Spinal Cord Stimulation

What is spinal cord stimulation (SCS)?

Spinal cord stimulation (SCS) is an advanced treatment that uses electrical pulses to block chronic pain signals from reaching the brain.

A device, called a spinal cord stimulator, is implanted in your body. It is used to treat severe pain and is usually offered when your pain hasn’t responded to other nonsurgical treatments, such as medications and physical therapy.

How does spinal cord stimulation work?

Spinal cord stimulation works by blocking pain signals – electrical currents that begin in your nerves and travel to the brain via your spinal cord. When these electrical currents reach your brain, it translates them into pain. A spinal cord stimulator delivers an alternative electrical current directly to your spinal cord. This blocks the chronic pain signal and your brain ignores it.

The spinal cord stimulator doesn’t eliminate the pain signals but helps your brain to ignore them. You are in control of the device, and a remote is used to adjust the electrical current in response to the level of pain you are experiencing.

Are there different types of spinal cord stimulators?

There are different types of spinal cord stimulators available, which are usually categorized by power source (non-rechargeable and rechargeable) and waveform type (high-frequency or burst stimulation).

• Traditional stimulation: Delivers low-frequency pulses that give a mild feeling over the area of pain.
• High-frequency stimulation: Delivers fast pulses to block pain without giving a sensation of tingling.
• Burst stimulation: Sends bursts of electrical pulses which are designed to mimic your body’s nerve patterns and reduce feelings of pain.
• Dorsal root ganglion (DRG) stimulation: Targets a specific cluster of nerves in the posterior root of the spinal cord, called the dorsal root ganglion. This cluster of sensory nerve cells help transmit pain signals before they enter the spinal cord and can be targeted to reduce pain. DRG stimulation can be an effective treatment for chronic intractable pain conditions such as neuropathic pain, isolated chronic pain, and chronic pain following certain surgeries.
• Closed-loop spinal cord stimulation: An advanced treatment for chronic back and leg pain, the system is able to monitor and record pain signal activity within the spinal cord, which it analyzes and then adjusts stimulation in real time. It can offer superior pain relief and long-term success rates in some patients.

Which conditions does spinal cord stimulation treat?

Spinal cord stimulation can manage chronic pain caused by health conditions and injuries, including:

• Back pain
• Neuropathic pain
• Spinal cord injuries
• Complex regional pain syndrome
• Angina or other types of chest pain
• Diabetes-related neuropathy
• Persistent spinal pain syndrome after laminectomy surgery
• Postherpetic neuralgia
• Phantom limb pain

What happens during spinal cord stimulation surgery?

Before surgery, your doctor will tell you what you need to do to prepare. This may include blood tests, a physical examination and imaging tests.

There are two steps to the surgery. First, you have a trial period. A temporary version of the device is implanted so you can try out spinal cord stimulation before it is permanently implanted.

If the spinal cord stimulation trial helps you to manage your pain, the permanent device will then be implanted.

For both the trial and the permanent device, you will be given local anesthesia in your spine and back.

The steps involved in fitting a temporary spinal cord stimulator involve:

• Making an incision in your back near where they’ll insert the leads (tiny wires), usually the middle of your back.
• Inserting the leads into the space between your spinal cord and vertebrae (called the epidural space).
• Connecting the leads to a power source outside your body.
• Attaching the power source to your body via stitches or surgical glue.
• Adjusting the electrical current to manage your pain.

The steps involved in fitting a permanent spinal cord stimulator involve:

• Making an incision in the same place on your back.
• Inserting a tiny needle.
• Inserting permanent leads.
• Guiding the leads under your skin to where the permanent generator will be implanted.
• Implanting the permanent generator (this is usually near the upper buttocks).
• Programming the device to make sure it is working before closing the incisions.

The exact details of the procedure will depend on the type of spinal cord stimulator you are receiving.

What happens after spinal cord stimulator surgery?

You can usually go home the same day. You will be given a set of instructions on how to take care of the incision sites, and full instructions on how to use the spinal cord stimulator.

What are the benefits of spinal cord stimulator surgery?

Spinal cord stimulation is a safe and effective way to manage pain. It offers an alternative option when other treatments haven’t worked.

It can reduce the need to take pain medications and the side effects associated with taking them.