Spinal Cord Stimulation Surgery for Chronic Back Pain
What patients need to know about this spinal cord pain management device
Each year, approximately 34,000 patients suffering from chronic back pain receive spinal stimulator implants. First used as a means of pain management in 1967, spinal cord stimulation (SCS) works through the use of electrical stimulation to nerves throughout the spinal cord, increasing activity within the nerves to decrease the amount of pain signals that reaches the brain. The Food and Drug Administration (FDA) initially approved SCS in 1989. Today, the therapy is used in 70 percent of neuromodulation treatments and is expected to increase as a means of managing chronic spinal cord conditions. Patients suffering from neuropathic back and leg pain have been the primary beneficiaries of SCS therapy. Increasingly, patients are turning to SCS to avoid unnecessary back surgery.
In this article
Spinal cord stimulators uses continuous low-voltage electrical current that runs through the spinal cord to block pain signals before they influence the brain. Surgeons implant a tiny device into the body to deliver the pain-dampening electrical pulses. Patients using spinal stimulation devices have been able to better manage their chronic pain while decreasing use of prescription opioid medications. Stimulators do not eliminate pain; the device simply disrupts the signal to the brain. And since some patients experience an unpleasant tingling sensation from the device’s electricity, many doctors perform a trial stimulation before the device is permanently implanted. Stimulation may be right for you if you suffer from chronic back pain and have not felt relief using other therapies. Each year, as many as 34,000 neurostimulation devices are implanted into new patients making SCS the most commonly used implantable pain management system. While a stimulator won’t cure back pain, it should be seen as a treatment that will reduce back pain by 50 to 70 percent.
Each year, as many as 34,000 neurostimulation devices are implanted into new patients making SCS the most commonly used implantable pain management system.
According to the American Association of Neurological Surgeons, the following list is criteria patients considering spinal stimulation should meet:
- Pain should not be associated with malignancy
- Unresponsive to conservative treatment for at least six months
- Cannot undergo revision surgery or chances of successful outcome is low
- No pacemaker or other medical contraindications
- No major psychiatric disorders, including somatization
- Drug-free or willing to stop drug use prior to surgery
- No related litigation
- Understands the surgery and can consent for the procedure
A stimulator is used to treat various spine pain conditions and symptoms, but for the sake of this article we are focused on how it treats back and spinal conditions. The most common back and spinal conditions treated with stimulation are:
Yes, most health insurance plans—Medicare, commercial payers, and most workers' compensation programs—cover spinal cord stimulation though pre-authorization may be required. Check with your clinic or hospital first to learn more about what information your insurance carrier will need. Your doctor or health coverage carrier are your top resources for any questions and both can provide benefit and coverage detail, as well as what out-of-pocket cost you may have to consider.
Your stimulator will be implanted by a neurosurgeon or other doctor specializing in pain management.
Once you and your doctor qualify you as a candidate for stimulation surgery, the system agreed upon by you and your doctor will be implanted. This outpatient procedure takes up to 3 hours to complete and is performed at a hospital or surgery center, which typically allows you to return home once your procedure is completed and you’ve been medically discharged. In some cases, your doctor may require an overnight stay. Medtronic, manufacturer of the world's smallest SCS, the Intellis device, explains the surgical steps as follows:
- You will be placed on your stomach on an operating room table and given medication which will make you drowsy.
- Your doctor will make a small incision in your back and place the leads (medical wires) that deliver the stimulation into the epidural space of your spinal cord.
- A second incision (about 2 to 4 inches long) is made where your doctor forms a pocket under the skin that is large enough to hold the neurostimulator.
- Your doctor connects the leads to the neurostimulator and closes the incisions to complete the surgery.
For some patients, doctors may recommend a trial period for spinal cord stimulation. The procedure involves your doctor placing a temporary electrode beneath your skin through a small incision. During the trial period, you will be able to try the treatment to see if using a stimulator solves your chronic back pain. Patients noticing at least 50 percent less pain typically move to the permanent treatment, according to the National Institutes of Health.
|These are designed to sustain therapy over long periods at the highest output level. Because of its high power capabilities, the RF system is suitable for the most challenging cases in which there is complex, multi-extremity pain. With this type of system, the patient must wear an external power source to activate stimulation.|
|Caption: Device types. Courtesy AANS|
Your doctor will recommend that you restrict your physical activity for the first several weeks after your procedure. Once that period is over, you can return to your normal lifestyle. For activities you may be uncertain about, ask your doctor before resuming those activities.
While it won’t take long before you’re enjoying your normal activities again, for the first 4 to 6 weeks post-op, Mayfield Clinic says avoid the following activities to make sure that you don’t create movement in the leads of your stimulator:
- Bending, twisting, stretching, and reaching for objects
- Pull items toward you or make sudden movements
- Lifting objects over 5 pounds
- Raising your arms above your head
- Sleeping on your stomach
- Climbing flights of stairs or sitting for long periods
- Driving, until cleared by your surgeon
- All housework and yard-work
- Sexual activity
- You may shower, but do not take a tub bath for the first month after your procedure. Be sure to pat dry your incision.
Potential Side Effects
The Pain Doctor explains that there can be a few side effects consisting of.
- Minor pain at the incision site
- Scar tissue around the electrode
- Infections at the injection site, which requires that the hardware be removed
- Damage to the generator or leads that requires additional surgery to repair
- Lead migration
Call Your Doctor If...
With any spinal surgery, there can be complications and discomfort once you return home. Call your doctor if any of the following happens:
- If your have a fever of 101 or higher
- If the incision begins to opens or looks infected
- If you have a persists headache lasting 48 hours.
- If you have sudden severe back pain, sudden leg weakness, loss of bladder and/or bowel function. This is an medical emergency. Immediately get to a hospital and call your surgeon.
If you have experienced little to no results after six months of conservative back or spinal therapies and you fit the criteria for stimulation, talk with your doctor. If your doctor is unable to offer SCS as a treatment option for your chronic back pain, ask for a referral to a pain management specialist. Keep in mind that this treatment only serves to manage pain and does not guarantee its elimination.
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Dr. Francis Gamache Jr., MD, of the Hospital for Special Surgery conducted a 14-month study involving 240 patients with neck and back conditions seeking a second opinion on a spine problem that may require surgery. Of that number, “155 (65 percent) came for a second, third, or fourth surgical opinion following an earlier opinion from a surgeon who recommended an operation.” If you’re unclear as to what constitutes a second opinion, learn what they are and how to as for them in order to make an informed health decision before spine surgery.