Spinal Cord Stimulation (SCS)

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Spinal cord stimulation (SCS) provides therapeutic treatment of chronic neck, back, and extremity pain by using a special medical device.  Although the science of SCS has been around for a long time, advances have improved this device technology by prolonging battery life, making device components smaller, and improving pain control to multiple areas.  Many chronic pain patients have regained life and vitality using SCS.

 

SCS works by producing electrical impulses that block pain from being perceived in the brain.  Pain is replaced by a mild tingling sensation.  The success of spinal cord stimulation depends on (1) careful patient selection and (2) a successful SCS trial.

 

Careful patient selection is important to a successful outcome and may include a psychological evaluation, as SCS is not for all chronic pain patients.  In general, a patient may be considered for this therapy if:

 

  • Nonoperative treatments have failed
  • Surgery is not an option or is not likely to work
  • Surgery has not improved pain and symptoms
  • The patient is not addicted to drugs
  • The patient does not have a pacemaker

Spinal Cord Stimulation Devices

The SCS device consists of a generator, thin wires (called “leads”), and a remote control. The generator is implanted in the body (it is small and thin). One or more leads are surgically implanted under the skin and plugged into the generator at one end and lead to the spinal area. Low-voltage electrical pulses are produced by the generator, travel through the lead, and deliver mild electrical stimulation to the spine, where the energy travels through the spinal canal to the brain. The theory behind SCS devices is that this electrical energy intercepts or blocks the body’s pain signals, which travel along this same pathway (spine to brain).

 

The patient is given a remote control device that communicates with the implanted generator. With the remote control, the patient can turn the SCS generator on and off and adjust the intensity of the electrical pulses. Patients report that they can feel the SCS, which often replaces pain with a mild tingling.

 

There are several different manufacturers and models of SCS devices. The physician recommends the SCS device best suited to meet the patient's treatment plan, lifestyle, age, body type, and other factors.

Possible Risks and Complications

Implantation of a spinal cord stimulator, like other medical procedures, may present risks.  Potential complications include risk of infection, bleeding, headache, allergic reaction, spinal fluid leakage, and paralysis. The physician details the possible benefits and risks with the patient well in advance of the device trial or implantation procedure.

SCS Trial

Before an SCS device is permanently implanted in the body, a trial or test period may be scheduled to determine if and how much the SCS reduces pain. Instead of implanting the SCS generator in the body, the patient wears an SCS generator on a special belt around his waist. The physician administers a local anesthetic and makes a tiny incision or uses a needle to place one or more leads in the body. The leads plug into the SCS generator in a way that allows the patient to move easily.

 

The physician develops the trial based on the needs of the patient; it may be a few days or a few weeks. The objective is to see, for example, if the SCS can reduce pain levels by 50% or whatever the physician considers the appropriate goal. If the trial succeeds, a permanent system can be implanted. If the SCS generator does not work well for the patient, this trial procedure is completely reversible (the lead or leads can be easily removed).

Permanent SCS Implantation

If a permanent SCS device is implanted, the generator portion is typically placed in the upper buttock or abdomen, but the exact placement often depends on the patient’s anatomy and preferences. The thin leads are implanted under the skin. The device cannot be seen under the skin although there may be a scar from the incision to implant the generator.
 

The SCS implantation may or may not require a short hospital stay.  (Some procedures may be done on an outpatient basis.) Most patients experience some postsurgical pain and tenderness at the incision site which resolves in a few days.

Procedure Aftercare

At discharge, the patient is given written instructions for home care. Most patients are encouraged to walk as soon as possible and may be allowed to perform limited activities. Restrictions may be placed on lifting, twisting, bending, and stretching. The physician will provide patient-specific directions. The physician’s office typically contacts the patient 24 to 48 hours after the procedure for follow-up. Patients may be asked to record pain symptoms and activities, since a pain diary can provide important information to the physician to further fine-tune care.

Conclusion

Spinal cord stimulation (SCS) is an important, device-based treatment option that blocks or interrupts pain signals traveling along the spine going to the brain with electrical impulses. SCS therapy requires the implantation of a generator and one or more wires in the body and is usually preceded by a trial with an external device to be sure the therapy will work for a given patient. Not all pain patients are candidates for SCS therapy, but SCS devices have provided significant pain relief to many back pain patients.