Spinal Cord Stimulation Trial

Spinal cord stimulation or (SCS) is an implanted medical device that looks and works a lot like a pacemaker. In fact SCS systems are sometimes called pacemakers for pain. It can help you avoid having complicated surgery. Basically it works by tricking the brain by interrupting the pain signals being sent to the brain with its own signal which feels like a mild tingling or massaging sensation. You can try the SCS system on a trial basis for a week to see if it helps you, before deciding to go permanent with it. If it does not help, we will remove it as it is a reversible treatment. It is an option for patients suffering from complex regional pain syndromes (CRPS) also know as reflex sympathetic dystrophy (RSD), nerve damage (neuropathic pain), failed back surgery pain, spinal cord damage, phantom limb pain, and pain caused by blood vessel disease.

It is not a "first line" treatment and is performed after more conservative therapies have failed. We have had great success with our patients with SCS systems. The spinal cord stimulator electrically stimulates the spinal cord with a low voltage impulse that blocks the sensation of pain. Patients who qualify for the SCS report a 50 to 70% percent reduction in overall pain, as well as an increased ability to participate in normal family and work activities. Although it is not a cure, SCS therapy can be successful in reducing pain. Many patients find that they can decrease or stop taking painkillers or other pain medications after undergoing spinal cord stimulations. SCS devices are approved by the U.S.Food and Drug Administration (FDA) as a method of pain control for the treatment of chronic pain of the arms, legs, and trunk, or pain resulting from failed back surgery.

The Device

A SCS system typically consist of three components designed to work together. The leads are thin wires with electrodes that deliver the signal to your spine. Electrical stimulation is delivered through the implanted lead near the spinal cord in the epidural space. The lead is connected to an implanted long life battery or a receiver that receives energy from an external battery. The generator is a small device that holds the electronic components and sends the electrical signal through the leads. The controller or “remote control” lets you adjust the strength and/or location of the electrical pulses that are custom pre-programmed for your situation and needs by our specialist. Picture the remote control sort of like a tv remote control. You can turn the intensity up or down, or turn it off if not needed. As the pain changes the stimulation can be adjusted as necessary with this remote.

Procedure Overview

The procedure is done in two stages at different times. In the trial stage, temporary wires are placed  to generate electrical stimulation. This is really a test to determine if a permanent spinal cord stimulator should be used if the system works successful on you. If this trial is successful in relieving your pain, then we will send you out to a specialist to have the permanent device is placed under the skin, usually about two weeks later. The spinal cord stimulation trial implant is an outpatient procedure done in our facility’s ambulatory surgery center under strict sterile conditions. You will be connected to monitoring equipment (EKG monitor, blood pressure cuff, and a blood-oxygen monitoring device). The doctor or nurse will start an intravenous line and give some medicine to help you relax. You may also receive an antibiotic. The procedure is performed with you lying on your stomach.

The doctor will cleanse your back with antiseptic solution and inject some numbing medicine. With the assistance of a special X-ray machine called a fluoroscope, the doctor will place a needle through the skin next to the nerves to be stimulated. When the needle is in the correct position, the doctor will advance the spinal cord stimulating wires through the needle, connect them to a special battery, and begin stimulating the nerve with electrical impulses.

You will probably sense a tingling sensation in the area of your usual pain, which means the electrical impulses are going to the right place. The electrical current coming from the battery will be adjusted until the sensation is no longer unpleasant. After the procedure, we ask that you remain at the Clinic until the doctor feels you are ready to leave.

Procedure Details

Will you be asleep for the procedure? Since you need to talk to the doctor and tell him the type of sensation you are experiencing, you will not be put to sleep. However, you will receive enough medication to keep you comfortable. How long will the procedure take? Normally, the spinal cord stimulator trial implant will take one hour or longer.

Before the procedure

Do not eat or drink anything after midnight the day before the procedure. If you are on medications, you may take them with sips of water. If you are a diabetic, discuss your medication with your doctor. You may need to stop taking certain medications several days before the procedure. Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements. The doctor will tell you if and when you need to discontinue the medications. Tell the doctor if you develop a cold, fever, or flu symptoms before your scheduled appointment.

After the procedure

The purpose of the trial placement is to determine how much pain relief can be achieved and if you can increase your level of physical activity. Do not expect to be completely pain free. Keep the area clean and dry to help prevent skin infection. Try to do your normal activities so we can determine to what extent you can increase your level of function. You may experience some muscle discomfort where the needles were place. This may be treated with a mild pain reliever such as Tylenol. Do not drive for the remainder of the day. Please have an adult drive you home or accompany you in a taxi or other public transportation. Depending on how you feel, you may resume normal activities and return to work in one to three days.

Procedure Risks

The risks are minimal but potentially include: Infection, spinal cord compression, meningitis, spinal fluid leak, bleeding, movement of the wires, and hardware failure. Please call the doctor right away if you experience any redness or swelling in the area of the sutures, fever, chills, an alteration of the stimulation pattern, movement of the electrical signal, or failure of the battery.