Spinal Cord Stimulator Trial and Implant
Spinal cord stimulator implants use mild electrical stimulation sent from an implanted generator to block nerves in the spine from sending pain signals to the brain. This procedure is expected to grow, given advancements made in spinal cord stimulation (SCS) technology; an increase in the number of patients who suffer from chronic back pain; the ability of the device to be removed; and its ability to help reduce the need for opioid painkillers.
A unique aspect of SCS is a short trial period to determine if it is the best treatment option before a long-term device is implanted. The physician works closely with the patient to ensure if he or she is a candidate for a spinal cord stimulator implant.
Candidates for spinal cord stimulator implants could experience any one of an extensive range of conditions, including but not limited to the following examples:
- Chronic neck or back pain
- Chronic regional pain syndrome
- Complex regional pain syndrome
- Failed back syndrome
- Failed back surgery syndrome
- Peripheral neuropathy
- Radicular pain syndrome and radiculopathies
- Reflex sympathetic dystrophy
In recent years, technological advances in SCS have improved the quality of treatment and made it more convenient and accessible to more people. High-frequency therapy in SCS, recently approved by the U.S. Food and Drug Administration, has led to improved outcomes. Generator implants have also decreased in size, with some having wireless capability to make the procedure less invasive. There are also generator implants now safe to use with magnetic resonance imaging (MRI) technology, eliminating a barrier which previously had excluded some patients from pursuing this treatment.
SMS has also become easier to use thanks to controlled sensors that react to body movement and automatically adjust. Generator life has also increased, with some rechargeable devices lasting well beyond 10 years before they have to be removed.
The spinal cord stimulator trial involves stimulation through thin wires inserted into the body controlled by an external transmitter. The trial lasts approximately one week and does not involve an actual implant in the body.
While the patient is lying face down, a local anesthetic is applied to the injection site. In some cases, the patient is sedated and a small incision is made to assist with the injection. A hollow needle is then inserted through the injection site. A special X-ray is used for guidance to assist in locating the epidural space in the spinal canal.
Once the epidural space is located, thin electric wire leads are passed through the hollow needle to attach electrodes to the targeted area. The patient is then able to provide feedback to ensure the electric pulse stimulation is being applied to the targeted area. The leads inserted into the back are connected to an external transmitter that can be worn by the patient, and controlled by a hand-held device.
Following an instructive session on how to adjust the electric pulse duration and intensity, and a brief recovery period from the procedure, the patient is sent home to begin the trial period. Once the trial period is completed, a decision is made on whether or not to proceed with a spinal cord stimulator implant.
There may be some discomfort around the injection site in the days following the procedure.
The spinal cord stimulator implant procedure is similar to the trial procedure up until electrodes are affixed to the targeted area. However, part of the lamina, the bone covering the spinal cord, may be removed to attach the electrodes during the implant procedure.
Once the electrodes are firmly placed in the targeted area, the patient is sedated and a small incision is made to implant an electric pulse generator no larger than a stopwatch. The generator is usually placed near the abdomen, upper buttocks or upper chest.
Leads from the electrodes are then connected to the generator beneath the skin. Like the spinal cord stimulator trial, the electric pulse duration and intensity are controlled by the patient through a hand-held device. The patient can then begin recovery.
Facet joints are stabilizing joints between and behind vertebrae in the spine that allow for flexible movement. The sacroiliac joint connects the triangular bone at the bottom of the spine (sacrum) to the pelvic bone, (iliac crest). Pain associated with the sacroiliac joint and facet joints can be debilitating and diminish quality of life.
Radiofrequency ablation techniques are applied in a variety of methods to treat different conditions throughout the body.
It is normal to experience pain following the implant procedure. Patients are typically discharged the same day and can gradually increase activity after two to three weeks. Complete recovery from surgery may take up to eight weeks and certain activities may be restricted even longer to avoid disrupting the leads connected to the implanted generator.
Patients may be advised to avoid using SMS until swelling subsides following the procedure.
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