What Is Spinal Cord Stimulation?
Chronic pain, especially chronic lower back pain, can be debilitating and have severe impacts on quality of life. No one knew this better than Wayne; his back problems got so bad he could hardly walk to the end of his driveway to pick up the mail.
When physical therapy, lifestyle modifications, and conservative treatment methods fail to provide long-term relief, spinal cord stimulation (SCS) may be a way to alleviate pain and restore function without surgery. After consulting with Dr. Ramos, Wayne decided that spinal cord stimulation would give him the best chance of leading a normal life again.
SCS has been documented as an effective pain management treatment used to treat people suffering from significant lower back discomfort that radiates into the legs. SCS is often used when other conservative measures have failed including:
First approved by the Food and Drug Administration (FDA) in 1989, SCS aims to treat pain from nerve problems in the torso, arms, and legs that may have resulted from an accident, injury, or disease. As many as 50,000 neurostimulators are implanted worldwide every year, and SCS represents over 80% of all neuromodulation therapies. This number is expected to grow as aging populations continue to cope with chronic pain management.
After undergoing a successful revision spinal fusion surgery at South Florida Orthopaedics & Sports Medicine with orthopaedic surgeon Anuj Prasher, Wayne was referred to Dr. Ramos to help him manage the pain he was experiencing elsewhere in his body. The convenience of having his orthopaedic surgeon and pain management specialist in the same practice saved Wayne time and streamlined his care.
Dr. Ramos’ mannerisms are just outstanding,” says Wayne. “We have been working (together) for other pain problems that I have, and so far things have progressed very well. Not only can he converse back and forth on anything as needed, but you have access to all services in one location, and you don’t have to worry about going here or there and traveling eighty miles or whatever.”
How Does Spinal Cord Stimulation Work?
By implanting a small device, similar to a pacemaker, in the back of the spine, SCS masks pain signals before they get to the brain’s pain receptors. The implant delivers soft electrical stimulation to the spinal nerves creating an electrical field to hide painful sensations and replace them with more tolerable ones such as mild thumping, vibrating, and buzzing.
SCS is a long-term treatment that can help patients:
- Cope with chronic pain
- Alleviate discomfort
- Decrease the need for pain medication
- Reduce the use of opioid medications for months or even years
Before proceeding with the implant procedure, patients undergo a one-week trial period at home to ensure that the therapy produces results.
All SCS systems contain three key components:
- A generator with a battery that produces electrical pulses
- A lead wire comprising between eight to thirty-two electrodes that transport electrical pulses to the spinal cord
- A hand-held remote control with power options and settings
How Is SCS Performed?
Using a monitor, the surgeon winds two thin lead wires into the epidural space on the back of the spine. Guided by patient feedback, the physician adjusts the placement of the electrodes until the painful area feels masked by tingling sensations (a technique known as topographical mapping).
The wires are hooked up to a battery and placed in a fanny pack outside the body. An external pulse generator is also connected and sits on a belt. The patient will experiment with different settings at home and determine if they experience significant pain improvement during that time. If the trial period is successful, the leads are discarded, and the full spinal cord stimulation implant procedure is scheduled and performed.
The procedure for both the trial period and the permanent implant is an outpatient procedure. The trial can be done in the office, whereas the implant procedure requires a sterile environment. Patients who pursue the permanent SCS implant option will receive a tiny power generator no larger than an Apple Watch, usually implanted under the skin on top of one buttock.
Wayne appreciated how simple it was to schedule appointments at South Florida Orthopaedics & Sports Medicine. The process made his life easier and allowed him to receive faster treatment.
“Scheduling appointments has been absolutely no problem, in fact, better than most practices,” says Wayne. “Dr. Ramos was very prompt for consultation. He schedules pretty frequently, and the wait time was minimal.”
After SCS Implant Surgery
During the trial period, and for two to three months after surgical implant, patients should avoid any significant bending, stretching, or twisting movements. This allows the implant to settle into a more permanent position and minimizes the risk of displacing the device.
Once fully healed, patients typically transition smoothly back to their regular activities and report long-term pain relief. Grateful for his successful surgery and restored function, Wayne applauds the attention and follow up care he received from Dr. Ramos.
“Dr. Ramos kept in close contact throughout with me and my family to let them know what was going on,” he says. “And he came in after the surgery and spoke with me to let me know how everything went. He stayed with follow-ups too afterward. Dr. Ramos has been as good as I can expect from any doctor.”