Is Spinal Cord Stimulation Right For You?
For those who suffer from chronic back pain, neck, arm, or leg pain, spinal cord stimulation can help. In many cases this technique is used after back surgery has failed, and a patient has experienced failed back surgery syndrome. FBSS, as it is often called, is not really a syndrome at all but rather a term used to describe patients who underwent back surgery and did not achieve meaningful results. While back surgery sometimes treats the underlying issues that are causing a patient’s pain, the surgery often doesn’t eliminate pain in chronic sufferers. For that reason, interest in spinal cord stimulation may be recommended.
Success Rate
The success rate for this surgery is high.
At least 1/3 of patients report greater than 80% pain relief one year post-op.
Most patients do not experience paresthesia after this procedure.
85-90 percent of those who have undergone SCS treatment report a 50-70 percent reduction in overall pain.
About
Spinal cord stimulation, or SCS, has been around for decades, but the applications it can be used for are growing. In addition to FBSS, SCS has been used to treat cervical and lumbar radiculitis, neuropathy, and complex regional pain syndrome. In all of these cases the goal is to treat pain. Once used to treat nerve damage exclusively, the surgery is now used in many chronic pain situations.
Those who have the surgery have a spinal cord stimulator battery placed under the skin in the buttocks or abdomen. The lead is placed in the epidural space adjacent to the spinal cord. The surgeon will make incisions and place the leads with the aid of fluoroscopy. A laminotomy (removal of the bony arch of the spine) is performed and the leads are secured with sutures. The leads are run down the spine to connect to the device, which is inserted in a second incision below the waistline. After both pieces are placed and connected, incisions are closed with sutures and the patient is taken to recovery. The SCS device will be implanted by your spinal surgeon. The surgery takes about an hour and patients often go home the same day.
When the device is turned on mild pulses are delivered to the spine, effectively blocking pain signals from reaching the brain. The SCS is able to target nerves experiencing pain therefore making a significant difference in pain. Many who get the device, which looks similar to a pacemaker, are able to scale back on pain medications that have negative side effects or could lead to addiction.
Before committing to a permanent implant, a trial device is offered. This way patients can determine if the device is a good fit for them, as some report not much improvement with the device and others complain that the tingling sensation isn’t worth it. If a patient tries SCS and doesn’t like it during the trial period, the lead can be pulled out in office. The trial period helps doctors determine who is a good candidate for the device. Those who are deemed good candidates report at least 50 percent reduction in pain and significant improvement in daily activity levels. Because the device doesn’t eliminate pain but rather interferes with the pain signals sent from the back to the brain, the results can vary greatly from one patient to another.
Patients should know that the SCS device will need to be replaced as it is battery powered. Every device has a pulse generator with a battery, a lead wire with a number of electrodes, and a hand-held remote that controls the device, making it possible for patients to turn it on and off and adjust the settings. If the battery is non-rechargeable, the device will have to be swapped out every 2-5 years. If the device has a rechargeable battery, it can last 10 years or longer. Device replacement means additional procedures in the future.
Only your doctor can tell you if you’re a good candidate for SCS, and they don’t make the recommendation to everyone. Doctors will look at a patient’s history, taking into consideration overall health, medications they take, pain history, and goals. Most patients who get a SCS device have experienced chronic pain in the back, leg or arm, and have undergone a failed back surgery. Other situations that indicate a person may be a good candidate for SCS include: when conservative therapies have failed; additional surgeries have been ruled out; the patient has no underlying health conditions, untreated depression or drug addiction that could affect the surgery and its outcome; and if the pain is stemming from a correctable problem. The most important criteria is that the patient has undergone an SCS trial and been deemed a good candidate for the device.
Benefits
The goal of SCS surgery is for anyone who is deemed a good candidate to experience a 50-70 percent reduction of pain after the device is implanted. Chronic pain caused by complex regional pain syndrome, a failed back surgery, arachnoiditis (inflammation and scarring of the protective lining of the spinal nerves that causes pain), sciatica or another ailment causing chronic pain in the arms or legs, a spinal cord injury, stump pain, angina, peripheral vascular disease or multiple sclerosis may all benefit. With reduced pain also comes increased ability to perform daily tasks and a higher-level of functionality aided by the blocked pain signals to the brain.
Risks
Every surgery includes the following risks: bleeding, infection, blood clots, and reactions to anesthesia. SCS has some more specific risks, including: negative changes in stimulation that can cause tissue damage; lead and/or the device failure after implantation; hematoma; epidural hemorrhage; spinal cord compression; paralysis; battery failure or leakage; spinal fluid leak; pain at the site of the electrodes or device that doesn’t alleviate over time; seroma; allergic reaction to implanted materials; weakness, clumsiness, numbness, or pain below the implant; and movement of the device. These potential complications are rare.
Symptoms it solves
The goal of SCS surgery is to reduce pain in the back, neck, arms or legs caused by a number of potential health issues or previous injury.
Alternatives
Those who undergo SCS have often had several failed attempts at relieving neck, back, arm, or leg pain. All of these interventions, which include pain medication, physical therapy, steroid injection and other physical modalities, are alternatives that are tried first. There are also a number of back surgeries that can be tried before SCS to alleviate pain. SCS is most commonly used after one or more back surgeries have failed. SCS may be tried in place of a lengthy, complicated back surgery at the discretion of the doctor or because the patient doesn’t want the other surgery.