FAQs on Spinal Cord Stimulator Implant in Nashville

A spinal cord stimulator (SCS) is a unique device used to stimulate the spinal cord and nerves. This device is surgically implanted, and it delivers tiny electrical impulses, which are transmitted via a small wire placed behind the spinal cord. The wire contains tiny electrodes that are programed to generate electrical currents.

Why is a SCS implanted?

When the SCS is turned on, the stimulation feels like a tingling in the region where the pain is usually felt. The pain is reduced due to the electrical current, which interrupts the pain signals from reaching your brain. While stimulation does not eliminate the source of pain, it will interfere with the pain signals. The goal of SCS is to reduce pain by at least 50%, which will significantly help you perform regular activities with less pain, as well as reduce the amount of pain medication required.

Who is a candidate for spinal cord stimulation?

SCS is recommended for patients with chronic, severe neuropathic pain that does not respond to other treatment modalities. Neuropathic pain occurs due to damaged nerve tissues, such as with complex regional pain syndrome, diabetic neuropathy, post-laminectomy nerve damage, and radiculopathy.

Why is the spinal cord stimulator trial necessary?

Before having a permanent SCS implanted, the doctor will recommend a spinal cord stimulator trial. The trial involves placement of a temporary wire, which allows the patient to experience spinal cord stimulation without having to undergo full device implantation. If the trial proves successful, a permanent SCS can be implanted.

What happens before surgery?

Discuss all medications with the doctor, as blood-thinning agents are typically held 5-7 days before the procedure. You are not allowed to eat or drink after midnight the night before the SCS procedure. The morning of the procedure, shower using antibacterial soap, and remove all hairpins, body piercings, nail polish, and jewelry.

Bring a list of all medications and allergies. When you arrive at the surgical center, an anesthesiologist will discuss anesthesia with you, and a nurse will discuss the risks and benefits of the SCS procedure. You will need to sign several consent forms, and an IV catheter will be placed in your arm.

What happens during the surgery?

Once you are given sedation, your back and stomach are shaved and prepped for lead and generator placement. A local anesthetic is injected where the incisions are to be made. The placement of the leads is done using x-ray guidance through a small incision made in the center of the back. Once the leads are positioned in the epidural space, and secured with sutures, the electrodes are positioned.

You will then be awakened to answer questions about pain and discomfort. Once the doctor assures the correct setting for the device, a wire is passed under the skin from the spine and into the abdomen or buttock. A small incision is made below the waistline so the surgeon can implant the generator device and suture it in place. Once in position, the incisions are closed with staples or sutures and a dressing is applied.

What happens after surgery?

After surgery, you will be moved to a recovery area. A nurse will monitor your vital signs and condition until you are stable. Most patients are discharged home the same day or the following morning. Discharge instructions include:

  • Take pain medicines as directed.
  • Report a severe or persistent headache to the doctor.
  • Avoid strenuous activities for 8 weeks to prevent lead movement, such as bending, twisting, lifting, or climbing stairs.
  • Do not drive for 2 weeks after the surgery or until allowed by the doctor.
  • Do not perform any housework or yard-work until the first follow-up visit with the doctor.
  • Avoid sexual activity.
  • You cannot take a tub bath or swim for 4 weeks, and must shower as directed by the doctor.

What is the success rate of the spinal cord stimulator?

Spinal cord stimulation does not work for all patients, which is the reason for the trial before permanent placement. According to research studies, the reduction in pain with SCS is 50-70%. In one study, patients reported long-term improvement of pain with SCS, along with improved functional status.

Resources

De Ridder D, Plazier M, Menovsky T, Kamerling N, & Vanneste S (2013). Subcutaneous stimulation for failed back surgery syndrome: A case report. Neuromodulation.

Kemler MA, Barendse GA, van Kleef M, de Vet HC, et al. (2000). Spinal Cord Stimulation in Patients with Reflex Sympathetic Dystrophy. NEJM, 343:618-24.

Taylor RS, Taylor RJ, Van Buyten, Buchser E, North R, & Baylis S (2004). The cost effectiveness of spinal cord stimulation in the treatment of pain: a systematic review of the literature. J Pain Symptom Management, 370-378.