Spinal Cord Stimulator

Am I a Candidate for Spinal Cord Stimulation?

Effective pain relief depends on expert evaluation of the cause of your pain. Your NYC doctor determines the best treatment for your pain based on a thorough examination and imaging studies. Conditions that may make you a good candidate for spinal cord stimulation include:

• Chronic leg (sciatica) or arm pain: ongoing, persistent pain caused by arthritis, spinal stenosis, or by  nerve damage.
• Failed back surgery syndrome: failure of one or more surgeries to relieve persistent leg or arm pain, but not a technical failure of the original procedure.
• Non-surgical refractory back pain, when you are not a candidate for back surgery 
• Complex regional pain syndrome: a progressive disease in which patients feel constant, chronic burning pain, typically in the foot or hand.
• Arachnoiditis: painful inflammation and scarring of the protective lining of the spinal nerves.

Other: stump pain, angina, peripheral vascular disease, multiple sclerosis, or spinal cord injury.

Painful diabetic neuropathy; for patients whose pain is refractory to, or who can’t tolerate, conventional medical treatment.

Your doctor may recommend spinal cord stimulation if you’ve tried conservative treatment options for at least six months without relief and surgery isn’t a good option for you.

Spinal cord stimulator (SCS) procedures are medical interventions used to alleviate chronic pain and enhance quality of life for individuals who may have not responded effectively to other conservative treatments. An implanted device emits electrical impulses directly into the spinal cord, effectively blocking pain signals from reaching the brain. Before each procedure begins, a comprehensive evaluation process takes place in order to ascertain if a candidate for SCS exists – this evaluation typically involves reviewing medical history records, physical exams, imaging studies and various pain assessments. During the procedure, patients are administered local anesthesia as well as conscious sedation to relax them during surgery. Surgeons make a small incision at the area where electrode leads will be installed – thin wires with small electrodes attached at their tips – then guide these leads through epidural space until they arrive near spinal cord.

Who Performs The Procedure?

Neurosurgeons and doctors who specialize in pain management (an anesthesiologist or physiatrist) implant spinal cord stimulators. The surgical decision determining whether a spinal cord stimulator will be a good option for you is a two-step process. 

Stage 1. Temporary Trial 

For a temporary trial, you must see if the device decreases your pain level. An SCS trial is performed to determine if it will work for the type, location, and severity of your pain. The procedure is usually performed in an outpatient center or an office-based surgery suite. Before the trial, you must stop taking blood-thinning medications three to seven days in advance. Local anesthetics are used to numb the lower back area. An X-ray fluoroscopy is used to insert a hollow needle through the skin to reach the epidural space. Over specific nerves, the trial lead is inserted and positioned. Your skin is just taped over an external generator which is connected to the wires. It takes about 30 minutes to complete the procedure. You will be followed up on a daily basis by a representative, and it is important to keep track of how the stimulator affects your pain, sleep, function, and the need for pain medication.  The trial leads will be removed after 5 to 7 days, and you will discuss whether or not to go ahead with the implant. 

Stage 2. Surgical implant

SCS can be implanted into your body if you felt greater than 50% improvement in pain, sleep, or function after the trial. A minimally invasive procedure involves your doctor placing the device, which is similar in size to a pacemaker, under your skin. Depending on your comfort level, the implant may be placed in your lower back or buttocks. A two-hour implant procedure typically involves anesthesia or sedation to make the procedure as comfortable as possible. It is common for you to go home the same day, so you need to bring someone with you to accompany you home. There are a number of possible complications associated with minor surgical procedures, including anesthetic risks, infections, poor wound healing, and pain at the site of the procedure. Most of these issues resolve on their own or with medication within a few weeks or months after any procedure. It is extremely rare for complications to lead to serious injuries or even death, though they can occur in mild or temporary cases.