What is Spinal Cord Stimulation?
It is a therapy that uses electrical impulses to block pain from being perceived in the brain. Instead of pain, the patient feels a more pleasant tingling sensation.
Who is a good candidate for a Spinal Cord Stimulator?
Intrathecal pain therapy works by delivering small doses of analgesic directly to the pain receptors in the spinal cord, blocking the message to the brain. Because the doses are small and applied directly at the site of pain receptors, the entire body is not flooded with medications, and therefore negative side effects such as grogginess, confusion and over-sedation are usually avoided.
Doctors will generally consider the following:
- Conservative treatments have been tried and failed.
- Treatment is most effective when pain is in one or both arms or legs, or for low back pain that persists after surgery.
- Further surgery is not likely to help.
- The patient has no untreated drug addictions.
- The patient has had a psychological evaluation.
- The patient does not have a pacemaker or other contraindications.
- The patient has had a successful SCS trial.
- The patient is willing to play an active role in establishing and maintaining increased quality of life.
After you and your physician discuss the SCS and determine that you would like to proceed, a trial will be arranged to learn if it will be effective in treating your pain. The trial involves a surgical procedure to implant a temporary stimulator to determine if the area of your pain will be covered by stimulation, and if the stimulation actually reduces your pain. The trial may last a minimum of 24 hours or as long as 10 days. You will want to be certain that you have satisfactory pain control and that you are comfortable with the sensations of stimulation. If the trial is successful, the permanent stimulator implantation will be scheduled.
Implantation: The Surgical Procedure
The procedure will take place in an operating room. You will be given a local anesthetic and sedation so that you can be awake during the procedure with minimal discomfort in order to give feedback to the physician regarding effective lead placement. After the local anesthetic has time to numb the area where the lead will be placed, the lead is inserted within the spinal column through a needle or through an incision. Once the lead is in place, your physician will activate the system. You will help the physician determine how well the stimulation pattern covers your pain pattern. You will also get a sense of how stimulation feels to help determine if it is right for you.
Risks of Surgery
Any time surgery is performed there are possible complications. For spinal procedures, these rare risks include:
- Paralysis, loss of bladder/bowel function
- Allergic reaction
- Spinal fluid leakage
After a trial, there is usually little discomfort other than that caused by the dressing and tape. You must sponge bathe until the lead is removed at your follow-up visit. As with any surgery, you will have some discomfort at the incision sites, and there will be some swelling which usually lasts for several days. There will be some discomfort over the area where the receiver is implanted. This is normal. Your doctor may prescribe an analgesic until this subsides. You must avoid showering (sponge bath only) until your follow-up visit, unless instructed otherwise. Immediately following implantation, you should avoid lifting, bending, stretching and twisting. Light exercise, such as walking is important to build strength and to help relieve pain.
Leads can remain permanently in place. However, if you engage in extreme bending, stretching, twisting, or strenuous activity such as jumping exercises and diving, etc., the leads may move or become damaged and require surgical repositioning or removal. This can occur especially within the first 8 weeks after implantation. Moving or lifting heavy objects can move or break the leads. Sometimes leads will move as a result of normal bending, stretching, or twisting, or due to your unique physical structure. Check with your doctor before performing any strenuous activity, and limit activity to no excessive bending/stretching or lifting > 10 lbs for the first 8 weeks.
Things to Keep in Mind
Do not drive a motor vehicle or heavy equipment while using the stimulator. You may use it if you are a passenger. The stimulator will set off metal detectors (such as at airports). You will want to be sure you have your SCS identification card in order to pass through. Department store theft detectors may cause an increase or decrease in stimulation as you pass through. This is temporary and will not harm you or the stimulator however, you may wish to turn the stimulator off before passing through. Anything with magnets can affect your stimulator in addition to theft detectors and metal detectors, be mindful of large stereo speakers with magnets, high voltage power lines, electric arc welding equipment, electric sub-stations and power generators. Magnets can turn an internally powered generator (IPG) on or off. You will want to avoid MRIs as they can damage the stimulator. Normal household equipment will not harm or interfere with the stimulator. This includes cellular or portable phones, microwaves, computers, TVs, appliances, electric blankets and heating pads. The stimulator control magnet may cause damage to certain items or erase information on items with magnetic strips (bank or credit cards), magnetic media (video cassette tapes, computer diskettes, cassette tapes), and home electronic items (computer, VCR, television, camera). The magnet will stop watches and clocks, so you will want to store the magnet at least two inches away. Life of batteries depends upon stimulation settings and usage. Ex ternal batteries last anywhere from several hours to several days. When the battery of an implanted pulse generator is depleted, you may need surgery to replace the IPG. Report to your doctor’s nurse changes in stimulation patterns, increase in pain, or unexplained increased / decreased stimulation.
Will I be pain free?
There will be residual discomfort. Most patients report a 50%- 70% decrease in pain. The goal is to lower the level of pain and make it more manageable.
How will a spinal cord stimulator help me?
- Depending upon your work, you should be able to resume work at home or a job that does not require strenuous physical activity.
- You can resume sexual activity.
- You can travel, keeping in mind that sitting for long periods of time is best avoided.
- You will be able to participate in recreational activities such as walking, fishing, and gardening.
- You will feel more in control of your attitude, and should notice a positive effect upon relationships.
General Pre/Post Instructions
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e. high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure.
What is Vertebroplasty?
Vertebroplasty is an image-guided, minimally invasive, nonsurgical therapy used to strengthen a broken vertebra (spinal bone) that has been weakened by osteoporosis or, less commonly, cancer. Vertebroplasty can increase the patient’s functional abilities, allow a return to the previous level of activity, and prevent further vertebral collapse. It is usually successful at alleviating the pain caused by a compression fracture. Often performed on an outpatient basis, vertebroplasty is accomplished by injecting an orthopedic cement mixture through a needle into the fractured bone.
What are some common uses of the procedure?
Vertebroplasty is used to treat pain caused by osteoporotic compression fractures. After menopause, women are especially vulnerable to bone loss. More than one-fourth of women over age 65 will develop a vertebral fracture due to osteoporosis. Older people suffering from compression fractures tend to become less mobile, and decreased mobility accelerates bone loss. High doses of pain medication, especially narcotic drugs, further limit functional ability. Vertebroplasty is often performed on patients too elderly or frail to tolerate open spinal surgery, or with bones too weak for surgical spinal repair. Patients with vertebral damage due to a malignant tumor may sometimes benefit from vertebroplasty. In rare cases, it can be used in younger patients whose osteoporosis is caused by long-term steroid treatment or a metabolic disorder. Typically, vertebroplasty is recommended after simpler treatments—such as bedrest, a back brace or pain medication—have been ineffective, or once medications have begun to cause other problems, such as stomach ulcers. Vertebroplasty can be performed right away in patients who have severe pain requiring hospitalization or conditions limiting bedrest and medications.
How is the procedure performed?
Vertebroplasty is generally performed in the morning. The patient will be sedated and receive a local anesthetic to numb the skin and the muscles near the spinal fracture. Intravenous antibiotics may also be administered to prevent infection. Through a small incision and guided by a fluoroscope, a hollow needle is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra. Once the needle is shown to be in the proper location, the orthopedic cement is injected. Medical-grade cement hardens quickly, over the next 10 to 20 minutes. A CT scan may be performed at the end of the procedure to check the distribution of the cement. The longest part of vertebroplasty involves setting up the equipment and making sure the needle is perfectly positioned in the collapsed vertebra.