, and injections, haven’t provided adequate relief.
Types of Spinal Cord Stimulators
SCS devices are generally categorized based on the region they target:
- Lumbar SCS: For lower back and leg pain
- Thoracic SCS: For mid-back pain or pain that radiates to the chest or abdomen
- Cervical SCS: For neck, shoulder, and upper extremity pain
Procedure Overview
The spinal cord stimulator procedure involves two main stages: a trial phase and, if successful, a permanent implantation phase.
- The Trial Phase
The trial phase is a temporary procedure that allows you and your physician to assess the effectiveness of the SCS before committing to a permanent device. This is a minimally invasive, outpatient procedure that typically takes about 1-2 hours.
Steps of the Trial Procedure:
- Preparation and Anesthesia: Local anesthesia or light sedation is used.
- Electrode Placement: The physician inserts one or two thin wires (leads) near the spinal cord using a needle, with imaging guidance to ensure precise placement.
- Temporary Device Connection: The leads are connected to an external SCS device worn outside the body. You will wear this device for a trial period, typically 5-7 days.
During the trial period, you’ll evaluate how well the device reduces your pain and note any improvement in mobility or daily activities. If you experience significant relief, you can discuss moving forward with a permanent implant.
- Permanent Implantation
If the trial is successful, you may proceed with a permanent implant. This is a surgical procedure that generally takes 2-3 hours and is typically done in an outpatient setting.
Steps of Permanent Implantation:
- Anesthesia: General or local anesthesia is used, based on your needs.
- Lead Placement: Leads are placed along the spinal cord at the appropriate level (cervical, thoracic, or lumbar).
- Implantable Pulse Generator (IPG): A small device, about the size of a pacemaker, is implanted under the skin, usually in the buttocks or abdomen. The leads are connected to the IPG.
- Programming: After implantation, the device is programmed to optimize pain relief.
You’ll be able to go home on the same day or the day after the procedure.
Pre-Requisites for SCS Placement
Before undergoing the SCS procedure, you will need to meet several prerequisites to ensure the best outcome:
- Bloodwork and Medical Evaluation: Blood tests and a comprehensive medical evaluation are done to check for any conditions that may affect surgery or healing.
- Psychological Evaluation: Since chronic pain can affect mental health, and SCS devices involve managing expectations and a lifestyle adjustment, a psychological assessment is typically required. This helps determine if you are a good candidate for SCS and able to manage the device.
Post-Procedure Information
When Can I Go Home?
- For the trial phase, you can usually go home the same day.
- For the permanent implant, most patients go home the same day or the day after surgery.
After the Procedure
- Activity Restrictions: You’ll need to avoid bending, twisting, and heavy lifting for a few weeks to allow for healing and proper placement of the device.
- Pain Management: Some discomfort is normal after the procedure, but it can usually be managed with prescribed pain medications.
- Follow-Up Appointments: You will have follow-ups with your physician to adjust the settings of the stimulator for optimal pain relief and monitor your healing process.
Final Thoughts
Most patients who undergo SCS implantation report significant pain reduction, improved mobility, and a better quality of life. The extent of pain relief can vary, but the device can be reprogrammed to improve effectiveness over time. Periodic reprogramming may also be necessary as your pain levels or pain locations change.
If you have any questions about your recovery or if you need further guidance after the procedure, please do not hesitate to contact our office.