Spinal cord stimulation (SCS), also called neurostimulation, delivers mild electrical stimulation to the nerves along the spinal column, modifying or blocking nerve activity to minimize the sensation of pain reaching the brain. Spinal cord stimulation is being recommended for an increasing number of conditions such as failed back surgery syndrome, cervical and lumbar radiculitis, neuropathy, and complex regional pain syndrome among others.
Spinal Cord Stimulation (SCS)
1. How It Works:
- SCS devices deliver mild electrical currents to the spinal cord through small medical wires (leads).
- These electrical currents interfere with the pain signal’s transmission, replacing the sensation of pain with a milder sensation, often described as a gentle tingling or numbing sensation called “paresthesia.”
2. Components:
- Leads: Thin insulated wires equipped with multiple electrodes. These are placed in the epidural space (outside the spinal cord but inside the spinal canal).
- Generator: A small battery-powered unit that generates the electrical impulses. It’s implanted under the skin, typically in the buttock or abdomen.
- Remote Control: Allows the patient to adjust the strength and patterns of stimulation, turn the system on or off, and switch between programs.
3. Indications for SCS:
- SCS is typically considered for patients with chronic pain conditions who haven’t found relief from other treatments. Indications include:
- Failed back surgery syndrome (persistent pain after surgery)
- Complex regional pain syndrome (CRPS)
- Neuropathic pain (pain from nerve damage)
- Peripheral vascular disease
- Certain cases of refractory angina
4. The Procedure:
- Trial Phase: Before the permanent implantation, a trial phase is conducted to determine if SCS will be effective for the patient. Temporary leads are placed in the epidural space, connected to an external generator. If the patient experiences significant pain reduction (typically 50% or more) during the trial, they may be a candidate for permanent implantation.
- Permanent Implantation: The leads are placed more permanently in the epidural space and connected to an implanted generator.
5. Benefits:
- Provides significant pain relief for many patients when other therapies have failed.
- Can reduce the need for pain medications.
- Is reversible – if a patient decides they no longer want SCS, the device can be turned off or removed.
6. Risks and Complications:
- Potential risks, as with any surgical procedure, include infection, bleeding, headache, and possible damage to nearby structures.
- In some cases, the device may shift or stop working, requiring adjustment or replacement.
- Not all patients will achieve the same level of pain relief.
7. Considerations:
- SCS doesn’t cure the underlying cause of pain but can help manage and reduce its intensity.
- It’s important to maintain regular follow-up visits with the healthcare provider to ensure optimal functioning of the device and to make necessary adjustments.
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How the Stimulator Works
- Pain signals travel up the spinal cord to the brain.
- A generator, similar to a cardiac pacemaker, sends pulses to a thin wire called a lead.
Spinal Cord Stimulator
- The lead delivers these pulses to nerves along the spinal cord.
Back Stimulator
- The pulses modify the pain signals as they travel to different parts of the brain.
What is a Spinal Cord Stimulator
- The pulses change the way your body perceives pain—providing potential relief from physical pain as well as the suffering* associated with pain.
Spinal Cord Stimulation Success Rate
Spinal Cord Stimulation (SCS) has emerged as a prominent therapeutic intervention for a range of chronic pain conditions, particularly when conventional treatments fall short. Clinical outcomes vary based on the pain etiology and the patient’s individual factors. However, research has consistently demonstrated its efficacy. Studies indicate that approximately 50% to 70% of patients experience significant pain reduction, often defined as a decrease of 50% or more in pain intensity. Moreover, many patients report improved daily functioning and a reduced reliance on pain medications. Notably, the trial phase before permanent implantation serves as a predictive indicator, ensuring that only those who respond positively to the treatment undergo full implantation. However, like any medical procedure, the success of SCS can be influenced by the accuracy of the initial pain diagnosis, the skill of the implanting physician, and the patient’s adherence to post-procedure guidelines and follow-up. It’s crucial for individuals to have comprehensive discussions with their healthcare providers to establish realistic expectations and understand potential outcomes.
