A spinal cord stimulator is an advanced treatment for chronic pain. With this therapy, a small implanted device generates electrical signals within the spinal cord. Pain messages are then changed before they are sent to the brain. Previous areas of pain are replaced with a different sensation. Usually patients describe this is a tingling feeling.
Candidates for the Procedure
A potential candidate for spinal stimulation will undergo a trial procedure. The trial determines if a patient is a candidate for surgical implantation. The patient should obtain good pain relief and feel comfortable with the sensations of stimulation. During the trial, the patient will be:
- Placed face down (prone) on a procedure table and will be given light sedation.
- The patient has to be awake enough to communicate with the surgeon.
- The surgeon will use an x-ray machine to visualize the spinal anatomy.
- Next, local anesthetic will be given to numb the skin and subcutaneous tissues.
- After that, a special needle will be placed just outside the spinal cord.
- A wire or lead will then be threaded through the needle along the spinal canal.
- The patient will then tell the surgeon where stimulation is felt and the wire/lead will be adjusted appropriately.
- The needle is then pulled out, leaving the wire/lead in place. Thus, there will be a wire coming out of the skin which will be taped down. This will be attached to an external battery and stimulator generator.
- The patient will then go home for several days to assess the amount of pain relief.
- Upon return to the doctor's office, the trial wire/lead will be pulled out.
At this point, a decision will be made on whether or not to proceed to implantation based on the results of the trial. Should the decision be made to do an implantation, the procedure will be done at Tallahassee Memorial Hospital. Spinal cord stimulators can significantly decrease pain, but as with any surgical procedure, there are risks involved. These include infection, bleeding, injury to the spinal cord, equipment failure, or future lack of benefit. It should also be noted that after implantation the patient will no longer be able to have a MRI. Prior to implantation, the patient will also be referred to a psychologist. The psychologist will assess the patient's understanding and expectations of the procedure.
For implantation, the wire/lead will be placed just as during the trial. However, the lead will be connected to a small battery placed underneath the skin. The battery is placed in either the upper buttock or abdomen. The patient will also have a remote device that controls the generator. Today, most batteries implanted are rechargeable. From time to time, the patient will have to recharge the battery at home using a remote control device. The remote control device is placed on top of the skin, overlying the implanted battery, and the battery's energy is restored over a few hours.