Spinal Cord Stimulator

What is a Spinal Cord Stimulator?

A spinal cord stimulator (SCS) refers to a device that neurosurgeons surgically implant under the patient’s skin, which offers to many patients a non-narcotic pain therapy.   The implant sends a low Spinal Cord Stimulatorlevel electric current into the spinal cord to relieve pain, which most patients describe as a ‘bubbly’ sensation. The spinal cord stimulators include thin wires (the electrodes) and a small peacemaker like a battery (the generator) 1. The electrodes carry current from the generator to the nerve fibers of the spinal cord and placed in between the spinal cord and the vertebrae.

The spinal cord stimulator allows the patient to send the electrical impulse by turning on the device when they feel pain. This stimulation changes the electrical impulses and masks pain signals before reaching the brain. A recent study of spinal cord stimulation shows excellent long-term relief in 50 to 80% of patients suffering from chronic pain 2.

Types of Spinal Cord Stimulator

Spinal cord stimulators classified as 3 main types that include 3:

  1. Conventional implantable pulse generator, or IPG: A battery-operated spinal code stimulator.
  2. Rechargeable implantable pulse generator: A rechargeable battery-operated spinal cord stimulator.
  3. Radiofrequency stimulator: This uses a battery that’s outside of the body and an older system.

Indications of Spinal Cord Stimulator

The most common indications include:

  • Back pain that recurs even after surgery (failed back surgery syndrome)
  • Complex regional pain syndrome
  • Post-surgical pain
  • Radicular and nerve root pain
  • Postherpetic neuralgia
  • Phantom or post-amputation pain
  • Intercostal neuralgia
  • Pain due to peripheral nerve injury
  • Arachnoiditis
  • Heart pain (angina)
  • Injuries to the spinal cord
  • Peripheral vascular disease
  • Visceral abdominal pain and perineal pain

Contradictions of Spinal Cord Stimulator

Main contradictions of spinal cord stimulator include:

  • Post-surgical infection
  • Coagulopathy
  • Spinal stenosis
  • Psychiatric disorders
  • Substance abuse

Complications of Spinal Cord Stimulator

The major spinal cord stimulation (SCS) surgical complication includes 4:

  • Hardware-related (lead migration, breakage, connection failure, and malfunctioning pain at the pulse generator site)
  • Rotation of the pulse generator
  • Hematoma and seroma at the pulse generator site
  • Discomfort at the pulse generator site
  • Post-dural puncture headache
  • Spinal epidural hematoma
  • Cerebrospinal fluid (CSF) leak
  • Transient paraplegia
  • Neurological deficit

How this technique performs?

Neurosurgeons and doctors who specialized in pain management implant spinal cord stimulators to the successful patient body. This includes two different stages:

  • Trial stage
  • Implantation stage

The trial stage determines if a stimulator will work for the type, location, and severity of the pain. This starts with the administration of local anesthesia in the numb area of the lower back. Surgeons insert a hollow 14-gauge Tuohy needle through the skin into the epidural space between the bone and spinal cord by using X-ray fluoroscopy. The placement of the lead depends on the location of the patient’s pain. A previous study shows that the lead placement for patients with low back pain occurs typically between T9 to T10 5. After then, starts with the low-frequency stimulation and observes the results.

Final implantation stages will take over if the patients feel good for a 4-7 days period and the record shows over 50% improvement in pain, then the doctors will take a further step for a permanent SCS implantation.

References

  1. Anderson DJ, Kipke DR, Nagel SJ, Lempka SF, Machado AG, Holland MT, Gillies GT, Howard MA, Wilson S. Intradural Spinal Cord Stimulation: Performance Modeling of a New Modality. Frontiers in Neuroscience. 2019;13(March):1–14. doi:10.3389/fnins.2019.00253
  2. Dones I, Levi V. Spinal cord stimulation for neuropathic pain: Current trends and future applications. Brain Sciences. 2018;8(8). doi:10.3390/brainsci8080138
  3. Eckmann M, Papanastassiou A, Awad M. A Unique Case for Spinal Cord Stimulation: Successful Treatment of Small Fiber Neuropathy Pain Using Multiple Spinal Cord Stimulators. Case Reports in Medicine. 2017;2017:3–6. doi:10.1155/2017/6969285
  4. Vallejo R, Bradley K, Kapural L. Spinal Cord Stimulation in Chronic Pain. Spine. 2017;42:S53–S60. doi:10.1097/BRS.0000000000002179
  5. Andrei D Sdrulla, MD P, Yun Guan, PhD M, Srinivasa N Raja M. Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms. Pain Practice. 2018;18(8):1048–1067. doi:10.1111/papr.12692.Spinal

 

 

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