Spinal cord stimulation is an aggressive pain management technique that involves the surgical implantation of an electrotherapeutic device onto the spinal cord. In the procedure, a device is implanted that introduces low levels of electrical current to the dorsal portion of the spinal cord to block the sensation of pain. Spinal cord stimulators may be a fully implanted system or a system with an external power source.
Spinal cord stimulation is often used to treat neuropathy (neuropathic pain, or nerve pain) from failed back surgery syndrome or radiculopathy. Spinal cord stimulation has shown to be an effective long-term treatment for back pain.
Treatment for Spinal Cord Disorder:Treatment is done by applying an electrical current to the source of chronic pain. This creates a pleasant sensation that blocks the brain's ability to sense the previously perceived pain. There are two related forms of electrical stimulation commonly used to treat chronic pain.
- Spinal Cord Stimulation (SCS): In spinal cord stimulation, soft, thin wires with electrical leads on their tips are placed through a needle in the back near to the spinal column. The leads are placed through a needle inserted in the back (no incision is required). A small incision is then made and a tiny, programmable generator is placed in the upper buttock or abdomen (under the skin) which emits electrical currents to the spinal column.
- Peripheral Nerve Field Stimulation (PNFS): Very similar to spinal cord stimulation, peripheral nerve field stimulation involves placing the leads just under the skin in an area near to the nerves involved in pain.
The procedure to implant the neurostimulation system takes approximately 1 to 3 hours and may require a brief hospital stay. The intensity of electrical stimulation can be changed and the system can be turned on and off or adjusted as necessary to provide optimal pain relief. Although programming is initially done at the physician's office, patients can learn how to control the stimulation on their own and adjust it to their pain levels.
Benefits for surgery is significant and sustained reduction in chronic pain, Improved ability to function and participate in activities of daily living, less oral pain medication needed.
Advantages to spinal cord or peripheral nerve field stimulation for the treatment of chronic back pain:
- A trial can test patient response before the patient commits to a permanent implant.
- It has few side effects and is easily reversible; if it doesn’t work or is no longer needed it can be removed.
- Implantation of the system is minimally invasive, requiring a relatively minor surgical procedure on an outpatient basis.
- Leads are inserted just under the skin, and patients can travel anywhere, and participate in any recreational activities, including swimming.
As with all surgical procedures, there are potential risks to stimulation therapy, although most are relatively minor. Risks include:
- Allergic reaction to the implanted materials
- Pain at the incision site (usually resolves in a few weeks)
- Weakness, numbness, clumsiness, paralysis
- Battery failure and/or battery leakage requiring a surgical incision to remove and replace the battery
- Fluid leak from the spinal cord, causing headache
- Undesirable changes in stimulation may occur over time due to scar tissue forming around the leads, or movement of the lead position
- Undesirable or unpleasant stimulation of the chest or rib area as a result of nerve root involvement
- Migration of the electrode may occur, resulting in a loss or change of stimulation
- Skin breakdown over the generator or electrode site
- Stimulation may work for a period of time and then lose effectiveness after 1-2 years