Spinal cord stimulation (SCS) typically involves implanting an electronic device in the body to help relieve chronic back and leg pain. The device, called a "spinal cord stimulator" or "dorsal column stimulator," sends electrical impulses through wires/electrodes placed near the spinal cord; the impulses block pain signals from reaching the brain. SCS does not cure chronic pain, but usually lessens it by 50 percent and more by replacing a patient's feeling of pain with a tingling sensation. Before implantation, a patient is asked to go through a trial period with an external device; this allows pain levels to be evaluated, and determine whether they decrease when the device is used.
Not everyone is a candidate for SCS. It is an option only for those who have tried, but been unsuccessful with, conservative treatments; will likely not be helped by surgery; are not addicted to drugs; have been psychologically evaluated; do not have pacemakers; and have undergone trials with an external spinal-cord stimulator.
Implantation of a spinal cord stimulator is a two-step process that involves first implanting the stimulator, and then a pulse generator to power it. To implant the stimulator, an incision is made in the patient's back; the wires with electrodes on the end are fed through and positioned on the spinal cord. Exact placement depends on the area of pain.
To implant the pulse generator, an incision is made in the buttocks or abdomen, and the generator is placed between layers of skin and muscle. An extension wire is run from the spine to whichever area the generator is placed in.
Incisions are closed with either staples or sutures. The procedure takes 3 or 4 hours, and the patient usually goes home on the same day.
Pain from SCS implantation is treated with prescription medication and/or over-the-counter painkillers. A patient should refrain from lifting, bending, twisting and stretching during the healing process, which can take 6 to 8 weeks.
In addition to the risks associated with any surgical procedure, those related to SCS include spinal-fluid leakage and paralysis. Complications related specifically to the stimulator include the following:
It is also possible that the device's wires could shift or become damaged, which might require surgical intervention. The pulse generator's battery, if it is a standard one, needs to be surgically replaced every 2 to 5 years, although there are generators that run on rechargeable batteries that can last up to 10.