Spinal Cord Stimulator

What is a spinal cord stimulator and how does it work?

Small battery packs (the generators) and electrodes are used for spinal cord stimulation. A generator is typically located under the skin near the buttocks or abdomen, where electrodes are placed under the vertebrae (the epidural space). The electric impulses are sent by a remote control using spinal cord stimulators when patients experience pain. A separate circuitry and antenna are attached to the remote control.

Researchers do not fully understand spinal cord stimulation, but they now know that it has the potential to affect multiple muscles directly, as well as alter how the brain perceives pain.

What is spinal cord stimulation used for?

When nonsurgical pain treatment options fail to provide sufficient relief, spinal cord stimulation is used most often. Different types of chronic pain can be treated or managed with spinal cord stimulators, including:

• Injuries to the spinal cord
• The pain caused by nerves (such as diabetic nerve damage, radiation damage, or chemo-induced nerve damage)
• Peripheral vascular disease
• Complex regional pain syndrome
• Pain after an amputation
• Heart pain (angina) untreatable by other means
• Visceral abdominal pain and perineal pain
• Back pain, especially after having undergone back surgery (failed back surgery syndrome)
• Post-surgical pain
• There is a painful inflammatory condition called arachnoiditis, caused by inflammation of the arachnoid membrane that covers the brain and spinal cord.

The stimulation of the spinal cord can improve sleep quality while reducing the need for pain medicines. In addition, other pain management methods such as medication, exercise, physical therapy and relaxation are often used.

Who should get a spinal cord stimulator?

The doctor will check to see whether spinal cord stimulation is right for you – and whether it is likely to relieve you significantly from chronic pain. An imaging test and a psychological evaluation are likely to be ordered by your pain specialist to make this recommendation. The insurance companies are sometimes required to perform psychological screenings to ensure depression or anxiety are not contributing to your pain.

Each patient benefits from spinal cord stimulation differently, but generally, those who benefit from it most are those who:

• Not enough pain relief has been achieved with medications, less-invasive therapies, or surgeries previously performed.
• The patient should not have any psychiatric disorders that would prevent the procedure from being effective.

Spinal Cord Stimulator Types

There are three main types of spinal cord stimulators:

Traditionally, spinal code stimulators are powered by batteries. During an operation, a battery is implanted into the spine. If the battery runs out, a new surgery is necessary. Because it has a lower electrical output, it may be an option for people suffering only from pain in one body part.

IPGs that can be recharged without undergoing further surgery operate similarly to conventional IPGs. These simulators can produce more electricity since their energy source is rechargeable. The electrical signal is stronger and may reach a greater distance to relieve hip pain or back pain.

The battery used in radiofrequency stimulators is external to the body. In modern times, newer designs and technology have made this stimulator less viable. It, too, is powered by a rechargeable battery, and because of its power, it may be more effective for patients with pain in their lower back or legs.

Earlier on in the course of a chronic illness, SCS is more effective than conventional treatments.

Chronic pain may be relieved with SCS if:

• The pain in the leg (sciatica) or arm (neuropathy) is ongoing, persistent, and generally associated with aging.
• Nerve pain caused by diabetes, often in the legs or feet, resulting in burning or stabbing sensations.
• A failed back surgery is not caused by a technical complication of the original procedure, but rather by one or more surgeries designed to relieve persistent arm or leg pain for a prolonged period of time.
• Chronic, burning pain is an important symptom of complex regional pain syndrome. It usually occurs in the foot or hand.
• The spinal nerve lining gets inflamed and scarred due to arachnoiditis.
• These symptoms can also include pressure sores in the elbows, angina, peripheral vascular disease, multiple sclerosis, and spinal cord injury.

What happens during surgery?

It takes approximately one to two hours for the surgery to be completed.

Step 1: prepare the patient

A light anesthetic will be administered to you while you lie on the table. After that, the leads and generator will be placed on your back and buttock.

Step 2: place the leads

Fluoroscopy (an X-ray) is used to insert electrode leads. It’s a simple procedure that involves cutting a small spot at your midline and exposing the bony vertebra on your back.

During a laminotomy, a portion of bone is removed from the arches to create room for leads to be placed. The leads are placed over the spinal cord in the epidural space and are sutured in place. There is no direct contact with the spinal cord.

Step 3: test stimulation (optional)

In some cases, the doctor may wake you up to test how well the stimulation covers the pain area when using an SCS device. However, modern SCS devices can position their leads based on anatomical evidence or electrical monitoring. At the end of the surgery, the pulse generator settings obtained in the trial will determine how the pain is managed, so your feedback will be vital to ensure the best pain relief.

A lead implanted during a clinical trial may not need to be repositioned or replaced in some cases if it is perfectly positioned.

Step 4. tunnel the wire

The lead electrodes are inserted into the buttock and replaced. The wire is then inserted under the skin to implant the generator.

Step 5. place the pulse generator

It is performed under the waistline by making a small incision. The surgical procedure involves creating a pocket for the generator underneath the skin. Wires of the pulse generator are connected to the pocket. Using the skin pocket, the pulse generator is placed correctly.

Step 6. close the incisions

Sutures and skin glue are used to close the incisions.

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