It’s estimated that more than 60,000 people each year are implanted with spinal cord stimulators. And many of those people have reported positive effects from its use. These devices are especially helpful to spinal cord injury survivors who have lost motor or sensory function.
So what exactly is spinal cord stimulation? And is it right for you? Continue reading and we’ll walk you through everything you need to know.
What is a Spinal Cord Stimulator?
A spinal cord stimulator is a device that’s surgically implanted under the skin. It works by sending a mild electric current directly to your spinal cord. Thin wires transport this current to the nerve fibers of your spinal cord from a pulse generator.
When the device is turned on, the spinal cord stimulator will stimulate the nerves in the location where you are experiencing issues. Complications that you would normally experience are minimized because those electrical pulses both mask and modify those aching sensations from getting to your brain.
Using spinal cord stimulation will not eliminate the source of your aches but it will interfere with its signals to the brain. The amount of relief that a person experiences varies. Some people feel an unpleasant tingling sensation while others have described it as mild and pleasant.
Because a person’s reaction is tough to determine beforehand, a trial spinal cord stimulation is performed before permanently implanting the device. A 50-70 percent reduction in pain is the goal. Still, even a lesser amount of reduction can go a long way for people.
A successful stimulation experience means that you can have more control over your daily life and activities, such as house and yard work, as well as possibly reduce the number of analgesics you need to take. And if it’s unsuccessful, the stimulator can be removed and no damage to the nerves or spinal cord will occur.
Types of Spinal Cord Stimulators
There are multiple types of spinal cord stimulators available today. However, all stimulators contain three primary components:
- A lead wire that has up to 32 electrodes. This carries electrical pulses to the spinal cord.
- A pulse generator that has a battery that makes those electrical pulses.
- A hand-held remote control. This turns the stimulator off and on and it can adjust the settings too. You can also control some stimulators by using an app.
A system that doesn’t have a non-rechargeable battery needs to be replaced surgically every two to ten years, depending on how often it’s used. A rechargeable battery system can last longer, however, it must be charged every day. However, improvements are being made all the time to these batteries.
The pulse generator has settings that are programmable. Some spinal cord stimulator devices can sense a change in body position and then adapt the level of stimulation to your activity.
Other systems have lead wires that can be programmed independently to cover several areas of pain. Some systems send a sub-perception pulse that has no tingling at all. Speak with your healthcare professional to determine which system is best for you.
Who Is a Good Candidate?
Before undergoing spinal cord stimulation therapy, a doctor will first need to evaluate your medication regimen, physical condition, and pain history. A surgeon or pain specialist will go over your previous surgeries and treatments. Since physical pain also has mental and emotional effects, a psychologist will evaluate your condition as well.
There are many ways to treat chronic back pain, and all options should be considered. A patient who has been chosen to undergo spinal cord stimulation has most likely dealt with debilitating and chronic pain for at least three months in their leg, lower back, or arm. They have probably also have had at least one spinal surgery.
You may be a good candidate for a spinal cord stimulator implant if:
- You wouldn’t benefit from more surgery
- You don’t want any more surgeries
- You don’t have any medical conditions that would stop you from getting an implant
- Other therapy treatments have failed you
- The issues that you’re experiencing are due to a correctable problem
- You don’t have an untreated drug addiction or depression
- You’ve undergone a successful spinal cord stimulation trial
Spinal cord stimulation is optimal for people who are in the early stages of a chronic issue. Ideally, before a cycle of aches-agony-disability-aches becomes established.
What a Spinal Cord Stimulator Relieves
A spinal cord stimulator can help to reduce chronic issues caused by:
- Failed back surgery syndrome: this is when at least one surgery fails to reduce constant leg or arm pain, but it’s not caused by any technical failures of the original surgery
- Arachnoiditis: this is uncomfortable scarring and inflammation of the protective lining for the nerves of the spine.
- Chronic arm or leg (sciatica) issues: these are constant and ongoing issues caused by spinal stenosis, arthritis, or nerve damage.
- Complex regional pain syndrome: this is a progressive disease where patients feel chronic, ongoing burning sensations, typically in their hands or feet.
