SPINAL CORD STIMULATION
Spinal cord stimulation is the blockage of pain signals at the level of the spinal cord. This is accomplished by the stimulation of nerves within the spinal cord. It works by blocking the transmission of pain impulses to the brain. Many patients have tried transcutaneous electrical nerve stimulation (TENS), a temporary treatment in which an electrical current is sent to pads placed on the skin of the painful region thereby reducing the pain. However, spinal cord stimulation or dorsal column stimulation is a more effective and permanent modality for the treatment of many different chronic pain conditions. This technology has been around since the early 1970s and has helped thousands of patients.
Spinal cord stimulation involves surgically placing one or two spinal leads and an implantable generator. The first step is to perform a stimulation trial. This involves placing the leads in the spinal canal via Epidural needles. Therefore unlike traditional surgery, we trial the device for one week to see how much benefit is achieved. No incisions are made! The leads are secured to the patient’s back to an external generator. For the trial week, I tell patients to do SCS Pamplet activities which normally increase the pain, whether going to a mall, activities at home, or anything else. One week later the patient returns and the leads are removed in the office. Only then does the patient decide if he or she wants permanent placement.
If the trial is successful, then permanent spinal cord stimulation implantation can be performed. This involves a second procedure whereas incisions are made to implant the entire system (leads in the spinal canal and the generator in subcutaneous tissue). The technology has improved greatly, especially over the last several years.
I have treated many patients with for chronic neck and low back conditions, as well as those with upper and lower extremity pain. Appropriate candidates are ones where conservative treatments, such as medication and injection therapy, have failed; where surgery would not be beneficial; or where the patient is attempting to avoid surgery. Contraindications are few but include those with coagulation disorders or who use blood thinners, or have an active infection.
Patients successfully treated can see a reduction of their pain between 50 and 80 percent. Spinal cord simulation can reduce pain for many conditions whereby other options have failed. I have aided patients with degenerative disk disease, spinal stenosis and nerve root impingement. Additionally, patients with refractory vertebrogenic pain, pre or post surgical back syndromes and refractory joint arthropathy. can benefit. SCS can chronic nerve pain such as from shingles, diabetic neuropathy or amputation/phantom limb pain. Lastly, by blocking pain transmission, even pain from chronic joint ailments such as pre & post surgical shoulder, hip and knee pain may benefit.
The advantages of this modality, once again, is that during the trial period the patient can see what the device “feels like” and how much pain is alleviated before entertaining permanent placement. This is opposed to surgery where once you’ve had it, you can’t take it back. Additionally, the device is 100% reversible. So even if you’ve had it for a time, the device can be removed at any time thereafter and you’re back to square one. It is safe for long term use and can improve ones pain, function, and quality of life. The device is controlled with an external patient programmer. Different programs can be given for different types and location of pain the patient may experiences at various times. For example there may be situations where back pain is greater, and others where there is greater leg pain. The stimulation can be programed to change to meet his/her needs in a dynamic fashion. Lastly, the device does not involve taking medications so there is no drug issues or side effects such as drowsiness, disorientation, nausea or other problems such as drug addiction. It treats the specific are of pain without affecting the entire body.
Short term risks of both trial and permanent placement include infection, bleeding, headaches, failure to relieve pain, issues with the hardware, and nerve injury. Long term complications can involve device failure either involving a mal-position of the spinal leads leading to a lack of proper stimulation, or damage or other malfunction to the generator. Presently, there is a rechargeable battery which has a life span of about nine years. Thereafter replacement of the generator through a minor surgical procedure is required. It must be realized that spinal cord stimulation is a palliative treatment in that it does not eliminate the source of pain but reduces the pain the patient experiences. There is no way of predicting who will receive benefit and who will not, which is why a trial is performed.
In conclusion, in the appropriate patient, spinal cord stimulation can be a very good pain relieving modality as part of an overall comprehensive pain management program. It is a very good treatment option in patients with conditions refractory to more conservative treatments and who wish to avoid or have failed surgery. I have personally used this to treat many patients improving their ability to function, perform various activities, and lead a more normal life.