Spinal Cord Stimulation

What is Spinal Cord Stimulation

Spinal cord stimulation (SCS) is a surgical treatment used to manage chronic nerve pain that doesn’t respond well to medication or less invasive procedures, such as injections. It’s commonly recommended for conditions like post-laminectomy syndrome, radiculopathy, complex regional pain syndrome (CRPS), phantom limb pain, and treatment-resistant neuropathy.

This therapy involves implanting a medical device called a spinal cord stimulator.

Purpose of Spinal Cord Stimulation

The goal of spinal cord stimulation is to disrupt or mask pain signals before they are interpreted by the brain, especially for chronic pain in the back, legs, or arms. This treatment doesn’t cure the underlying cause of pain but instead changes how the brain perceives it.

There are two types of stimulation:

• Low-frequency stimulation: replaces pain with a tingling sensation.
• High-frequency stimulation: delivers bursts of electricity that block pain without the tingling sensation (paresthesia-free).

Who Can Benefit from Spinal Cord Stimulation?

SCS is typically considered when other pain treatments have failed. It may be recommended for:

• Chronic back or neck pain unrelieved by other treatments
• Non-repairable injuries
• Pain with no identifiable, treatable cause
• Chest pain (angina) not responsive to other therapies
• Failed back surgery syndrome (persistent pain after spinal surgery)
• Peripheral neuropathy (burning pain from damaged nerves)
• Arachnoiditis (inflammation and scarring of spinal nerve tissues)
• Reflex sympathetic dystrophy (CRPS)

• Post-amputation pain

Before a permanent device is implanted, patients usually undergo a trial phase using an external stimulator to test its effectiveness. This trial lasts about 5–7 days.

How is the Procedure Done?

1. Trial Phase:

• • Temporary leads (electrodes) are inserted into the epidural space.
  • These are connected to an external stimulator secured to the patient’s back.
  • Patients use the device for about a week to assess pain relief.
  • If successful, they may proceed to permanent implantation.

2. Permanent Implantation:

• Done under live X-ray guidance for precision.
• Local anesthesia is used to numb the skin.
• Leads are implanted in the epidural space and connected to an internal stimulator, often placed in the lower back or abdomen.
• MRI imaging is typically performed beforehand to confirm enough space in the spine for the device.
• During the procedure, patient feedback helps ensure the leads cover the areas of pain effectively.

What Happens After Surgery?

Recovery varies, but success is typically defined as at least 50% pain relief. Some patients report up to 85% reduction in pain. However, results can vary—up to 30% of patients may not experience long-term improvement.

After surgery, patients receive a remote to control the stimulator. They may be asked to track how different settings affect their pain levels.

Recovery Timeline

• Initial healing takes 2–3 weeks, during which activity should be limited.
• More strenuous activities should be avoided for about 3 months to ensure the leads stay in place.
• Full recovery can take 6–8 weeks.

Possible Complications

• While generally safe, SCS can involve complications such as:

  • Lead movement or malfunction
  • Breakage of leads
  • Unintended shocking or stimulation
  • Pain or discomfort at the implant site
  • Infection
  • Irritation from the generator

  Serious surgical risks are rare, and most complications are related to the device rather than the surgery itself.

Risks and Side Effects

• Potential but rare risks include:

  • Infection
  • Bleeding
  • Allergic reaction
  • Worsening pain
  • Spinal headaches
  • Nerve damage

  Doctors use sterile techniques and imaging guidance to reduce these risks.

Conditions Treated with Spinal Cord Stimulation

Spinal Stenosis

Post-laminectomy Syndrome

Complex Regional Pain Syndrome (CRPS)