Spinal Cord Stimulation
What is spinal cord stimulation (SCS)?
Spinal cord stimulation is a pain management technique that involves implanting a spinal cord stimulator device that sends electronic signals to the spinal cord. The electronic signals or pulses from the SCS unit block the transmission of painful sensations through the spinal cord effectively producing pain relief.
The exact mechanism of how SCS produces pain relief is not fully understood. SCS in various forms has been performed in humans since the 1970s. Technologic advances have made the devices used in SCS smaller and more efficacious.
An SCS system is comprised of a set of electrodes that are inserted into the epidural space, connecting wires and an impulses generator. The generator is usually placed under the skin in the area of the buttocks just below the belt line. The wires or leads are tunneled under the skin.
Once in place the SCS unit is hidden and self contained. The SCS unit is controlled by a hand held programmer and the battery that powers the SCS is contained in the implanted generator. There are a number of well-established companies that make the SCS units.
What will happen to me during the procedure?
The placement of the SCS unit is a two-step process. Initially if you are a good candidate for therapy, a temporary SCS unit is placed. This is an outpatient procedure done under mild IV sedation.
During the test procedure electrodes are inserted into the epidural space, brought out through the skin, and connected to an external SCS generator. The patient can use and “test drive” the therapy for 7 to 10 days.
At the end of the test period the leads are simply removed and the patient can consider whether he or she wants to go to a permanent implant.
SCS therapy is one of the only treatments in medicine where one can try a treatment before committing to further steps. If a decision is made to go towards a totally implanted SCS system the patient is usually sent to a spine surgeon for implantation.
The implantation is done in the hospital operating room for sterility. In general after implant, patients can leave the hospital that day or evening.
What should I expect after the procedure?
After the initial test implantation of the SCS unit you may go home and resume most of your daily activities.
You may have a bit of discomfort from the needles used to place the wire leads. Usually ice or mild pain relievers are sufficient to treat the discomfort.
In about 7-10 days you will return to the clinic where you and your physician will evaluate the test period. Generally for the trial to be successful you should experience greater than a 75% reduction of your baseline pain.
If you elect to go onto a permanent implantation of the SCS unit you will be referred to one of our spine surgeons for a meeting to discuss the implantation. The permanent implant is done in an operating room. In most cases you return home the same day of the SCS implantation.