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FAQ’s on Spinal Cord Stimulation And Spinal Cord Implant
What is spinal cord stimulation?
Spinal cord stimulation is a procedure that uses a spinal cord implant to deliver low voltage stimulation of the nerves in the spinal cord to obstruct the transmission of pain signals. This is most often used in cases of chronic pain that are refractory to non-surgical and conservative measures, or in pain that persists despite attempted surgery. The procedure is primarily for pain management and is done in conjunction with other treatment modalities, such as oral analgesics and/or physical therapy.
What is a spinal cord implant?
A spinal cord implant is also known as a spinal cord stimulator (SCS) or a dorsal column stimulator. It is a surgically implanted pulse generator that is normally placed under the skin of the buttock or the abdomen,
and is connected to the spinal nerves by a lead containing anywhere from 4 to 16 electrodes (depending on the specific case).
The SCS does not eliminate the pain, but only interferes with the pain signals – rather than the pain, patients feel a tingling sensation. The relief of pain will vary, as some patients may find the tingling sensation intolerable.
There are many kinds of SCS, but these are the three most common types:
Conventional systems: these are low-maintenance devices that normally require replacement of batteries every 2 to 5 years. This will require a minor surgical procedure.
Radiofrequency systems: these require an external power source, because of the high levels of energy needed to sustain therapy over long period. This is normally reserved for the more complex, multi-extremity cases with more severe pain.
Rechargeable systems: these are the newest type of SCS device. The patient recharges the power source when required. However, a minor surgical procedure may be required to replace the power source if this turns out to be impractical.
What conditions can benefit from spinal cord stimulation?
Conditions that cause chronic (more than six months) pain and are not responsive to more conservative, non-surgical techniques may benefit from spinal cord stimulation. SCS has been used as a treatment option for cases of:
Failed back surgery syndrome: persistent pain after attempted surgery (such as disc laminectomy) can be treated with SCS
Chronic regional pain syndrome
Chronic back or leg pain
Chronic peripheral neuropathy
Phantom limb pain
SCS has also been explored for use in other conditions, such as angina pectoris and Parkinson’s disease, although more research is required.
What are the risks and outcomes?
Results following the implant of a spinal cord stimulator are generally successful, with studies reporting 40 to 70% of patients undergoing the procedure reporting a reduction in pain symptoms. Pain is significantly reduced for most patients, and most are able to resume normal activities of daily living, and may even be able to go back to work following the procedure.
However, as with any surgery, there are risks that accompany the procedure. The general risks of surgery include infection at the surgical site, intraoperative damage to the surrounding nerves, muscles and tissues, as well as the risk of bleeding and hematoma formation. Specific risks associated with SCS implantation are:
Problems with stimulation (mechanical failure)
Migration of leads
Epidural hemorrhage/hematoma/infection, leading to paralysis
Leaks of cerebrospinal fluid
Persistent pain at site
Unpleasant sensation and/or movement caused by the stimulation
Paralysis, weakness, clumsiness, numbness, or pain below the level of implantation
De Ridder D, Plazier M, Kamerling N, Menovsky T, Vanneste S. Burst spinal cord stimulation for limb and back pain. World Neurosurg. 2013 Nov;80(5):642-649.e1. doi: 10.1016/j.wneu.2013.01.040.
Harat A, Sokal P, Zielinski P, Harat M, Rusicka T, Herbowski L. Assessment of economic effectiveness in treatment of neuropathic pain and refractory angina pectoris using spinal cord stimulation. Adv Clin Exp Med. 2012 Sep-Oct;21(5):653-63.
Hassan S, Amer S, Alwaki A, Elborno A. A patient with Parkinson’s disease benefits from spinal cord stimulation. J Clin Neurosci. 2013 Aug;20(8):1155-6. doi: 10.1016/j.jocn.2012.08.018.
Ramasubbu C, Flagg A 2nd, Williams K. Principles of electrical stimulation and dorsal column mapping as it relates to spinal cord stimulation: an overview. Curr Pain Headache Rep. 2013 Feb;17(2):315. doi: 10.1007/s11916-012-0315-6.