Spinal Cord Stimulation
Spinal cord stimulation (SCS) is a proven, effective pain management therapy that is often used to treat people suffering from significant lower back and neck pain that radiates into the extremities such as the arms or legs. These patients may have tried and failed other conservative measures such as facet injections, radiofrequency ablation, or epidural injections.
Chronic pain, especially lower back and neck pain, can be debilitating and have severe impacts on one’s quality of life.
When physical therapy, lifestyle modifications and conservative treatment methods fail to provide long-term relief, spinal cord stimulation may offer an effective solution to alleviate pain and restore normal functioning without surgery.
Spinal cord stimulation was first introduced by the Food and Drug Administration (FDA) in 1989 to treat pain from nerve problems in the torso, arms, and legs, and some 34,000 patients around the globe now receive spinal cord stimulator implants annually. SCS represents roughly 80 percent of all neuromodulation treatments, and that number is predicted to climb in the future as aging populations grapple with managing chronic pain and illness.
How Does Spinal Cord Stimulation Work?
SCS, simply put, conceals pain signals before they hit the brain’s pain receptors. A tiny device is implanted in the back of the spine, delivering soft electrical stimulation to the spinal cord. By creating a field of electrical energy, SCS masks the painful sensations patients feel with more tolerable ones such as mild thumping, vibrating, and buzzing. At times, patients will not be able to feel any paresthetic sensations at all.
SCS is a long-term therapy, meaning it can help patients cope with chronic pain and reduce the use of opioid medications for months or even years. SCS is typically employed to treat neuropathic pain, discomfort due to nerve damage that may have resulted from an accident, injury, or disease.
There are different kinds of SCS systems. However, all have three key components:
- A generator with a battery that produces electrical pulses
- A lead wire containing between eight to thirty-two electrodes that transport electrical pulses to the spinal cord
- A hand-held remote control with power options and settings
What is the SCS Implant Procedure?
Before proceeding with implantation, patients will undergo a one-week trial period at home, to ensure that the therapy produces results; it acts as a test-drive of sorts.
Using a monitor, a surgeon will weave two small lead wires the size of fishing lines into the epidural space on the posterior part of the spine. Using patient feedback, the physician adjusts the placement of the electrodes until the painful region feels masked by tingling sensations (a technique known as topographical mapping).
The wires are connected to a battery, inserted in a fanny pack outside the body, and an external pulse generator placed on a belt. At home, the patient will try the various settings and intensities and then judge if they have 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 trial and the implant procedures are similar outpatient procedures. The trial can be done in the office, whereas the implant procedure requires a sterile, operating-room-like environment.
Patients who pursue the permanent SCS implant option will receive a tiny power generator no bigger than an Apple Watch, usually implanted under the skin on top of one buttock or the other.
What Should I Expect After SCS Implant Surgery?
For the duration of the trial period and the first weeks after surgical implant, patients are instructed to refrain from significant bending, stretching, or twisting motions while the body heals. This allows the implant to ‘scar’ its way into a more permanent position and avoids any changes in the shape of the spine during the process that can cause displacement of the device.
During the trial, patients are only allowed to take sponge baths; after the implant procedure, they can shower but should avoid soaking in water until the incisions fully heal.
Once fully healed, patients typically report long term relief from pain without much of a change to their day-to-day activities or hobbies at all.