Spinal Cord Stimulator (SCS)
by Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch M.D
Spinal Cord Stimulator therapy is an exciting procedure that is becoming increasingly popular for the treatment of many causes of chronic back pain. This revolutionary treatment works by blocking pain perception from traveling up through the spinal cord to the brain. It involves a small device that is placed near the spinal cord in the epidural space. The spinal stimulator device delivers low-level electrical impulses that interfere with the perception of pain, especially chronic nerve pain.
The syndromes most commonly treated with SCS include:
- Nerve Root Compression
- Failed Back Surgery Syndrome
- Spinal Stenosis
- Degenerative Disk Disease
- Sciatica or Lumbar Radiculitis
- Complex Regional Pain Syndrome
- Peripheral Neuropathy
- Central Sensitization
Spinal Cord Stimulator uses groundbreaking technology that works by introducing an electrical current into the epidural space near the source of chronic pain impulses. Under a local anesthetic and minimal sedation your doctor will first place the trial SCS leads into the epidural space. The spinal stimulator lead is a soft, thin wire with electrical leads on its tip and is placed through a needle in the back into the epidural space. The trial stimulator is typically worn for 5-7days as the lead is taped to your back and connected to a stimulating device. If the trial successfully relieves your pain you can undergo a permanent SCS if desired.
The implanted device near the area of pain produces a low voltage current, which creates a sensation that blocks the brain’s ability to sense the previously perceived pain. It interferes with the perception of pain received by the brain by creating a pleasant sensation that replaces the pain. The intensity of the stimulator can be changed, and the system can be turned on and off as necessary to provide optimal pain relief as experienced by the patient.
Spinal cord stimulator improves lumbar back pain in patients with many different conditions, and has proven to be extremely effective in patients with Failed Back Surgery Syndrome. It is shown to reduce the level of pain as well as the amount of pain medication taken by patients (De Andres 2007).
As expected with any minor surgical procedure, there is always a chance of side effects. In this particular procedure the risks are low, however it is important to know them. While the incision is healing it is important to keep it dry and clean so an infection does not occur. If there is any drainage or redness at the site then you may have developed an infection and should be seen by your doctor.
Other rare side effects may include bleeding, scar tissue deposition, electrode failure, inadequate pain surface area coverage and nerve problems.
The American Society of Interventional Pain Physicians developed a large evidence-based practice guideline for the management of chronic spinal pain with interventional techniques. The evidence for spinal cord stimulator in failed back surgery syndrome and complex regional pain syndrome is strong for short-term relief and moderate for long-term relief (Boswell 2007). A recent study concluded that approximately 50 to 60% of patients with failed back surgery syndrome reported greater than 50% pain relief with the use of spinal stimulator at follow-up (Tuner 1995).
Another study examined people suffering from spinal stenosis who received spinal cord stimulator. The research showed a 67% improvement rate, based on verbal pain scores, narcotic (pain medication) intake, and function (Chandler 2003). This can be a very helpful treatment modality for many chronic back pain sufferers.
Spinal cord stimulator has shown to be very effective in reducing chronic pain from certain conditions, however this technique does not work for everyone. One benefit to SCS is a trial is offered with a temporary device. Only if you receive significant relief will you go on to have a permanent SCS system. For those that it does help, SCS is an innovative treatment that can bring significant relief and improve quality of life.
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- Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025
- Dorsal column stimulation for lumbar spinal stenosis. Chandler GS 3rd, Nixon B, Stewart LT, Love J. Pain Physician. 2003 Jan;6(1):113-8 PMID: 16878166
- Spinal cord stimulator for chronic low back pain: a systematic literature synthesis. Turner JA, Loeser JD, Bell KG. Neurosurgery. 1995 Dec;37(6):1088-95; discussion 1095-6. PMID: 8584149
- Patient satisfaction with spinal cord stimulator for failed back surgery syndrome De Andrés J, Quiroz C, Villanueva V, Valía JC, López Alarcón D, Moliner S, Monsalve V. Rev Esp Anestesiol Reanim. 2007 Jan;54(1):17-22 PMID: 17319430
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