What is a Spinal Cord Stimulator (SCS)?

A spinal cord stimulator (SCS) consists of the following components: thin wires or electrodes and a small battery pack or the generator. This device is surgically implanted under your skin, from where it sends a mild electric current to your spinal cord. Current is carried to the nerve fibers of the spinal cord through thin wires from a pulse generator. When the SCS is turned on, it stimulates the nerves in the region where you are experiencing pain. Pain is minimized because the electrical pulses alter and cover the pain signal from reaching your brain.

Read a detailed article on Spinal Cord Stimulator.

Spinal Cord Stimulator Surgery

To test and implant a spinal cord stimulator, two procedures are required: the trial and the implantation. The technology for spinal cord stimulation is rapidly evolving, but this is a standard procedure:

Spinal Cord Stimulator Trial

The first stage is the trial period. A temporary device will be implanted by your doctor for you to try out. Your doctor will carefully position the electrodes in the epidural space of the spine, guided by a type of X-ray called fluoroscopy. The position of these electrodes along the spine is determined by the location of your pain. During this trial procedure, the electrodes are usually placed through a single incision in your lower back. The generator or battery will be placed on a belt that you will wear around your waist. For about a week, you will evaluate how well this device relieves your pain. If you experience a 50% or greater reduction in pain, the trial is considered a success. If the procedure is unsuccessful, the wires can be safely removed in the clinic without causing any damage to the spinal cord or nerves. If the procedure is successful, the device can be implanted permanently.

Spinal Cord Stimulator Implantation

The generator is implanted under the skin, and the trial electrodes are replaced with sterile electrodes during the permanent implantation procedure. This procedure can take about 2 hours to be completed and is comprised of the following parts:

1.The lead is placed in the epidural space of the spine.

2.The pulse generator is placed just under the skin (in the abdomen or buttock).

After administering local anesthetic, the surgeon will make two incisions: on one side to hold the generator (usually along the buttock or lower abdomen) and on the other side to insert the permanent electrodes (along your spine). Once both the generator and the electrodes are implanted and running, your surgeon will close the incision site. During the placement of the electrode, your surgeon may provide sedation to keep you relaxed and may also ask for your feedback.

Conditions treated by Spinal Cord Stimulator

A spinal cord stimulator can aid the patients in the reduction of chronic pain caused by:

Chronic leg (sciatica) or arm pain:

Persistent pain caused by spinal stenosis with neurogenic claudication.

Failed back surgery syndrome:

It is not a technical failure of the initial procedure, but rather the failure of one or more surgeries to alleviate pain in the arms or legs.

Complex regional pain syndrome:

A condition that causes patients to experience severe, chronic burning pain, usually in the foot or hand.

Arachnoiditis:

It’s painful and debilitating scarring and inflammation of the protective lining around the spinal nerves.

Other:

Angina, multiple sclerosis, stump pain, spinal cord injury, or peripheral vascular disease.

What to expect after a spinal cord stimulator implantation?

When you wake up, you will find yourself in a recovery room. Your blood pressure, heart rate, and respiration will all be monitored, as well as your pain. After surgery, your spinal stimulator will be turned on to relieve your chronic pain. Any discomfort patients experience following the procedure is usually incisional and is dependent on the type of stimulator received. You can expect some pain at the incision sites for at least three to seven days. To help ease any discomfort, the doctor will inject local anesthesia in the region around the implant site.

The majority of patients are sent home the same day or the next morning. Before you leave, the pulse generator will be programmed. When you return home, you will be given written instructions to follow. You should follow the home care instructions of the surgeon for about 2 weeks after surgery or until your follow-up appointments. You can expect the following in general:

Restrictions

For the next six weeks, do not lift, bend, twist your back, or reach overhead. This will keep the leads from going out of place, until it heals.

• You shouldn’t lift anything more than 5 pounds.
• You should avoid all sorts of strenuous activities.
• You should avoid lying on your back in your sleep.
• Avoid raising your elbows over your head.
• Avoid excessive sitting.

Activity

• To reduce the swelling and pain, ice the incision site for 3-4 times a day for about 15-20 minutes.
• Avoid sitting or lying in one place for more than an hour, unless you are sleeping.
• Cerebrospinal fluid leakage around the lead site may cause spinal headaches. Sometimes, the leak may recover on its own. Lie down and drink plenty of non-carbonated caffeinated drinks (coffee, tea).
• After every 3-4 hours, get up and take a walk for about 5-10 minutes. You may progressively increase the amount of time you spend walking.

Incision Care

• To avoid infection, wash your hands thoroughly before and after cleaning your incision.
• You may take a shower a day after surgery. In addition, your doctor can advise you to take sponge baths rather than regular baths or showers.
• Every day, gently wash the incision with soap and water.
• It’s best not to wash the incision in a bath or pool.
• Applying lotion or ointment to the incision is not recommended.
• Cover the incision site with a dry gauze dressing if there is any drainage. Contact the office if drainage soaks into two or more dressings in one day.
• It’s common for the incision to have some clear, pinkish drainage. Keep an eye out for increased drainage or spreading redness. If your incision is infected, colored drainage will appear and it will begin to separate.

