SPINE PROCEDURES

Spinal Cord Stimulation

The use of electricity in the treatment of pain dates back to antiquity. Electric eels were applied to painful areas of the body as early as 600 BC. In colonial America, Benjamin Franklin experimented with a wide variety of electrical treatments for pain. During the 1920s electricity was being suggested for treatment of diseases as far ranging as cancer to drug addiction.

During the late 1960s, electricity was brought to the forefront in the treatment of pain with the introduction of the dorsal column stimulator- an early prototype of the spinal cord stimulator that is in use today. The early results of this new treatment modality were poor due to device failures and poor patient selection. Nevertheless longterm success rate during the 1960s and 1970s were quoted as being approximately 40%. Over the last 15 years great improvements have been made in the stimulators that are being implanted. We have also learned that careful patient selection is necessary in order to achieve the current long-term success rate of approximately 70%.

Some patients who have undergone spinal surgery including discectomies and fusions may not get total relief of their pain. These patients may undergo several operations to relieve their leg and/or back pain often times without any additional success. It is felt that scarring of the coverings of the spine and nerves of the lower back is responsible for this type of pain that responds so poorly to surgery. This situation is often called Failed Back Syndrome. If your physician feels that there is no structural reason to explain your pain such as a recurrent herniated disc, narrowing of the spine or spinal instability he may suggest that you consider having a spinal cord stimulator placed.

In order to have reached this point in your care, you will have had continued pain after one or more back operations and have been unable to become pain free despite all types of non-invasive methods including physical therapy, injections, acupuncture etc. Spinal Cord Stimulators are sometimes placed for other reasons including leg pain from neuropathies, vascular disease causing arm or leg pain, reflex sympathetic dystrophy or even intractable angina (chest pain form heart disease). Additionally, in select patients this procedure may be applicable to chronic neck and arm pain.

The Spinal Cord Stimulator (SCS) does not treat the underlying problem that is causing the pain, rather it works to decrease the perception of pain that a patient feels. It is theorized that there is a "gate" in the spinal cord that controls the flow of pain signals to the brain. The theory suggests that it is possible to stop the pain signals or "close the gate" by activating nerve fibers. The SCS stimulates the pain-stopping nerve fibers, replacing pain with a pleasant tingling sensation.

If your doctor feels that you may benefit from a SCS he will have you see one of the pain specialists who work with us. The pain specialist will see you in consultation, if he too agrees that you may benefit from a SCS he will refer you to a psychologist who works with the pain team. The pain specialist will also set you up to come into the hospital for a SCS trial.

For the SCS trial the patient is brought to a special procedure room at the hospital. An intravenous is started and the patient is place on a special x-ray table. After the lower back is cleaned with an antiseptic solution and sterile towels place over the area, a local anesthetic is given to numb up the area where the SCS trial lead will be placed. An epidural needle is then inserted between the vertebrae in a very careful manner. Once the epidural space is identified, an epidural catheter with a set of electrodes at the tip is placed. The needle is removed leaving the temporary lead in place, which is in turn connected to an external stimulator. The lead is positioned so that the area of pain is adequately covered by the electric impulses. A sterile dressing is applied and the patient sent to the recovery room and released from the hospital within the same day.

You will go home with the temporary SCS for a few days so that you can decide if the device gives you adequate relief of your pain. We do not expect a 100% relief of pain. A trial would be considered successful if a patient experiences a 50 to 75% decrease in the intensity of pain. After a few days you return to see the pain specialist and the trial lead is removed in his office. It is then up to you to decide if the SCS gives you enough relief of your pain to undergo surgery to have a permanent one surgically placed.

If you decide that the temporary SCS gives you significant pain relief and you wish to have the device implanted, you will return to our office and we will make arrangements for surgery. The operation can usually be done as a one-day procedure, where you go home the evening of surgery. Together with you we will decide on the type of stimulator that best suits your needs; dual lead vs single lead, internal vs external power supply.

Surgery is done using a combination of local anesthetic and IV sedation. You will not be in pain during the operation to implant the spinal cord stimulator. We do need you to be awake and cooperative so that you may assist us in getting the epidural lead place in the correct position to help with you particular pain distribution. The operation will take about 90 minutes. Most people will be able to go home the same day as surgery. The will be 2 small incision; one in the back area and one on your side. You will have been given instructions as to how to use your stimulator with the externally driven telemetry unit.

Once you go home there will be no special care required. You will need to keep the incisions clean and dry for a few days. You will be required to have follow up visits with both the pain specialist and with your surgeon.

Back to Spine Procedures