Spinal cord stimulation is a type of neuromodulation that effectively treats neuropathic (nerve-related) pain. Spinal cord stimulation has been shown to reduce the amount of pain medication required, reduce pain scores (patients’ measures of their pain), improve everyday functions, and improve quality of life in patients.
What is Spinal Cord Stimulation?
A spinal cord stimulator is a device that is surgically implanted under the skin in your spine near the vertebrae with wires leading to the epidural space. Spinal cord stimulation is a type of therapy to help deliver mild electrical pulses to mask the pain before it has time to reach the brain. The wires of the spinal cord stimulation are attached to the spine’s nerve fibers and when turned on, it stimulates those nerves where the pain is and blocks the pain signal from reaching the brain.
A spinal cord stimulation does not erase the pain from your body, it is simple a deterrent. Each person will have a completely different experience from this type of therapy because of the different levels of pain they are experiencing and also how the body reacts to such stimulation. The goal is for the stimulator to reduce pain up to 70% but that can be more or less for each person. A patient may experience a tingling sensation due to the SCS working, it is not painful but some patients may find it unpleasant.
There are several different types of spinal cord stimulation and your surgeon will help you choose the right one for you and the pain you are experiencing. All spinal cord stimulation have batteries that help create the electrical pulses, a hand-held remote that can turn on and off and also a lead wire that delivers electrical currents.
Candidates can vary but they all have one thing in common: chronic pain. Steps are taken for each person before they are offered a spinal cord stimulation. They will need to have a full medical history check, see if medication can help with pain or physical therapy and even surgery.
Who can benefit from Spinal Cord Stimulation?
This highly-targeted method of neuromodulation can be used to treat specific sites of pain in the body (such as after back surgery that has been ineffective) or more generalized pain (such as with complex Regional Pain Syndrome).
Spinal cord stimulation has played a role in the treatment of failed back surgery syndrome and failed neck surgery syndrome for over 20 years.
These syndromes are described as persistent or recurring pain in the lower back or neck, respectively, after one or more spinal surgeries.
It can occur with or without sciatica (pain down the back of the leg caused by irritation of the sciatic nerve).
Complex regional pain syndrome
This is a condition when someone experiences pain that is out of proportion to the underlying injury. It usually affects one limb (arm, leg, hand or foot) and is divided into two types: type 1 is pain without nerve injury, and type 2 is pain with nerve injury.
Painful peripheral vascular disease
Progressive blockage of the arteries that supply blood to the limbs can cause a condition known as peripheral vascular disease.
For some people, this can cause longstanding pain, particularly in the lower legs.
Spinal cord stimulation can be used to reduce the pain associated with chronic painful peripheral vascular disease, and has also been found to improve the condition and reduce the likelihood of amputation.
Chronic angina pectoris
Spinal cord stimulation has been found to successfully treat chronic angina pectoris, a chest pain caused by coronary artery disease.
This is usually an option for patients whose pain has not been relieved by medication and who are not suitable for other forms of heart surgery.
How is this treatment performed?
Spinal cord stimulation can be implanted initially on a temporary basis as a trial. The electrical device, or pulse generator, is kept outside the body and the electrodes are placed through the skin.
This trial placement allows the settings to be easily adjusted and gives the patient and specialist team an opportunity to see how effective the spinal cord stimulation system is in treating the pain.
It also allows the specialist to find the best positioning for a future permanent spinal cord stimulation system.
Implanting a more permanent spinal cord stimulation system in the body requires surgery.
Depending on each patient’s requirements, they may need a procedure called a laminectomy (the removal of a small part of the vertebrae) to provide the access needed to place the electrodes.
What are the risks involved?
Spinal cord stimulation is considered to be relatively safe, however, as with any procedure there are always some risks to consider:
Device-related risks
The vast majority of complications are non-life-threatening events related to failure of the device. These risks include:
- Failure of the device to sufficiently reduce pain
- Wearing off of the treatment effects over time
- Breakage of the electrode(s)
- Malfunction of the electrode(s)
- Migration of the electrode(s) from the intended location.
Biological risks
Other risks include:
- Pain at the site of insertion
- Infection at the site of insertion
- A collection of fluid called a seroma.
More serious complications are extremely rare, but include:
- A small risk of injury to the spinal cord during placement of the electrodes
- A small risk of blood collecting in the epidural space (outermost part of the spinal canal), called a hematoma, which may require further surgery.
How effective is Spinal Cord Stimulation?
A medical specialist will view spinal cord stimulation treatment to be successful if a patient’s symptoms are reduced by at least 50%.
Spinal cord stimulation has been extensively studied in a number of diseases and has been found to be quite effective in treating longstanding pain that failed to respond to conventional treatments.
A recent study showed very strong evidence for the use of spinal cord stimulation in the treatment of lower back failed back surgery syndrome.
Similarly, many studies have shown that spinal cord stimulation provides better pain control, improved function and an overall better quality of life when compared to other treatments for a range of other pain syndromes.
These include trunk and limb pain, complex regional pain syndrome (pain caused by damage or malfunctioning nerves, resulting in long term pain), diabetic neuropathy (nerve pain resulting from diabetes) and angina pectoris (cardiac chest pain), that isn’t helped by other treatments.