- Other: angina, multiple sclerosis, stump pain, peripheral vascular disease, or a spinal cord problem.
It’s important to know when to see a pain management physician.
Deciding on Surgery
Spinal cord stimulators are implanted by either neurosurgeons or doctors such as physiatrists or anesthesiologists. It’s a two-step process to determine if stimulation is the right path to go down. Let’s take a look at those two steps below.
Step 1: The Trial
This trial is a “test drive” that is used to decide if a spinal cord stimulator will work the location, type, and severity of your aches. It’s performed at an outpatient location. If you take blood-thinner, you’ll be required to stop taking that medication three to seven days before you start the trial and remain off of it during the trial period.
To numb the lower back area, you’ll be given a local anesthetic. By utilizing X-ray fluoroscopy, a hollow needle will be inserted through your skin and into the space that surrounds the spinal cord and fluid.
The trial lead(s) is then inserted and placed over specific nerves. The wires will be attached to an external generator that will be worn on a belt.
Once completed, you’ll be sent home and given directions on how to use the stimulator as well as take care of the place of the incision. You’ll want to have a written log of the stimulation settings you use during different activities. After about five days, you’ll go back to your doctor’s office to talk about permanently implanting the spinal cord stimulator or taking out the trial leads.
Step 2: The Surgery
If the trial provided at least a 50 percent improvement with concerns to your pain, then surgery can be set up to implant the device.
At your doctor’s office, you’ll sign consent and other papers so that the surgeon will be aware of your medical history. The surgeon will want to know what vitamins and medicines you’re taking, allergies, anesthesia reactions, history of bleeding, former surgeries, etc. Let your healthcare provider know about all of the medications that you’re currently taking.
During the Surgery
The implantation usually lasts between one to two hours. We’ll go over the various parts of the surgery below.
Preparing the patient
You will lie on a table, stomach-side down. You’ll then be given light anesthesia. The areas of your buttock and back where the generator and leads will be placed are going to be prepped.
Placing the Leads
With the aid of X-ray fluoroscopy, the electrode leads will be inserted. A small skin incision will be made in the middle of your back. The bony vertebra will be exposed.
A part of the bony arch will be removed to give room to place the leads. The leads will then be placed into the epidural space and held tightly by sutures.
Tunneling the Wire
After the electrodes are placed they will then run under the skin from the spine all the way to the buttock.
Below the waistline, a small skin incision will be made. Beneath the skin, your surgeon will make a pocket for the generator. The electrode will attach to the pulse generator and the generator will then be placed within that pocket of skin.
Closing the Incision
Next, the surgeon will then close the incision. This is done with skin glue and sutures. They will then apply a dressing.
Living With Your Stimulator
After the stimulator has been programmed, you’ll be sent home with directions on how to regulate the stimulation. On follow-up visits with your doctor, they might change the amplitude, pulse width, and frequencies.
With the handheld programmer, you’ll be able to select different programs, turn the device off and on, and adjust the stimulation strength. Many people are given several programs in order to get the best possible relief. You can use the stimulator at all times.
Similar to a cardiac pacemaker, a spinal cord stimulator won’t be damaged by electronic devices like pagers, security doors, cell phones, and anti-theft sensors. When flying, you’ll have to make sure to carry your Implanted Device ID card. This is because the stimulator will be detected at the security gates in the airport.
Theft detectors, airport security gates, and department store doors might cause a decrease or increase in stimulation as you pass through. This stimulation will only be temporary and won’t shouldn’t harm the system. Still, you should turn off the device before passing through such gates, as a precaution.
The different spinal cord stimulation systems have varying restrictions when it comes to them being used with ultrasounds, electrocauteries, cardiac pacemakers, MRIs, defibrillators, and diathermies.
Is Spinal Cord Stimulation Right for You?
Clearly, there’s a lot to think about when one is considering if spinal cord stimulation is right for them. This is a procedure that can provide a lot of relief, both physically and emotionally.
If you think you could benefit from spinal cord stimulation, speak with your doctor. Do you happen to be looking for exceptional interventional pain services in the Northwest Arkansas area? Contact us today!