What are the indications for a spinal cord stimulator system?
A spinal cord stimulator is an implanted device that sends electrical signals directly to the spinal cord to block the transmission of painful sensations to the brain. The most common scenarios involve patients with leg pain or arm pain symptoms from a condition known as neuropathic pain, which is pain resulting from damage to the nervous system including the spinal cord and nerves. Patients have failed more traditional methods to control the pain including medications and physical therapy and do not have an obvious surgical fix such as a pinched nerve from a herniated disc. Prior to implantation of a permanent stimulator, the patient will first undergo a spinal cord stimulator trial. The trial involves placement of a lead into the epidural space in similar fashion to an epidural catheter for giving birth. The stimulator is then connected to an external battery which the patient can turn on and off. The trial takes anywhere from 4-7 days at which time the patient decides whether or not the stimulation provided by the lead is helpful in reducing the leg/arm pain symptoms. If the answer is yes, the patient will undergo a spinal cord stimulator implant.
How is implantation of a spinal cord stimulator system performed?
Spinal cord stimulator devices have 3 components: lead, wire, and generator. There are two types of leads, a percutaneous lead which is thin and a paddle lead which is wider and contains more contacts. Our practice places paddle leads which have the advantage of more contacts and therefore more variety of stimulation programs. Only surgeons (as opposed to pain management physicians) are able to place paddle leads since they require a small amount of bone removal to place into the epidural space. The surgery is done under general anesthesia. A small incision is made in the middle of the back, typically in the thoracic area. A small portion of the lamina (posterior arch of the spinal canal) is removed to allow access into the epidural space. The paddle lead is gently placed into the epidural space. The wire is tunneled under the skin to another small incision typically above the buttock area where the generator (battery) will be implanted under the skin. The wire is connected to the battery. The incisions are closed. The surgery takes approximately one hour to complete.
What is the recovery from a spinal cord stimulator implant procedure?
The hospital stay is usually overnight although some patients can go home same day if they desire. There is usually pain in the back region from the 2 incisions and the tunneling procedure. The incisional pain usually significantly improves within 3-4 weeks after surgery. The stimulator can be turned on immediately after the surgery usually at a low setting. The stimulator is usually reprogrammed within several weeks of surgery.