Neck and back pain can affect your quality of life by making even simple tasks difficult. There are several different options available to treat, manage, and reduce neck and back pain, depending on the cause. Some patients have tried many different treatments to relieve neck and back pain, from medications to surgery, with little relief. For these patients, spinal cord stimulation may be an option.
What Is Spinal Cord Stimulation?
Spinal cord stimulation is a procedure during which thin, insulated wires called leads are implanted in the epidural space surrounding the spinal column. A small device implanted near the spinal cord generates mild electrical pulses. This process can modify or block pain “messages” sent to the brain by the nerves.
The spinal cord stimulation device is similar to a pacemaker used to control abnormal heart rhythms. This procedure can be an effective solution for patients that have not found relief from back and neck pain through other treatment methods.
What are the Benefits of a Spinal Cord Stimulator Procedure?
Spinal cord stimulation can offer several benefits for the right patients. While spinal cord stimulation typically does not relieve pain completely, it is an effective long-term solution that can significantly reduce pain, without many of the side effects of other treatments. Implantation of the spinal cord stimulation device is minimally invasive compared to other procedures to treat neck and back pain.
- Minimally invasive
- Targeted pain relief
- Reduces need for medication
- Fewer side effects from treatment
Spinal cord stimulation is often used to treat a condition called failed back surgery syndrome, a term used for patients who continue to experience pain even after one or more surgical procedures.
It may also be recommended for patients with chronic neck or back pain, or conditions like arachnoiditis, complex regional pain syndrome, peripheral neuropathy, and refractory angina.
Who Is An Ideal Candidate For Spinal Cord Stimulation?
Patients for these procedures will typically have chronic debilitating pain for at least three months in the lower back, leg (sciatica), or arm. Most patients will also typically have had one or more spinal surgeries, such as a discectomy. Dr. Trujillo reviews all of a patient’s previous treatments and surgeries to determine if the person is a good candidate for spinal cord stimulation.
These are some of the general conditions or attributes that a candidate could have:
- Conservative therapies have failed.
- You seek to avoid further surgery due to the risks or recovery.
- The pain is in a location where it can be managed with spinal cord stimulation.
- You do not have untreated depression or drug addiction.
- You’ve undergone a successful spinal cord stimulation trial.
Spinal cord stimulation may not be suitable for patients with an infection, particularly an infection that affects the entire body or the intended site of the stimulation device. It is also not recommended for patients who have a demand-type cardiac pacemaker, untreated bleeding disorders, untreated drug addiction, or a psychiatric condition that could contribute to the pain.
What Chronic Pain Conditions Can Spinal Cord Stimulation Treat?
- Chronic leg (sciatica) or arm pain: ongoing, persistent pain caused by spinal stenosis, nerve damage, or arthritis.
- Failed back surgery syndrome: failure of one or more surgeries to relieve persistent arm or leg pain, without a technical failure of the actual procedure.
- Complex regional pain syndrome: a progressive disease where patients feel constant, chronic burning pain in the foot or hand.
- Arachnoiditis: painful inflammation and scarring of the protective lining of the spinal nerves.
- Other issues, such as spinal cord injury or peripheral vascular disease.
Trial Stimulator Implant Procedure
Unlike other spinal procedures, spinal cord stimulation is also reversible, and patients are able to undergo a trial period before having the device implanted. Patients typically undergo a trial period before the complete procedure is done. During the trial procedure, the wires (called leads) are inserted, but the transmitter is not implanted. Instead, the leads are connected to an external device that the patient wears outside of the body.
To implant the leads, patients are given local anesthesia and may also be sedated. Dr. Trujillo then inserts a hollow needle into the epidural space, through which the leads are passed. Patients awakened after the leads have been placed so that they can give Dr. Trujillo feedback on the placement. When all pain areas have been covered, the leads are connected to an external neurostimulator, which patients wear on a belt.
The trial period typically lasts about a week. If the patient experiences sufficient pain relief and wishes to proceed, Dr. Trujillo will move forward with the procedure to add the spinal cord stimulation implant. If the patient does not wish to proceed, the leads and external devices are removed.
