Introduction
Spinal cord stimulation (SCS) is a technique for providing relief from chronic pain associated with a range of medical conditions. The treatment was developed in the late 1970s based on what is now known as the field of neuromodulation, which is also used in another similar treatment technique called peripheral nerve stimulation.
Neuromodulation is a mechanism for changing pain signal transmission in the spinal cord using small electric currents delivered to the cord using small electrodes.
Research indicates that, although it does not help everyone, on average pain is reduced by around 50%, and around 65% of patients report decreased pain after having a spinal cord stimulator implanted.
Indications
Pain associated with the following conditions may be significantly alleviated by SCS…
- Angina.
- Complex regional pain syndrome.
- Neuropathic pain.
- Pain from previous spinal surgery (often affecting the leg).
- Post Laminectomy Syndrome.
In some cases, pain may not be completely eliminated, however if it is substantially reduced, it can reduce reliance on pain medication.
Spinal cord stimulation is often recommended where other treatments have not helped.
Preoperative Instructions
We will ask you to complete a pain chart and a pain diary to record your levels of pain over a 7-day period prior to the procedure. On the pain chart indicate which parts of the body are impacted by pain. The pain diary is a record of levels of pain over the period, noting any changes over each day. There is also a short survey which asks you to describe in a few words the type of pain that you have.
You should avoid undergoing any other medical procedures, such as for example dental treatment or a colonoscopy, within 48 hours of the procedure (before or after).
Do not eat or drink anything, or smoke, in the 6 hours immediately before the procedure (although any medication can continue to be taken with small sips of water). Medication for diabetes should not be taken until after the procedure.
If you are taking any medication containing aspirin (or other blood thinning medication), you should stop taking this at least 11 days before the procedure.
Please also let us know ahead of the procedure if…
- You have any allergies.
- You have high blood pressure.
- You have or have had any bleeding or blood clotting issues (e.g. DVT – deep vein thrombosis or pulmonary emboli in the lungs).
- You are taking any antibiotics.
- You have a pacemaker or defibrillator.
- You are ill (in which case we may need to postpone the procedure) .
You should also not drive yourself to or from the appointment.
Procedure
The procedure is in two stages – in the first stage electrodes are implanted along the target part of the spinal cord with the ends of the wires that connect to the device exposed above the skin.
During the procedure a small incision is made to the back and electrodes are placed via a needle.
You will need to stay in hospital for 1 night only, usually.
The electrodes are connected to a portable stimulation device for 7-10 days and the effectiveness of the stimulator is assessed.
If the stimulator is providing a marked reduction in pain levels, stage two involves the permanent insertion under the skin of a miniature stimulator (called an 'implantable pulse generator' or 'IPG') equipped with a battery. Placement is generally in the low back or buttock. This is a permanent installation, with the batteries capable of being recharged without removal, with an overall battery lifespan of 5-15 years (depending on the setting of the stimulator).
Where stage one does not result in marked pain reduction, the electrodes will be removed in a short procedure.
Postoperative Instructions
You will need to stay in hospital for 1-2 days after the final procedure. Full recovery can take up to 6 weeks, with daily gentle exercise, such as walking. We will also provide you with an information sheet on the implantable pulse generator and what you must avoid (for example metal detectors at security checkpoints).
After both stages there will be some pain at the insertion site for around 48 hours. During this time you should not lift anything, and not stretch, twist or bend over further than 45 degrees. The dressing on the incision must be kept dry (i.e. no showers or baths) and you will be checked frequently for any signs of infection at the insertion site.
You should arrange a visit to your doctor 3-4 days after surgery to review the incision site and to have any stitches removed.
At the 6-8 week mark we will make an appointment for you to come in for a review.
Risks
The procedure to test and install a spinal cord stimulator is a very low risk procedure, however all medical treatment comes with some level of risk. Possible complications may include…
- Failure of device.
- Electrode failure / displacement.
- Bleeding.
- Infection.
- Pain at insertion site.
- Allergic reaction to anaesthetic.
- Blood clots (i.e. DVT or pulmonary embolism).
- Permanent nerve damage.
If you experience severe pain or weakness, any swelling or infection at the incision site or your temperature is over 38C, you should let us know urgently or visit the nearest emergency department.