Spinal cord stimulation is one of the newest and most reliable treatments in pain management; it masks the sensation of pain before the impulse gets to the brain. It involves a small pacemaker-like device that sends electrical pulses to your spinal cord. This therapy was seen to be useful to the patients for bearing their chronic pain and not being dependent on opioids. It is especially for those patients whose back pain is because of poor posture, from severe back pain from a herniated disc, or chronic back pain due to scoliosis that is poorly responsive to other treatment forms.
What is a Spinal Cord Stimulator?
The spinal cord stimulator is an implanted device that delivers mild electrical currents to the spinal cord. The current is carried by thin wires, or leads, from the pulse generator itself to the nerve fibers of the spinal cord. Once activated, the SCS changed and masks those pain signals in transit to the brain. It has been of particular use in patients having disorders in the low back.
Surgery
ScS devices can use either of these - low-frequency electrical current or high-frequency electrical currents. The low-frequency devices interrupt the pain by creating a mild tingling sensation, known as paresthesia. High-frequency or burst pulse devices mask the pain and produce no paresthesia. ScS does not cure the cause of the pain, but the treatment changes the way the brain perceives the pain. Generally a 50% to 70% reduction in pain is the objective, which would greatly improve activities of daily living and decrease the necessity for medication that is prescribed to control severe pain.
SCS System Components
The individual components of an SCS system are three basic components and are as follows :
Pulse Generator: This unit is powered by an internal battery and provides electrical pulses.
Lead Wire: The wire contains a number of electrodes ranging from 8 to 32 that provide the electrical pulses on the spinal cord.
Remote Control: This will enable the patient to switch it on and off and change settings as appropriate.
The non-rechargeable battery systems are replaced surgically after every 2 to 5 years, while the rechargeable ones last after 8 to 10 years or even longer. The pulse generator itself is programmable. Some stimulators are position-sensitive, which implies they adjust the stimulation level as the body changes its position.
Candidacy for SCS
Treatment eligibility means that the neurosurgeon, physiatrist, or pain specialist must assess whether the therapy is appropriate for the patient. This will include an assessment of his general physical condition, medication regimen, history of pain, treatments attempted in the past, and psychological evaluation to ensure the best possible outcome. This assessment is very important for patients who experience back pain due to various causes such as bad posture or scoliosis.
Conditions Treated by SCS
SCS can treat chronic pain from a variety of conditions, including:
- Chronic leg pain (sciatica) or arm pain
- Diabetic neuropathy
- Failed back surgery syndrome
- Complex regional pain syndrome
- Arachnoiditis
- Other conditions including stump pain, angina, peripheral vascular disease, multiple sclerosis, or spinal cord injury
The Surgical Procedure
Step 1: Trial Stimulation
Trial stimulation, known as a "test drive," is the procedure used to determine effective pain reduction by SCS. This is an outpatient procedure where the area is anesthetized, and a hollow needle is used to insert the trial lead intending to place it into the epidural space. The lead is fixed to a small, external generator that the patient carries on his or her belt. The patient commences a home trial for 4 to 7 days, keeping a practice log of pain levels and stimulation settings.
Stage 2: Surgical Implant
If the trial is successful then a permanent SCS device is implanted. Pre-surgical preparation involves signing consent forms, undergoing certain tests, and stopping certain medications. On the day of surgery, light anesthesia is given and the areas on the back and buttock are prepped for lead and generator placement, respectively.
Surgical Steps
Placement of the incision and lead: A small cut over the middle back and introduction of the electrode lead into the epidural space above the spinal cord with fragments for fixation.
Test stimulation: The patient may be awakened to determine whether the stimulation covers the appropriate painful regions.
Tunneling of Wires and the Generator Placement: The lead wire is tunneled under the skin, running from the spine to the buttock, where the generator is implanted.
Closure: This is done through the closure of incision using sutures and skin glue after which a dressing will be applied.
Postoperative Care
A gradual, steady return to normal activities is recommended, but avoid those which may displace the leads: bending, lifting, twisting, and reaching overhead. Also, excellent care of the incision and management of medications are very important.
Recovery and Follow-Up
Follow-up appointments occur with the physician about 10 days post-operatively for an incision check and possible pulse generator adjustments. During this time, close and continuous contact with the pain specialist and the representative of the device is deemed very important in order to conduct all the small adjustments that can lead to more effective pain management.
Complications and Contraindications
Like with any surgery, the implantation of an SCS contains the risks of bleeding, infection, and reactions to anesthesia. There are also general complications that can occur, such as a change in stimulation, lead migration, and allergies to the implant materials. In certain instances, more surgeries may become necessary if leads need to be repositioned or a nonfunctioning device needs to be replaced.
The SCS devices are managed by the patient through a handheld programmer that turns the device on and off in addition to an adjustment for stimulation strength and duration. The device can be used at daytime and nighttime, continuously if required. Though some activities will cause slight differences in the intensities of the stimulation, in general this system is not affected by many everyday electronic devices and security gates.
Spinal cord stimulation offers significant pain relief and improvement in quality of life for many patients with chronic pain, particularly chronic back pain, by reducing the use of opioid medications. Proper patient selection and management of the device itself make SCS an important long-term intervention in pain management.
There is quoted, within the understanding process of spinal cord stimulation, a "long train" put through assessment and treatment. From the various preliminary assessments to trial phases and culminating into final implantation and adjustments, each part of the process is connected, in a way, like a chain toward successful therapy. It is this kind of holistic, overall approach that values for patients and health professionals in their ever-so-patient navigation of the steps toward successful pain management.
