FAQs on Spinal Cord Stimulator in Houston TX

Spinal cord stimulator therapy is an innovative alternative to treat chronic back pain and failed back surgery along with CRPS, postherpetic neuralgia and more. The procedure has been there for the last four decades and becoming increasingly popular with the sophisticated medical technology around.

An off-shoot of the “Neuromodulation” process that advocates manipulation and regulation of neurons, spinal cord stimulation involves use of advanced transmitters emitting low-level electrical impulses that obstruct pain signals and hinder their perception.

What is Spinal Cord Stimulator?

Spinal cord stimulator, also known as spinal stimulator or neurostimulator, is a small electrical transmitter purpose made to be used as a medical device. It contains “a series of four to eight evenly spaced electrodes” that creates an electromagnetic sphere of very low level when implanted in the epidural area external to the spinal cord. Tiny electrical impulses emitting from the stimulator stir nerves and spinal cord to help in chronic pain management for those feeling pain sensation in neck and back.

The device is programmable with over 100 options in many of them. Spinal cord stimulator is also used to reinforce motor function in those experiencing disability and functional difficulties.

What is Spinal Cord Stimulator Therapy? What is the action mechanism?

Spinal Cord stimulator therapy blocks the pain sensation from reaching the brain. Whether it is chronic back pain or chronic nerve pain, we feel it only when the brain perceives impulses sent through the Aδ and C fibers. The procedure makes use of the competition between these tiny and fragile neuron filaments with large Aβ fibers, which send light, touch, and similar sensations not related to pain to the brain.

Electrical impulses interfere with neurons carrying painful signals from the spinal cord, but let non-painful signals continue without any hindrance. While non-painful sensations attract the attention of the brain, painful sensations are not processed. This effectively obstructs perception of pain and provides relief to patients.

When Patients Require Spinal Cord Stimulator? What Conditions Are Appropriate to Implant Spinal Cord Stimulator?

Despite its effectiveness, spinal cord stimulator therapy is regarded a second-line of treatment in cases where surgery fails to assure any benefit or not an option for consideration. Such conditions include,

  • Chronic back pain
  • Chronic neck pain
  • Sciatica pain that begins with the lower back and travels down to the leg causing acute pain, weakness, or lack of sensation.
  • Chronic arm or leg pains, including Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome traced to “aberrant response to tissue injury.”
  • Pain due to failed back surgery
  • Pain due to injury to the spinal cord
  • Post-laminectomy syndrome
  • Spinal Stenosis

Spinal Cord Stimulator is also useful to check pain impulse emanating from:

  • Peripheral neuropathy pain due to damage to peripheral nerves
  • Diabetic peripheral polyneuropathy pain linked to microvascular injury associated with diabetes
  • Peripheral vascular disease
  • Pelvic pain
  • Intercostal neuralgia or abdominal nerve compression
  • Post-herpetic neuralgia, a type of nerve pain centered around neck
  • Central pain syndrome linked to damaged Central Nervous System
  • Post-stroke pain
  • Neurological pain associated with injury to occipital bone, sensory nerves, and motor nerves
  • Claudication Pain impacting feet, calves, thighs, hips or buttocks due to arterial damage
  • Radiculopathy
  • Degenerative disk disease

How Is Spinal Cord Stimulator Implant Performed?

The spinal cord stimulator implant procedure has two stages – the trial and the permanent placement. Lasting up to 90 minutes, the trial stage involves administration of intravenous sedatives, but not general anesthesia. Patients lie down in the prone position (on stomach) and a needle is inserted in to the numbed skin covering the lumber spine.

A catheter lead with electrical diodes is inserted through the needle and placed close to the spinal cord. The lead is connected with a stimulator and electrical impulses are sent to the spinal cord. If the patient feels tingling sensation in the area of pain, the placement is successful. Else, doctors have to manipulate the catheter until they achieve the right placement.

Once the placement is found correct, the entire unit, catheter and the battery unit connected to it, is left in the same position. For better mobility, the outer unit is attached to the waist of the patient using a belt. He is asked to monitor pain relief in a variety of programming modes.

A review is done after 5 to 7 days. If the pain is at least 50 percent relieved, a permanent spinal cord stimulator placement is suggested.

How Is Permanent Spinal Cord Stimulator Placement Done?

Performed with administration of general anesthesia, the permanent spinal cord stimulator placement is done in two stages.

