Spinal Cord Stimulation for Failed Spinal Surgery

What is spinal cord stimulation?

It involves the placement of a needle into the epidural space, with the placement of leads (or electrodes) that stimulate nerves with mild electrical impulses into a targeted region near the spinal cord. It is a reversible, minimally invasive approach to treating pain that has goals of reducing suffering, improving function, reducing health care utilization, and improving quality of life.

Am I a candidate for spinal cord stimulation?

Currently, spinal cord stimulation is offered to patients with chronic and severe neuropathic pain (pain caused by damaged nerves) who have not received adequate pain relief with other treatments, such as physical therapy, medications, or injections.

Who should not have this procedure?

If you are taking blood thinning medications (coumadin, arixtra, fragmin, innohep, lovenox, normiflo, orgaran, acova, angiomay, ipravask, pradaxa, plavix, heparin, ticlid or in some cases aspirin) or have an active infection, you should not have the procedure. Also, if you are pregnant, have a serious neurological deficit with a surgically correctable pathology, and anatomic spine instability at risk for progression, you should not have the procedure. Finally, if you need future MRI (magnetic resonance imaging) or are immunosuppressed, you may not have the procedure.

How does spinal cord stimulation work?

Spinal cord stimulation interrupts some of the painful nerve impulses to the brain. In most cases it does not block all of the painful impulses.

Will spinal cord stimulation fix whatever is causing my pain?

No. Spinal cord stimulation does not “fix” any anatomic damage that my cause pain. It can, however decrease your pain.

 How will I know if spinal cord stimulation will help me?

It is difficult to predict whether or not spinal cord stimulation will help you. Therefore, we usually perform the procedure in two states. In the first state, we will place temporary leads close to the spinal cord. An external pulse generator will allow you to adjust the electrical pulse generator will allow you to adjust the electrical stimulation that controls your pain. This is the spinal cord stimulation trial phase. The trial period usually lasts 2-4 days, during which you will go about your usually activities at home and at work to see how well this treatment reduces your pain and affects function under 24px circumstances. If stimulation relieves 50% of your pain, we often recommend permanently implanting the pulse generator with surgery.

 How long does the procedure take?

The trial can take between 2-3 hours and the permanent implant 2-3 hours as well, depending on your particular situation.

 What happens during the procedure?

The trial procedure (phase I) is performed at the Charlottesville Pain Management Center. You will lie on your stomach for the entire procedure. You will take some medication by mouth, about 1 hour before the procedure to help you relax. We will place an IV in your wrist and give you antibiotics and will monitor your heart rate, your blood pressure with a cuff on your arm, and the oxygen level of your blood with a small monitor that clips to the end of one finger. We will clean the implantation site with an antiseptic solution, place sterile drapes, inject a local anesthetic to numb the skin and deeper tissues, and then perform the procedure. During the procedure, we will insert two thin wires (leads or electrodes) through two small puncture holes. The leads will then be connected to the pulse generator. We will determine where the leads should be positioned by how much pain relief you feel at each position. Permanent stimulator implantation (phase II) is performed in the hospital in the operating room, but most patients usually go home on the same day.

 What are the risks and side effects?

Generally speaking the procedure is safe and uneventful. However, the procedure has risks, side effects, and the possibility of complications. Epidural bleeding, epidural infection, spinal cord injury, nerve damage causing numbness or weakness which may require hospitalization and possibly antibiotics or emergent surgery.

Will the procedure hurt?

You may feel mild discomfort at first. With a small needle, we inject a local anesthetic that will numb your skin and deeper tissues, and it takes a moment for the anesthetic to take effect. You will also receive some medication by mouth to help you relax. This will make the procedure even easier to tolerate.

Will I be “put out” for the procedure?

No. The leads are placed under local anesthesia as described above. You will receive some medication by mouth to help you relax and to make the procedure easier to tolerate.

 Where are the leads inserted?

For the pain involving the lower back, legs, or feet, the leads are inserted in the middle of the lower back. For pain involving the neck, arms or hands, the leads are inserted in the middle of the upper back.

