If chronic pain is taking over your life and you feel like you have exhausted all treatment options, neurostimulation may drastically enhance your quality of life. Implanting a spinal cord stimulator (SCS) can substantially lower the pain you experience in a given body part. Neurostimulation entails using SCS to offer a unique way to alleviate pain. This technology is constantly improving; excellent results about what SCS can do have been registered in the last few years.
At Dr. Rappard's Practice, our neuro-interventional surgeon offers neurostimulation therapy services for chronic pain, and our spinal cord stimulators are the most advanced. We understand that chronic pain can be unbearable and do what we can to provide our patients with the best possible solution.
If other treatment options, such as physical therapy and pain medication, have failed, we will evaluate your case to determine whether you are the ideal candidate for neurostimulation. Our procedures are fast, comfortable, and yield favorable results. Call us if you need pain treatment in Los Angeles; we will gladly help.
What a Spinal Cord Stimulator Is
An SCS is an implanted appliance that provides long-term relief for people with chronic and severe pain that other therapies have not alleviated. This device interferes with pain signal transmission by releasing low amounts of electricity near the painful site in the spinal cord. Patients who use these stimulators report enhanced daily function and reduced painkiller use.
This device comprises a generator (a tiny pacemaker-resembling battery pack) and thin wires (electrodes). The electrodes go between the vertebrae and the spine (epidural space), while the generator goes underneath the skin, often near the abdomen or the buttocks.
A spinal cord stimulator allows a person to transmit electrical impulses with a remote controller whenever they experience pain. The remote controller and its antenna remain outside the body. The electrical current that the electrodes create replaces the pain sensation with a pleasant tingling or buzzing feeling. The magnitude of the electrical stimulation may be decreased or increased to suit a patient’s needs.
Professionals still do not comprehend the mechanism behind spine stimulation. However, they understand that it might target several muscle groups in the spinal cord and even change how the brain senses pain.
Conventional spine stimulators replace pain sensation with a slight tingling known as paresthesia. For people who find paresthesia uncomfortable, more advanced appliances offer stimulation they cannot feel. Highly specialized pain doctors insert the most recently developed appliances under ultrasound or X-ray guidance.
Uses of Spinal Cord Stimulators
Spinal cord stimulators are used most frequently after nonsurgical treatment options for pain have not provided enough relief. Doctors may use these devices to manage or treat different kinds of persistent pain, like:
- Perineal pain and visceral abdominal pain.
- Pain after amputation.
- Complex regional pain syndrome.
- Pain associated with peripheral vascular disease.
- Nerve pain, for example, diabetic-related neuropathy and severe cancer neuropathy from chemotherapy, surgery, or radiation.
- Pain related to spinal cord injuries.
- Angina (heart pain) that other options cannot treat.
- Arachnoiditis (painful swelling of the arachnoid, membrane covering the spinal cord and brain).
- Postoperative pain.
- Back pain, particularly pain that persists even after a surgical procedure (failed back surgery syndrome).
Spinal cord stimulators can enhance the general quality of sleep and life and lower the use of pain medication. They are typically used alongside traditional pain management options like exercise, medications, relaxation methods, and physical therapy.
Suitable Candidates for Spinal Cord Stimulators
Like all other treatment options, your physician must ensure that implanting a spinal cord stimulator is ideal for your medical condition and will likely significantly relieve chronic pain and discomfort. To do this, the doctor may order psychological screening and imaging tests. Some insurance providers require that a patient undergo a psychological assessment to ascertain that disorders such as anxiety or depression are not making the pain even worse.
No two patients are the same, but generally, patients who obtain optimal results after being implanted with SCS are those that:
- Do not suffer from mental disorders that would lower the procedure’s effectiveness.
- Have not had adequate pain relief after using medication or undergoing prior surgeries or minimally-invasive therapies.
Types of Spinal Cord Stimulators
There are three primary types of SCS:
- Conventional implantable pulse generators (IPGs) are battery-operated simulators. A surgeon places a battery into the spinal cord during surgery. When the battery depletes, the surgeon replaces it with another operation. This appliance is suitable for patients experiencing pain in a single body part as its electrical output is much lower.
- Rechargeable IPGs work like conventional devices. The only difference is the battery is rechargeable without another operation. Since the battery is rechargeable, the electricity output of these stimulators is higher. This stimulator could be suitable for patients experiencing lumbar spine or leg pain since the electric signal reaches further.
- Radiofrequency stimulators use batteries that are outside the body. Due to better technology and newer designs, these spine stimulators are rarely used nowadays. Their batteries are rechargeable, and just like rechargeable IPGs, they can be suitable for patients experiencing leg and lower back pain due to their power.
Your doctor will explain how to operate the stimulator and adjust the electrical signal’s intensity. Varying body positions might require different settings for the stimulator; for example, one device setting may be appropriate for the walking position and another for the sitting position. Most appliances allow physicians to save three or two preset programs to assist their patients in easily accessing the most frequently used settings. Some recently developed devices have numerous electricity delivery waveforms, including burst, high-density, and high-frequency waveforms.
Spinal Cord Stimulators Implantation
Before SCS implantation, your physician should ensure you do not have any risk factors that may increase your likelihood of developing complications. The SCS implantation process is done in two stages. These are the trial stage and implantation.