  • Incision Phase

A surgery is performed to make place for the implanting the spinal cord stimulator. Usually performed around the lower back around the spinal cord, it also includes removal of a little bit of bone, if required. Use of fluoroscopic machines helps to keep it minimally invasive and ensures the stimulator implant it done rightly. The catheter lead is fixed with soft tissues to ensure that it remains in position.

  • Placement Phase

The spinal cord stimulator is implanted and the catheter is placed below the skin connection with the battery pack, which is located just above the buttock. Once the connection is established following surgical intervention, a test run is carried out prior to applying sterile bandages to the area. Now the implant is over.

How Long Does It Take?

The process involves about two hours and does not include any major surgery.

Is The Trail Phase Necessary?

The high cost of the device ($15,000) makes insurance providers to ask for a trial to see if it is medically necessary and evaluate its suitability for a patient. Trial also helps in risk assessment without invasive surgery.

Do I Need Rest After Spinal Cord Stimulator Implant?

You can go home after the procedure and visit your doctor after a week for turning on the programming on spinal cord stimulator. It is advisable to avoid bending or twisting for a few days, but no need to skip your most-needed activities.

How Long Does Spinal Cord Stimulator Implant Last?

The life-expectancy of the device depends on stimulation intensity and duration. Those with internal batteries last for many years and can be replaced through surgical procedure. Those with external batteries need only change of batteries periodically.

What Are The Side Effects of Spinal Cord Stimulator Implant?

There is no long-term side effect ever documented when the spinal cord stimulator implant is done using the right procedure. A warm or tingly sensation is the most common feeling that patients experience. Bruising, bleeding, numbness, or post-operative complications may be experienced, if adequate precaution is not taken during the procedure. The risk of rejection of the stimulator by the body is less than 5%.

The risk of repeated surgery may arise due to fast wearing off of the device, implant migration, or nerve damage.

Who Should Not Go For Spinal Cord Stimulator Therapy?

  • Those taking blood thinners or with heart disorders
  • Patients with uncontrolled diabetes or infection
  • People using pacemakers or treated with diathermy or therapeutic ultrasound

 

How Well Does Spinal Cord Stimulator Work? What Are The Benefits of Spinal Cord Stimulator?

 

Close to 50,000 patients undergo spinal cord stimulator therapy every year as the procedure is a superb way of “masking” intractable pain and function better. A great option where surgery in not viable, it is effective for people experiencing chronic back and neck pain. Studies have demonstrated that spinal cord stimulator is 60% successful in reducing lower back pain over a period of 15 years while at least 50% had the benefits for more than 20 years.

 

A 2006 study, pegged the success rate at 70% while 2002 research findings reported the pain relief at 88%. St. Jude’s Medical, a manufacturer of spinal cord stimulator devices, claims that 84% of patients using their implants witness a vast improvement in their quality of life while at last 77% found significant pain relief. As many as 80% users gave up use of narcotic pain killers after the procedure.

 

According to a report in the Lancet journal, use of spinal cord stimulators helped 85% diabetic peripheral neuropathy patients reverse their sensory loss. Almost half of them regained it completely. Researchers also discovered that a third of users stopped taking opiate painkillers after the therapy and the average pain relief was more than 7 in a scale of 10.

References

  • Kumar K, Toth C, Nath RK, Laing P: Epidural spinal cord stimulation for treatment of chronic pain – some predictors of success. A 15-year experience. Surg Neuro 1998;50:110-121.
  • North RB, Kidd DH, Zahurak M, et al: Spinal cord stimulation for chronic, intractable pain: Two decades’ experience. Neurosurgery 1993;32:384-395.
  • Kumar K, Hunter G, Demeria D. Spinal cord stimulation in treatment of chronic benign pain: challenges in treatment planning and present status, a 22-year experience. Neurosurgery. 2006; 58:481-496.
  • Cook AW, Oygar A, Baggenstos P, et al.: Vascular disease of extremities. electrical stimulation of spinal cord and posterior roots N Y State J Med. 76:366-368 1976
  • Turner JA, Loeser JD, et al.: Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome. a systematic review of effectiveness and complications Pain. 2004;108:137-147
  • Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for chronic back and leg pain and failed back surgery syndrome: a Systematic Review and Analysis of Prognostic Factors. Spine. 2005;30:152-160.