Spinal Cord Stimulation (SCS) is a medical treatment used to manage chronic pain, particularly pain that does not respond to other therapies, such as medications or surgery. It involves the use of an implanted device that sends electrical impulses to the spinal cord to mask pain signals before they reach the brain.
What is Spinal Cord Stimulation (SCS)?
SCS works by using a small device implanted in the body, which delivers electrical impulses to the spinal cord to interfere with the transmission of pain signals. The device is usually controlled by a handheld remote, allowing patients to adjust the intensity of the stimulation.
Spinal Cord Stimulation Trial
Before committing to the permanent implant of the spinal cord stimulator, most patients undergo a trial phase to evaluate whether the therapy will be effective in relieving their pain.
What Happens During a Spinal Cord Stimulation Trial?
- Consultation and Assessment:
- A healthcare provider evaluates the patient's medical history, current pain, and treatment goals.
- Imaging studies (like X-rays or MRI) may be done to assess the spine and nerves.
- Trial Procedure:
- The trial is done in our clinic and involves temporary placement of a spinal cord stimulator.
- Local anesthesia is applied to the insertion site, typically in the lower back.
- Thin leads (electrodes) are inserted through a needle into the epidural space (the area around the spinal cord). These leads are connected to an external pulse generator, which sends electrical impulses to the spinal cord.
- The leads are not permanently implanted; they remain in place only for the duration of the trial, which typically lasts around 5-7 days.
- The patient is given a handheld remote to control the stimulation, adjusting the intensity and sensation to see how effective it is in managing their pain.
- During the Trial:
- Patients will monitor their pain levels and how the stimulation feels. The goal is to determine whether the stimulation reduces pain and improves function, such as mobility and quality of life.
- If the trial is successful (usually if the pain is reduced by at least 50%), the patient may be considered for a permanent SCS implant.
- Post-Trial:
- If the trial is successful, the patient will proceed with implantation of the permanent device. If it is not successful, the trial leads are removed, and alternative pain management options will be discussed.
- The trial typically involves minimal downtime; most patients can return to normal activities during the trial period, though they are advised to avoid heavy lifting or strenuous activities.
Permanent Spinal Cord Stimulation Implant
If the trial is successful, you will be referred to a Neurosurgeon/Orthopedic surgeon for a permanent spinal cord stimulator placement. This device can provide long-term pain relief by continuously delivering electrical impulses to the spinal cord.
Benefits of Spinal Cord Stimulation
- Pain Reduction: SCS is effective for many types of chronic pain, including failed back surgery syndrome, complex regional pain syndrome (CRPS), neuropathic pain, and leg and back pain due to conditions like degenerative disc disease.
- Non-Opioid Pain Relief: It offers a drug-free alternative to pain relief, helping patients reduce or eliminate their reliance on pain medications, including opioids.
- Reversible: If the spinal cord stimulator is not effective or has unwanted side effects, it can be turned off or removed.
- Improved Functionality: Many patients experience improved mobility and a better quality of life as a result of the pain relief.
- Minimal Recovery Time: Because the procedure is minimally invasive, recovery time is generally short, and patients often return to normal activities within a few days to weeks.
Risks and Side Effects of Spinal Cord Stimulation
Though spinal cord stimulation is generally safe, there are some risks and potential complications:
- Infection: Like any surgical procedure, there is a risk of infection, especially around the implant site.
- Lead Migration or Fracture: The leads can move or become displaced over time, requiring adjustment or replacement.
- Device Malfunction: The pulse generator or leads may malfunction, leading to a reduction in effectiveness or failure of the system.
- Pain or Discomfort: Some patients report discomfort around the implantation site or the sensation of stimulation.
- Nerve Damage: In rare cases, the procedure may cause nerve injury or complications from the leads being placed too close to certain nerves.
- No Pain Relief: In some cases, spinal cord stimulation may not provide sufficient pain relief, and alternative treatments will need to be considered.
Who is a Good Candidate for Spinal Cord Stimulation?
Spinal cord stimulation is typically considered for individuals who:
- Have chronic pain that has lasted for at least 6 months or longer.
- Have not responded well to conservative treatments such as medications, physical therapy, or injections.
- Have conditions like failed back surgery syndrome, complex regional pain syndrome (CRPS), neuropathy, or degenerative disc disease.
- Are motivated and committed to following the post-operative care plan, as spinal cord stimulation requires ongoing management and follow-up.