Spinal Cord Stimulation for Chronic Back Pain
Back pain is common in the United States, with some estimating that upwards of 85% of Americans will suffer from some sort of back condition during their lifetimes. In most cases, this pain will go away with non-operative treatment. In some patients, surgery will be needed due to severe pain that does not respond to non-surgical options. In certain cases, spinal cord stimulation may be an appropriate and effective treatment option.
How Does Spinal Cord Stimulation Work?
A battery operated device known as a Spinal Cord Stimulator (SCS) is surgically implanted in the back and electrical leads or wires are placed over the appropriate area of the spinal cord.
Spinal cord stimulation works by delivering electrical impulses to the appropriate nerve(s) in the spine, which in turn suppresses pain signals. This is known as neuromodulation. In most cases, patients will be able to reduce or eliminate use of narcotic pain medications.
Initial settings are established during surgery, but can be adjusted post-surgically (by the patient or at the office) based on the patient’s changing need for relief.
Reasons for Undergoing Spinal Cord Stimulation
Surgery, usually failed back surgery, that causes the patient continued or worsened pain. Common back surgeries include:
- Lumbar fusion for back pain
- Surgery for sciatica
- Surgery for degenerative disc disease
While these surgeries, when performed by an experienced neurosurgeon, boast a 90-95% success rate, there is a small chance that some patients will be left with little or no relief. Oftentimes, spinal cord stimulation is an effective treatment for such pain, especially when revision surgery is not a good option.
Patients with chronic back pain, with or without associated leg pain, may also be candidates for spinal cord stimulation if conservative treatments have failed, surgical intervention is not expected to offer significant relief and/or if the patient is not a good candidate for surgery due to age or health issues. Some of the most common conditions treated by spinal cord stimulation include:
- Neck, Arm or leg pain
- Trauma or injury
- Degenerative disc disease
- Peripheral neuropathy
The Trial Period
Before permanent implantation is considered, patients will undergo a trial procedure to determine if SCS is likely to be effective. This procedure is performed as an outpatient. The neurosurgeon will use a specially made needle to implant a temporary lead into the area of the of the spine to maximize pain relief. This lead is connected to an external pulse generator, which is typically worn on a belt.
Patients will discuss the results of their trial at a consultation about a week after the procedure. If the trial procedure shows promising results, permanent implantation will be scheduled.
Expectations for Permanent implantation
The permanent implantation process is straightforward and takes between one and two hours. For patient comfort, the procedure can be done under anesthesia and is an outpatient procedure.
During surgery, the electrical leads will be placed via a small incision in the back. The surgeon, guided by continuous x-ray or fluoroscopy, uses a specially made needle to deploy the electrodes that will ultimately provide stimulation to the spine. In some cases, a laminotomy, or removal of a small piece of bone, is performed to allow access to the epidural space above the spinal cord. The leads are then positioned appropriately.
The SCS will be tested using intra operative neuromonitoring to ensure exact placement of the leads, and wires will be threaded under the skin to the pulse generator (battery) implanted in the lower back or buttocks.
Post-operatively, patients experience little downtime. Discharge occurs on the same day or after one night in the hospital. We will encourage patients to walk within their physical limits shortly after surgery. Most patients are free to perform normal, non-strenuous activities after 4 weeks but should avoid certain activities such as bending, stretching and twisting for 6-8 weeks.
Today’s SCS devices are smaller and longer lasting allowing for minimized incision size and fewer short- and long-term complications. However, spinal cord stimulation implantation is not without risk. These risks vary between patients and specifics will be discussed during consultation.
Results of Spinal Cord Stimulation
It is very difficult to predict the results of SCS, however good candidates for the procedure often experience greater than 50% relief from their pain. Unlike many procedures involving the nervous system, SCS allows for a trial period that gives us an idea of potential results. With a successful trial period, we can be confident that the permanent procedure will offer significant relief as well.