Once your doctor has cleared you of any risks, the first stage you will undergo is the trial period. Here, your surgeon implants a temporary appliance for your testing. The surgeon carefully inserts the electrodes into the spine’s epidural space, guided by fluoroscopy—usually, the pain location impacts where the surgeon will place these electrodes along the spinal cord. Your surgeon might need you to provide feedback while undergoing the procedure for better placement of the electrodes.
The trial procedure generally requires just one surgical incision in the lumbar spine to insert the lead electrodes. The battery or generator will remain outside the body, generally attached to a belt you wear around the waist.
You will assess how effectively the device alleviates pain for approximately one week. Your doctor will also routinely monitor your pain levels and look for complications or side effects. Your trial is successful if your pain level is reduced by 50 percent or more.
If the trial fails, your doctor will carefully remove the electrodes while avoiding damaging the nerves and spinal cord. They can then work with you to determine other pain management options that would work better. And if the trial is successful, your surgeon will schedule surgery to insert the device permanently.
The Implantation Procedure
During implantation, the surgeon places the generator beneath your skin and replaces the electrodes used during the trial phase with sterile ones. Unlike the electrodes used during the trial period, the sterile electrodes will be secured by stitches to reduce movement. This procedure is generally outpatient and can take approximately one to two hours.
Once the surgeon has administered local anesthesia, they will make a single incision (along the spine) to implant the electrodes and another cut (usually along the buttocks or lower abdomen) to place the generator. Similarly to the trial phase, the surgeon uses fluoroscopy to decide where they will insert the electrodes.
Once the surgeon has connected the generator and electrodes and the device has started running, they will close both incisions using sterile methods. The surgeon may administer sedation to help you feel comfortable and will need your feedback while inserting the permanent electrodes.
Recovery After the Procedure
Many are discharged from the hospital on the day of the procedure after the anesthesia wears off. Your incisions might be painful for days following your surgery. Do not reach, twist, or stretch, as doing so may pull at your incisions. Your surgeon will place dressings over the incised sites, which may be taken off after about three days. Incisions often heal within approximately two to four weeks after the surgical procedure.
Your physician will instruct you on what to do during your recovery, but typically, light activities are recommended for approximately two weeks after the procedure. The doctor will also counsel you on proper postoperative care for cleaning the incision site once you remove the dressing and how to use your remote controller properly to manage your pain.
Once your doctor approves that you can return to your regular activities, you can resume work. This is generally one to two weeks after our surgery.
When your doctor holds a check-up appointment, discuss precisely how the implanted device functions, any side effects or worries you have had, and your questions regarding daily use.
Benefits of Spinal Cord Stimulator Surgery
The advantages of undergoing surgery to implant a spine stimulator are numerous. These devices:
- Do not need a prolonged recovery period after implantation.
- Boost a patient’s daily functionality, which might have been diminished due to severe pain.
- Make the patient lower their intake of pain medication.
- Undergo a trial phase before implantation to evaluate their suitability.
- Have minimal side effects and are a long-term solution for pain management.
- Do not need a significant surgical procedure to implant.
Risks and Complications
The complications and risks of the surgery to implant SCS are rare. However, every surgical procedure has risks. A few patients might experience the following:
- Spinal cord trauma. Even though extremely rare, inserting SCS can cause paralysis and nerve injury.
- Device damage, for example, if an intense physical activity or a fall breaks the stimulator.
- Device malfunction.
- Device migration: the electrodes may shift from their position, resulting in the device failing to block pain effectively. This usually needs another surgical procedure to return the electrodes to their proper location.
- Infection that might arise in the initial two to eight weeks.
- Epidural hematoma.
- Unintentional damage to the spine, nerve roots, and membranes.
FAQs About Spinal Cord Stimulators
Typically, SCS devices are highly effective at relieving pain, allowing patients to engage in more activities than before surgery. However, you need to be aware of certain restrictions. The following FAQs will inform you of these restrictions, assisting you in living with SCS accordingly:
Can the Stimulator be Removed?
Yes. Your SCS can be removed if you are not content with the degree of pain relief it offers or if there is a mechanical issue with the system or an infection.
Can I Swim With SCS?
You can swim with your permanent stimulator but not with the temporary one. A temporary SCS should not be wet. Therefore, you must avoid showers and baths during the trial period.
Is It Possible To Drive With SCS?
No, it is not. Power off the device when you are working heavy machinery or driving since unexpected changes in stimulation levels may cause distraction
Do Spinal Cord Stimulators Set Off Airport Security?
Airport security gates usually detect SCSs. However, your doctor will issue you with an ID card that can enable you to bypass the screener.
Is SCS MRI-Compatible?
MRIs are usually unsafe for patients with these devices. Some recently-developed devices are safe with given scan locations and MRI machines, but your physician must evaluate your device first. If your SCS is MRI-incompatible, undergoing an MRI can result in severe injury. Talk to your doctor in advance so they can determine whether an MRI will harm or interfere with your stimulator.
Can I Do CT Scans and X-rays With the Device?
CT scans and X-rays are safe, provided you power off your stimulator. Before undergoing scanning, inform your technician, nurse, or doctor that you have the device implanted.
If you suffer from chronic pain in any body part, implanting SCS can help relieve the pain. The device can help you find comfort and resume daily activities. At Dr. Rappard's Practice, we boast expert pain specialists ready to help you if you wish to implant SCS to relieve pain. We have helped several clients seeking these services in Los Angeles, and they have testified to our effective services.
Contact us at 424-777-7463 to schedule an appointment to discuss your pain with our neuro-interventional surgeon.