Spinal Cord Stimulators (SCS) are surgically implanted devices which transmit small amounts of electrical current to the affected spinal nerves. This innovative treatment works by changing pain signals that travel up through the spinal cord to the brain. Placed near the spinal cord in the epidural space, the spinal cord stimulator device delivers low-level electrical impulses to the spinal cord or to specific nerves that interfere with the perception of pain, especially chronic nerve pain. SCS is typically reserved for the most difficult to treat pain conditions and when other measures have failed. Following implantation, patients typically feel a “gentle tingling” or “massage” like feeling. Depending on patient preference, and the type of device used, patients may feel nothing at all beside relief of their chronic pain. The device can be controlled by the patient and adjusted to suit their needs. This includes the freedom to turn the device on and off, as well as changing the intensity of the stimulation for optimal comfort and pain relief.
SCS technology can applied to many different types of chronic pain conditions, some that are typically very difficult to treat. SCS can be used for chronic neck and back pain, radiating pain due to pinched nerves and spinal stenosis, chronic sciatic pain, chronic regional pain syndrome (CRPS), neuropathic pain of the arms or legs including diabetic neuropathy, and post-laminectomy syndrome.
The first step is SCS trial placement which is done on an outpatient basis, this procedure takes relatively little time and is done in a sterile OR environment. The patient is first given a local anesthetic and minimal sedation; the procedure is done with the patient lying face down. The doctor then places the trial SCS leads (typically 2) through a needle in the back into the epidural space. The thin lead is then taped to the patient’s back and connected to an external stimulating device, which is like a battery. The trial stimulator is typically worn for three to seven days, and if the trial successfully relieves the patient’s pain, they can undergo a permanent SCS if desired.
If the SCS trial provides adequate pain relief, then a permanent system may be implanted. SCS is a reversible therapy, so even though it is called permanent, treatment can be discontinued at any time and the implanted parts turned off and/or removed.
Prior to the procedure, the patient is lightly sedated, if leads are to be placed under the skin, a local anesthetic will be administered while the leads are placed, then the patient will be given a general anesthesia prior to the rest of the system being implanted. If surgical leads are used, the patient will likely be under general anesthesia the entire time. The leads are inserted in the epidural space above the spinal cord using a small needle or through a small incision. The exact location of the lead or leads depends on the specificity of the patient’s pain. The generator (similar to the size of a pacemaker) is usually implanted in the abdominal or buttock region, but the physician/patient may determine other comfortable areas in which to place it.
Once the leads and generator are in place, connected and working, the incision will be closed, a dressing applied, and the patient will be taken to recovery. Most patients go home the same day. Before being released from the hospital, the patient will receive instructions on caring for the incision area and how to program and regulate the SCS device.