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What is spinal cord stimulation?

Professor Ashkan explain what spinal cord stimulation is and how it is surgically inserted.


Overview

A spinal cord stimulation (SCS) is a device that is surgically inserted under the skin by your spine, near the vertebrae with wires leading to the epidural space. SCS is a type of therapy that delivers mild electric pulses to mask the pain signals before they reach the brain. The SCS wires are attached to the spines nerve fibres, it stimulates the nerves where pain is coming from and blocks the pain signals from reaching the brain when it is turned on.


A SCS does not block all pain from your body, it simple works as a deterrent. Each person that is fitted with a SCS will have a different experience with this therapy because there are different levels of pain that they are experiencing and also because everyone will react differently to such stimulation. The goal is for the stimulation to reduce pain by up to 70%, however this can be more or less depending on the severity of the individual case.



Once the SCS has been fitted and is turned on, patients may get a tingling sensation which shows that it is working, although this is not painful some patients describe it as being unpleasant.


There are several different types of SCS that your consultant will review before making a decision as to which one is best for you. All SCS have batteries that create the electrical pulses, a lead wire delivers the electrical pulses. The SCS can be turned on and off using a hand held remote.

Candidates for SCS vary, but will all have one thing in common; chronic back pain. Steps will be taken for each person before that are offered an SCS. Possible candidates will have to have a full medical history check before they are chosen for it, their consultant will also see if any medication, physiotherapy or surgery can help to reduce their symptoms.


Candidates may benefit from SCS if:

· Conservative and surgical solution has failed

· More surgery will not be beneficial

· Chronic neck and/or back pain

· Chronic leg and/or arm pain

· Complex pain syndrome

· Arachnoiditis

· Angina

· Peripheral vascular disease

· Multiple Sclerosis


The goal is for patients to have a better quality of life and be able to perform daily activities without being in pain. Medication may still be necessary after the SCS has been fitter, however it will be reduced.


SCS insertion

Initially, there will be a trial for SCS to see if it will be successful in reducing the pain and to ensure the patient is still ok to go ahead after the trial.


During the surgery the patient will be sedated and will lie on their stomach. An X-ray is used to locate the precise area and the electrode wire are inserted into the spine; the generator will sit near the buttock. A laminotomy is performed in the spinal cord to ensure that there is enough space for the wires and then to secure in to the epidural space.


The patient will be woken while still in surgery, a test stimulation will be performed which will determine if it is working and any changes that they may need to make if necessary. Once the test has been done, the patient will be put back under sedation and the generator will then be implanted in to the buttock. The lead wire runs from the generator and attaches to the electrode wire. Once everything has been put in place the incisions will be closed and the patient will be taken the ward to recover.


After surgery there will restrictions while the patient recovers, which will be discussed with your surgeon after the surgery. These are put in place to ensure that you do not damage yourself or the incision wounds; so no strenuous activities, bending or twisting. Is it also recommend to avoid smoking or using any products that include nicotine as this will slow down the recovery process (nicotine prevents bone from healing).


Risks associated with the surgery:

· Epidural haemorrhage, hematoma, infection, spinal cord compression, and/or paralysis (can be caused by placing a lead in the epidural space during a surgical procedure)

· Battery failure and/or battery leakage

· Cerebrospinal fluid leak

· Persistent pain at the electrode or stimulator site

· Lead migration, which can result in changes in stimulation and reduction in pain relief

· Generator migration and/or local skin erosion

· Paralysis, weakness, clumsiness, numbness, or pain below the level of implantation


After the surgery patients will be sent home with instructions that show how to use the SCS, which will also be explained to you in person after the surgery. Your consultant will provide a check-in appointment to see if the patient is getting on well with the SCS machine.


This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

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