Implantation Of Spinal Cord Stimulator
The procedure to implant the device is similar to the trial procedure. Permanent leads are implanted, just as the temporary leads were. Once the permanent leads are in place, the generator is implanted via a small incision. Generators can vary in size, but the largest ones are about the size of a stopwatch. Generators may be implanted in the abdomen, upper buttocks, or upper chest, depending on the patient’s preferences. Wires are then tunneled through the body from the leads to the generator. Patients are given a controller to adjust the stimulation as needed.
Because it is a surgical procedure, patients may need a few weeks or months to completely recover. The device is usually not visible under clothing. The devices typically last 10-25 years before replacement.
Is There Recovery After The Placement Of The Spinal Cord Stimulator?
This is a minimally invasive procedure with Dr. Trujillo, but there is still a recovery period. To keep initial pain to a minimum, and to keep the leads from migrating, certain physical activities will need to be limited for about three months. Dr. Trujillo will discuss these with you. Light activity can usually be resumed in two to three weeks. Full recovery will take from six to eight weeks.
What Is The Success Rate Of Spinal Cord Stimulation?
Dr. Trujillo carefully screens patients before deciding upon this treatment option. This procedure doesn’t cure the patient’s condition that is causing the pain, it simply allows the patient to manage the pain. Spinal cord stimulation is considered to be successful if the patient’s pain is reduced by at least 50 percent.
There have been numerous studies on the effectiveness of spinal cord stimulation, and they show good to excellent long-term relief from 50% to 80% of patients suffering from chronic pain.
Also, should the patient at some point desire to discontinue this treatment, the procedure is reversible.
How Much Does Spinal Cord Stimulation Cost?
Spinal cord stimulation is not an inexpensive procedure, plus there is ongoing maintenance to consider. Still, if a patient’s chronic pain that has yet to respond to any treatment, including surgery, responds to spinal cord stimulation it’s likely to be viewed as well worth it.
Once Dr. Trujillo understands your unique situation and understands the best system for you, we’ll be able to give you a good estimate of what it will cost. As you would expect, costs vary depending upon your insurance provider. We will also be able to understand what your provider covers and doesn’t cover once we know your situation.
After your consultation, you should have a good idea of what you can expect.
Is Spinal Cord Stimulation Safe?
Dr. Trujillo is trained in general surgery, anesthesia, and pain medicine. That combination is perfect for our chronic pain patients from Show Low and the surrounding areas. These procedures are a common method for addressing chronic nerve pain originating in the spinal cord or the spinal nerves exiting the spinal column.
These are safe procedures. In most cases, if there is a problem it is device-related. Serious adverse effects, such as hemorrhage in the epidural space or neurological damage caused by an injury to the nerve root or spinal cord are quite rare.
Are There Risks to a Spinal Cord Stimulation Procedure?
No surgery is without risks. Although minimally invasive, this is surgery with Dr. Trujillo, so it includes all the risks involved with any surgery: excessive bleeding, infection, development of blood clots, reaction to anesthesia, and the like. These are very rates with this procedure.
There are risks specific to this procedure:
- Cerebrospinal fluid leak
- Undesirable changes in stimulation (can result from cellular changes in tissue around the electrodes, movement of the electrode, loose electrical connection, and/or lead failure)
- Battery failure
- Battery leakage
- Persistent pain at the electrode or stimulator site
- Development of a seroma at the implant site (can usually be drained)
- Lead migration
- Allergic response to the implant materials
- Generator migration and/or local skin erosion
- Paralysis, weakness, clumsiness, numbness, or pain below the level of implantation
Is Spinal Cord Stimulation Painful?
The procedure where Dr. Trujillo places the generator and the leads are not painful at all, thanks to anesthesia. Afterward, the amount of discomfort is typically manageable with over-the-counter medication, but some patients want opioid pain management initially. These devices are quite small, the largest being about the size of a stopwatch. Tunneling the leads to the proper location is not overly traumatic to the body.