Spinal Cord Stimulation
Spinal Cord Stimulation: What is it?
Spinal cord stimulation (SCS) is a type of neuromodulation where mild electrical signals are sent to areas of the spinal cord to relieve pain. SCS is a option for patients who have painful conditions that have not responded to more conservative therapy. SCS is currently approved by the FDA for chronic pain of the trunk and limbs, intractable low back pain, leg pain, and pain from failed back surgery syndrome. In Europe, SCS has additional approval for refractory angina pectoris and peripheral limb ischemia.
How does Spinal Cord Stimulation work?
The SCS procedure involves the placement of electrical leads outside the spinal sac. While the mechanism of action is not completely understood, the “Gate Theory” is most often cited. Electrical stimulation to the spinal cord preferentially activates large nerve fibers (i.e., those nerves that control touch and vibration); activation of these fibers “closes the gate” on the small nerve fibers (i.e., those nerve that control pain) thus blocking the transmission of pain signals to the brain. In essence, the patient is replacing a painful sensation with a tingling sensation that is often described as “champagne bubbles”.
What conditions are approved for Spinal Cord Stimulation?
SCS is currently approved by the FDA for chronic pain of the trunk and limbs, intractable low back pain, leg pain, and pain from failed back surgery syndrome (FBSS). In Europe, SCS has additional approval for refractory angina pectoris and peripheral limb ischemia.
In the United States, FBSS is the most common use of SCS. FBSS is diagnosed in patients who have persistent back pain despite having undergone spinal surgery of any type. Clinically, the patient experiences persistent pain, disability and reduced quality of life. Medical studies have shown that SCS for FBSS offers better long term pain relief at lower annualized cost than either repeat spinal surgery or optimized conservative treatment. SCS for FBSS may not take away all of the pain, but it should make it much more bearable. Many patients will be able to reduce their opioid pain medication significantly. The International Neuromodulation Society has an excellent fact sheet for patients on the use of SCS for FBSS. Please click this LINK to download.
Another painful condition where SCS has a role is Complex Regional Pain Syndrome (CRPS). CRPS is a debilitating chronic pain syndrome that affects patient’s extremities following trauma (i.e., injury or surgery) to that extremity. The International Neuromodulation Society has an excellent fact sheet for patients on the use of SCS for CRPS. Please click this LINK to download.
SCS also has a role in the treatment of painful neuropathies. Neuropathy is pain that is initiated or caused by dysfunction of the nervous system. Diabetes Mellitus is one entity that can lead to destruction of small nerve fibers in the hands and feet leading to painful neuropathy. The International Neuromodulation Society has an excellent fact sheet for patients on the use of SCS for painful neuropathies. Please click this LINK to download.
Spinal Cord Stimulation: a 2 Step Process
Your provider will determine if you are a suitable candidate for SCS. Patients will meet with the members of neuromodulation/ SCS team to be educated on the device and to have all questions answered. Approval from insurance will be sought. At this point, the patient will have a psychological evaluation to gauge their understanding and expectations for the procedure . Once cleared, a temporary implant or SCS trial is planned.
Step 1: The Trial
Prior to getting a permanent implant, patients undergo trial stimulation. This is a temporary implant that can be placed in a procedure similar to an epidural. It is typically done in the office, and it can be completed in less than 60 minutes. The patient is sent home with an external battery source that can worn like a beeper. The patient is given several pain relieving algorithms that they can use to control their pain over the next 5 days of the trial period. If pain control is achieved, patients will go on to have a permanent implant scheduled.
Step 2: The Permanent Implant
The permanent implant is a minor surgical procedure typically done in an outpatient surgery center. The SCS electrode is placed outside the spinal sac, and the lead is attached to a small battery source (i.e., like a pacemaker battery) which is implanted in the lower abdomen near the pelvis. The stimulator is programmed by the company representative, and the patient is given a remote control (or an APP on a smart cell phone) which is used to control the pain relieving algorithms programmed into the device.
Spinal Cord Stimulation: What are the advantages?
- SCS technology is scientifically proven to benefit patients with complex pain problems.
- SCS technology is backed by 50 plus years of experience.
- SCS technology is constantly improving and new programs can be downloaded into your previously implanted stimulator in the future.
- Most importantly, you can trial the SCS first to determine if it is the right therapy for you!