Who performs the procedure for Spinal Cord Stimulation?
Neurosurgeons and doctors who specialize in pain management (an anesthesiologist or physiatrist) implant spinal cord stimulators. You can use the free tool below to find doctors and clinics who provide SCS treatment:
What are the results for Spinal Cord Stimulation?
The results of Spinal Cord Stimulation (SCS) depend on careful patient selection, successful trial stimulation, proper surgical technique, and patient education. According to Mayfield Clinic, Stimulation does not cure the condition that is causing pain. Rather, it helps patients manage the pain. SCS is considered successful if pain is reduced by at least half.
Published studies of Spinal Cord Stimulation show good to excellent long-term relief in 50 to 80% of patients suffering from chronic pain [1-6]. One study reports that 24% of patients improved sufficiently to return to gainful employment or housework with stimulation alone or with the addition of occasional oral pain medication .
Spinal cord stimulation (SCS) therapy is reversible. If a patient decides at any time to discontinue, the electrode wires and generator can all be removed.
What are the risks of Spinal Cord Stimulation (SCS)?
No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. According to Mayfield Clinic, specific complications related to SCS may include:
- Undesirable changes in stimulation (can possibly be related to cellular changes in tissue around electrodes, changes in electrode position, loose electrical connections, and/or lead failure)
- Epidural hemorrhage, hematoma, infection, spinal cord compression, and/or paralysis (can be caused by placing a lead in the epidural space during a surgical procedure)
- Battery failure and/or battery leakage
- Cerebrospinal fluid leak
- Persistent pain at the electrode or stimulator site
- A pocket of clear fluid (seroma) at the implant site. Seromas usually disappear by themselves but may require a drain.
- Lead migration, which can result in changes in stimulation and reduction in pain relief
- Allergic response to implant materials
- Generator migration and/or local skin erosion
- Paralysis, weakness, clumsiness, numbness, or pain below the level of implantation
Conditions for which you might need additional surgery include movement of the lead, breakage of the lead or extension wire, or (in rare cases) mechanical failure of the device. Reasons for removal of the device include infection and failure to relieve pain.
Sometimes scar tissue develops around the electrode and can make the stimulation less effective.
Living with a Spinal Cord Stimulator
Once the SCS has been programmed, you are sent home with instructions for regulating the stimulation by controlling the strength and the duration of each stimulation period. Your doctor may alter the pulse width, amplitude, and frequencies on follow-up visits if necessary.
The pulse generator has programmable settings:
- Frequency (rate): number of times stimulation is delivered per second. Too few pulses results in no sensation. Too many results in a washboard or bumpy effect.
- Pulse width: the area the stimulation will cover.
- Pulse amplitude: determines threshold of perception to pain.
The handheld programmer lets you turn the stimulator on and off, select programs, and adjust the strength of the stimulation. Most people are given multiple programs to achieve the best possible pain relief at any point throughout the day or during specific activities. You can use your spinal cord stimulator around the clock if necessary.
Some people feel differences in stimulation intensity depending on their position (e.g., sitting versus standing). This is caused by variations in the spread of electricity as you change positions and is normal.
Just like a cardiac pacemaker, your stimulator cannot be damaged by devices such as cellular phones, pagers, microwaves, security doors, and anti-theft sensors. Be sure to carry your Implanted Device Identification card when flying, since the device is detected at airport security gates. Department store and airport security gates or theft detectors may cause an increase or decrease in stimulation when you pass through the gate. This sensation is temporary and should not harm your system. However, as a precaution, you should turn off your system before passing through security gates.
The various SCS systems have different restrictions to their use with MRI, ultrasound, defibrillator, electrocautery, diathermy, and cardiac pacemakers. Be sure to know the limitations of your specific SCS device. Also, chiropractic manipulation may cause the lead to move. Consult your surgeon first.