Medications

• Follow the instructions of your doctor or surgeon for pain relief medication. As the pain subsides, reduce the amount and frequency of your medicines.  Don’t take the pain relief medicines if you don’t need it.

Follow-up appointments

A follow-up appointment with your doctor will be scheduled two weeks after your spinal cord implant procedure. During this time, the doctor will check the incision to make sure it’s healing properly and isn’t red or infected. They’ll even tell you whether or not you’re ready to take a bath. Finally, they will assess how well the stimulator is working for you and whether it is appropriate to raise your activity level.

If the pain does not improve, your doctor will arrange for you to meet with a representative from the spinal cord stimulator company to get the device reprogrammed so that you can receive more pain relief.

In a month, you’ll have another appointment to re-examine the incision and check on your progress. If you’re feeling better and the procedure has healed, you’ll be able to resume your regular activities.

What are the results?

The results of spinal cord stimulation are dependent on careful selection of the patient, successful trial stimulation, proper surgical procedure, and patient education. Stimulation does not treat the problem that is causing pain. Rather, it helps patients in pain management. If pain is decreased by at least half, spinal cord stimulation is considered a success.

In published studies of spinal cord stimulation, 50 to 80% of patients suffering from chronic pain reported good to excellent long-term relief. (https://mayfieldclinic.com/pe-stim.htm) According to one study, with stimulation alone or with the addition of occasional oral pain medicine, 24% of patients improved enough to return to their jobs or housework. (https://mayfieldclinic.com/pe-stim.htm)

Spinal cord stimulation therapy is reversible. The electrode wires and generator can all be removed if a patient wishes to stop using them at any time.

Risks associated with spinal cord stimulation surgery

Every surgery has some risks associated with it. The following are some of the most common surgical complications:

• Infection
• Bleeding
• Bad reaction to anesthesia
• Formation of blood clots

The following are some of the risks associated with spinal cord stimulator surgery:

• Unwanted changes in stimulation (can be linked to cellular changes in tissue around electrodes, loose electrical connections, electrode position changes, and/or lead failure)
• Compression of the spinal cord and/or paralysis (can be caused by the placement of lead in the epidural space during a surgical procedure)
• Leakage or battery failure
• Persistent pain at the stimulator site or electrode
• Allergic reaction of the body to the implanted materials
• Local skin erosion
• Numbness, swelling, pain or weakness below the level of implantation

Breakage of the extension wire or lead, movement of the lead, or (in exceptional cases) mechanical failure of the device are all conditions that can necessitate additional surgery. The reasons for the removal of the device include inability to relieve pain and infection. Sometimes, scar tissue may form around the electrode, reducing the effectiveness of the stimulation.

When to call a doctor?

If you experience any of the following symptoms when recovering from a spinal cord stimulator surgery, call 911 or head to the nearest emergency room right away:

• Unbearable pain in your legs
• Paralysis or motor weakness in your legs
• Sudden numbness in your legs
• Loss of bladder or bowel control

These symptoms indicate that there is bleeding in your spine, which is a serious emergency that requires urgent medical attention.

You should contact a doctor to examine your implant and incision site, if you are having any of the following symptoms:

• Redness or increased swelling at the incision site
• Fever of 100 or higher
• Your chronic pain isn’t being managed properly

Quality of life after spinal cord stimulation surgery

You will be sent home with instructions for managing the stimulation by controlling the intensity and length of each stimulation period once the SCS has been programmed. If required, your doctor may adjust the pulse width, amplitude, and frequency during follow-up visits.

There are stimulation settings on the pulse generator:

• Frequency (rate): The number of times stimulation is transmitted per second. There will be no sensation if there are too few pulses. If you use too many, it will result in a washboard or bumpy effect.
• Pulse width: the area that will be covered by the stimulation.
• Pulse amplitude: decides the threshold of perception of pain.

You can use your handheld programmer to turn the stimulator on and off, select your preferred program, and change the stimulation strength or amplitude. Most people are given several programs to help them get the best pain relief at any time during the day or during specific activities. If necessary, you can use your spinal cord stimulator around the clock.

Depending on their position, some people experience different levels of stimulation (e.g. sitting versus standing). This is normal and is triggered by changes in the spread of electricity when you change your place.

Devices like smartphones, microwaves, and metal detectors will not damage your stimulator. Since the device is detected at airport security gates, make sure you have your Implanted Device Identification card with you while flying. When passing through security gates or theft detectors in department stores and airports, you can experience an increase or decrease in stimulation. This feeling is only transient and does not do any damage to your body.

Conclusion

Overall, high rates of recovery and success have been seen after a spinal cord stimulator surgery. Most patients report that the treatment is painless and worth it. When your chronic pain is under control, your incisional pain will heal quickly, and you’ll be able to resume a life of activity and abundance.