Spinal Cord Stimulator (SCS)
Spinal Cord Stimulation (SCS) alters the experience of pain by sending impulses to the spinal cord that compete with pain signals. As a result, the pain messages that your body sends to the brain are blocked or modified.
What is Spinal Cord Stimulator?
A spinal cord stimulator system is made of four parts:
- Impulse Generator (IPG): this is a computer that is roughly the size of a matchbox that controls the impulses delivered to the spinal cord. It is implanted under the skin and has an inbuilt battery.
- An electrode: this sits in the epidural space and delivers very small and precise currents to the spinal cord.
- A hand-held controller: this is used to turn the system on and off, adjust the type of stimulation, location of stimulation and level of stimulation.
- A hand-held charger: some IPGs are rechargeable and require regular charging to maintain stimulation.
Why would someone need SCS?
Spinal cord stimulation is most commonly used for leg, back and arm pain that has not responded to spinal surgery. It can also be used to treat back pain that is not suitable for spinal surgery. Other conditions that may also respond to SCS include complex regional pain syndrome (CRPS), pain following nerve injury, refractory gain, post-herpetic neuralgia and peripheral vascular disease.
If your pain specialist decides that this treatment is suitable for your condition, a comprehensive trial is undertaken to determine if SCS will be helpful to you. There are many different spinal cord stimulator devices available for the management of chronic pain. Your pain specialist will determine the appropriate spinal cord stimulator for you, by assessing you independently and using up-to-date clinical research and current best practice.
After administering local anesthetic, a specialized needle is used to enter the epidural space which lies underneath the bones of the vertebrae. A thin stimulator lead (electrode) is then advanced in the epidural space to a specific level of the spine. When the stimulator is positioned correctly, it will be secured to the skin and covered with a dressing. This will remain in place for the duration of the trial. The trial period and procedure takes place at Spine Team Spokane.
Throughout the trial period different modes of stimulation may be used to confirm the effectiveness of this treatment in your specific case. You will usually be discharged home the day following insertion of the trial lead, but will require follow up with your pain specialist at Spine Team throughout the trial periods of 7-10 days.
Throughout the trial period it is important that you follow the restrictions given to you by the device representative and your Spine Team pain specialist. It is also important that you complete the pain diary to determine the effectiveness of the SCS over the course of the trial period.
At the completion of the trial, the lead will be removed, and a decision will be made whether to proceed to a permanent implant which will be implanted at Kootenai Hospital.
How is a permanent implant performed?
You will be admitted to Kootenai Hospital the day of the procedure. An anesthetist will be present to give you sedation. The stimulator leads (electrodes) are again inserted via a specialized needle. Once correct positioning is confirmed the leads are secured under the skin.
A small impulse generator/battery (IPG) is then implanted under the skin at a site chosen by you and your doctor. You will usually remain in hospital for one to two nights before being discharged home.
You will then return to Spine Team 1 week post procedure for programming by the device company technician. This is will allow time for your surgical sites to heal and surgical pain to subside. A technician from the SCS device company will work with your doctor to program the stimulator to give you as much relief as possible.