FAQs on Spinal Cord Simulator Implants
It is a device that is implanted around the spinal cord and emits electrical impulses to alter the way the brain perceives pain signals. The device can be very effective for chronic pain conditions that are not amenable to surgery.
Over the past 20 years, spinal cord stimulator implants have improved dramatically in both the technology they provide, the smaller size of the implant, and the outcomes have improved as well.
The implants consist of two elements. The first is the battery pack itself, which is placed in the subcutaneous soft tissues either above the buttock region or around the side of the abdomen. The second part of the implant is the wire that feeds down into the spinal canal which is attached to the paddle lead that has diodes on it to transfer the electrical impulses.
The newest devices have a rechargeable battery that patients simply wear a belt every few nights that has been able to recharge the battery through the skin. Most implant devices now have over 200 separate programs to help patients who have back or neck pain, arm or leg pain, and even pelvic, abdominal or reproductive area pain.
For what conditions is a spinal cord stimulator helpful?
A stimulator is a potentially excellent option as a last resort for patients with chronic pain. It may provide exceptional pain relief and a decreased need for pain medications for those suffering from failed back surgery syndrome, failed neck surgery syndrome, diabetic neuropathy, peripheral neuropathy, chronic pelvic pain, chronic abdominal pain, post laminectomy syndrome, chronic testicular pain, coccydynia, RSD and CRPS.
Spinal cord stimulator devices are not designed to fix any of these problems. They are simply designed to mask the pain that has no surgical option. The theory is that if there is no method of fixing the problem, then the next best thing is to mask the pain that is chronic and potentially disabling.
How are the devices implanted?
The first step in receiving a spinal cord stimulator is what is called a trial implant. The pain management doctor performs the trial implants on an outpatient basis. Patients are given IV sedation, but cannot be “knocked out” as input is needed during the procedure.
Through a tiny incision, a small catheter lead is placed in the spinal canal, and the patient is asked if the electrical stimulation covers the area of pain. The trial implant is programmed during the procedure to position it so that the patient receives stimulation around the area of the typical pain.
Once appropriate positioning is achieved, the implant is left in place and covered with a sterile dressing. After 5 to 7 days, the implant is removed in an office setting and the patient is asked how much pain relief was achieved during that time.
If the answer is over 50%, then a final implant is in order. Often times a psychological evaluation is required as well for insurance approval.
The final implants are placed under general anesthesia, and takes about an hour. Because the paddle lead is so much larger than the trial implants, a slight amount of bone is necessary to remove from the back of the spine in order to properly place the paddle lead. Fluoroscopy is used, which is a real-time form of x-ray, in order to properly place the device.
Once the implant is in the desired position above the lumbar area or up in the neck, the wire is moved through the soft tissue and attached to the battery pack in the desired position above the buttock area or around the side of the abdomen. The key is to place the battery subcutaneously in an area that patients will not sit on or rub up against frequently.
Patients are allowed to go home the same day, and typically on the first visit after the procedure is when the device is programmed for the stimulation.
How well do these devices work?
The trial implants do not usually get rid of all of an individual’s pain. The leads are very thin, and only have so many programming options. The final paddle leads that are placed have over 200 programming options that can typically mask a significant amount of an individual’s discomfort.
Overall, for back and leg pain, studies have shown over a 60% effectiveness. There have not been large enough studies for neck and arm pain to formulate statistical significance, but smaller studies have shown excellent results for these areas as well.
The latest implants have improved over the last couple of decades, and the newest studies are showing over an 80% effectiveness rate for chronic pain that is treated within two years of onset. This is for both back and leg pain, and it is remarkable considering the procedure is a last resort option. One study of SCS implants showed that 84% reported that their quality of life was greatly improved, with 77% receiving good or excellent pain relief.
Over 80% reduced their narcotic usage.(references) Another study in Lancet showed that 85% receiving a spinal cord implant for diabetic neuropathy achieved substantial return of sensory loss, while over 50% noticed complete reversal of their sensory loss. Over 1/3 of the participants in thestudy reduced their narcotic needs significantly while the average pain reduction on the visual analog scale was over 7 points!
There are anecdotal reports for spinal cord stimulators working well for coccydynia pain, occipital neuralgia, testicular pain, and chronic pelvic or abdominal pain. Due to the fact that the risk profile is fairly low versus the potential tremendous benefits available, it is being tried for most chronic pain conditions where surgery is no longer an option. For instance, if an individual is having pelvic pain due to postsurgical scarring, going back in for more surgery will just create more scar tissue. Therefore, a stimulator may provide excellent relief without those risks.
What are the risks of these implants?
The incidence of serious complications is low with these procedures, however, there is a very high incidence of minor complications. This may include non-infectious wound drainage, slight lead migration of the paddle lead, or skin irritation from the battery pack.
There’s also a risk of a dural puncture during the trial or final placement along with the potential for infection as it is a substantial foreign body. The biggest risk is infection. With the size of the implant, it happens about 5% of the time.
What is the bottom line with spinal cord stimulator implants?
These devices represent an excellent last resort option for individuals with chronic pain that is not amenable to surgery. The implant can make a tremendous difference in a persons life by masking pain and reducing the need for narcotics while also avoiding depression, disability, and allowing individuals get back to work and play with their kids and pets.
If you are dealing with a chronic pain issue that has failed with surgery or is not amenable to being fixed, then a spinal cord stimulator implant may just be the answer. The US Pain Network connects those in pain with pain relievers Nationwide.
Visit our Find a Pain Doctor page and insert your zip code or city, state to find one close to you today!