SPINAL CORD STIMULATION
Spinal cord stimulators consist of thin wires (the electrodes) and a small generator. During surgery, the electrodes are placed in the epidural space between the spinal cord and the vertebrae, and the generator is placed under the skin, near the buttocks or abdomen.
Once the device is implanted, patients use a handheld remote control to send electrical impulses when they feel pain. The remote control and its antenna are not implanted.
The mechanisms behind spinal cord stimulation are not fully understood, but experts know that treatment targets multiple muscle groups directly from the spine and even alters how the brain senses pain.
Traditional spinal cord stimulators create paresthesia by replacing the sensation of pain with light tingling. Some patients prefer newer devices that offer “sub-perception” stimulation that cannot be felt.
Spinal cord stimulation is performed under X-ray and/or ultrasound guidance by physicians with highly specialized training in interventional pain management.
Spinal cord stimulation is a treatment option for patients who have not experienced sufficient pain relief from nonsurgical pain treatment options. Patients with the following conditions may benefit from spinal cord stimulation:
Back pain, especially back pain that persists even after surgery (also known as failed back surgery syndrome)
Peripheral vascular disease
Injuries to the spinal cord
Nerve-related pain (such as severe diabetic neuropathy and cancer-related neuropathy from radiation, surgery, or chemotherapy)
Complex regional pain syndrome
Pain after an amputation
Visceral abdominal pain and perineal pain
The benefits of spinal cord stimulation include improved overall quality of life and sleep, and reduced need for pain medicines. It is typically used along with other pain management treatments, including exercise, medications, physical therapy, and relaxation methods.
Patients who benefit the most from spinal cord stimulation are those who:
Have not experienced sufficient pain relief with medications, less-invasive therapies, or prior surgeries
Do not have psychiatric disorders that would decrease the effectiveness of the procedure
There are three types of spinal cord stimulators:
1. Conventional implantable pulse generator (IPG) is a battery-operated spinal cord stimulator best for people with pain in just one body part because the device has a lower electrical output. Once the battery runs out, it must be replaced during another surgery.
2. Rechargeable IPG is best for people with pain in the lower back or in one or both legs, since the electrical signal can reach further. This device works similarly to the conventional IPG, but uses a rechargeable battery that doesn’t require additional surgery.
3. Radiofrequency stimulator relies on a rechargeable battery that’s outside the body. This stimulator is rarely used today and may be better for patients with pain in the lower back and legs because of the device’s power.
Patients should speak to their doctor to find out which device is best for them.
Spinal cord stimulator surgery is done to test and implant a spinal cord stimulator, a device that sends low levels of electricity directly into the spinal cord to relieve pain.