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Overview

Spinal Cord Stimulation (SCS) is the electrical stimulation of a precise level of the spinal cord to generate paresthesia to the area(s) the patient feels pain. Spinal Cord Stimulation is an accepted pain management treatment for certain intractable pain conditions.

Indications

Indications for spinal cord stimulation include the following:
 Failed Back Surgery Syndrome (FBBS)
 Adhesive Arachnoiditis
 Peripheral Causalgia / Neuropathy
 Reflex Sympathetic Dystrophy (RSD)
 Phantom Limb / Stump Pain
 Ischemic Pain of a Vascular origin

Observing careful patient selection criteria ensures successful outcomes. Patients typically do best when most of their pain involves the limbs or lower back area. The patient will be required to have a psychological evaluation prior to approval for a trial in order to insure that there are no contraindications for a trial or permanent implant.

What to Expect

The injection site is numbed using a local anesthetic. One or more insulated wire leads are inserted through an epidural needle or through a needle into the space surrounding the spinal cord, called the epidural space. Electrodes at the end of the lead produce electrical pulses that stimulate the nerves, blocking pain signals to the brain. The patient gives feedback to help the physician determine where to place to place the stimulators to best block the patient’s pain. The lead is connected to an external trial stimulator, which will be used for three to seven days to determine if Spinal Cord Stimulation will help the patient. If the patient and physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the lead is removed.

Permanent Implantation
The permanent implantation may be performed while the patient is under sedation or general anesthesia. First, one or more leads are inserted into the predetermined location in the epidural space. Next, a small incision is created, and the implantable pulse generator (IPG) battery is positioned beneath the skin. Most often, it is implanted in the buttocks, back or abdomen. The lead is then connected to the IPG battery. The implant’s electrical pulses are programmed with an external control unit. The patient can use the external control unit (remote) to turn the system on or off and adjust the stimulation power level and switch between different programs. After surgery, patients may experience mild discomfort and swelling at the incision sites for several days.

Outcomes

With proper patient selection, psychological screening for contraindications and careful use of proper lead placement to cover the painful area as much as possible at the trial phase the outcome of spinal cord stimulation can be a life changer. It can cause the pain to be controllable for the patient with programing available for different pain throughout the day if indicated. The goal is activity and functional improvement to reasonable levels determined in the initial patient evaluation process.