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Spinal Cord Stimulation Surgery for Chronic Back Pain

Published October 6, 2020
| Written By SpineNation Editorial Staff   | Medically Reviewed by Jerry Nichols, MD

What patients need to know about this chronic pain management device



Each year, approximately 34,000 patients suffering from chronic back pain receive spinal stimulator implants. Spinal Cord Stimulation was first used as a means of pain management in 1967. Spinal cord stimulation (SCS) works through electrical stimulation to nerves throughout the spinal cord, increasing the nerves' activity to decrease the amount of pain signals that reach the brain. 

The Food and Drug Administration (FDA) initially approved SCS in 1989. As of 2019, this type of therapy was used in 70 percent of neuromodulation treatments. 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.


What Is Spinal Cord Stimulation?

Anterior_thoracic_SCS.jpg style=Spinal cord stimulators use continuous low-voltage electrical currents that run through the spinal cord to block pain signals before influencing the brain. Surgeons implant a device about an Oreo cookie's size into the body to deliver the pain-dampening electrical pulses. The device is a battery, and electrical leads are attached to the battery and implanted into the spinal cord. The electric leads are placed near the affected nerve roots believed to be causing pain in the patient.

Patients using spinal cord stimulators can manage their chronic pain better while decreasing the use of prescription opioid medications. Stimulators do not eliminate pain; the device disrupts the signal to the brain. Most patients experience a tingling sensation from the device's electricity (sort of like a TENS unit, but internally). Some find this sensation unpleasant. Newer technology allows the patient to turn off the tingling sensation while still receiving electrical currents in the spine. Patients are advised to turn stimulation off whenever driving a motor vehicle.

Most surgeons perform a trial surgery before the device is permanently implanted. The temporary implant allows a patient to experience the stimulator's effect and measured benefit before committing to a permanent implant. Spinal cord stimulation may be right for you if you suffer from chronic back or leg pain and have not felt relief using other therapies. 

A stimulator won't cure back pain, and it isn't an effective treatment for all types of pain. However, 50 to 70 percent of patients deemed suitable candidates for spinal cord stimulation may experience a pain reduction of about 50 percent. The percentage of patients that experience a 30% reduction in pain is even higher. These significant reductions in pain contribute to a much greater quality of life for patients.


Who is a Candidate for Surgery?

According to the American Association of Neurological Surgeons, patients and providers should consider the following criteria to determine if a spinal cord stimulator is right for the patient.

  • The patient's pain should be unresponsive to conservative treatment for at least six months
  • The patient should not have a pacemaker or other medical contraindicationsA psychiatrist should evaluate whether a patient has any psychological disorders or diagnoses that might impact this treatment negatively
  • The patient should be drug-free or willing to stop drug use before surgery
  • The patient understands the surgery and can consent for the procedure

What Conditions Does a Stimulator Treat?

A spinal cord stimulator treats various pain conditions and symptoms. For this article, we are focused on how a stimulator treats back pain and spinal conditions. The most common back and spinal conditions treated with stimulation are:

Does Insurance Cover the Procedure and Device?

Most health insurance plans, including Medicare, commercial payers, and most workers' compensation programs cover spinal cord stimulator implants. Preauthorization may be required, so check with your clinic or hospital first to learn more about what information your insurance carrier will need. Your doctor and health coverage carrier are your top resources for any questions. Both can provide benefit and coverage detail, as well as what out-of-pocket cost you may have to consider.


What Happens During Surgery?

Once you and your doctor qualify you as a candidate for stimulator surgery, the system agreed upon by you and your doctor will be implanted. The implant surgery is performed by a neurosurgeon or another doctor specializing in pain management. This outpatient procedure takes up to three hours to complete and occurs at a hospital or surgery center. Typically, patients are discharged and able to return home the same day. In some cases, your doctor may require an overnight stay. Medtronic, the manufacturer of the world's smallest SCS, the Intellis device, explains the surgical steps as follows:

  • The patient is placed on their stomach on an operating room table and given medication, which will make them drowsy.The surgeon will make a small incision in the back and place the leads (medical wires) that deliver the stimulation into the epidural space of your spinal cord.A second incision (about two to four inches long) is made where the doctor forms a pocket under the skin that is large enough to hold the neurostimulator. The doctor connects the leads to the neurostimulator and closes the incisions to complete the surgery.

Trial Period

For most patients, doctors and insurance carriers require a trial period for spinal cord stimulation. The procedure involves your doctor placing a temporary electrode beneath your skin through a small incision. The battery is placed outside of the patient's body in a belt-like apparatus. According to the National Institutes of Health, patients noticing at least 50 percent less pain during the trial period typically move to permanent treatment and implantation.

Types of Spinal Cord Stimulators


  1. Conventional Systems. These require little effort on the patient's part for maintenance. However, a minor surgical procedure is needed to replace the power source when it runs out.

  1. Radiofrequency Systems. These are designed to sustain therapy over long periods at the highest output level. Because of its high power capabilities, the Radiofrequency system is suitable for the most challenging cases in which complex, multi-extremity pain occurs. With this type of system, the patient must wear an external power source to activate stimulation. 

  1. Rechargeable Systems. These are the newest type of SCS device. The patient is responsible for recharging the power source when it runs low. A rechargeable system typically lasts longer than a conventional system. Eventually, a minor surgical procedure may be required to replace the power source if the time between recharges becomes impractical.

Recovery

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.

Precautions

Recovery time for implant surgery is expected to be about four to six weeks. Mayfield Clinic says to avoid the following activities to make sure that you don't create movement in the leads of your simulator:

  • Bending, twisting, stretching, and reaching for objects
  • Pulling items toward you or making sudden movements
  • Lifting objects over five 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 sites
  • Scar tissue around the electrodes
  • Headache
  • Infections at the injection site, which requires that the hardware be removed
  • Damage to the generator or leads that require additional surgery to repair
  • Lead migration
With any spinal surgery, there can be complications and discomfort once you return home. Call your doctor if any of the following happens:

  • If you have a fever of 101 or higher
  • If the incision begins to opens or looks infected
  • If you have a persistent headache lasting 48 hours
  • If you experience sudden severe back pain, leg weakness, bladder loss, or disrupted bowel function
  • Loss of control over your bladder or bowels is a medical emergency; immediately get to a hospital and call your surgeon

Conclusion

If you have experienced little to no results after six months of conservative treatments or therapies, and you fit the criteria for spinal cord 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. 

Updated: October 6, 2020
Disclaimer

Information provided within this article is for educational purposes and is not a substitute for medical advice. Those seeking specific medical advice should consult his or her doctor or surgeon. If you need to consult with a specialist, you may be able find a health care provider in our Specialist Finder. SpineNation does not endorse treatments, procedures, products or physicians.


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