Spinal Cord Stimulation

What is a Spinal Cord Stimulator?

A spinal cord stimulator is an electrical device implanted to help control spine-related pain. It is like a pacemaker for the spine. Typically two thin, flexible wires are placed in the epidural space above the spinal cord. These are then connected to a device also implanted underneath the skin that sends an electrical signal to the nerves in the spinal cord.

The electrical signal will decrease the feelings of pain by overriding or diluting the signals from the pain nerves.  This means the patient doesn’t feel their pain as much or at all. Think of the pain as a loudspeaker and the spinal cord stimulator turns down the volume.

When is it used as a treatment?

This device is typically used when patients have tried physical therapy, medications, nerve blocks, and even surgery, yet they are still in pain. Often, patients are not surgical candidates because there isn’t a surgery that will help with their pain, or they have other medical conditions that would prevent them from having surgery. For these patients, spinal cord stimulators can be an option.

Patients who have spinal cord stimulators can often reduce or even eliminate the medications they use for pain.

What is the procedure like?

A valuable feature to spinal cord stimulators is that you are able to try out the device before committing to a surgical implant. After being medically cleared for the procedure, the patient can begin the first phase which is called a trial. This is done under mild sedation and a local anesthetic which is used to numb the skin. Here, one of our pain physicians uses a needle to access the epidural space. Then two small flexible wires are inserted through the needle and placed at the appropriate level of the spine above the spinal cord in the epidural space.

This procedure is similar to a nerve block, except once the wires are in place, the device is turned on while the patient is still in the operating room. The patient is able to feel the stimulation as a light buzzing sensation over the areas where they used to feel pain. Once the pain pattern is covered, the buzzing sensation can either stay on if the patients like how it feels, or the buzzing sensation can be turned off.

The system is adjusted to cover the patient’s specific area of pain, making adjustments in the operating room as needed. After that, the needles are removed, but the flexible wires stay in the patient’s back, connected to a small external stimulator device usually worn on a belt.

The patient will spend about a week with the system going about his or her normal routine to see if it’s right for them.

At the end of the trial, the patient will return to the clinic where the wires are painlessly removed.  The physician will also discuss the trial week to determine if the patient should and would like to proceed with the implant procedure.

If the stimulator provided the patient relief from their pain, they often choose to have the system implanted. This is a minor, out-patient surgical procedure similar to the trial procedure in that the wires are placed back in the epidural space by way of two needles and the system is again turned on to make sure the pain pattern is covered. The difference here is that once the patient is again happy with their pain coverage, we give them more sedation. This is not general anesthesia, but the patient may fall asleep on their own. Then, two small incisions are made so that both the wires and the stimulator can be implanted underneath the skin.

This is an outpatient surgical procedure.



What does the stimulator feel like?

People experience the stimulation in two ways Traditional stimulation feels like a slight buzzing sensation. A newer option is a silent or high-frequency program where the patient doesn't feel any slight buzzing at all. The systems are customizable to each individual patient.

Will I still be able to feel normal sensations once the device is in place? 

Yes, the stimulator only affects pain nerves, so your sensory and motor nerves are unaffected. Also, if you have a new painful sensation, like dropping a hammer on your foot, you will still feel that normally. This device reduces the constant background of chronic pain.

What is the recovery time after the implant?

The incisions and pulse generator site may cause moderate discomfort for a few days. The wires can take about six to eight weeks until scar tissue forms inside your body, which secures the wires in place within your body. During the six to eight week period, severe and excessive movement should be avoided as it can cause the wires to move.  Normal activities should not be a problem.

If the wires move too much, the system may need to be reprogramed.  This reprogramming can be done, simply and wirelessly. In very rare instances, if the migration is severe, the patient may have to undergo revision surgery to put the wires back in place.

How long does the battery last?

Like cell phones that use a charging pad, these implants will need to be regularly charged. The patient will simply place a charger over their pulse generator site.  The device will charge through their skin.

Charging times and frequency varies depending upon the use of the device and personal preference. Some patients charge it for 10 to15 minutes every day, and others prefer to charge it for about an hour once per week.

The battery inside the pulse generator has a typical lifespan of about seven to ten years, at which point they must be replaced. This is a minor surgical procedure where the pulse generator is simply removed and a new one is implanted. The wires are not affected.

What are my limitations?

Once the system is in place and the leads have had time to scar into place, there are very few limitations. With the system self-contained inside the body, patients can swim, play golf, work out, ride a bike, work in the yard, or do any of the things that they enjoy. The idea behind the spinal cord stimulator system is to reduce or eliminate chronic pain so that it is no longer a part of your life.