Spinal cord stimulation has been successful in pain management of a subgroup of back pain patients that do not respond to minimally invasive procedures such as epidural injections, and are not candidates for Spinal surgical interventions. This modality has also been successfully used in patients with Failed Back Surgery Syndrome, Neuropathies/Neuralgias, Peripheral Vascular Disease, Arachnoiditis, Phantom Limb Pain, and Complex Regional Pain Syndromes. This procedure allows a patient to control their pain using a remote control. Instead of Pain, the patient feels a sensation that is not painful in the area where they have the pain. Multiple programs are available and rechargeable batteries are available.
After initial evaluation, if you are deemed to be a good candidate, educational material in the form of a video tape and brochure will be given to you by your physician. A psychological evaluation might be necessary prior to the procedure; in some situations the insurance companies mandate this evaluation.
The procedure is performed in two stages. The first step is the trial and does not involve an incision. During this stage after an IV and antibiotic infusion is started in the preop area, you will be placed in the prone (face down) position. The area of the injection will be numbed by local anesthetics and using live X-ray, the epidural space will be accessed by a needle. The lead will then be advanced into the epidural space to the desired level using fluoroscopic guidance During the procedure, your physician will ask you question about the quality of stimulation and the coverage area. If the painful areas are covered successfully, the leads will be tied to your back and connected to an external device the size of a remote control. The patient will have the ability to control the extent of stimulation with this device. The patient will be sent home after the procedure to try the device for a few days. If the trial is not successful, the leads will be taken out of your back easily Only if the trial part is beneficial the second stage will be scheduled by a spine surgeon. This part will involve two small incisions in the back and buttocks area, and many of the other steps are similar to the trial except often a small piece of spine bone will be removed by the surgeon to a new placement of a paddle containing the leads.
The implantation stage is also an outpatient procedure, (but you may be kept overnight for observation), and you will go home after recovery from anesthesia.
The sutures will be removed in the office within one week after the procedure. Typically two weeks after the implantation the generator will need to be reprogrammed to achieve better pain control and more individual options. Moderate Post-op pain is typical & will often be treated with narcotic medications.