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Spinal Cord Stimulator

What are Spinal Cord Stimulators (SCS)?

Spinal cord stimulators (SCS) are medical grade devices that gently transmit a mild electric current to the spinal cord by way of an implanted battery attached to fiber-thin wiring, placed atop the spinal cord via surgical technique. Delicate wires carry the current from a pulse generator to the affected nerve fibers of the spinal cord. When activated, the SCS stimulates the nerves in the specific area, modifying and masking the pain signal from reaching the brain; this technique effectively alleviates discomfort.

It is important to note that stimulation does not eradicate the root cause of pain; rather, it reframes the brain’s perception of it. Therefore, the extent of pain relief may vary from person to person. Nonetheless, the objective of SCS is to achieve a reduction of neuropathic pain by at least 50%. Even a marginal decrease is significant as long as it enables individuals to perform daily activities better and minimizes reliance on pain medication. At NeuroSpine Plus, our goal is to help patients reduce their pain and live a more active lifestyle by utilizing the least-invasive technique possible.

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Who qualifies as a candidate?

Determining if SCS is appropriate for prolonged pain management goals involves assessing your physical condition, medication regimen, and surgical and pain history. A review of previous treatments and surgeries will be conducted by a member of our surgical team,  physiatrist, or pain management specialist. Moreover, as chronic pain may have emotional implications, a psychologist referral may be requested to optimize the chances of a successful outcome.

Usually, patients selected for SCS experience chronic and debilitating pain for over three months in the lower back, leg (sciatica), or arm. They may have also undergone one or more spinal surgeries which have failed to alleviate their radicular complaints.

You might be eligible for SCS if:

  • Conservative therapies have proven ineffective.
  • Additional surgery may not be beneficial.
  • Additional surgery may not be viable given the medical/ surgical history
  • You have successfully completed an SCS trial with a pain management provider or physiatrist
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What symptoms are treated with a spinal cord stimulator?

  • Chronic leg (sciatica) or arm pain (radiculopathy): persistent pain caused by arthritis, spinal stenosis, or nerve damage.
  • Diabetic neuropathy: a diabetic condition causing burning or stabbing pain, often affecting the legs or feet.
  • Failed back surgery syndrome: when one or more surgeries fail to relieve persistent arm or leg pain, excluding technical malfunctions of the original procedure.
  • Complex regional pain syndrome: an advancing disease characterized by constant, chronic burning pain, typically in the foot or hand.
  • Arachnoiditis: painful inflammation and scarring of the protective lining of spinal nerves.

If you believe you may be a candidate for a spinal cord stimulator, call our office today to book your consultation at 201-399-3388.

How is a spinal cord stimulator procedure performed?

A spinal cord stimulator procedure involves two stages, the trial and the implantation of the permanent device if deemed effective at pain relief.

First, there is a trial period where a pain management provider or physiatrist will insert a temporary device for you to assess. Using fluoroscopy, a specific type of X-ray, they will carefully position the electrodes in the epidural space of your spine. The electrode placement depends on the location of your pain.

Typically, only one incision is made in your mid to lower back to place the electrodes during the trial. The generator or battery will be positioned externally, usually attached to a belt worn around your waist.

Over the course of approximately 5 to 7 days, you will evaluate the pain reduction provided by the device. The trial is considered successful if you experience a 50% or more reduction in your pain level.

If the trial is unsuccessful, the wires can be easily removed in a clinical setting without causing damage to your spinal cord or nerves. However, if the trial is successful, permanent implantation may be discussed for prolonged pain relief.

Before the surgery, you will be given general anesthesia by a trained anesthesiologist. You will be completely asleep before the procedure begins. Once you are anesthetized, our team of experienced neurosurgeons and physician assistants will perform the following procedure:

  1. A small incision is made on your mid back to access the spine
  2. If warranted, a decompressive laminectomy will be performed to access the spinal cord where the electrodes will be placed
  3. A smaller incision is made above the buttocks where the generator, also referred to as a battery, is placed beneath the skin above the musculature
  4. The electrode wiring is connected to the generator and secured into place
  5. The entire procedure is conducted with serial  X-ray imaging technology to ensure optimal placement.
  6. The incision(s) are closed with multiple layers of dissolvable sutures and covered with a dry, sterile dressing

What to expect following a Spinal Cord Stimulator Procedure

This procedure is typically performed ‘outpatient’, meaning you will likely go home the same day. Depending on the complexity of your surgery, medical history, and comfort level postoperatively, you may require admission for overnight observation. 

