Spinal Cord Stimulator

In spinal cord stimulator devices, mild electric currents are sent to your spinal cord surgically under your skin. Pulse generators send current to spinal cord nerve fibers via thin wires. Rather than sending pain signals to the spinal cord, SCS sends impulses that compete with them. Consequently, your body’s pain messages are blocked or modified. With SCS, the goal is to reduce pain by over 50%. Despite this, even a small reduction in pain can have significant effects if it makes it easier to perform daily activities and reduces your pain medication use. Patients experience a 76% reduction in pain on average.

To determine if a candidate is eligible for a spinal cord stimulator, we perform a variety of checks beforehand. A physical assessment, medication regimen, and history of pain will determine if you are a candidate for this treatment. All previous treatment and surgery will be reviewed by a neurosurgeon, physiatrist, or pain specialist. In addition to its physical effects, chronic pain also has emotional effects, you will be assessed by a psychologist to maximize the chance of success. A candidate for SCS usually suffers from chronic debilitating pain in the lower back, leg (sciatica), or arm for at least 6 months. If conservative therapies have not worked, you may be a candidate for SCS. Additional surgery would not be beneficial to you. A further surgery will increase your risks and take a long time to recover. SCS may be preferred over a large, complex spine surgery in some cases.

An SCS can help lessen chronic pain caused by:

• Pain in the legs (sciatica) or arms caused by arthritis, spinal stenosis, or nerve damage.
• Failed back surgery syndrome: failure of one or more surgeries to relieve persistent leg or arm pain, but not a technical failure of the original procedure.
• Back pain that cannot be treated by surgery, when you are not a candidate for back surgery
• Complex regional pain syndrome: a progressive disease characterized by persistent, chronic burning pain.
• Arachnoiditis: irritation and scarring of the spinal nerve protective lining.
• Other symptoms include stump pain, angina, peripheral vascular disease, multiple sclerosis, and spinal cord injury.
• Painful diabetic neuropathy; patients who cannot tolerate conventional medical treatment or whose pain is refractory.

Spinal cord stimulators are implanted by neurosurgeons and doctors specializing in pain management (anesthesiologists or physiatrists). There are two steps to deciding whether a spinal cord stimulator will be a good option for you. 

Stage 1. Temporary Trial 

Before using the device permanently, you must undergo a temporary trial to determine whether it reduces your pain. This trial or “test drive” determines if an SCS will work for the type, location, and severity of your pain. In both outpatient and office-based surgical settings, this procedure is performed. Blood-thinners must be stopped 3 to 7 days prior to the trial if you take them. The lower back area is numbed with local anesthetic. The epidural space between the spinal cord and bone is accessed using X-ray fluoroscopy. A trial lead is inserted over specific nerves and positioned there. There is just a tape on your skin that connects the wires to the external generator. It takes about 30 minutes to complete the procedure. During daily follow ups, a representative will tell you how the stimulator is helping you with pain, sleep, function, and how much pain medication you need.  The trial leads will be removed after 5 to 7 days, and the doctor will discuss whether to proceed with the implant. 

Stage 2. Surgical implant

SCS devices can be implanted in your body if the trial is successful and you feel greater than 50% improvement in pain and sleep and/or function. The device, similar to a pacemaker, will be placed under your skin during the minimally invasive procedure. Depending on your comfort level and your doctor’s recommendation, the implant is placed in your lower back or buttocks. To make the implant procedure as comfortable as possible, anesthesia or sedation is used during the procedure. You will typically return home the same day, and you will need someone to drive you home. There are complications associated with minor surgical procedures, such as anesthetic risks, infections, poor wound healing, and pain. In most cases, these types of side effects resolve on their own or with medication within a few weeks or months, regardless of the type of procedure. Although most complications are mild or temporary, they can cause serious injuries or even death in rare circumstances.

The device may cause complications after implanting, including pain relief loss, lead migration, allergies, and discomfort or pain from lead migration. The device can be reprogrammed, treated with medical treatment, corrected surgically, or removed to resolve these complications. Recovery takes about four to eight weeks. While you are recovering, engage in only light activity and avoid lifting items heavier than 5 pounds, twisting, bending, climbing, stretching, and any movements that require reaching over your head. It is generally safe to swim, travel, and return to your favorite activities after your recovery period, with your doctor’s approval.

Spinal cord stimulators are covered by nearly all major insurance plans, including Medicare and Medicaid.