An electrical device that is surgically implanted subcutaneously, (under the skin) in the epidural space consisting of an electrical impulse generator, wire leads, and electrodes is called a spinal cord stimulator implant. The intended use of this device is to manage chronic pain and to increase a persons’ capacity for standing and walking. Approximately fifty thousand people undergo this procedure worldwide annually to control their chronic pain.
What conditions are treatable with the spinal cord stimulator implant?
The device is most often used to control chronic pain related to FBSS (failed back surgery syndrome), but is also be used to control chronic pain related to other conditions of the spine such as CRPS (complex regional pain syndrome), Peripheral Neuropathy, Causalgia, Arachnoiditis, and peripheral ischemic pain.
What are expectations when a patient receives the spinal cord stimulator implant?
Due to the invasive nature and cost, the device is only used in select patients. Patients who have undergone psychological evaluation and found to have no psychological issues that could be the cause of their pain, patients who have failed to find success with conservative physical therapy, and who experienced at least a 50% reduction in felt pain during a trial period are candidates for the procedure.
When patients undergo the procedure it has already been determined that the device has successfully controlled their pain to a certain level. The patient therefore can expect for this pain relief to be ongoing after the procedure has been performed. Research indicates that 50-60% of patients experience a 50% reduction in pain or better.
How is the stimulator implant procedure performed?
Before the actual implant a test run will be performed, for the test run electrodes are placed under the skin but the generator remains external. If patients report a 50% or more decrease in pain levels it is determined a success and the implant procedure can be done. The trial procedure takes only about twenty minutes to perform.
This is an outpatient, minimally invasive treatment procedure that can be performed in one hour to one and a half hours and requires that only a tiny incision be made to place the very small battery powered generator subcutaneously in the abdomen or upper buttock region. This unit will be connected to electrodes implanted in the spine by very thin wire leads. The procedure is performed with local anesthesia to numb the skin.
How long do the implants last?
This device is permanent and will continue to provide relief for several years. However due to being battery powered the patient will need follow up procedures every two – five years to install a new battery. Advancements in rechargeable batteries are allowing this time between maintenance to be extended.
What risk or side effects are possible with the implant?
This device does not work for all patients; it does nothing to address the cause of the patients’ pain but instead disrupts the nerve impulses to the brain to stop pain. There is the risk of the patients’ body rejecting the device and the risk of infection. Spinal fluid leakage may occur, migration of electrode(s) which may result in the device being ineffective and/or causing stimulation in an undesired area which could cause further complications like pain and muscle spasms.
Numbness, weakness, loss of coordination and paralysis are also possibilities. The skin over the electrodes may breakdown and the device may lose effectiveness after a period of time.
How successful are the implants for the relief of pain?
A reduction in felt pain of 50% of more is considered to be successful with the device and 50-60% or recipients of the device report 50-70% decrease in felt pain levels.
What is the bottom line on this procedure?
For patients that are nonresponsive to medications, surgery, and other treatments or patients who have experienced failed back surgery; this device may be their only recourse for pain management. Discuss your condition with your pain management specialist to determine if this procedure is right for you.