Typically, patients can begin walking within an hour post-procedure, with assistance. While you might experience mild discomfort at the incision sites, this sensation is generally short-lived, subsiding within days. Notably, many individuals report a significant reduction in pain shortly after their surgery.

It is essential to discuss postoperative activities with your doctor to ascertain which, if any, should be temporarily avoided in the interest of optimal recovery.

At NeuroSpine Plus, we are committed to ensuring you are well informed and prepared for a smooth recovery process.

Your postoperative healing progress will be closely overseen by our team of providers, ensuring a routine recovery. A member of our team will contact you within the first 48 hours of your procedure to monitor your progress. Your initial post operative appointment will be scheduled within two weeks of your surgical date. A member of our team is always available to answer questions or address your concerns during your recovery period. 

General postoperative recommendations include, but are not limited to the following:

  • Use of postoperative pain medications as prescribed

  • Over-the-counter Tylenol for pain

  • Do not smoke

  • Do not drink alcohol

  • Attend all scheduled follow-up appointments

  • Do not use NSAIDs until cleared by your surgeon (Advil, Ibuprofen, Motrin, Aleve, etc)

  • Incision care includes washing your incision with gentle antibacterial soap 48 hours after your procedure. No scrubbing, submerging, or soaking the incision(s). No lotions, creams, oils, or ointments atop the incision(s).

What to expect following a Spinal Cord Stimulator Procedure

 

  • Use of postoperative pain medications as prescribed
  • Over-the-counter Tylenol for pain
  • Do not smoke
  • Do not drink alcohol
  • Attend all scheduled follow-up appointments
  • Do not use NSAIDs until cleared by your surgeon (Advil, Ibuprofen, Motrin, Aleve, etc)
  • Incision care includes washing your incision with gentle antibacterial soap 48 hours after your procedure. No scrubbing, submerging, or soaking the incision(s). No lotions, creams, oils, or ointments atop the incision(s).

When to contact your doctor's office following spinal cord stimulator surgery

If you have concerns during your postoperative period to include, but not limited to the following:

  • High fever greater than 100.4F
  • Change in urinary or bowel habits
  • Severe positional headache that will not resolve when lying flat
  • Swelling or discoloration of one or both calves
  • Shortness of breath
  • Chest pain
  • Palpitations
  • Lightheadedness
  • Incisional compromise
  • Loss of strength in your arms or legs

If you have a question regarding your initial postoperative period, a member of our team is always available to answer and address your concerns at 201-399-3388.

Spinal Cord Stimulator FAQs:

It is generally safe to have X-rays and CT scans following the implantation of a spinal cord stimulator. However, it is important to inform your doctor, nurse, or technician about the presence of your spinal cord stimulator before any scan.

MRI scans are not always safe for individuals with spinal cord stimulation devices. Many newer devices may be compatible with specific models of MRI machines and scanning locations, but many facilities require documentation from the manufacturer to ensure compatibility. If your device is not MRI-compatible, undergoing an MRI could lead to serious injury.

Yes, airport security gates will detect the presence of your stimulator. Some individuals may experience uncomfortable (yet harmless) interference with their stimulators when passing through airport security gates. If you are unable to avoid going through the security screener, make sure to turn off your device before doing so.

Swimming is permissible with a permanent, implanted generator once your incisions are well-healed. However, you should avoid getting your temporary stimulator wet during the trial period, as electrode leads and the battery pack are exposed. 

Yes, a spinal cord stimulator can be safely removed if you are dissatisfied with the level of pain relief it provides or if there is an issue with your system.

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