 What should I expect after the procedure?

You may have soreness for a day or two from the needle insertions. You should experience a tingling sensation in the areas where you 24pxly experience pain, which is the stimulator at work. Ideally you will experience reduced pain for the duration of the trial.

What should I do after the procedure?

You should arrange to have someone drive you home after the trial procedure (phase I). We advise patients to take it easy for a day or so after the procedure to heal and to allow the inflammation to subside. Continue 24px activity especially that which causes familiar pain. Build up your physical strength by walking for brief periods of time each day. Move your body without twisting by moving your shoulders and hips at the same time with a “log moving” movement. Handle the equipment (remote control and external trial stimulator) with care. Avoid extreme temperatures and avoid submerging in water. Take only sponge baths and avoid getting the dressings wet. Do not lift more than five (5) pounds (a gallon of mild weighs 8 pounds), climb many stairs, sleep on your stomach, pull on the trial cable or leads, disconnect trial cable from lead, or operate vehicles with the transmitter turned on. If you have any questions about what activities are safe or not safe to perform, ask us; call 434 -295 -3600.

Living With a Spinal Cord Stimulator

 Are there things I can’t do?

Yes. You will not be able to undergo MRI, therapeutic ultrasound diathermy, or microwave or short-wave diathermy once the stimulator is permanently implanted. Most spinal cord stimulator leads do not contain ferrous (iron-containing) material to be significantly affected by the static magnetic field induced in a MRI. However, the gradient magnetic fields and radiofrequency fields from MRI (both pulsed during imaging) can cause device malfunctions or failure by induced currents caused by rapid changes in the magnetic field or thermal and electrical burns as a result of RF-induced currents.   Additionally, devices that  have a magnetic (reed) switch may be activated, causing the device to reset, potentially affecting therapy

 Can I go through the metal detectors at the airport?

Yes, but you should never drive or operate heavy equipment with the stimulator turned on because it can impair your ability to control the hand or foot pedals.

 Where can I get additional information:

We will give you a patient education booklet on spinal cord stimulation before you decide to have a trial of stimulation. More detailed information is available from the manufacturer of your stimulator, usually on the manufacturer’s Web site.

Post Trial Instructions for Spinal Cord Stimulators

In order to have a successful trial, it is important to follow the guidelines below.

UNDERSTAND AND AGREE THAT:

A. A spinal cord stimulator is a specialized piece of medical equipment that stimulates nerves with mild electrical impulses through small electrical leads placed close to my spinal cord. If spinal cord stimulation works for me I will experience a tingling sensation instead of pain. Successful SCS therapy generally means at least a 50% reduction in pain, as well as improvements in my ability to function.

B. The trial screening will last from one (1) to four (4) days.

C. During the trial screening period, I WILL:

• Restrict my activities to reduce the possibility of lead movement (and subsequent loss of stimulation) as follows:
• I will limit my activity for 10 to 12 hours after the procedure with bed rest. The day after the procedure, I may walk for brief periods, keeping my back as straight as possible.
• I will limit my activity for the duration of the trial with the following:
• I will not raise my arms above my head.
• I will not twist, bend or stretch my body at the waist. I will not climb many stairs.
• I will not pull on trial cables or leads.
• I will not disconnect trial cables or leads.
• I will not lift items weighing more than five (5) pounds. A gallon of milk weighs eight (8) pounds.
• I will avoid sitting for long periods of time or driving a car (while the stimulator is on).
• I will not operate vehicles, machinery or power equipment with the transmitter turned on.

D. I will do as much of my 24px activities of daily living as possible during the trial. If I only have pain during a specific activity, I will perform this activity to evaluate the effectiveness of the stimulator.

E. I will check with Charlottesville Pain Management Center before undergoing any medical or dental procedures such as MRI, lithotripsy, electrocautery, radiation, external defibrillation or diathermy.

F. I will handle the remote control and external trial stimulator with care. I will avoid extreme temperatures and avoid submerging in water.

G. I will NOT shower or bathe